Demands made on the health service have increased over recent years. This is most acutely felt in emergency care. Emergency dpartment nurses have had a huge impact on care delivery, some would argue that this is attributable to the motivation and concern for patient care. Others might say that it is in response to the reduction in junior doctors hours. I would suggest that it is a combination of both, in conjunction with the political driving force of the government targets. The health service is developing at such a pace it is sometimes difficult to keep up. This was illustrated at a conference recently by a piece of on screen animation whereby an airplane, which represented the NHS, was flying along while still being built!

The desire to provide a better service for patients has brought opportunities for the development of nurse led services such as minor injury units, walk in centres, and NHS Direct, integrating in many cases with their local emergency department. Further developments have been accelerated by the creation of the Emergency Services Collaborative. Expertise from staff involved in healthcare delivery is harnessed and turned into benefits for the patient. Using the “hearts and minds” approach, (with often little or no financial input), can sometimes make major improvements to the patient experience for example “See and Treat”.¹

However, despite the introduction of many new services and innovations, there is a lack of evidence of the impact of these services on the system as a whole because of inadequate plans for evaluation being build into projects. It is rigorous thorough evaluation that will enable patients, politicians, and the rest of the health community to truly measure the impact nurses are having on healthcare delivery.

In this issue we have three excellent papers that review the effectiveness of nurses and their new roles.

The article by Marr et al maps the range and scope of emergency nurse practitioner (ENP) services in the Northern and Yorkshire region.² This research highlights the lack of standardised training that ENP’s undertake. For any new service it is essential that healthcare professionals are adequately prepared, otherwise the patient may receive substandard care and the carer exposes themselves to litigation. The recently launched Faculty of Emergency Nursing may go some way to address this issue. The study also highlights the difference in scope of practice and empowerment. The study covered a large area of the country and provides us with a good overview, this is a study that I feel should be undertaken nationally to give a complete picture of service provision. It would then be possible to work towards providing equitable care for patients attending with minor injuries throughout the UK.

The issue of ongoing competence also needs to be addressed, as at present there are no national requirements for continuing professional development.

In the field of cardiac care, many areas have undertaken to set up fast track services to deliver the target of 75% of patients receiving thrombolysis within 30 minutes of arrival to hospital. The study by Heath et al investigates whether “fast tracking” the patient to coronary care unit for thrombolysis is preferable to nurse initiated thrombolysis in the A&E department.³ It concludes that the prescription and administration of thrombolysis by experienced cardiology nurses in A&E provides a safe and timely strategy for door to needle times with significant benefits.

The third study by Frampton et al considers how safe and effective nurses are at administering high concentration nitrous oxide relative analgesia in children undergoing minor procedures.⁴

These studies highlight the effectiveness of nurses delivering high quality patient care improving the patient experience.

The development of new services is often restricted by legalities, for example nurses administering opioids. New innovations may need to be held in check until the appropriate guidelines or legal hurdles have been overcome, but at times this process seems very bureaucratic. This has a place in the protection of the patients, but is often frustrating for those attempting to deliver high quality care and make progress against the “targets”.

However, nurses only make up one portion of the team caring for the patient. It is sometimes easy to focus on one particular group of health carers and for them to become disengaged with the rest of the team. We need to focus on a multiprofessional approach, value and respect each other’s contributions. Emerg Med J 2003;20:398