Scope of emergency nurse practitioner practice: where to beyond clinical practice guidelines?

Aim The aim of this paper is to discuss some of the issues around continuing development of the Emergency Nurse Practitioner (ENP) role in a Victorian metropolitan Emergency Department (ED) setting. More specifically the discussion will consider the evolving clinical practice of the ENP in relation to clinical practice guidelines (CPG) and optimal utilisation of ENP skills and expertise. Background Internationally the mainstay of ENP practice is predominantly minor injury/minor illness models of care. This trend reflects traditional areas of need, or service gap. It is recognised however, that for a service to be sustainable and effective, it must be flexible, dynamic and prepared for future challenges. The development of CPGs to inform 'scope of practice', has become contentious. The restrictive nature of ENP specific guidelines has become evident over time, and together with the labour intensive nature of their development, continuing use is questionable. The trend towards the use of multidisciplinary clinical practice guidelines that utilise existing clinical protocols has gained support for future nurse practitioner (NP) role development. These guidelines are generally of a robust, evidence based nature, with regular review and update and don't apply to any specific clinician group. Method An exploration of the progression of the ENP role and service model at a large metropolitan hospital ED was undertaken. An examination of the ongoing changes in demand for ENP service within this organisation was carried out together with the strategies in place, or required, for ENP role expansion and flexibility. Setting The setting for this discussion is a large metropolitan Emergency and Trauma centre in Melbourne, Victoria, Australia. The ENP team consists of endorsed ENP and those in training, generally referred to as Emergency Nurse Practitioner Candidates (ENPC). This ENP/C team is employed and cover sixteen hours per day, seven days per week, primarily in the 'fast-track' area of the department. 'Fast-track' is an area within the ED specifically treating patients presenting with minor injury and minor illness deemed likely to be seen, treated and discharged within a four hour time frame. Conclusion The ENP model of care at this organisation confirms ongoing evolvement and expansion of the role in terms of increasing numbers of ENP/C. Questions continue as to the most efficient utilisation of the role to best benefit the ED as a whole and more specifically, patient outcomes. The need for a continued, cooperative and collaborative approach by stakeholders to inform role progression and continuing clinical practice expansion is paramount for continuing department improvements and better patient outcomes.