title: Analysis of three advanced practice roles in emergency nursing.
abstract: BACKGROUND
  There are many Emergency Department (ED) demand management systems that include advanced practice emergency nursing roles. The aim of this study is to examine and compare three advanced emergency nursing practice roles: ED Fast Track, Clinical Initiatives Nurse (CIN) and Rapid Intervention and Treatment Zone (RITZ).
  
  
  METHODS
  A descriptive exploratory approach was used to conduct this study at an urban district hospital in Melbourne, Australia. The study participants were patients managed in each of the three systems with advanced practice emergency nursing roles: Fast Track, CIN and RITZ.
  
  
  RESULTS
  There were a total of 551 patients: 195 Fast Track patients, 163 CIN managed patients and 193 RITZ patients. CIN managed patients were older (p<0.001), with higher levels of clinical urgency (p<0.001), and higher hospital admission rates (p<0.001). CIN managed patients had shorter waiting time for nursing care (p=0.001) and lower incidence of medical assessment within the time associated with their triage category (p<0.0001). ED LOS for discharged patients was significantly longer for CIN managed patients (p<0.001). CIN managed patients had a significantly higher incidence of electrocardiography (p<0.001), blood glucose measurement (p<0.001), intravenous cannulation (p<0.001), pathology testing (p<0.001), and analgesia administration (p<0.001) when compared to Fast Track and RITZ patients.
  
  
  CONCLUSIONS
  Advanced practice roles in emergency nursing can have different applications in the ED context. Clarity about role intent and scope of practice is important and should inform educational preparation and teams within which these roles operate.
authors.affiliation: Deakin University - Northern Health Clinical Partnership, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia. julie.considine@nh.org.au
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.forename: Elspeth
authors.initials: E
authors.lastname: Lucas
authors.forename: Roslyn
authors.initials: R
authors.lastname: Payne
authors.forename: Matthew
authors.initials: M
authors.lastname: Kropman
authors.forename: Helen E
authors.initials: HE
authors.lastname: Stergiou
authors.forename: Herman
authors.initials: H
authors.lastname: Chiu
mesh_terms: D000208:Acute Disease / Q000451:nursing; D000293:Adolescent; D000328:Adult; D057179:Advanced Practice Nursing / Q000379:methods / Q000458:organization & administration*; D002983:Clinical Competence; D019091:Critical Pathways; D017598:Efficiency, Organizational; D016529:Emergency Nursing / Q000379:methods / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D015401:Nursing Administration Research; D009936:Organizational Innovation; D010348:Patient Care Team; D010351:Patient Discharge / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D014218:Triage; D014739:Victoria; D014850:Waiting Lists; D055815:Young Adult