Evaluating the Reliability of a Remote Acuity Prediction Tool in a Canadian Academic Emergency Department.

STUDY OBJECTIVE: There is increasing interest in harnessing artificial intelligence to virtually triage patients seeking care. The objective was to examine the reliability of a virtual machine learning algorithm to remotely predict acuity scores for patients seeking emergency department (ED) care by applying the algorithm to retrospective ED data. METHODS: This was a retrospective review of adult patients conducted at an academic tertiary care ED (annual census 65,000) from January 2021 to August 2022. Data including ED visit date and time, patient age, sex, reason for visit, presenting complaint and patient-reported pain score were used by the machine learning algorithm to predict acuity scores. The algorithm was designed to up-triage high-risk complaints to promote safety for remote use. The predicted scores were then compared to nurse-led triage scores previously derived in real time using the electronic Canadian Triage and Acuity Scale (eCTAS), an electronic triage decision-support tool used in the ED. Interrater reliability was estimated using kappa statistics with 95% confidence intervals (CIs). RESULTS: In total, 21,469 unique ED patient encounters were included. Exact modal agreement was achieved for 10,396 (48.4%) patient encounters. Interrater reliability ranged from poor to fair, as estimated using unweighted kappa (0.18, 95% CI 0.17 to 0.19), linear-weighted kappa (0.25, 95% CI 0.24 to 0.26), and quadratic-weighted kappa (0.36, 95% CI 0.35 to 0.37) statistics. Using the nurse-led eCTAS score as the reference, the machine learning algorithm overtriaged 9,897 (46.1%) and undertriaged 1,176 (5.5%) cases. Some of the presenting complaints under-triaged were conditions generally requiring further probing to delineate their nature, including abnormal lab/imaging results, visual disturbance, and fever. CONCLUSION: This machine learning algorithm needs further refinement before being safely implemented for patient use.

Application Effect Evaluation of Optimizing Emergency Nursing Process Before Emergency Coronary Intervention in Patients with AMI and Hypertension.

Objective: The study aimed to assess the impact of optimizing the emergency nursing process on certain outcomes in AMI patients with hypertension undergoing coronary intervention therapy. Methods: This is a retrospective cohort study, a total of 90 patients with AMI complicated with hypertension admitted from October 2020 to March 2022 to observe the effect and safety of two different nursing methods in patients with AMI complicated with hypertension. According to the different nursing process, the subjects were divided into the optimization and conventional groups, with 45 cases in each group. Then, the rescue efficiency, success rate, recurrence rate, re-PCI rate, negative emotions, and adverse reactions of the two groups were observed. Results: The results showed that the first aid time (39.23±6.28 vs 49.78±9.14), PCI time (45.13±8.60 vs 60.40±8.16) and ECG time (4.18±0.69 vs 6.87±1.00), success rate (93.33% vs 66.67%) and recurrence rate (8.89% vs 22.22%) of the study subjects undergoing the optimized emergency nursing process were significantly better than those undergoing the general emergency nursing process (P < .05), and their negative emotions (7.51±1.77 vs 14.07±1.93) and adverse reactions (3 vs 9) were significantly lower than those of the conventional group (P < .05). Conclusions: It is suggested that optimizing the emergency nursing process before PCI for patients with AMI complicated with hypertension positively impacts the clinical efficacy and prognosis. Optimizing the emergency nursing process may potential benefits for patient health, healthcare resource utilization, or the quality of care, which should be consider in clinical practice.

Impact of Enhanced Emergency Nursing Processes on the Rescue Outcomes of Emergency Patients with Chest Pain.

Background: Chest pain, a sudden and perilous symptom, is frequently encountered in the emergency department. Prompt and efficient first-aid measures and nursing interventions are crucial for effectively rescuing emergency patients experiencing chest pain. Objective: This study aims to investigate the impact of an enhanced emergency nursing process on the rescue outcomes of emergency patients with chest pain. Design: A randomized controlled study was conducted. Setting: The research was conducted at Suzhou Hospital of Integrated Traditional Chinese and Western Medicine. Participants: A total of 90 emergency chest pain patients admitted between December 2021 and June 2022 were selected and divided into two groups, with 45 cases in each group. Interventions: The control group received routine emergency nursing, while the observation group underwent an improved emergency nursing protocol. Primary Outcome Measures: (1) Treatment initiation time, emergency rescue time, recovery time of vital signs, and hospital stay; (2) curative effect; (3) pain scores; (4) incidence of adverse events; and (5) patient satisfaction. Results: Compared to the control group, the observation group exhibited shorter treatment initiation time, emergency rescue time, recovery time of vital signs, and hospital stay (P < .05). The effective rate in the observation group was higher (P < .05), and pain scores were lower at 30 min, 60 min, 120 min, and 240 min post-rescue (P < .05). The occurrence of adverse events was reduced in the observation group (P = .005), and patient satisfaction was higher at discharge (P < .05). Conclusion: The enhanced emergency nursing process effectively reduces the clinical rescue time for emergency patients with chest pain, enhances rescue efficiency, seizes crucial opportunities for saving lives, and improves patient satisfaction. These findings have significant positive implications for clinical applications.

Reliability and Accuracy of the Pediatric Swiss Emergency Triage Scale-the SETSped Study.

BACKGROUND AND IMPORTANCE: The Swiss Emergency Triage Scale (SETS) is an adult triage tool used in several emergency departments. It has been recently adapted to the pediatric population but, before advocating for its use, performance assessment of this tool is needed. OBJECTIVES: The purpose of this study was to assess the reliability and the accuracy of the pediatric version of the SETS for the triage of pediatric patients. DESIGN, SETTING, AND PARTICIPANTS: This study was a cross-sectional study among a sample of emergency triage nurses (ETNs) exposed to 17 clinical scenarios using a computerized simulator. OUTCOME MEASURES AND ANALYSIS: The primary outcome was the reliability of the triage level performed by the ETNs. It was assessed using an intraclass correlation coefficient.Secondary outcomes included accuracy of triage compared with expert-based triage levels and factors associated with accurate triage. MAIN RESULTS: Eighteen ETNs participated in the study and completed the evaluation of all scenarios, for a total of 306 triage decisions. The intraclass correlation coefficient was 0.80 (95% confidence interval, 0.69-0.91), with an agreement by scenario ranging from 61.1% to 100%. The overall accuracy was 85.8%, and nurses were more likely to undertriage (16.0%) than to overtriage (4.3%). No factor for accurate triage was identified. CONCLUSIONS: This simulator-based study showed that the SETS is reliable and accurate among a pediatric population. Future research is needed to confirm these results, compare this triage scale head-to-head with other recognized international tools, and study the SETSped in real-life setting.

Development of training program for the Eye, Ear, Nose, and Throat emergency nurses in China based on core competency: a Delphi study.

BACKGROUND: Nursing work in the Eye, Ear, Nose, and Throat (EENT) emergency department is highly specialised and faces significant challenges. Therefore, a high level of nursing competence is necessary for nurses. To develop core competencies, a systematic and standardised training program is required. This study aims to construct a standardised, systematic, and professional training program for nurses working in the EENT emergency department in China. METHODS: Based on a literature review and semi-structured interviews, the training scheme draft was developed according to the theoretical framework of core competency for emergency nurses. From July 2023 to October 2023, a total of 21 experts including clinical experts, and nursing experts were selected to conduct 2 rounds of Delphi consultation to construct the training program for EENT emergency nurses. RESULTS: The effective response rate for 2 rounds of expert consultation was 100%. The expert authority coefficient was 0.905, and Kendall's W coefficients were found to be 0.359 and 0.340, respectively. The coefficients of variation for each item of the second round of expert consultation ranged from 0 to 0.19. The finalised training program for EENT emergency nurses consisted of 4 first-level indexes (training objectives, training management, training contents, and training assessment). The training objectives included 3 secondary indicators and 16 tertiary indicators. Training management included 5 secondary indicators and 8 tertiary indicators. Training contents included 4 secondary indicators and 16 tertiary indicators. Training assessment included 3 secondary indicators and 6 tertiary indicators. CONCLUSION: This study systematically and comprehensively explores the cultivation of nurses working in the EENT emergency department from the aspects of training objectives, training management, training contents, and training assessment. This training program is based on the theoretical framework of core competency standards for emergency nurses. It is in line with the actual needs of the clinic, and the training program is scientific and reliable, which can be promoted nationwide to provide a reference basis for the improvement of the training of emergency specialist nurses. TRIAL REGISTRATION: Not applicable.

Psychometric properties of the Farsi version of the Disaster Nursing Readiness Evaluation Index (F-DNREI).

BACKGROUND: Considering the vital role of nurses in responding to disasters, it is essential to measure their readiness with a valid and reliable tool. The present study aimed to assess the psychometric properties of the Farsi version of the Disaster Nursing Readiness Evaluation Index (F-DNREI). METHODS: This cross-sectional study was conducted between 2023 and 2024 among 200 nurses working at educational hospitals affiliated with one of the medical universities in Tehran, Iran. The Disaster Nursing Readiness Evaluation Index was translated into Persian. The face, content, and construct validity, as well as internal consistency, were analyzed. RESULTS: In the exploratory factor analysis, five factors were extracted: practical skills for disaster response, adaptability to stressful situations at the disaster site, communication and cooperation skills for teamwork, emergency nursing skills, and effective coping with daily stress. Together, these factors accounted for 39.7% of the total variance. The results of the confirmatory factor analysis indicated that the extracted model fit well: CMIN/DF = 1.519, CFI = 0.889, RMSEA = 0.051. The Cronbach's alpha and McDonald's omega coefficients for the entire questionnaire were 0.890 and 0.891, respectively. CONCLUSIONS: Given that Iran is frequently exposed to disasters, it becomes essential to assess the preparedness of Iranian nurses using a valid and reliable scale. The availability of the Farsi version of the Disaster Nursing Readiness Evaluation Index (F-DNREI), which has undergone validation and reliability testing, facilitates accurate measurement of this concept.

Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia.

BACKGROUND: Emergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-being and patient satisfaction. This study seeks to identify the prevalent challenges faced by these nurses in Saudi hospitals when handling Canadian Triage and Acuity Scale (CTAS1 and CTAS2) cases, with the aim of mitigating or managing these issues in the future. METHODS: This study incorporated a mixed-method approach to identify obstacles in Emergency Department (ED) nursing treatment of CTAS1 and CTAS2 cases in two major Saudi Arabian hospitals. The research began with qualitative focus group interviews with expert ED nurses, followed by a quantitative survey to measure and explore relationships among the qualitative findings. Data analysis leveraged qualitative thematic analysis and principal component analysis, ensuring rigorous examination and validation of data to drive meaningful conclusions. FINDINGS: From expert interviews, key challenges for emergency nurses were identified, including resource management, communication, training compliance, and psychological factors. A survey of 172 nurses further distilled these into five major issues: patient care management, handling critical cases, administration support, patient care delay, and stress from patients' families. CONCLUSION: Through a mixed-method approach, this study pinpoints five pivotal challenges confronting emergency nurses in Saudi hospitals. These encompass difficulties in patient care management, the psychological toll of handling critical cases, inadequate administrative support, delays due to extended patient stays, and the stress induced by the presence of patients' families, all of which significantly impede emergency department efficiency and compromise nurse well-being.

Challenges and facilitators in child-friendly healthcare from the perspective of pediatric emergency nurses: A qualitative study.

PURPOSE: This study aimed to determine pediatric emergency nurses' experiences and opinions regarding child-friendly care within Watson's Human Care Model framework. DESIGN AND METHODS: This study is qualitative research conducted with nurses in the pediatric emergency unit of a university hospital between 06 March and 06 April 2024. This study used a purposive sampling method and conducted semi-structured interviews with 17 nurses. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist. FINDINGS: This study determined two themes, five sub-themes, and 13 categories. The theme "challenges to child-friendly healthcare implementation" included a lack of physical space and agitated and violent families. It has been reported that physical space, especially where privacy is not protected, makes child-friendly care complex, and the violent reactions of families are significant obstacles. The second theme, "facilitators for an ideal child-friendly pediatric emergency unit," included the design of the pediatric emergency unit/improving physical environment, availability of appropriate equipment, and effective communication strategies. This theme emphasizes the importance of colorfully designing the physical space and equipment in a way that does not scare children. CONCLUSION: It has been determined that the healing environment and care processes are essential for child-friendly care. During the care processes, communication according to the age of the children and communication with agitated families was emphasized as an essential component of care. PRACTICE IMPLICATIONS: The study results will guide hospital management, healthcare professionals working in the field, and future studies on designing the child-friendly emergency unit that children deserve.

"Working in the emergency department is not a job; it's like a war" A narrative inquiry and interpretive phenomenology of the violence experienced by emergency nurses in Turkey.

AIMS: This study aims to reveal the violent experiences of nurses working in the emergency department and the meanings they attribute to them. METHODS: This research was conducted as narrative inquiry and interpretive phenomenology and recruited 15 nurses. Interviews with nurses actively working in the emergency department and who had been exposed to violence by patients or their relatives were conducted with a semi-structured interview form. The consolidated criteria for reporting qualitative research (COREQ) checklist was used. RESULTS: In the study, three themes were determined (1) Unpredictable event, (2) Interminable effects of violence, and (3) Like a bottomless pit. With seven sub-themes. CONCLUSIONS: This study underlined that violence applied to nurses by patients or relatives of patients in the emergency department is an unexpected situation that causes negative emotions. Violence affects all aspects of life and limits communication with the patient. Coping with a violent situation is challenging for nurses, and they demand support from the management.

Nursing Quality Indicators in Emergency Nursing: A Scoping Review.

BACKGROUND: Nursing quality indicators (NQIs) are essential for evaluating and managing care, yet few validated NQIs exist for emergency nursing. The dynamic nature of this field demands specific, validated indicators. PURPOSE: The purpose of this review was to identify NQIs in adult emergency nursing using Donabedian's quality categories (structure, process, outcome) and explore their validation. METHODS: A scoping review was conducted including articles from 2010 to February 2023, using the Cumulative Index to Nursing and Allied Health Literature and Medline (Ovid) databases. RESULTS: Among 936 screened articles, 18 were included, identifying 85 NQIs across structure (n = 14), process (n = 45), and outcome (n = 26) in emergency nursing. However, the validation of these NQIs was limited. CONCLUSIONS: NQIs evaluate emergency nursing quality, primarily in process assessment. Future work should validate the NQIs identified in this review for adult emergency nursing and search for potential new ones.

Frailty means falling between the cracks: A qualitative study exploring emergency nurses' understanding of frailty and its use in informing clinical decision-making related to acuity, care, and disposition.

THE PURPOSE: Of this study was to understand emergency nurses' use of frailty to inform care, disposition decision-making, and further assessment. METHODS: A qualitative, descriptive, exploratory approach was used. Field notes from group discussions held during a conference presession on frailty and post-session evaluation data were analyzed. RESULTS: Two common ideas threaded these discussions: frailty as vulnerability to "falling through the cracks" and that of an iceberg. Participants stressed the broad and expansive ramifications of frailty, and lack of structure/process to accurately describe, quantify, and utilize the concept. Participants described issues of physical and emotional/social fragility, including being unable to complete activities of daily living independently; also of concern were the patients' social determinants of health and financial challenges. CONCLUSION: The conceptual understanding of frailty encompassed physical, social, cognitive, and access deficits. Emergency nurses are aware of this concept and would conduct formal frailty screening if provided with training, time, and resources.

Polish Perspective: The Influence of National Emergency Severity Index Training on Triage Practitioners' Knowledge.

INTRODUCTION: The aim of this study was to assess the impact of the national government initiative Emergency Severity Index version 4.0 validated triage training on triage practitioners' knowledge and accuracy. METHODS: This pre/post intervention study evaluated the knowledge of triage practitioners, who constituted 30% of employees trained by the national program, in 74 emergency departments across Poland in 2020. Statistical analysis was used to evaluate the impact of the triage training. RESULTS: No significant differences in triage knowledge were found based on experience, length of ED service, or previous training. Training resulted in increased accuracy (61.3% vs 81.1%) and decreased overtriage and undertriage. Participants significantly reduced errors and improved Emergency Severity Index guideline-based case evaluations, especially for Emergency Severity Index 1-3 cases, with the most notable improvements observed among those without prior triage experience. The training significantly improved interrater reliability. DISCUSSION: The Emergency Severity Index pilot training demonstrated a significant improvement in the accuracy of triage practitioners. Emergency Severity Index level 4 has been identified as a challenging area to learn, as well as yielding promising results in the acquisition of knowledge across levels 1 and 2, among less experienced practitioners.

Save Your Back: Comparison of the Compressive Force on the Lower Back Based on Differences in the Training Techniques.

INTRODUCTION: Musculoskeletal injury prevention for nurses is aimed at removing the need to manually position patients. In the ED, this is not always possible or practical. The purpose of this study is to compare the calculated estimated compressive force on the lumbar spine between recommended lifting techniques and the SHAPE lifting method during the horizontal transfer of a patient. METHODS: Twenty-one student nurses completed the horizontal transfer of a simulated patient while motion was collected using inertial measurement units. Motion data were analyzed to calculate an estimated compressive force on the lumbar spine while completing the movement based on current recommended lifting methods and while using the SHAPE lifting method. RESULTS: A significant reduction in estimated peak and average compressive force at the lumbar spine was found during both the push and the pull portions (P < .001) of the horizontal transfer. DISCUSSION: While the optimal way to limit musculoskeletal injury among nurses is to eliminate the need for manual handling of a patient, this is not always possible in the ED. It is critical that when emergency nurses must reposition a patient, they perform the movement in the most biomechanically sound method while using a friction reduction. These findings, coupled with the previous biomechanical risk factor reduction related to the SHAPE lifting intervention, gives promise to a safer lifting strategy for emergency nurses moving forward.

Emergency Department Discharge Teaching Interventions: A Scoping Review.

INTRODUCTION: Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions. METHODS: A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions. RESULTS: Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health. DISCUSSION: Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.

Nursing Considerations for Emergency Department Care of the Breastfeeding Dyad.

Although postpartum dyads frequently present to the emergency department, treatment of the lactating parent and breastfeeding child is often driven by medical misconceptions. Incorrect advice about continuation or cessation of breastfeeding for medical reasons can lead to maternal and infant harm. In lactation, demand begets supply; missing a feed can be detrimental to short- and long-term breastfeeding outcomes. The purpose of this Clinical Nurses Forum article is to argue the importance of appropriate care of the breastfeeding dyad in the emergency department setting and to interpret current evidence-based information on lactation for the emergency staff nurse. High-quality care for the breastfeeding dyad requires knowledge of lactation physiology, contraindications for breastfeeding, and safe medications and diagnostic procedures. The well-informed emergency nurse must advocate for evidence-based care of the breastfeeding dyad within the emergency department.

Ensuring Throughput: Development and Validation of Charge Nurse Competencies for United States Emergency Care Settings.

INTRODUCTION: Charge nurses are shift leaders whose role includes managing nursing resources and facilitating appropriate patient care; in emergency departments, the charge nurse role requires both clinical and leadership skills to facilitate the flow of patients, while ensuring patient and staff safety. Literature on orientation and specific training is notably sparse. This study aimed to evaluate the content and process of core competency training and identify evaluation and implementation strategies necessary to improve charge nurse performance in United States emergency departments. METHODS: A modified Delphi technique was used in phase 1 and a qualitative content analysis method was used in phase 2 to address specific aims of the study. RESULTS: In total, 427 emergency nurse managers, directors, educators, and charge nurses responded to the initial survey to identify elements, teaching modalities, and evaluative processes; 22 participated in 1 of 2 focus groups to provide further information about the pedagogical approaches to teaching emergency charge nurse competencies. The top 5 competencies were identified as patient flow management, communication, situational awareness, clinical decision making, and nurse-patient assignment, with understanding that each competency overlapped significantly with the others. Low-fidelity simulation and gamification were identified as a preferred method of both training and evaluation. DISCUSSION: These findings have the potential to support a standardized approach to emergency charge nurse training and evaluation focusing on communication skills, clinical decision making, and situational awareness to facilitate safe and effective nurse-patient assignment and emergency department throughput.

A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit.

INTRODUCTION: Noninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making. METHODS: This study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the "gold standard" brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings. RESULTS: VitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and "gold standard" clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the "gold standard." DISCUSSION: Taken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.

The Effect of Mandatory Triage Questions on Triage Processes: A Qualitative Exploratory Study.

INTRODUCTION: The study purpose was to obtain an understanding of both the types of questions mandated for the triage encounter in emergency departments across the United States and how emergency nurses perceive the relevance of these questions to the triage process. METHODS: A qualitative descriptive exploratory study using focus group data was used. Data were collected at an in-person emergency nursing conference held in September 2022. Data were analyzed using Mayring's 8-step process. RESULTS: Participants (n = 35) voiced concerns about a lack of expertise at all points in the triage process. The overarching problem is reported as data required by regulatory agencies are conflated with triage assessment information. Participants in this study reported that the conflation of the triage assessment with regulatory compliance is causing significant issues in the ability of emergency nurses to appropriately evaluate patient presentations. Thematic categories were identified as who's assessing the patients? assessment or compliance? important questions, situationally important questions, questions asked before discharge, and the lack of emergency nurse input. DISCUSSION: The conflation of regulatory data collection with patient assessment at the initial triage encounter challenges the ability of the emergency nurse to rapidly and accurately identify patients at risk of deterioration. We recommend that initial triage processes encompass questions that focus on establishing the stability of the patient and the safety of the waiting room and include inquiry relevant to the patient presentation.

Defining Research Funding Priorities: Emergency Nurses Association Foundation.

INTRODUCTION: Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program. METHODS: A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage. RESULTS: Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research. DISCUSSION: These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice.

Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program.

INTRODUCTION: Emergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement. METHODS: The emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence. RESULTS: Using the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%. DISCUSSION: This development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.