National Early Warning Score: A survey of registered nurses' perceptions, experiences and barriers.

AIMS & OBJECTIVES: To describe registered nurses' perceptions, experiences and barriers for using the National Early Warning Score in relation to their work experience and medical affiliation. BACKGROUND: Indications of inconsistencies in adherence to the National Early Warning Score have emerged. DESIGN: Web-based questionnaire study. METHODS: The questionnaire was sent to 3,165 registered nurses working in somatic hospitals in the southern part of Sweden. Strengthening the Reporting of Observational Studies in Epidemiology was adhered. RESULTS: Seventy-one per cent of the 1,044 respondents reported adherence to the National Early Warning Score guidelines recommended frequency of monitoring and 74% to the clinical response scale. The shorter the working experience, the higher the proportion of registered nurses who answered positively to the National Early Warning Score allowing them to better prioritise their care with short nursing experience. When categorising nurses according to their workplace's medical affiliation, adherence to the National Early Warning Score guidelines recommended frequency of monitoring was reported highest in surgery and orthopaedics (66%) and lowest in the cardiac high dependency unit (52%). Corresponding proportions of reported adherence to the clinical response scale were highest in orthopaedics (82%) and lowest in the cardiac high dependency unit (48%). Lack of response from the doctor was reported as one of the main reasons for not adhering to the National Early Warning Score by 50% of the registered nurse. CONCLUSION: In general, registered nurses perceived the National Early Warning Score as a useful tool, supporting their gut feeling about an unstable patient. Barriers to the National Early Warning Score were found in doctors and the most experienced registered nurses, indicating the need for resources to be focused on the adherence of these members of the healthcare team. RELEVANCE TO CLINICAL PRACTICE: In general, the registered nurses answered positively to the National Early Warning Score. We found indications that there is a need to focus resources on the adherence of the most experienced registered nurse and the doctors.