COMPETENCIES FOR EMERGENCY NURSING

1. NATURE OF SPECIALISATION

Emergency nursing is a speciality, involving nursing care for patients of all ages in the
emergency and/or critical phase of their illness or injury, focusing on the level of
severity and time-critical interventions (ENSSA, 2010) with or without advanced
technology. It is the nursing care of individuals of all ages, urgent to non-urgent, with
perceived or actual physical and/ or emotional alterations of health that require
intervention.

Emergency nursing is episodic, primary, and usually acute in nature. It is carried out in
the emergency nursing practice, which is not confined to the emergency department,
but includes the pre-hospital emergency response e.g. disaster management, inter-
facility patient care, occupational environments that have high risk (for example oil rigs
and mines) and hospital environments.

Emergency nurses are prepared to take care of foreseeable emergencies, skilled at

identifying life-threatening problems, prioritizing the urgency of care, and rapidly and
effectively carrying out resuscitative measures and other treatment. These nurses act
with a high degree of autonomy and ability to initiate required measures without
outside direction, educating the patient and their family/significant others with the
information and emotional support needed to manage the situation.

Whilst collaborating with members of the multidisciplinary emergency team, the

emergency nurse plays a crucial role in the identification and management of life-
threatening problems and priorities. This includes the prioritising of care, resuscitative
and stabilization measures with appropriate management, and the provision of
information and emotional care to the patient and family members/significant others
and colleagues within a supportive environment, in accordance with established
evidence-based protocols.
 The emergency nurse will use clinical judgement and critical reasoning skills to manage
the emergency patient and consequently implement interventions with the aim to
restore stability, prevent complications and achieve and maintain optimal responses
and outcomes for all patients.

The emergency nurse will be professionally equipped to serve the community as a

specialist emergency practitioner in the pre-hospital inter-facility and hospital
environment. Such emergency nurse will be able to function independently with basic,
intermediate and advanced clinical competencies, which are recognised both
nationally and internationally in the emergency environment.

In the Emergency Department (ED) they will perform as independent, interdependent

and dependant clinical practitioners, leaders, consultants and specialist practitioners
in providing evidence-based care to patients and their families/significant others as
set out by the relevant legislative frameworks.

The emergency nurse will be able to:

 Function competently and professionally in the emergency environment.

 Have a range of skills, knowledge and attitudes to enable them to make a
meaningful contribution to the provision of emergency health services.
 Display a sense of equity, justice and ethics to ensure accountability.
 Actively resuscitate patients facing life threatening situations within any
emergency setting
 Provide primary, secondary and tertiary care to patients during, but not limited
to, the acute phase of illness or injury, ranging from prevention to rehabilitation
and end of life care; a trauma system supportive approach.
 Work as a specialist practitioner with other team members within the health care
system in the prevention of morbidity and mortality; before, during and after
emergencies.

2. UNIQUENESS OF EMERGENCY NURSING

Emergency nursing encompasses a field of nursing where the focus is on the care of
patients of all ages who are experiencing either perceived or actual minor to life-
threatening emergencies, which are managed in collaboration with members of the
healthcare team. Emergency nursing takes place along a continuum, which starts from
the scene of the accident or initial illness (pre-hospital setting), transfers to an
appropriate care facility (inter-facility setting) and the emergency department (hospital
environment), where the emergency nurse functions within a complex technological
environment and displays a high level of knowledge, skill and competence in caring for
the patient and family/ significant other until discharged home, to an appropriate ward
or rehabilitation centre.

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2.1 The emergency setting
The emergency setting includes basic level, intermediate level and advanced
capabilities, based on various accreditation frameworks. The basic level facility
offers emergency first response and stabilisation (primary health care clinic). The
intermediate facility (regional) offers sufficient resources to initially stabilize and
commence management. The advanced facility (tertiary/academic) offers
definitive care and comprehensive emergency services (Calvello, Tenner, Broccoli
et al, 2015). Care within the emergency setting spans the full spectrum of
prevention and curative care and may include rehabilitative care within a healthy
work environment.

The emergency nurse is also an integral component of the first line of emergency
defence in a major incident or a disaster. Providing health care in these situations
presents many unusual challenges, such as an unstable environment, managing
with limited human and material resources, and safety risks, while caring for
patients during their most vulnerable time.

A lack of sufficient resources will require optimum prioritisation, creativity and

improvisation in order to manage patients properly (Powers and Daily, 2010).

Emergency nurses furthermore play a vital role in the provision of military health
care services. The military emergency nurse executes this unique role in unsafe,
unstable situations, often in a hostile environment, where the emphasis is placed
on ethical conduct towards own and enemy forces in need of care. In this role it
is expected of the military nurse to simultaneously function as a soldier and a
health care provider.

The occupational emergency nurse executes this unique role in unsafe, unstable
situations, and often unhygienic environments (dust, mud and rock falls), where
an emphasis is placed on legal compliance with Health and Safety standards as
governed by the Compensation for Occupational Injuries and Diseases Act (COIDA)
and the Mine Health and Safety Act. In this role it is expected of the occupational
emergency nurse to function as both an employee and a health care provider.

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2.2 The Emergency Nurse is able to carry out the following core skills:

 Address injury prevention initiatives on primary, secondary and tertiary

levels, in order to identify and provide education to the community through
programmes to promote wellness and prevent injuries, such as alcohol
awareness, child passenger safety, gun safety, bicycle and helmet safety,
and domestic violence prevention etc.
 Critically reflect on practise and analyse epidemiology evidence (studies re
burden of disease and injuries) to determine and implement injury
prevention strategies on a primary (before the injury happens), secondary
(assuring appropriate, timeous level of care) and tertiary (community-based
education in preparation of return of the patient to the community) level.
 Triage and respond to the rapidly changing physiological and psychological
status of complex emergency care patients based on haemodynamic
parameters, with a focus on mechanism of injury or history of the illness and
the presenting signs and symptoms.
 Analyse the mechanisms of injury and/or pre-hospital history and/or the
patient’s clinical presentation to formulate patient-centred interventions
and health and safety precautionary measures.
 Be prepared to take care of any foreseeable emergencies, while focusing on
the time and criticality aspects of the patient.
 Have a broad clinical knowledge, demonstrate sound clinical judgement and
initiate appropriate management, urgent to non-urgent, in time-critical and
often overcrowded, chaotic environments.
 Have a flexible and adaptable approach, to appropriately manage the
dynamic and often uncontrolled environment and patient situations found
in the Emergency settings.
 Collaborate with the multi-disciplinary team to assess, diagnose, prioritise,
stabilise and transfer or discharge a patient population that encompasses
the whole human life span, with perceived or actual minor to severe
physical and/or emotional alterations of health that are undiagnosed or
require further interventions.
 Initiate appropriately and sensitive contact and conversations (sometimes
difficult) with patients and family/ significant others, employers and
colleagues about the progression of care during their healthcare journey.

2.3 Different settings for provision of care

Emergency nursing consists of care delivered in the pre-hospital, inter-facility and
hospital environment, which is often challenging and usually time-sensitive. This
environment includes, but is not limited to the following settings:

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  Pre-hospital, which includes major and minor incidents or disasters; and
military, mining and hostile environments;
 Industrial and occupational environments;
 Inter-facility, which includes road, water and air evacuation interventions,
and maintaining care during inter-facility transfers (which may include the
initiating of care in a mobile environment, e.g. the emergency nurse working
on a ship or an aeroplane) or in open/dangerous areas such as the mines etc.
 Hospital, including emergency department/unit) and associated definitive
care facilities.

3. OVERLAP OF COMPETENCIES
While each of the study areas below may yield a stand-alone qualification, there is
shared knowledge and skills (commonalities) among these, creating an overlap of some
competencies. This will probably have educational implications, where some modules
may have to be shared by the different specialities. It is possible that some of the
named disciplines may not become full qualifications, depending on educational
requirements and the percentage of core content.

Emergency Nursing competencies overlap with one another and should include
components of:

 Intensive Care/Critical Care Nursing

 Orthopaedic Nursing and Neurological Nursing
 Medical and Surgical Nursing Care
 Paediatric and Neonatal Emergency Nursing Care
 Maternal/Obstetrical Emergency Nursing
 Forensic Nursing
 Operating Theatre Nursing
 Community Health Nursing

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4. SUMMARY OF CORE COMPETENCIES

DOMAIN 1: PROFESSIONAL, ETHICAL AND LEGAL PRACTICE

SUBDOMAIN/CORE
SPECIFIC COMPETENCY
COMPETENCY

1.1. Professional 1.1.1 Accept accountability for increased responsibility,

Practice including own professional judgment, actions, outcomes of
care, ethical practice and continued competence in
accordance with legislation and policy frameworks (both
national and international).

1.1.2 Engage in continuous professional development, utilising

formal and informal platforms, by reflecting and
recognising own level of competence and limitations, seek
development opportunities and record development
activities to provide evidence of life-long learning.

1.1.3 Commit to the development of peers, students and other

categories of healthcare providers by creating a healthy
practice environment that promotes and fosters
professional growth and resilience.

1.1.4 Foster professional autonomy and accountability within

the independent, dependant and interdependent roles of
the Emergency Nurse within themselves and others.

1.1.5 Actively participate in activities and affairs of professional

associations and regulatory bodies to advocate for
professional matters and emergency care (specifically
emergency nursing) in the development of legislation and
policies, including the improvement of emergency care
practices.

1.1.6 Collaborate with the multi-disciplinary team to ensure a

team-based approach in the care of emergency patients,
and collective learning and implementation of evidence-
based practice.

1.1.7 Promote access to emergency care as a right to all South

Africans as stipulated by the Constitution of South Africa.

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1.2. Research 1.2.1 Contribute towards improving knowledge by conducting or
activities for synthesising research and other evidence that reveals,
Professional examines and evaluates current emergency nursing
Practice practice, knowledge, theories, criteria and creative
approaches to ultimately improve emergency care and
professional development.
1.2.2 Engage in research activities to inform evidence-based
practice, to improve and promote optimal patient
outcomes.
1.2.3 Disseminate research findings through activities, such as
presentations, publications, consultations and journal
clubs to a variety of audiences that include but are not
limited to healthcare providers in the emergency care
setting.
1.2.4 Critically analyse and discuss the findings of research within
the healthcare team in the field of emergency care, and
negotiate for the implementation of relevant and
appropriate applicable research findings in the emergency
setting.
1.2.5 Provide and translate evidence-based recommendations
for patients with complex, acute, critical illness/injury or
atypical presentations.
1.2.6 Analyse the effects of community systems, resources such
as Emergency Medical Service (EMS) pre-hospital
protocols, and identify opportunities for improvement to
promote optimal emergency care.

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1.3. Legal Practice 1.3.1 Practice in accordance with professional and other
relevant international and national legislation applicable
to specialist nursing practice and the special patient
population (emergency patients).

1.3.2 Recognise and act upon laws relating to the professional

role and/or professional Code of Conduct.

1.3.3 Practice in accordance with current emergency care

policies and evidence-based procedural guidelines and
protocols.

1.3.4 Interpret and evaluate current regulations to develop or

implement clinical practice guidelines and policies for
situations of violence, neglect and abuse.

1.3.5 Identify, mitigate and manage potential and actual

medico-legal risks in the emergency setting, and the
reporting thereof to the relevant authorities.

1.4. Ethical Practice 1.4.1 Deliver emergency care in a manner that preserves and
protects the autonomy, dignity, rights, values, beliefs and
preferences of health care workers, patients and their
family/significant others in the midst of challenging,
unpredictable emergency settings.

1.4.2 Participate in ethical and legal debates concerning

complex decisions and orders in the emergency setting,
for example: end of life decisions (do not attempt
resuscitation or do not escalate care/palliative care) and
care of the vulnerable populations. This includes research
activities.

1.4.3 Acknowledge the significance and contribution of the

emergency patient and family/significant others in ethical
decision making in conjunction with the multidisciplinary
team, and assisting them to make informed decisions.

1.4.4 Maintain and advocate for patient autonomy and

confidentiality within the legal and ethical framework of
emergency care, and the patient’s access to emergency
care.

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 1.4.5 Intervene according to legislative guidance in cases of
illegal, unethical or inappropriate behaviour that exposes
the emergency patient to risk and jeopardizes the best
interests of the patient, e.g. report suspected criminal
activity and adverse events to relevant structures,
including the regulatory body.

1.4.6 Recognise, address and respond appropriately to safety and

quality improvement concerns in emergency care practices.

1.4.7 Participate in and advocate for the patient,

family/significant others and the profession in all aspects of
decision making, especially in ethical dilemmas and time-
constrained situations. Serve as a mentor and role model by
participating in the resolution of ethical and clinical
dilemmas.

1.4.8 Advocate for staff in addressing risks and safety concerns in

the emergency setting (violence towards staff, patients,
family/significant others), promoting advancement and
positive practice environments whilst recognising
limitations, legal responsibilities and scope of practice.

1.4.9 Display sensitivity to cultural, professional and

technological diversity within the multi-disciplinary team
and emergency care continuum.

1.5. Coaching 1.5.1. Serve as a mentor, role model and expert resource for pre-
hospital personnel, inter-professional/ inter-disciplinary
colleagues and students, as well as nurses and EMS staff.

1.5.2. Develop, implement and evaluate educational programmes

related to emergency care (e.g. triage, trauma, psychiatric
emergencies, disaster management etc.).

1.5.3. Facilitate the recognition, prevention, referral and

treatment of stress responses among emergency care
providers as it relates to critical incidents, compassion
fatigue, vicarious trauma, acute stress disorder or post-
traumatic disorder.

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1.6. Major Incident 1.6.1 Recognise the fundamental approaches to major incident
and Disaster and disaster nursing, including nursing in a combat
Practice situation.

1.6.2 Display competencies related to preparedness,

organisation and implementation of appropriate responses
within an ethically challenging environment, whilst applying
health policy and organisational and personnel planning for
emergencies.

DOMAIN 2: CLINICAL PRACTICE – CARE PROVISION AND MANAGEMENT

SUBDOMAIN/CORE
SPECIFIC COMPETENCY
COMPETENCY

2.1. Prevention 2.1.1 Critically reflect on practise and analyse epidemiology

through health studies (burden of disease and injuries) to determine and
promotion implement injury prevention strategies on a primary
(before the injury happens), secondary (assuring
appropriate, timeous level of care) and tertiary
(community-based education in preparation of return of
the patient to the community) level.

2.1.2 Create awareness through collaboration and engagement

with the community (professional and non-professional) in
an attempt to avert or reduce episodes of critical illness and
the burden of injury (health promotion and injury
prevention).

2.2.3 Develop and communicate critical discharge advice and

information, including health promotion and injury
prevention information, to the emergency patient and/or
family/significant others in order to assist them to plan and
manage their own care effectively.

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2.2. Essential 2.2.1 Engage in a continuous cycle of assessment (primary and
Clinical skills, secondary survey), planning and implementation of
including interventions, and evaluation and re-evaluation of the
competencies effectiveness thereof.
across the
spectrum for 2.2.2 Collaboratively and continuously analyse, record and
the primary, report interventions, patient response and progress, as
resuscitative directed by care-appropriate management tools.
and secondary
phases of 2.2.3 Considers the unique age-specific aspects of assessment,
Emergency planning, implementation and evaluation techniques
Care during all phases of emergency care for the following
vulnerable patient population: bariatric, physically and
mentally challenged, cognitive impaired, forensic, geriatric,
new-born, paediatric, pregnant, psychiatric.

2.2.4 Promote optimal family-centred care in the emergency

nursing

practice involving, but not limited to the following:

 Collaboration with the patient, family/significant

others and multi-disciplinary team members to
establish a holistic and individualised plan of
emergency care;
 Provide assurance and appropriate information to
family/significant others, including the employer;
 Encourage the family, employer/colleagues to remain
involved with the care of the patient;
 Provide regular, honest, relevant and realistic
information;
 Collaborate with other services to provide on-going
support;
 Use of language consistent with the level of
understanding.

2.2.5 Consider psychosocial aspects in the care of the emergency

patient/family as well as the professional emergency staff.

2.2.6 Operate various relevant/ appropriate types of technology

used in the emergency and health care setting safely and
appropriately.

2.2.7 Apply timeous critical thinking and clinical judgment and

decision making underpinned by scientific, biomedical and
technological knowledge in the emergency setting to
prioritise and deduce comprehensive, individual care for

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 the emergency patient, in collaboration with the relevant
multidisciplinary team.

2.2.8 Monitor the haemodynamic, biomedical and clinical effects

of the disease/injury processes and multiple
pharmacological agents used in the emergency setting,
such as but not limited to analgesics, anti-microbial
therapy, cardio-vascular and respiratory agents, as well as
antidotes.

2.2.9 Manage and optimise the emergency nursing context

(physical, psychological and physiological) in a professional
manner to the benefit of emergency patients,
families/significant others and other health care workers,
for example:

 Implement aseptic techniques: infection

prevention/control;
 Implement appropriate bundles of care, e.g. to
decrease healthcare associated infections;
 Ensure equipment in the emergency setting is checked,
maintained and readily available for use;
 Provide a safe space for the mentally ill and victims of
abuse.

2.2.10 Monitor, critically evaluate and re-evaluate interventions

and progress of the patient condition regularly, as
determined by the signs of patient improvement and/or
deterioration, care management tools, and in
collaboration with the multidisciplinary team.

2.2.11 Specific minimal clinical skills:

- Open and maintain an airway, using basic and advanced

skills.
- Management of oxygenation and ventilation, including
but not limited to using a bag-valve-mask device, peep
valve and mechanical ventilation. Interpretation of
Venous Blood Gas and Arterial Blood Gas and making the
necessary changes to ventilator settings.
- Able to obtain peripheral and intra-osseous vascular
access.
- Fluid resuscitation (manage massive fluid resuscitation or
massive blood transfusion).
- 12-lead ECG interpretation.
- Basic life support (BLS).
- Use of a manual defibrillator.

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2.3. Clinical 2.3.1 Assess for environmental hazards and take immediate
competencies action to protect the patient, bystanders, colleagues and
for Primary the members of the multidisciplinary team to ensure the
Care provision safety of the emergency care environment. This includes
accessing the appropriate resources or disciplines to
provide safety.

2.3.2 Apply biomedical and social sciences knowledge such as

anatomy, physiology, pathophysiology, clinical
pharmacology, educational, psycho-socio-cultural, ethical,
legal and economical contexts of disease to assess an
emergency patient (e.g. primary, secondary and continuous
survey).

2.3.3 Triage and prioritise patient care based on haemodynamic

parameters, with a focus on mechanism of injury, history of
the illness and/or presenting clinical signs and symptoms.

2.3.4 Promptly assess and intervene when life-threatening

conditions are present.

2.3.5 Implement interventions to monitor and maintain airway

patency while protecting the patient’s cervical spine, using
the appropriate evidence-based practice guidelines.

2.3.6 Implement interventions to monitor and maintain

ventilation and oxygenation that include basic,
intermediate, advanced and difficult airway interventions,
using the appropriate evidence-based practice guidelines.

2.3.7 Implement interventions to monitor and maintain

circulation, using the appropriate evidence-based practice
guidelines.

2.3.8 Implement appropriate immobilization accordingly.

Implement interventions to assess and evaluate the
neurological status of the patient, utilizing the correct
equipment and techniques and using appropriate scoring
systems (disability).

2.3.9. Implement interventions to monitor and maintain the

metabolic status of the patient.

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2.4. Clinical 2.4.1 Implement the resuscitative actions, guided by best
competencies practice guidelines in accordance with the findings from the
for history and primary survey.
resuscitation/
management 2.4.2 Implement the prioritised interventions based on the
assessment and findings, including the use of appropriate
technological devices e.g. automated external defibrillator
(AED), defibrillator (internal/external) and external pacing.

2.4.3 Utilise evidence-based formulae to accurately calculate

drug dosages, fluid volumes, blood and blood products; and
administer drugs, fluids, blood and blood products for the
emergency patient population, while observing for
responses and reactions to the proposed treatment.

2.4.4 Implement individualised, comprehensive, evidence-based

care, based on the findings of the scientific, biomedical and
technological assessment of the emergency patient within
the relevant contextual variables/factors and
multidisciplinary collaboration.

2.4.5 Prepare for, assist with and perform procedures on the

emergency patient, including execution of insightful post
procedure observations, e.g. thoracotomy, ultrasound,
lumbar puncture, peri-cardiocentesis, needle
thoracentesis, CVP, intra-costal drains and intra-osseous
access.

2.4.6 Communicate effectively and timeously within the

multidisciplinary team in relation to consultation and
referral of complex problems or deterioration in the
patient’s status.

2.4.7.Practice effectively as a leader and member of the

emergency team.

2.5. Clinical 2.5.1 Systematically assess the emergency patient from head-to-
competencies toe (secondary survey) to identify actual and potential
for provision of injuries or underlying conditions.
Secondary Care
2.5.2 Continuously and timeously re-evaluate the intervention
plan, and prioritise care.

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 2.5.3 Interpret the relevant data of the emergency patient from
the various data sources, to direct further care.

2.5.4 Ensure the comfort of the patient through appropriate

basic strategies such as: decreasing spine board times, pain
management, positioning and splinting of fractures.

2.5.5 In collaboration with the multi-disciplinary team, validate

the emergency patient’s response to interventions, in
keeping with a patient-centred approach and being aware
of the time-sensitive environment.

2.6. Clinical 2.6.1 Actively participate in decision making on transfer of

competencies patients to appropriate care facilities.
for transfer
and receiving 2.6.2 Ensure continuity of care through an accurate, systematic
of patients and comprehensive handover to the healthcare providers
from EMS and of the next level of care, e.g. ward, intensive care unit (ICU),
other operating room (OR) or transferring facility.
healthcare
providers 2.6.3 Be cognisant of available resources, and initiate referrals to
ensure timely and relevant referral, to promote optimal
patient outcomes.

2.6.4 Prepare, package and monitor while accompanying the

emergency patient to ensure safe intra-hospital and inter-
facility transportation.

2.7. Therapeutic 2.7.1 Use advanced communication and interpersonal skills to

communication initiate, develop and discuss therapeutic relationships with
and emergency patients, their families or significant others.
relationships
2.7.2 Practice active listening skills in an unbiased manner,
respect points of view of others, and promote the
expression of diverse opinions and perspectives.

2.7.3 Establish and apply open channels of communication

(written, non-verbal and verbal) within the emergency
setting.

2.7.4 Be role models for and encourage patient-centred

communication, including patients with compromised

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 communication ability, in the challenging emergency
environment.

2.7.5 Advocate for the patient in relation to all interventions and

orders, especially in relation to clinical trials, “do not
resuscitate” orders and termination of life support.

2.7.6. Communicate with the family of the emergency patient to

orientate them about the emergency care interventions,
technology and the patient status (especially when there is
a change in the patient’s status) e.g. in cases of family
presence during resuscitation, and to foster smooth
transition of the patient across the emergency setting.

2.7.7 Establish rapport with the emergency patient and families/

significant others through active listening, giving honest
and appropriate answers, displaying a non-judgmental
attitude etc.

2.8. Clinical practice 2.8.1 Systematic assessment and provision of major incident,
and disaster and combat nursing by assessing needs and
management planning, providing and managing care in a resource limited
in a major environment while maintaining core competencies.
incident,
combat or 2.8.2 Care for vulnerable people and their families/significant
disaster others in a hostile, often unsafe or unstable environment,
situation using appropriate competencies. Treat people with special
needs and maintain ethical judgement towards wounded
enemy soldiers, hostile population groups or victims of
hostile actions.

2.8.3 Provide care management in emergency and disaster

situations, using competencies for maintaining the care
environment and team system with insufficient resources,
which requires improvisation and initiative.

2.8.4 Support the maintenance of the care environment through

competencies in maintaining environmental health, mine
health, ensuring safe water, optimal sanitation and
maintaining hygiene in a major incident, disaster or combat
scenario. These competencies may necessitate
improvisation in respect of communications/ information
sharing, cold chain management, supply of equipment and
sterility.

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 2.8.5 Display professional development competencies,
including:

- Monitoring, mentoring and evaluation, with a focus on

competency in leadership;
- Co-ordination and team work in a hostile environment
setting, while maintaining accountability as well as
legal/ethical aspects.
DOMAIN 3: QUALITY OF PRACTICE

SUBDOMAIN/CORE
SPECIFIC COMPETENCY
COMPETENCY

3.1. Quality 3.1.1 Always adopt safe practice. Regularly analyse the
Improvement emergency care system and its philosophy to align
emergency nursing accordingly, e.g. aligning with the
Primary Health Care approach, the implications of
National Core Standards for Emergency Nursing Practice,
other national health care programmes such as the
Strategy for Nursing Education, Training and Practice,
infection control programmes, Mine Health and Safety
standards, disaster programmes and adhering to best
practice guidelines (national and international).

3.1.2 Collaboratively develop, monitor and analyse indicators,

checklists and outcomes to monitor for risks, unintended
outcomes, and the implementation of quality initiatives
and effectiveness of emergency nursing practice, based
on contextual variables such as infection rates, length of
stay, morbidity, mortality and adverse events.

3.1.3 Recognise workplace violence and implement risk

mitigation strategies for the recognition and management
of disruptive and violent behaviour in the emergency
setting.

3.1.4 Design innovations to effect change in emergency nursing

practice and improve patient outcomes through the
integration of evidence-based knowledge and skills.

3.1.5 Evaluate the practice environment and quality of

emergency nursing rendered in relation to existing
evidence, feedback from health care users and pre-set
indicators, and implement appropriate strategies.

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 3.1.6 Use the results of quality improvement activities to initiate
changes in emergency nursing practice and in the health
care delivery systems.

3.2. Continuing 3.2.1 Create and utilize learning opportunities for orientation
Education and teaching of staff, patients and families of emergency
patients in the highly unfamiliar and stressful emergency
care environment.

3.2.2 Continuously reflect on the self and staff competence and

keep themselves and staff up to date with current health
issues and health care trends in this dynamic environment.

3.2.3 Consciously seek new experiences and formal and

independent learning activities to maintain and regularly
develop clinical and professional skills and knowledge, and
enhance personal growth.

3.2.4 Apply principles of teaching, learning and evaluation to

designing educational programmes that enhance the
knowledge and practice of staff.

3.2.6 Participate in the formal and informal education of

students and new staff members.

3.2.7 Act as a consultant or resource person for emergency care

in the
health care facility, e.g. as follows:
• Responding to and participating in calls for
resuscitation in other units;
• Responding to and participating in calls for major
incident management in the healthcare environment.
3.2.8 Maintain professional records that provide up to date
evidence of competency and lifelong learning.

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 DOMAIN 4: MANAGEMENT AND LEADERSHIP

SUBDOMAIN/CORE
SPECIFIC COMPETENCY
COMPETENCY

4.1. Management 4.1.1 Be a role model by demonstrating/displaying clinical

and Leadership competency, critical thinking, ethical practice and caring.
Ensure the appropriate utilisation and delegation of
available team members in the emergency environment,
taking into consideration the qualified staff and skills mix,
in order to provide safe patient care. Able to direct and
supervise, which include but are not limited to the
supervision and education (mentorship) of colleagues
and other healthcare practitioners in the emergency
department.

4.1.2 Share, foster and translate the vision and mission of the
organization into the practice of nursing in the emergency
care setting.
4.1.3 Coordinate the care of emergency patients across the
patient healthcare journey, to achieve optimal patient
outcomes within this time-sensitive environment.

4.1.4 Oversee the care given by others, while ensuring

accountability for the quality of care given to the
emergency patients and their families.
4.1.5 Mentor colleagues for the continued advancement of
emergency nursing practice, the nursing profession and
quality of care.

4.1.6 Develop and implement a succession plan to ensure

continuity of care (and emergency nursing leadership) in
the emergency nursing practice.

4.1.7 Participate in key roles on committees, councils and

administrative teams in the interest of empowering own
nursing practice, that of colleagues and the profession.

4.1.8 Influence decision-making bodies to improve the

emergency nursing practice environment and patient
outcomes.

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 4.1.9 Participate in efforts to influence health care policy on
behalf of heath care users and the profession.

4.1.10 Participate in designing systems that support effective

teamwork and positive outcomes in the emergency
nursing environment.

4.1.11 Introduce, evaluate and manage innovation and change in

the emergency nursing setting through encouraging
creativity, problem solving and critical thinking skills in
staff.

5. HIGHLIGHTING THE DIFFERENCES BETWEEN CRITICAL CARE NURSES, PRE-HOSPITAL

PERSONNEL AND EMERGENCY NURSES

PRE-HOSPITAL PERSONNEL EMERGENCY NURSING

Take charge of the scene, extrication Do not take responsibility for scene
management

Greater focus on ‘mechanism of injury’ Limited focus on ‘mechanism of injury’

Follow the biomedical model Look at the patient holistically

Some understanding of a hospital Advanced understanding of the hospital setting

setting

Focus on primary survey and primary Do primary and secondary surveys etc. – provide
interventions – very seldom do a far more comprehensive service, from injury to
secondary surveys and rather focus on rehabilitation
primary life saving

Focus on initial primary life-saving skills Resuscitation phases are more advanced,
(limited) involve a great deal more diagnostics and drugs

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Limited focus on psychosocial aspects – Psychosocial skills play a large part
utilisation of ‘softer skills’ more
prominent

Forensics – can highlight, identify high Forensics – need to identify, manage and pursue
index of suspicion, but do not pursue across all aspects
any further

Transfer to appropriate care, with Assist with advanced stabilization and transfer
minimal stabilization prior to transfer to appropriate definitive care from Level II to
Level I

Limited involvement in injury Injury prevention an important aspect – fully

prevention involved in community prevention initiatives
and programmes

CRITICAL CARE NURSING EMERGENCY NURSING

Work in the ICU Work in different environments i.e. pre-hospital,

Emergency Department etc.

Nurse patient during critically ill phase Manage patient from time of accident/injury
only until rehabilitation: whole patient journey

Closed unit Unpredictable, uncontrolled environment, often

hostile

Critically ill patients Large proportion of non-urgent patients in

addition to critically ill patients

Stable patient levels Fluctuating patient volumes and acuity levels

Transferred to the ICU from other areas Receiving patients directly from the scene
within the hospital

Less variation Alternating between patients of different ages,

diagnoses and urgent/non-urgent status in a
short space of time

‘Packaging’ patients from a controlled ‘Packaging’ patients for transfer in an

environment uncontrolled environment

Continuum of care is very broad but less Continuum of care is very broad – takes into
fluctuating over a short period of time account everything and everyone, fluctuating
over short period of time (advanced generalist)

Use advanced invasive technology for Basic haemodynamic monitoring – based on

haemodynamic monitoring clinical manifestations and history

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Patient usually ‘worked up’ and Work to establish diagnosis and then plan care
diagnosed

Advanced ventilation and weaning Initiate and manage ventilation; rarely involved
practices with weaning

ICP monitoring Clinical signs-raised ICP used only

Complex pharmacological usage, long Acute pharmacological management

term

Implement long term strategies to Initial prevention of infections during

prevent infections emergency nursing management

Minimal assessment of environment Assess for environmental hazards – HAZMAT

hazards

Advanced and long term wound care Initial wound care treatment

Dialysis No dialysis

Limited management of toxicology Initial management of toxicology – identification

and initial management

Involvement with family/significant First encounter with and often brief involvement
others is longer term with family/significant others who are often
highly stressed

Nursing outcome measures more Nursing outcome measures emphasis related to

related to patient outcomes, less time and appropriate interventions
related to time

Limited involvement in mass casualty Mass casualty incident management – manage

incidents from scene onwards, manage multiple patients

Often in charge of hospital disaster management

Some community prevention Large amount of community prevention –

primary, secondary and tertiary level

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6. SKILLS LIST FOR EMERGENCY NURSING

Assessment and recording

Yes No

 Effectively determine patient priority based on assessment

(triage)
 Direct patients to appropriate areas, teams, and services

 Use the structured A-E (primary) approach to undertake patient

assessment and management of life-threatening emergencies
 Use a structured approach to gather and document the clinical
history
 Use a structured (secondary) approach to undertake head-to-toe
patient assessment
 Safely and accurately record all clinical observations and
interventions
Safety within the hospital environment

 Ensure that patients are managed in a safe environment

 Safely assess, plan and implement moving of patient (e.g. MRI

scan, ICU)
 Follow guidelines/policies on the administration of medication

 Select appropriate equipment and safely administer medication

as prescribed
 Recognise and take appropriate action when a patient
experiences early signs of adverse medication reactions, allergic
reactions or anaphylaxis
 Ensure adequate information for patients about medication
prior to discharge
 Apply the isolation, waste, linen, and ‘sharp’ policies, and
standard precautions to promote best practices, and challenge
bad behaviour
 Apply and remove personal protective equipment (PPE)

 Apply guidelines to reduce healthcare related infections

 Demonstrate the use and removal of extrication devices

 Demonstrate the ability to identify and manage any medico-legal

and ethical issues encountered

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Airway and cervical spine management

Yes No

 Demonstrate effective and accurate airway positioning

 Demonstrate the removal of a foreign body removal: upper

airway
 Demonstrate the ability to manage the airway of a patient

 Demonstrate spinal immobilisation of patient with suspected

spinal injuries
Breathing and ventilation

Yes No

 Initiate appropriate oxygen therapy

 Deliver inhaled medication

 Prepare equipment and support patient undergoing chest

aspiration/ drain insertion for a pneumo- or haemothorax
 Demonstrate the principles of rapid sequence intubation

 Initiation of mechanical ventilation (non-invasive and invasive)

 Nursing care of a patient on a mechanical ventilator

 Monitoring and effectively address the oxygenation, ventilation

and metabolic status of a patient
 Demonstrate an emergency needle decompression of tension
pneumothorax
 Demonstrate the management of a chest drainage system

 Interpret a chest X-ray

 Demonstrate the ability to perform endotracheal suctioning

(open and closed)

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CIRCULATION WITH HAEMORRHAGE CONTROL
Yes No

 Monitor the haemodynamic status of a patient

 Recognise signs of shock and summon appropriate clinical

support
 Correctly analyse 12-lead ECG and troubleshoot where
recordings are of poor quality
 Demonstrate a systematic approach to ECG interpretations of
life-threatening and non-life-threatening arrhythmias
 Perform basic and advanced life support skills (including
defibrillation, cardioversion, administration of drugs, IV/IO
access)
 Instigate appropriate monitoring and investigations following
the return of spontaneous cardiac output
 Provide appropriate support during the process of imparting bad
news
 Care for the dying patient and family/significant others

 Demonstrate the management of acute wounds

 Demonstrate the administration of fluid and blood products

 Demonstrate the ability to initiate appropriate intravenous

access
 Demonstrate the ability to correctly calculate appropriate fluid
management
 Demonstrate effecting splinting of limbs

 Demonstrate effective splinting of pelvis

 Demonstrate the removal of a helmet

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Disability, differential diagnosis, defibrillation and drugs

Yes No

 Monitor a patient’s level of consciousness

 Monitor the blood glucose level

 Prescribe appropriate medication to facilitate:

- Sedation

- Analgesia

- Skeletal muscle relaxation

- Increased cardiac output with the use of positive

inotropes
- Thrombolysis in acute myocardial infarction

 Order appropriate investigations (e.g. venous blood gas, lactate)

Exposure and environmental control

Yes No

 Implement measures to reverse hypothermia

 Implement measures to reverse hyperthermia

Adjuncts

Yes No

 Perform an arterial stab and insert an arterial line if appropriate

 Perform a gastric lavage

 Demonstrate the removal of a ring

 Demonstrate eye irrigation

 Demonstrate the packaging for epistaxis

 Prepare for inter-facility ground or air transport

 Demonstrate the implementation of basic principles in the

preservation of forensic evidence

26
  Demonstrate an understanding of the disaster management plan
and be a part of the disaster management committee
Special circumstances

Yes No

 Supportive management for obstetric emergencies

 Assessment of foetal heart rate

 Emergency child birth

Communication and Leadership

Yes No

 Demonstrate effective communication with colleagues, both

internal and external, in the emergency care setting
 Demonstrate effective communication with patients of all ages
and their families/significant others, including regular updates
on care plans
 Demonstrate the ability to work effectively in a team

 Demonstrate the ability to lead a small team

 Demonstrate the ability to lead the departmental team on a shift

basis
 Demonstrate skill in managing, supervising and supporting
colleagues on a shift basis
 Demonstrate a teaching role in the unit

7. ACKNOWLEDGEMENT OF CONTRIBUTIONS

Wide consultation with the following national emergency care societies, via the members:

 Trauma Society of South Africa

 Emergency Nurses Society of South Africa
 Emergency Medicine Society of South Africa

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Individual consultation:

 Nicky Baltsoucos (Netcare Trauma Division)

 Mariesa Human (Netcare Trauma Division)
 Linda Pretorius (Netcare Trauma Division)
 Caroline Murray (Clinical Logistics Co-ordinator, Mediclinic)
 Bonnie Venter (ED UM Netcare Sunninghill)
 Queen Namane (Sibanye Gold Mining Group)
 Le-Andrie Bezuidenhout (Netcare Pholoso)
 Jasmin Gassiep (Gauteng Department of Health)
 Capt. Kathy Grant (South African Health Service – 2 Military Hospital)
 Neil Williams (Netcare)
 Capt C. Cloete (South African Health Service – 2 Military Hospital)
 Capt S. Kotze (South African Health Service – 2 Military Hospital)
 Nojoko N.T. L (Assistant-Director CMJAH)
 Isaacs C.C. (Trauma and Emergency lecturer, Rahima Moosa Nursing College)
 Madonsella D. (Trauma and Emergency lecturer, Rahima Moosa Nursing College).
 Miriam Matandela
 Gayle Heydenrych (Private Nurse Practitioner)
 Gerda Meyer (Academic Head, Netcare Education)
 Lindie Handley (A&E Unit Manager, Life Beacon Bay Hospital)
 Pataki T.W. (Limpopo College of Nursing)
 Motseo P.I. (Limpopo College of Nursing)
 Makoma Chauke (Trauma Practitioner)
 Linel van der Veen (Emergency Nurse Practitioner)
 Catherine Isaacs

CONTRIBUTORS TO DRAFT 1 DOCUMENT – INITIAL WORKGROUP

René Grobler : (President, Emergency Nurses Society of South Africa)

Petra Brysiewicz : (University of KwaZulu-Natal and Emergency Nurses Society of South

Africa)

Mande Toubkin : (Netcare Hospital Group: Trauma Division)

Penny Cartwright : (Netcare Hospital Group: Education)

Amanda Klette : (Secretary, Trauma Society of South Africa)

Celia Filmalter : (University of Pretoria)

Theo Ligthelm : (Ex-Military and Disaster Nursing)

Tanya Heyns : (University of Pretoria)

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