Abracadabra! Unveiling the invisible work of emergency nurse practitioners

Mr Matt Lutze1,2,3, Professor  Margaret Fry2,5, Ms  Glenda  Mullen4, Dr Jane  O’Connell2, Ms  Danielle  Coates4

1St George Hospital, Emergency Department, Kogarah, Australia, 2University of Technology Sydney, Faculty of Health, Ultimo, Australia, 3University of Sydney, Sydney Nursing School , Camperdown , Australia, 4Sydney Children’s Hospital Network, Emergency Department, Randwick, Australia, 5Director Research and Practice Development Nursing and Midwifery Directorate NSLHD  , St Leonards, Australia

Objectives: This study sought to quantify and qualify the collaborative and secondary consulting clinical practice patterns of emergency nurse practitioners (ENPs). Within the literature there is extensive evidence of the direct clinical management provided by ENPs. However, ENP secondary activities incorporating consultation, advice and clinical support are not well described.

Design/Methods: This was a three-month prospective multicentre study design which explored ENP secondary consultations using an electronic medical record template. The template was designed to capture direct (patient contact) and indirect (staff advice / consultation) activities.

Results: ED presentations across the four sites were 54,970. ENPs were involved in the care of 2628 (5%) patients. Of the 2628 patients ENPs managed 2017 (77%) patients as the primary provider (primary consultations) and 611 (23%) as secondary consultations (direct and indirect contact).

Secondary consultations conducted by ENPs were on average 11.1 minutes (median 7.0 minutes). Of the secondary consultations 60% (n=367) required direct patient contact. Secondary consultations were commonly initiated by nurses (n=191; 31%) or emergency registrars (n=136; 22%). The majority (n=424; 69%) of secondary consultations involved patients with either musculoskeletal (n=238; 39%) and wounds and burns (n=186; 30%). ENPs requested 155 (21%) investigations and prescribing was performed on 144 (24%) occasions. Procedural support (n=303, 50%) was predominantly for wound management (n=141; 47%) or plaster/splints/crutches (n=113; 37%). When an ENP provided a secondary consultation, re-presentation rates were lower (1% compared to 6.5%).

Conclusion/Recommendations: The study highlights the invisible and valuable work of secondary consultations by ENPs.  Approximately 25% of patients who received care from an ENP did so as a secondary consult. The study identified that all ED clinical staff utilised ENPs for expertise in patient management. The ENP secondary consultation template was quick and easy to use and could be adapted for other nurse practitioner specialties or other care providers.


Matt has been a nurse for almost 20 years and a nurse practitioner for more than 10. He has worked in the UK and Australia across ED, primary care, prehospital and critical care areas. Whilst Matt loves pretending he is a researcher, his attention to beer and its secondary benefits tend to enhance the quality of his discussions, usually about ultramarathon running or more important things like his kids and family… Oh the places you’ll go 🙂