Emergency Nursing

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Walk into the Emergency Department (ED) as a patient and you will see people waiting to be assessed and watching others being treated in a nonsensical order. However, walk in as a nurse and you see order, patients categorized by need “…using a systematic method” (CNO, 2007), and the wide variation of qualifications and credentials that each nurse possess’. From this point of view, you can observe the effect of the Canadian Triage & Acuity Scale, known as CTAS (Beveridge et al., 1999), and the distinction the Registered Nurse (RN) and Registered Practical Nurse (RPN) have on the efficiency and effectiveness of the ED. (Shannon)

Levels of the Emergency Department

Emergency nurses provide care for patients in the critical phase of illness or trauma, and have the ability to recognize life-threatening problems and rapidly arrange necessary care. To assist nurses and other health care providers to fulfill this task, the CTAS is a tool adopted in EDs across Canada (see figure 3). This scale enables EDs to “…prioritize patient care requirements, examine patient care processes, workload, and resource requirements relative to case mix and community needs” (Beveridge et al., 1999). For those minimally or acutely ill or injured ambulatory patients, a separate Fast-Track area has been designated within the ED, and has been thought to improve patient satisfaction and decrease wait times. In many cases, less expensive health care providers, such as Registered Practical Nurses, staff this area (Yoon, 2003). (FangFang, Shannon)

Role of the Registered Practical Nurse

The scope of the Registered Practical Nurse varies from one hospitals emergency department to the next. The Fast track zone tends to be the leading area for RPN’s to take charge in emergency departments. Once a patient is triaged at a level four or five on the CTAS scale the RPN is responsible to carry out a client assessment, to determine if she/he is able to meet the client care needs or if consultation with an RN is required (CNO, 2006). Within the emergency department the scope of an RPN encompasses head to toe assessments, wound care, administration of medications via oral, injection and intravenous therapy (IV). The starting and maintenance of IV therapies, assisting doctors/surgeons with procedures, documenting and collaborating with the health care team to better patient care. (Tera Gallagher)


Figure 3. Canadian Triage & Acuity Scale


Limitations of the Registered Practical Nurse

While both the academic courses for RNs and RPNs have similarities, there is a difference in both the intensity and extent of knowledge that is covered. Despite the continuing growth of the RPNs scope of practice, there are certain limitations that are encountered within the ED. These boundaries also vary from one institution to the next, however, similarities of general limitations the RPN encounters are as follows; administering medications through intravenous therapy, phlebotomy, administration of blood and blood products, insertion of nasogastric tubes, the maintenance of and administration of medication through the Peripherally Inserted Central Catheters, also known as PICC lines. Furthermore, RPNs do not have the academic background, nor do they possess the required knowledge and experience to provide full range of care for patients that are unstable or classified as a level one, two or three in accordance to the CTAS. Regardless of their limitations, RPNs facilitate movement of and treatment of the Fast-Track patients, which allows the RNs to attend to the seriously ill or injured patient in a timelier manner. (Rodrigo, Shannon)


Although there are limitations to these theoretical methodologies, they are by far the most efficient ways of facilitating an ED. By having a CTAS and a Fast-Track area, more patients can be assessed and are treated in priority sequence based on their condition. In addition, having the distinction between RN and RPN is necessary as it allows for the combination of two separate, but necessary skills sets to fuse together for a common goal; to treat the patient. (Shannon)


Beveridge et al., (1999). Implementation Guidelines for the Canadian ED Triage & Acuity Scale, Canadian Association of Emergency Physicians, Retrieved from www.caep/002.policies/002-02.ctas.htm

Canadian Association of Emergency Physicians (2009), (CAEP). Canadian E.D. Triage & Acuity Scale. Retrieved from http://www.caep.ca/template.asp?id=B795164082374289BBD9C1C2BF4B8D32

College of Nurses of Ontario (2003), (CNO). Building Your Leadership Skills. Communique, Vol.28 No.4 pp 18. Retrieved

from http://www.cno.org/pub/mag/CMQvol28no4.pdf

College of Nurses of Ontario (2005), (CNO). RNs and RPNs - Working Together. Retrieved from http://www.cno.org/prac/work_together.htm

College of Nurses of Ontario (2007), (CNO). Practice Guideline: Utilization of RNs and RPNs. Retrieved from


Emergency Nurses Association (1999), (ENA). Scope of Emergency Nursing Practice. Retrieved from http://www.ena.org/practice/scopes/Documents/ScopeEMNP.PDF

Figure 1. (n.d.) Retrieved from http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/hangover_ myths_slideshow/istock_photo_of_emergency_room_entrance.jpg

Figure 2. (n.d.) Retrieved from www.fotosearch.com/PHD532/aa043384

Figure 3. Canadian Association of Emergency Physicians (2009), (CAEP). Canadian E.D Triage & Acuity Scale. Retrieved from http://www.kliinikum.ee/eemas/MEDITSIINIINFO/KIRJANDUS/Triaazh/The%20Canadian%20ED%20Triage%20and%20Acuity%20Scale.gif

Scihealth (2009, April 22). SciHealth's Insight: Emergency Department Management Solution [Video file]. Retrieved from http://www.youtube.com/watch?v=b-wvPbBrLHo

Yoon, P. (2003). Emergency Department Fast Track System, HTA Initiative Series #10 Retrieved from http://www.ihe.ca/ publications/library/archived/emergency-department-fast-track-system/

Group 10: Shannon, Rodrigo, FangFang, Tera