Competency profile of critical care, emergency, and urgent care nurses in Spain: Foundations for a distinct specialty

Critical care, emergency, and urgent care nursing is practiced within a highly specialised clinical setting that requires advanced competencies extending beyond generalist nursing education and that are not currently formally delineated through a state-recognized residency-based specialty within the nursing specialties of the Spanish National Health System. The national regulatory framework allows for the justification of new specialties based on healthcare needs, clinical complexity, and the existence of clearly differentiated professional competencies.

To identify the specific competencies of nurses in critical care, emergency, and urgent care, by analysing their differences in relation to existing nursing specialties, as a basis for justifying their establishment as a distinct specialty.

A sequential mixed-methods, descriptive and comparative study was conducted in three phases: 1) a competency questionnaire based on the Nursing Interventions Classification, the Therapeutic Intervention Scoring System-28, and the National Aeronautics and Space Administration-Task Load Index; 2) an eDelphi consensus process; and 3) an association analysis between nursing interventions and NANDA-I diagnoses. Data were analysed using descriptive statistics and concordance measures, yielding high levels of reliability.

The first phase of the study was completed by 3476 nurses, and 302 experts participated in the second phase. In the third phase, 72.72% of the interventions reached a high frequency level (4-5), with a predominance of generalist activities such as nutrition, mobility, hygiene, safety, and comfort. In contrast, specific interventions; including oxygenation, advanced therapies, diagnostics, and critical communication; showed a high frequency exclusively in intensive care units, post-anesthesia care units, in-hospital and out-of-hospital emergency services, and advanced life support and nurse-led advanced life support teams (85.6%). Concordance in nursing interventions was 67.10%, and the intervention-nursing diagnosis association reached 53.65%, with only 31.46% shared with existing nursing specialties.

The findings identify an advanced and homogeneous competency core in critical care, emergency, and urgent care nursing, clearly differentiated from generalist practice and aligned with international advanced practice frameworks.

Establishing a dedicated specialty would standardise training and competencies, leading to improvements in patient safety, quality of care, and healthcare system efficiency.