Extended Practice Nursing: Advancing nurses scope of practice to meet evolving emergency department demands

Mr Terry Carroll1,3, Ms  Anna  Carison1, Mrs  Trish  Holiday1, Mrs Joanne  Pleban1, Ms  Jayne  Hughan1,, Dr Dianne Crellin1,2,3

1The Royal Children’s Hospital, Parkville , Australia, 2Murdoch Children’s Research Institute, Parkville, Australia, 3The University of Melbourne , Parkville, Australia


Meeting increasing demand for care in the Emergency Department (ED) has required constant innovation and workforce reform. Extending the scope of experienced emergency nurses could provide another opportunity to improve access and quality of care. Experienced emergency nurses have the potential to meet departmental demands providing autonomous care to certain patient presentations without undertaking a nurse practitioner candidacy.


To develop a pathway for experienced nurses to extend their scope of practice to manage patients with defined presenting complaints.

Innovation Plan

A scope of practice was produced, and core learning objectives identified to guide the development of a 6-month program to support participants obtaining the required knowledge and skills. Education, mentorship and clinical supervision were the foundation of the program. The program and the achievements of the participants were evaluated using several methods. The final objective was ensuring participants achieved proficiency in performing advanced health assessment, procedural skills, diagnostic interpretation and patient disposition decisions.

Data about Innovation

Two senior nurses completed the first six-month program. They achieved proficiency in advanced assessment and procedural skills assisting in managing specific patient presentations . Post-completion these skills are visibly applied in their substantive ED roles. Participants reported the program was extremely challenging, physically taxing but overall rewarding. Both expressed a keen interest to pursue advanced clinical practice roles in the future and would recommend participation in this program to other nurses. Nurse Practitioners who supervised participants reported improved role satisfaction through educating and seeing participant growth. They acknowledged a significant cognitive fatigue associated with providing supervision however valued the mentor relationships they formed.


The participants extended their scope of practice and achieved advanced clinical decision-making skills. It is anticipated that these skills will support them to contribute to improved efficiency and quality of care meeting the increasing demands on the department.


Terry is a recently endorsed Nurse Practitioner working at the Royal Children’s Emergency Department. He has a keen interest in advancing the scope of nursing practice to meet service needs and also meet the professional development needs of nurses aspiring to progress in their careers.