Paper title: Emergency Department Waiting Room Nurse Role: A Key Informant Perspective

Aim(s): To identify how and why the role of a waiting room nurse was implemented in an emergency department

Reference: Innes, K. E. (2017). Emergency Department Waiting Room Nurse Role: A Key Informant Perspective. Australasian Emergency Nursing Journal, 6-11. doi:https://doi.org/10.1016/j.aenj.2016.12.002

Date of Review: 01/22/2021

Abstract, Title and References: The aim of the article is clear and concise. The article provided details of a qualitative study aimed to identify how and why the role of a waiting room nurse was implemented in an emergency department, specifically located in Australia. The title, "Emergency Department Waiting Room Nurse Role: A Key Informant Perspective," is informative and relevant to the subject matter at hand. The references were relevant to the role of a waiting room nurse specifically within the emergency department. The references did not lack relevancy and were referenced correctly. Appropriate key concepts were included within the article such as the significance of the need to have a waiting room nurse to aid with decreasing wait times, assessing patients' conditions, and improving communication amongst patients, families, and staff within the emergency department.

Introduction/Background: The process of subject selection is clear; there were a total of five nurses to participate in the exploratory study. Each participant had to have a minimum of a Registered Nursing License (RN), ten years of experience working in a leadership role within the emergency room setting, previous experience implementing a waiting room nurse into the emergency department, and be willing to openly share their personal insight of the waiting room nurse role's need and development. All variables were defined and measured appropriately using an exploratory approach. For example, methods of data collection included three face-to-face interviews and two telephone interviews. Each participant was provided a copy of their interview transcribed with the interviewer's questions and their responses. These approaches enabled the study methods to be valid and reliable. There is sufficient and detailed documentation to support the aim and replicate the study.

Results: The study is presented in an appropriate manner. It utilized two tables to categorize areas that the participants stated should be addressed in the implementation of the waiting room nurse role. The first table's seven categories included the following: 1) Patient Safety; 2) Scope of Practice; 3) Experience; 4)Preparation of the Role; 5) Funding; 6) Role Conflict; and 7) Evaluation. The second table also displayed five themes: 1) Expedite care; 2) Three pillars of introduction; 3) Funding sources; 4) Challenges to implementing; and 5) Evaluating the benefit. The results of the exploratory study promoted nurse administrators in the emergency room to consider the importance of implementing a waiting room nurse to address important issues like improving patient outcomes and decreasing patients' length of stay. The use the findings can enhance the emergency room experience for patients, families and staff.

Discussion and Conclusions: The conclusion addresses the aim of the article and is sufficiently supported by references/results. Although there are no major flaws noted within this article, this study can initiate a future study that can address patients’ and doctors’ perception of unreasonable wait times, risks of adverse events, and meeting the emergency department's key performance indicators based upon their individual experiences too. A possible limitation of the article could have included funding due to the researchers not receiving funding from public, commercial or non-profit agencies. Another limitation could include its use of “purposive sampling” which could have diminished the variety of the participants in the study.

Overall: The exploratory design was appropriate and successfully met the aim of the article. The study enhances awareness that there is not a common practice to have the role of a "waiting room nurse" in the emergency room. Therefore, the article’s study can be utilized in the development of one. Additionally, the results of the exploratory study should promote nurse administrators to use the findings to identify qualified nurses to work as a "waiting room nurse" after the patient has been triaged to decrease unreasonable wait times, risks of adverse events, and increase meeting performance key indicators in the emergency department. Waiting room nurses can assess and monitor the condition of patients in the waiting rooms, initiate interventions early for patients, be proactive and detect clinical deterioration, and improve overall communication between patients, families, and staff. Overall, the article was clear, concise, and consistent within itself.

Overall Statement/Summary of the Article: The role of a waiting room nurse would be a beneficial to patients, families, and staff in emergency rooms everywhere as it could decrease unreasonable wait times, decrease risk of adverse events, and improve meeting key performance indicators.

Overall Strengths of the Article and What Impact it Might have in your Field: Overall, the article has a positive impact on the nursing field. Its exploratory design of the article was appropriate and successfully met the aim of the article. There was trust value present as the interviewers were recommended to the researchers from key position holders from the lead emergency nurse organization in Australia, The College of Emergency Nursing Australasia (CENA). Moreover, data saturation was achieved although the interviews were not lengthy and bias were not present due to researchers cross-checking the interviewees' statements. The study also enhances awareness there is not a standard practice to have the role of a "waiting room nurse" in the emergency room amongst hospitals. Therefore, the article’s study can be utilized in the development of a future one. Additionally, the results of the qualitative study should promote nurse administrators to use the findings to identify qualified nurses to work in triage to enhance the quality of patient triage, increase the percentage of patient satisfaction goals being met, and improve the overall quality of care that patients receive in all healthcare departments. Lastly, nurse administrators can also utilize the findings of this study to develop training programs to enhance nurses’ professional capability and future career growth.

Specific Comments on Weaknesses of the Article and What could be Done to Improve it: Although there are no major flaws noted within this article, this study can initiate a future study that can address patients’ and doctors’ perception of unreasonable wait times, risks of adverse events, and meeting the emergency department's key performance indicators based upon their individual experiences too. A possible limitation of the article could have included funding due to the researchers not receiving funding from public, commercial or non-profit agencies. Another limitation could include its use of “purposive sampling” which could have diminished the variety of the participants in the study. For example, a future study can take place in other countries outside of Australia. Lastly, a future study can take place in other departments outside of the emergency room.