Emergency Department nursing shift leaders’ responses to episodes of escalation of care for clinical deterioration

Mrs Vanessa Leonard-Roberts1,2, Professor Julie Considine2,3, Professor Judy Currey2

1Northern Health, Epping, Australia, 2Deakin University, Geelong, Australia, 3Eastern Health Partnership, Box Hill, Australia

Background: Recognising and responding to clinical deterioration is a national patient safety priority. The aim of this study was to determine the frequency, nature, and response of ED Nursing Shift Leaders to episodes of escalation of care for patient clinical deterioration.

Methods: A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban district ED in Melbourne, Australia. Participants were recruited from the senior emergency nurses at the study site that fulfilled the role of being in charge of the ED. Study data were collected between October and December 2015 across a variety of shifts.

Results: This study had three major findings. First, escalation of care for patients who are clinically deteriorating to the Nursing Shift Leaders is a common occurrence. A total of 37 episodes of escalation of care for clinical deterioration were observed across a variety of shifts, equating to 1.02 episodes of escalation of care per hour. Second, Nursing Shift Leaders rely on advanced clinical emergency nursing skills to recognise, prioritise and respond to escalation of care for a clinically deteriorating patient. Finally, the Nursing Shift Leaders’ role in responding to escalation of care for clinical deterioration is multifaceted.

Conclusions: The Nursing Shift Leader role is crucial in identifying, responding to and managing escalation of care for patient clinical deterioration and has a direct impact on patient outcomes.

Implications: The Nursing Shift Leader role is complex and requires a high level of management and clinical acumen. Opportunities to maintain these skills should be provided on an ongoing basis.


Vanessa Leonard-Roberts was born in Africa and worked for many years in South Africa as an intermediate life support paramedic. During periods of civil unrest Vanessa volunteered for the South African Red Cross Society, often working in areas of extreme conditions and political unrest. Vanessa spent 5 years with the National Sea Rescue Institute where she worked as a crew medic training new crew members in basic life support and maritime emergency care. In 2008 Vanessa immigrated to Australia and subsequently completed a Bachelor of Nursing Degree followed by a Diploma in Emergency Nursing. Vanessa is currently a Master of Nursing candidate through Deakin University and works as a Clinical Support Nurse at Northern Health, Victoria.