Expanded Roles and Competency Gaps of Emergency and ICU Nurses During Armed Conflict in Gaza

Area of Science:

• Nursing
• Conflict Medicine
• Healthcare Systems

Background:

• Armed conflicts severely disrupt healthcare systems.
• Nurses, particularly in emergency and intensive care units (ICUs), face expanded roles and competency demands during crises.
• Understanding these challenges is crucial for maintaining healthcare standards in conflict zones.

Purpose of the Study:

• To explore the expanded roles, task shifting, and competency gaps of emergency and intensive care unit nurses in Gaza's government hospitals during armed conflict.
• To identify adaptive strategies, barriers, and lessons learned relevant to international nursing standards.
• To inform policy and education for resilient nursing in conflict-affected settings.

Main Methods:

• A descriptive, qualitative research design was employed.
• Semi-structured key informant interviews and a focus group were conducted with nurses, supervisors, and academic leaders in Gaza's government hospitals.
• Thematic analysis followed COREQ guidelines and information power principles.

Main Results:

• Fourteen nurses and ten senior stakeholders participated, revealing eight key themes: role expansion, psychological impact, adaptation, core competencies, training, systemic barriers, teamwork, and support systems.
• Nurses assumed advanced clinical duties and autonomous decision-making due to staff shortages and resource scarcity.
• Gaps in pediatric, burn, and mental health care were identified, despite demonstrated resilience and adaptive strategies supported by mentoring and leadership.

Conclusions:

• Nurses in conflict-affected emergency departments and ICUs exhibited significant adaptability and role expansion.
• Critical gaps in preparedness and institutional support were evident, necessitating enhanced training and clear policy frameworks tailored to conflict settings.
• Integrating conflict-nursing skills, ethical decision-making, and psychosocial support into policy and education is essential for building nurse autonomy and conflict-readiness in Palestine and globally.