Role of Nursing in Emergency Department Care Delivery

Abdus Salam Khan, MD FACP
March, 2016

Emergency department is considered a nurse led department because of time essence and close interaction of nurses with their patients. The nurse utilize all resources in a coordinated fashion including the doctors working in the emergency department. We will talk about this phenomenon from a pure Pakistani perspective. It is going to be a bit disheartening but as it is necessary to accurately estimate our situation and then move on, so let us put things in perspective.

Nursing in Pakistan has never matured as it should have been. The underlying reason may be many folds, but most importantly it failed to attract the people who would champion the discipline and promote the standards and excellence.

The people who practice nursing feel that they are trapped in a never ending circle where improvement is not expected. They don’t act as custodian of the patients care and don’t take a leadership role. This results in dis-balanced care, in which nursing is not part of the decision making process, but a silent observer, yet becomes an aid to wrongful treatment and medical mistakes. Because of not being groomed properly they cannot understand the stakes of being silent on the face of a doctor, and at times follow orders which result in bad outcome. They also feel that in this system they are not seen as responsible for medical mistakes but are seen as responsible for servant care. This is the rude reality in Pakistan and we wish to change.

When we look at the medical canvas we start realizing that delivering the care to the sick is never a single person job and rather it is a teamwork. The most integral part of care delivery as out patient care (OPD) is the role of Physician and out patient care revolves around the doctor. How about emergency and inpatient care. It should revolve around nurses. When patients come to the hospital the role of doctors is usually the decision making and supervision of the care. The care delivery is the work of the nurses. They interact with patients on a minute by minute basis and should be responsible for everything until the patient leaves the hospital. Being this close to the patient and knowing everything about the patient they are in a position to channelize the care. They provide valuable information to doctors regarding patients, as well as communicate with patients what doctors cannot in limited time. They also see what is prescribed and can spot interaction, or possible problem before it can become a medical mistake. In other words they become a very important barrier against the medical errors and mistakes.

It is especially true for the emergency departments. The enormity of task and unpredictability makes it a delicate teamwork. Nursing role is bigger than physicians task when we look at the dynamics. The whole care from triage to admission and discharge can only be done with excellence when the nursing performs well. And the skills of nursing with the communication can solve more problems and prevent plenty before arising. The timely nature of care and unstable patient presentation keeping every one at toes, and nurses again are vital to escalation of a problem as well as de-escalation of an issue to make it non-issues just by good understanding and communication.

For that to happen we need appropriate training and education and then give nurses appropriate responsibility as well as accountability for their actions. This way a culture of responsibility and accountability ultimately will lead to safer care for all of us when we get sick. I would like for the nurses to take a pivotal role in the patient care and everything should be managed by them. We are far from there but the sad part is that we are not even moving in that direction.

My hope is that nursing staff should be part of this dialogue and shape their own future in healthcare and should not let people see them as sub-ordinate to the doctors. Educate themselves and take responsibility of their actions and face this challenge, with proper help and guidance from their physician colleagues. The task is huge but satisfaction is guaranteed.

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