Background: Increased demand, waiting times and length of stay has seen many emergency departments (ED) implement nurse-initiated protocols. While there is overwhelming evidence to support nurse-initiated care, the appropriate use of and adherence to protocols has been variable. In new south Wales, 74 standardised nurse-initiated protocols have been developed for implementation in all emergency departments.

Aim: To identify the barriers and enablers to emergency nurses use of nurse-initiated protocols in the ED.  

Methods: Quantitative and qualitative data was collected via a survey of emergency nurses and doctors. The survey contained 23 questions informed by the theoretical domains' framework. Descriptive statistics were used to summarise results of quantitative data and content analysis was performed on qualitative data. Data were then integrated to identify barriers and enablers to nurses’ use of nurse-initiated protocols in the ED.

Results: The nurses response rate was 82% (n=76) and doctors 72% (n=34) and both cohorts strongly supported the introduction of nurse-initiated protocols. Six categories were generated, one was classified as a barrier, three as enablers and two both a barrier and enabler to the use of nurse-initiated protocols in the emergency department. The barrier was i) lack of human and physical resources. Enablers were i) patient and organisational benefits. ii) nurses’ motivation to use protocols, iii) nurses desire to develop their nursing practice. Barriers and enablers were i) nurses' confidence, ii) the work environment

Conclusion: Emergency nurses are highly motivated to use nurse-initiated protocols, learn new knowledge, and extend their clinical practice to positively impact patient care and outcomes. Emergency doctors were also highly supportive. However, a lack of resources, time to use protocols and attend education and a lack of experience and understanding of protocols were identified as barriers that need to be addressed as part of any implementation.