Mechanical ventilation in Australian emergency departments: Survey of workforce profile, nursing role responsibility, and education

Summary 

Background

Little empirical data describes emergency nurses’ role in decision-making for ventilation and no Australian standards exist to guide ventilation decision-making in the emergency department (ED).

Methods

Self-administered questionnaire sent to nurse managers of 24 Australian EDs participating in a contemporaneous prospective, observational study of ventilation management.

Results

Survey responses were available from 21/24 EDs (response rate 87.5%) of which 10/21 (47.6%) were categorized as a principal referral centre. All departments reported a 1:1 nurse-to-patient ratio for ventilated patients, for patients requiring non-invasive ventilation (NIV) nurse-to-patient ratios ranged from 1:1 to 1:3. Nurse managers from 10/21 (48%) EDs reported having guidelines for the management of mechanically ventilated patients; guidelines for management of NIV were more frequently available (13/21, 62%). Nurses independently implemented the majority of ventilator setting changes in some EDs (9/21, 43%). Competency assessment took place prior to un-preceptored care of ventilated patients in 13/21 (62%) EDs.

Conclusions

Australian nurses participate actively in ventilation decisions but guidelines for ventilation decision-making are not always available. Nurse-to-patient ratios for patients receiving invasive ventilation appear consistent; lack of uniformity in ratios for NIV was common. Further work is needed to identify safe staffing levels for patients receiving NIV in the ED.

Keywords: Emergency department, Respiration, Artificial, Mechanical ventilation, Non-invasive ventilation, Decision-making