Emergency nurses leading quality patient care

Anna D’Ambrosi MCENA1, Matt Luther FCENA, FACNP, FACN1

1 Emergency Department, Calvary Health Care ACT, Bruce ACT

How do you get health care providers to engage in and lead quality improvement? How do you get emergency nurses to critically analyse their environment and practise?

Empowerment, ownership and respect of all nurses, no matter the position or ‘experience’ level. Truly understanding that everyone has a valuable voice.

Emergency Departments are an ever changing environment where nursing staff are faced with time and resource challenges. Emergency nursing staff must be empowered to lead and influence clinical practice to reduce risks and enhance patient safety. Engaging emergency nurses, through the establishment of Quality Portfolio groups (paralleling the National Safety and Quality Health Service Standards), improves clinical practice, enhances patient safety and improves professional satisfaction.

The caring and enthusiastic attitudes innate in emergency nurses allows organisations to instil professional pride amongst the Quality Portfolio groups through empowerment, support and ownership. This empowerment leads to the desired outcome, meeting the criteria established in the National Safety and Quality Health Service Standards.

The Quality Portfolio groups endeavour to; recognise preventable harm, implement suitable strategies and evaluate the effectiveness of the implemented strategies. Evidence based practise is then sort to be provided to enhance patient safety and quality outcomes.

The Quality Portfolio groups are provided a clear role description and consist of a diverse group of nurses with varying levels of emergency nurses experience. Each team member has specific skills, reporting and accountability requirements. They are provided with principles and functions to meet communication obligations, providing education to support individual learning needs, including face-to-face learning sessions, workshops and mandatory e-Learning modules.

The Blood Safety Quality Portfolio recognised the need for a blood transfusion pack for the emergency department. The objective was to provide the best possible patient outcomes by supporting staff to provide a high standard of clinical care. The results demonstrated a decrease in adverse events related to blood transfusions, while staff exhibited appreciation and support (through ownership) for the usefulness of the blood transfusion pack.

Another staff driven quality improvement initiative focused on reducing the risk of pathology mislabelling and over ordering. One such strategy was ensuring pathology was not collected prior to clinical assessment. A review of monthly pathology errors, lead to an escalation of this strategy and also ensured individual professional accountability for pathology errors, resulting in improvements across the focus area.

It has been demonstrated that our front line clinical emergency nurses are key to the success of the Quality Portfolios. They are the service provider, holders of the operational corporate knowledge and an essential component in leading projects. The organisation supports Quality Portfolios projects with the provision of materials, time, providing guidance/suggestions and support. They recognise that projects initiated and implemented by front-line staff are well received by their colleagues.


Anna D’Ambrosi is a registered Senior Emergency Nurse at Calvary hospital in Canberra. Anna successfully completed a Degree in Bachelor of nursing, University of Canberra in 2006 and a Post Graduate Certificate in Clinical Nursing Majoring in Emergency, Australian Catholic University in 2009.Anna has accomplished a high standard of competency in providing advanced nursing practice. She is competent through the course completion of advanced life support, medical emergency team, medication standing orders, standard operating protocols, triage, nurse initiated x-ray, paediatric, and many proficiency assessment tools. Anna is also an acting Emergency Nurse Clinical Manager and provides clinical education to emergency staff. She is the leader of the Blood Safe Quality Portfolio where she manages many valuable department projects. Anna is an Australian Rugby League Sports Trainer and has National Accreditation Level 1 R.L.S.T. This allows her to volunteer to assess and treat sport injury on the playing fields.