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In 1911, a BMJ editorial expressed concern over what was viewed as “an increasing tendency for nursing associations to employ nurses who are not only allowed but apparently in many places encouraged to prescribe and administer drugs, to treat minor injuries and generally act as minor medical practitioners”. In the view of the editor “in her proper place a nurse is invaluable both to the patient and to the doctor but that the training and qualifications of a nurse do not fit her and were never intended to fit her to discharge the functions of an independent practitioner”.1 There are some who would still concur with this view, but just as no one conceived of a male nurse in 1911 (they are now 17% of the workforce), the evolution of emergency medicine, combined with social, political and economic forces in healthcare, have provided a fertile environment for innovation and role development. The ED holds great appeal for nurses who are prepared to challenge and step outside of traditional boundaries in the interests of patients although this has often been met with uncertainty and resistance.
The nurse’s official role in the emergency department of the late 1960s was mainly to undress patients and record a set of vital signs for the doctor whose role it was to assess, diagnose and treat the patient. From 1967, there has been an increasing recognition and acknowledgement of the contribution of emergency nurses to the specialty in the UK. Short falls in indigenous medical staffing led to casualty departments being staffed by overseas doctors who, although clinically able, were often unfamiliar with local culture, colloquialisms and patterns of frequent attenders. In these situations, experienced nurses often elicited and deciphered complex medical histories for the doctor. Thus, in a very subtle way they held …