title: Treatment targets in emergency departments: nurses' views of how they affect clinical practice.
abstract: OBJECTIVE
  To understand nurses' views and experiences of four-hour treatment targets in the emergency department and how this impacts clinical decision-making throughout acute secondary care hospitals.
  
  
  BACKGROUND
  In many countries, national treatment targets in the emergency department have been introduced. However, research and a recent enquiry into poor clinical care in one hospital in the UK have highlighted that patient care may be compromised by the need to meet these targets.
  
  
  METHODS
  Qualitative descriptive study as part of a case study approach.
  
  
  METHODS
  Semi-structured interviews were conducted with 31 nurses working in UK secondary care hospitals which had an emergency department. Nurses were purposively sampled from three specialties: emergency arenas (emergency department, n = 5; medical assessment n = 4 surgical receiving n = 2) (n = 11), surgical wards (n = 11) and medical wards (n = 9).
  
  
  RESULTS
  Nurses in emergency arenas reported considerable burden, in terms of a very high workload and pressure from senior staff to meet the target. Respondents reported that negative impact on patient care for the majority of patients, excluding the most sick, for whom emergency arena nurses reported that they ensured received appropriate treatment, regardless of breaching treatment targets. Around half of the nurses working outside emergency arenas felt pressure and amended their work practices to enable colleagues in emergency arenas to meet treatment targets.
  
  
  CONCLUSIONS
  Four-hour targets were not viewed as clinically helpful by the majority of nurses, some of whom questioned their appropriateness for patient care.
  
  
  CONCLUSIONS
  Policy makers and senior managers should consider the suitability of treatment targets in the emergency department, particularly in relation to working conditions for nurses and other health professionals and its potential for negative impacts on patient care. While targets remain in place, senior nurses and managers should support nurses who breach the target to provide optimum clinical care.
authors: School of Nursing Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK.
authors: Louise
authors: L
authors: Hoyle
authors: Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors: Aimee
authors: A
authors: Grant
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D013222:State Medicine; D006113:United Kingdom; D000078329:Workforce; D016526:Workload; D055815:Young Adult
keywords: discretion; emergency care; emergency department; health care; health care administration; nurses; nursing care; qualitative; targets; work environment