title: Registered nurses' experiences of their decision-making at an Emergency Medical Dispatch Centre.
abstract: OBJECTIVE
  To describe registered nurses' experiences at an Emergency Medical Dispatch Centre.
  
  
  BACKGROUND
  It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses.
  
  
  METHODS
  A qualitative design was used for this study.
  
  
  METHODS
  Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used.
  
  
  RESULTS
  Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned.
  
  
  CONCLUSIONS
  Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses.
  
  
  CONCLUSIONS
  Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees.
authors.affiliation: Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden.
authors.forename: Bosse
authors.initials: B
authors.lastname: Ek
authors.forename: Marianne
authors.initials: M
authors.lastname: Svedlund
mesh_terms: D000328:Adult; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D013548:Sweden
keywords: ambulance; content analysis; decision-making; emergency; priority; triage