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Establishing an emergency nurse practitioner service
  1. J Bache
  1. Leighton Hospital, Crewe, Cheshire CW1 4QJ, UK
  1. Correspondence to: Mr Bache (john_bache{at}

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The role of the nurse in the emergency department has evolved over recent years.1 Emergency nurse practitioners (ENPs) were introduced into the accident and emergency (A&E) department at Leighton Hospital in July 1992, when designated nurse practitioner schemes were rare.2 They have been of enormous benefit to the patients and staff since then. This paper describes some of the potential advantages and disadvantages of an ENP service, and provides some practical advice on establishing such a service.Emerg Med J 2001;18:186–189

Potential advantages of an ENP service

Virtually all A&E departments in the United Kingdom perceive themselves to be understaffed, particularly as far as medical staffing is concerned. An intrinsic difficulty in establishing adequate staffing levels is the variable and largely unpredictable nature of the workload. There are more A&E nurses than doctors, so that sharing some of the workload between the two professions will result in greater flexibility. A&E is an intensely practical specialty and it seems illogical to suggest that a senior house officer (SHO), new to A&E, will be more knowledgeable than a nurse with years of experience, particularly when considering conditions which, in hospital practice, are virtually exclusive to A&E, such as sprains, minor cuts and bruises, and minor head injuries. A&E is very much a team effort and lends itself to the team approach.3 Perceived benefits of providing an ENP service identified by Tye et al included improved waiting times, increased job satisfaction for ENPs, improved quality of care, increased patient satisfaction, better use of resources, more holistic care, and improved continuity of care.4

Consequently, it seems reasonable to suggest that experienced nurses, after adequate training, will be able to share the workload of the doctors and treat suitable patients independently without reference to the doctors. Suitable nurses will be able to expand their role and increase the …

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