Expert Panel - Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services: Supplementary Annexure
4.2 New South Wales - Clinical Initiative Nurses in Emergency Departments
DescriptionThe Clinical Initiative Nurse (CIN) role was established in 18 NSW emergency departments in 2002 as a senior nursing role to manage care for patients in ED waiting rooms. In 2009 the role was acknowledged as valuable in the Garling review and funded more widely (38 emergency departments in total). A Clinical Services Redesign Program (CSRP) review of the role in 2010 found that that across emergency departments the role varied. The CSRP engaged with emergency department clinicians, managers and patients across NSW to standardise the role.
RationaleThe three priorities of the CIN role in the emergency department waiting rooms are:
- Review of patients within their Triage benchmark time to ensure they remain clinically safe;
- Provide ongoing communication with the patient;
- Initiate diagnostics or treatment, with a particular emphasis on managing patient’s pain.
OutcomesA state-wide role description has been agreed and implemented. Resources including waiting room posters, patient brochures, staff booklets and a state-wide education program have been developed to support the role re-implementation.
Using the CSRP methodology, which involved emergency department managers, clinicians and patients in the diagnostics and solution design, provided valuable engagement and ownership of the review and outcomes. The implementation of a state-wide `ready made’ education package was a key enabler for re-implementing the role. Key barriers that needed to be overcome include reaffirming the importance of ongoing assessment and communication for waiting patients and establishing that when the CIN has a high volume workload in the waiting room there may be a need to redeploy staff to provide additional support to meet the role demands.
While the state-wide education package was initially implemented in the 38 emergency departments that have CIN funding, there has been a request from smaller emergency departments to utilise the education, as the skill set it provides is viewed as useful for other emergency departments. The education package contains the following:
- Resource Manual;
- Facilitator’s Manual;
- Participants’ Manual; and
- CD and DVD Resources.