UK survey of A&E triage nurses highlights problems with a lack of training, low staffing and high stress

Nurses who assess patients at emergency departments would like more training and say their decisions can be negatively impacted by the high pressures of their work.

Researchers at the University of East Anglia conducted the first ever UK survey of triage nurses to discover the background, training and decision-making processes of this role in emergency departments. "Understanding the decision-making practices used by registered nurses assessing acuity at triage in emergency departments in the UK: A national survey" is published in the journal Emergency Nurse.

Lead author Hugh Gorick, a Ph.D. researcher at UEA's School of Health Sciences who also works as an assistant practitioner in an NHS hospital's Acute Medical Unit, said, "More than 24 million patients present to emergency departments in the UK every year, resulting in a high-pressure situation with limited resources.

"When the patients arrive, they will be triaged to assess how sick they are, to know how quickly they will need to receive treatment.

"These assessments need to be rapid and accurate to prevent delays and harm from occurring.

"Triage nurses told us that if they experience low staffing and busy environments this has a negative impact on their stress and their abilities to triage effectively.

"The survey also showed there is a huge variation in the frequency and quality of training for this vital role."

The study recruited 51 participants from hospitals across the UK through posts on social media and online forums for nurses.

The nurses who were assessing and prioritizing patients turning up at A&E departments came from different backgrounds and ranged from very experienced to newly qualified.

When they were tested on how they make decisions in these urgent situations, they generally scored well.

But the study found that training for triage nurses varied greatly, and 53% felt they wanted more training to be available. Meanwhile, 43% felt the quality and content of the training could also be improved.

It also highlighted a lack of space to conduct assessments in emergency departments as impacting efficiency, as well as a lack of staff.

Dr. Marie McGee, of UEA's School of Health Sciences, said, "This research highlights the need to ensure triage areas are properly staffed with enough space to see patients.

"We would recommend legislation for safe nurse staffing and the development of a national standard for triage nurses with defined knowledge and skills that need to be achieved and set periods for refresher courses.

"Managers also need to ensure the psychological welfare of nurses in emergency departments, with access to proper support systems."

The researchers previously carried out a systematic review which found that nurses around the world favor using clinical reasoning and intuition over triage algorithms to work out how sick a patient is before triaging for treatment.

However, this latest survey showed that nurses in the UK rely more on their training and comprehensive assessments, rather than just their gut feeling when making these decisions.

The researchers acknowledged that the number of triage nurses in the UK is not known, and as such it is difficult to assess the reach of this study.

The data was also self-reported and future research could look to use more in-depth methods, such as interviews, as well as looking more closely at training.

As a result, the team would like to hear from triage nurses about their experiences in UK emergency departments for the next stage of their research.

This will involve an interview which will take approximately 60 minutes, using Microsoft Teams.

To take part you must be a registered nurse working in the UK, whose role involves face-to-face triage.

Nurses who work exclusively with pediatrics, mental health or maternity are not eligible for this study.