Understanding interdepartmental and organizational work in the emergency department: an ethnographic approach

Social scientific and nursing studies, and the experiences of emergency department staff, have attested to the complex organisational and communicative work that accompanies emergency clinical work. Yet, little attention has been paid to developing a research framework to examine and develop communicative and organisational work in emergency departments (EDs). This paper explores the role of nurses in plugging gaps in the care of ED patients, and summarises the findings of a large, 3-year ethnographic study comprising 12 months of ethnography in two EDs in Sydney, Australia, and 2 years of analysis. The findings of the large study are summarised and exemplified here as part of a broader conceptual argument for the importance of ethnographic research in EDs. Ethnography involves capturing the moment-to-moment action of life when and where it happens, and in the context of, reflecting and amending, broader social patterns. The findings report on the relationship of communication, organisational and, in particular, interdepartmental and interorganizational work, to emergency clinical work and demonstrate that nurses play an important role in articulating and reconciling patients' and medical staff activities. The paper concludes that emergency nurses are well placed to use ethnographic research to advance the understanding and delivery of emergency care.