• emergency departments
• nursing, emergency departments
• quality assurance
• safety

Emergency care systems globally are facing their biggest challenge as they aim to cope with ever-increasing workloads against a backdrop of what is thought to be insufficient nursing staff with the right skills and experience to deliver safe care. In England, figures from NHS England reveal that there was an increase of almost half a million patients between 2013 and 2014, bringing the total number of attendances to emergency departments (EDs) in 2014 to 14.6 million.1 This trend is replicated elsewhere in Western health economies as well as in the developing world.2

Demand in ED can be variable and change rapidly. Staffing needs to respond flexibly to ensure there are always enough staff with the right skills to deliver efficient safe care. Some countries have agreed nurse to patient ratios for inpatient wards but in the UK until recently, in the absence of an evidenced-based staffing tool, calculating the right number of qualified nurses needed to deliver care and maintain patient safety in EDs has been an arbitrary exercise. Unsurprisingly, in some hospitals, financial constraints have often held sway in staffing establishments, to a greater or lesser degree to balance the books.3

Following a number of recent high-profile reviews into emergency care namely, …