Nurse Practitioners in the Emergency Department: Barriers and Facilitators for Role Implementation.

Emergency department (ED) wait times, length of stay, and overcrowding are common issues in developed health care systems in many countries. These ED issues are multifactorial in nature and require further evaluation in an attempt to provide consistent, adequate health care to each patient. Authors in countries, such as Australia and the United Kingdom, have attempted to address the concerns of increasing wait times, length of stay, and overcrowding by establishing nurse practitioners (NPs) into the ED who practice in domains traditionally dominated by physicians. Unfortunately, Canadian health care system leaders lack experience in implementing the unique role of the NP in the ED. In addition, emergency department fast track (FT) models have been studied and operationalized in Australia and the United States to streamline care for less acute patients. However, it is evident from review of the literature that NPs, in the Canadian health care system, are underutilized within FT units. Despite the fact that NPs have been practicing since the 1960s, there remains confusion by the public and even health care professionals about their role, scope of practice, and capabilities. The purpose of this article is to provide a greater understanding of the NP role in Canada with the intent to elucidate current barriers and facilitators to having NPs practice in the ED setting through appraisal of national and international literature sources. The article also illustrates how FT units streamline patient care and are suitable areas for NP practice within the ED. In addition, the authors describe how assessment, implementation, and evaluation of the role of NPs in the ED might be facilitated through the use of a Participatory Evidence-informed Patient-focused Process for Advanced practice nursing role development, implementation, and evaluation (PEPPA framework).