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We need nationally agreed patient group directives.

For years, paramedics have been able to administer a list of more than 30 drugs to ensure that patients receive appropriate and timely treatment. But for emergency care nurses (ECNs), patient group directives vary according to the organisation in which they practise.

Developing a social enterprise through right to request.

The 'right to request' the authority to run healthcare services was introduced by the previous government so that staff can respond to the needs of local communities by setting up social enterprises. This article explains how the right to request works in practice by describing how a social enterprise was set up in Bromley, Kent.

How safe staffing can improve emergency nursing: time to cut the Gordian knot.

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.

Is the named nurse a reality in accident and emergency?

Previous articles have looked at particular aspects of the named nurse concept, but few have addressed the perceived difficulties in the speciality of Accident and Emergency (A & E) nursing. This paper seeks to promote discussion with other specialist areas/departments/units.

Chemical incident planning: a review of the literature.

Chemical incidents cause problems for Accident and Emergency (A & E) departments which are different from those recognized in other major accidents. As well as possible trauma there is the added problem of contamination. A & E departments must be prepared for chemical disasters with a chemical incident plan, decontamination facilities and protective clothing for all staff involved. The plan should include how to protect the hospital from contamination and how to prevent its personnel from becoming secondary casualties. The results of a survey into the preparedness of inner London A & E departments were published in issue 6.2 of this journal, April 1998. On 20 March, 1995 a religious cult released a nerve gas (sarin) into the Tokyo subway system. More than 5500 people needed hospital treatment and 11 people died (Reuter News Service, 22 March, 1995). The hospitals were overwhelmed with casualties. Once chemical exposure of victims was suspected, clothing was removed and patients were showered. Stretcher patients were decontaminated by means of bed bathing and a change of bedclothes (Okumura et al 1996). Hospital contamination was a problem during this incident due to the delay in recognising chemical exposure. This resulted in staff contamination. Many lessons were learned from this disaster, including the need to be prepared for all eventualities. If a similar incident occurred in the London Underground system, it would be catastrophic. Underground staff, police, fire fighters, ambulance staff and the general public could all be contaminated before the chemical was identified. There could be mass casualties, including personnel in the emergency services. How would London A & E departments cope, faced with a chemical disaster such as this?

Flight nursing down under: a perspective.

The purpose of this paper is to describe in the broadest sense the scope of flight nursing practice in the Western Australian context. The Royal Flying Doctor Service--Western Operations provides aeromedical and associated health services, through primary health clinics to persons living in remote and rural areas of Western Australia. Flight nurses provide a significant contribution to fulfilling the core business of the Royal Flying Doctor Service, and in doing so demonstrate that they are able to combine the diversity and speciality that is flight nursing, with the challenges not only of the aviation environment, but of the diversity and remoteness of the physical environment that they may find themselves in.

Nurse practitioner autonomy in a clinical setting.

The ENPs who participated in this study were providing services to a group of patients similar in age and gender to those using emergency services at a national level. The ENPs were employed in a variety of settings and provided health care to patients with non-urgent through emergent conditions. They ordered less diagnostic tests for patients than providers in a national study, performed various invasive and therapeutic procedures as well as diagnostic procedures, and referred all patients except those transferred to the morgue or who left against medical advice for follow-up care. The ENPs had a slightly higher percentage (94 per cent vs. 84.4 per cent) of patients discharged home than providers in a national study.