The need for clinical specialization

Emergency nursing: The need for clinical specialization

Williams, Swapna Naskar

Emergencies are a common phenomenon encountered by all doctors and Nurses involved in direct patient care. Accidents occur at any time or place and can affect anyone irrespective of age and sex. Health professionals who are adequately trained and skilled in emergency procedure can provide prompt attention, appropriate care and constant supervision for the seriously injured and ill, preventing death, disability and suffering, whereas at present there is a serious dearth of properly qualified emergency personnel.

In India, emergency medical care. a much needed medical speciality. is moving into the realm of high technology, costly medications and equipment. In this milieu, there is an absolute need for qualified and competent emergency Nurses as well as physicians in order to provide a high quality of care to the emergency victims and also to their relatives. Anantharaman (2000) clearly stated that there cannot be progress in the care of emergency patients if emphasis is laid only on the training of doctors in emergency medicine, as Nurses are equally important members of an emergency care team.

Nurses constitute the largest single group of health care professionals in any health care organization. The very nature of their work brings them closest to the population they serve. Due to their person to person interaction, Nurses are expected to be mainly responsible for the efficient and effective management of patient care services. More importantly, it must be ensured that they are adequately trained to be able to cope with any and all emergency situations.

Nursing , being an integral, important and essential component of health care services, requires Nurses with up– to-date knowledge and skills. Developing adequate knowledge and skills of emergency Nurses, is imperative in order to provide competent care to emergency victims and to complement medical professionals’ efforts in attaining the goal of optimum utilization of ‘golden hours’. Further. the development of ‘observation medicine’ which falls with in the realm of emergency medicine has made emergency services more complex and challenging. It is important to improve clinical nursing practice in the emergency care areas and to prepare Nurses working in the emergency to cater to the multifarious and challenging needs of emergency victims and their relatives.

Nursing education in India has undergone many changes during the last few decades. There is a move from hospital based diploma training to university-based graduate and post-graduate nursing education programmes. The concept of task oriented patient care is being replaced by problem -oriented care. There has been a considerable development in nursing education, accordingly clinical nursing practice has not been able to keep pace with the technological developments. It is important to realize that the expanded roles of clinical Nurses are ever increasing. For this reason, opportunities for in-service education programmes through formal training should be made available to all clinical Nurses in order to improve the quality of nursing services, especially for Nurses working in the emergency, a highly sensitive infinite patient care area where one simple error or delay in initiating life saving measures can lead to loss of precious lives.

The existing basic professional nursing curricula as prescribed by the Indian Nursing Council are designed to prepare Nurses for first level positions only, and are not training Nurses to work in.the speciality and super-speciality areas. Nurses who have undergone basic nursing courses are perceived to be adequate for providing services in speciality areas which are designed for providing intensive and special ized care to patients with complex health problems. The situation has created a gap between the purposes for which the Nurses have been trained and the purpose for which they have been utilized in clinical areas. These circumstances can only be altered through the introduction of an advanced education programme in emergency nursing for general Nurses, in order to equip them with the requisite knowledge and skills necessary to provide quality patient care in emergency care areas. Only then the standards in clinical nursing practice will be raised to a level where Nurses are not only able to assist doctors competently but are also able to initiate and handle emergency care services independently thus preventing loss of precious lives.

Emergency nursing is the term used to describe the level of care that includes prompt action, continuous observation, monitoring, investigation, the treatment required to support & manage any emergency and life-threatening & critical conditions. Nurses play an important role in the emergency department. They assume leadership functions in organising and directing services for emergency victims and their relatives. Therefore, a speciality nursing education in emergency nursing will ensure that the existing competencies of Nurses are further developed and new competencies required are introduced. Nurses, who have undergone a speicality course in emergency nursing, would possess superior expertise and competencies and could assume more responsibility and accountability in order to adopt multiple roles such as practitioner, educator, manager and change agent. Thus it is expected that emergency Nurses with advanced training will be high level practitioners and these practitioners of nursing will attain teacher competencies as well.

The rapid transformation of the health care system has created a demand for Nurses who are competent for expanded roles in clinical specialities. The expanding horizon of medical sciences has resulted in the development of various clinical speciality and super-speciality units. Accordingly, speciality in paramedical and other disciplines assodated with medical services have been developed. It is apparent that the nursing profession has failed to move in a similar direction inspite of its being in direct contact with patients requiring specialized care and coordinating the other support services including the medical care in providing patient care. Presently, various short -term in-. service education courses are being organized by a large number of hospitals and institutions for preparing their own Nurses to work in various clinical speciality areas. This is the step in the right direction. The need for specialized Nurses in the country is substantial and warrants the introduction of speciality nursing education programmes to meet the special medical care needs of patients in various clinical speciality and super-speciality areas. More importantly, critical reflective thinking, selfdirection, life long learning and communication skills are the mandated expectations for health care providers in the 2l st century. Nurses, when working in collaboration with physicians and other health care professionals should be able to function to the best of their ability, as competent members of an team.

It is important, while planning and developing a speciality nursing curriculum at postgraduate level to identify and delineate the clinical nursing content to enable the motivated and interested Nurses to develop the requisite knowledge, skills and attitudes in order to work efficiently and effectively in their respective clinical speciality areas. To achieve competence, extensive field experience is required in observation of clinical phenomena and in testing of alternate research – based strategies in order to achieve results. Besides. specification of the common core subject content will be essential for students from all clinical specialities to enable them to adopt the role of educator, manager and researcher in addition to their role in clinical practice.

Emergency care areas are highly sensitive and specialized where prompt action, continuous observation, skilled and competent care is essential. Nurses must be adequately equipped with the requisite competencies in order to be able to work efficiently and effectively in the emergency care areas. Thus, the benefit of specialization would accrue through the saving of doctors’ precious time and also from patients’ special needs being better served. The potential of Nurses should be utilized to the optimum level. Nurses with specialized training, possessing superior expertise and competence will be more capable of meeting speciality care needs of the patient in a cost- effective and holistic manner.


1. Anantharaman V. Challenges of Asian emergency medicine is new millennium: aspirations and expectation verses availability. Emergency Medicine Update. Bangalore EMCON 2000.1-9.

2. Holleran Rs. Mosby’s emergency and flight nursing review (2nd Ed.) St. Louis, Mosby Year Book Inc. 1996; 6-7. Jordan KS. Emergency nursing core curriculum (5th Ed.) Philadelphia, W.B. Saunders C.O. 2000.

Author: Lecturer, College of Nursing, All India Institute of Medical Sciences, New Delhi.

Copyright Trained Nurses’ Association of India Apr 2002

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