Emergency Department nursing shift leaders’ perceptions of their role in responding to escalation of care for patient clinical deterioration

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

1Northern Health, Epping, Australia, 2Deakin University , Geelong, Australia, 3Centre for Quality and Patient Safety, Eastern Health Partnership, Box Hill, Australia

Background: Clinical leadership is fundamental to patient safety and is vital to an effective response to patient clinical deterioration. The Emergency Department (ED) Nursing Shift Leader is a key leadership role, however to date there have been no studies exploring the management of clinical deterioration from the perspective of the ED Nursing Shift Leader. The aim of this study was to explore ED Nursing Shift Leaders’ perceptions of their role in responding 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. In-depth semi-structured interviews were conducted between December 2015 and March 2016.

Results. Two major themes and four subthemes were identified from the interviews. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management.

Conclusions: Strong collaboration, logistical management and expert clinical skills were all identified as fundamental to the Nursing Shift Leaders capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

Implications: The ED Nursing Shift Leader role is complex and challenging. Investment in this frontline leadership role has the potential to benefit the team, the organisation and the profession and ultimately improve patient outcomes.


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.