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The Barriers and Enablers to Implementing Nurse-Initiated Protocols in the Emergency Department: A Focus Group Study
Julie Gawthorne1,2, Kate Curtis1,3, Andrea McCloughen1
1Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Camperdown, New South Wales, Australia.
Aim:
To identify the barriers and enablers to implementing nurse-initiated protocols in an emergency department.
Background:
Nurse-initiated protocols empower emergency nurses to autonomously initiate interventions, investigations and treatments based on predefined clinical guidelines. These protocols reduce waiting times and enhance staff and patient satisfaction. However, their uptake remains inconsistent, and the reasons for this variability are not well understood.
Method:
Focus groups were conducted with emergency nurses using an interview guide informed by the theoretical domains framework to explore perceived barriers and enablers to protocol implementation. Audio recordings were transcribed and analysed using inductive content analysis.
Results:
Six focus groups with 34 participants identified seven categories influencing protocol implementation. Barriers were: (i) nurses' workload and psychological stress, (ii) lack of competence, confidence and experience, and (iii) documentation burden and limited access to resources. Enablers were: (i) education and clinical support, (ii) improved clinical practice, and (iii) positive healthcare outcomes. The nurses and doctor relationship was identified as both a barrier and an enabler.
Conclusion:
Effective implementation of nurse-initiated protocols requires systemic changes that empower nurses within a well-supported, adequately resourced environment. Addressing structural and professional development challenges is crucial to ensuring these protocols are consistently integrated into emergency departments.
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