Investigating Emergency Department Nurses' Educational Needs and Exploring Strategies to Meet Challenges Against Management of These Needs: A Qualitative Study

Background: Nurses who are occupied in emergency departments play a critical role in health services provision and patient care. Considering the importance of providing appropriate and immediate care in emergency departments, nurses need to acquire sufficient skills and up-to-date knowledge. Objective(s): This study aimed to identify the educational needs of nurses working in the emergency department and explore strategies to meet challenges against the elimination of these needs. Method(s): This qualitative study was conducted using a content analysis approach. This study selected the emergency departments of two large educational hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, southern Iran. This study was conducted on 15 emergency department nurses selected via purposive sampling with maximum variation within January 2020 and March 2021.The data were collected by performing 15 in-depth, semi-structured interviews (11 face-to-face and 4 telephone interviews due to the coronavirus disease 2019 pandemic) and making field notes. Then, the recorded interviews were transcribed verbatim and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. The consolidated criteria for reporting qualitative studies (COREQ) was used to report the findings of this study. Result(s): Three main themes, namely the need for comprehensive and continuous education, challenges of managing educational needs, and strategies to meet educational needs, were extracted following data analysis. Conclusion(s): Clarifying the educational needs of nurses and exploring strategies to solve these challenges can be effective by providing continuous practical training and adopting effective teaching-learning strategies to promote nurses' education and improve their performance in clinical skills. Accordingly, the provision of appropriate infrastructure for mobile health applications and utilization of mobile-based educational applications in emergency departments have to be taken into account by hospital managers and health policymakers.Copyright © 2023, Author(s).

Nurses with workplace violence in pneumology settings during Covid-19

Background: Workplace violence (WPV) has consequences both for healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV. Aims and Objectives: Describe the Italian WPV and identify its predictive factors. Method(s): This is a secondary analysis conducted in hospital pneumology settings from a larger study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI;Likert scale 1 to 4) and the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Result(s): The analysis was conducted on 484 pulmonary nurses (72.9% female;mean age 38.9 years, SD 9.8). Thirty-four per cent (n=164) of them have had an experience of WPV in last year and/or their last week and 16.7% (n=81) only in their last week. Comparing main results between nurses with WPV vs no WPV the number of patients was higher for nurses with WPV (MD +4.8;p<.001). The PES-NWI results were significantly worse for nurses with WPV: global mean scores (MD +0.2;p<.001);nurse participation in hospital affairs (MD +0.3;p<.001);nurse manager ability leadership, and support of nurses (MD +0.2;p<.001);physician-nurse relationship (MD +0.2;p<.001). Conclusion(s): Public health companies should reduce WPV by investing in resources for the management and prevention of the phenomenon. Integrated and multimodal programs of prevention and management of WPV are useful to combat it. Improving the work environment and job satisfaction should reduce WPV.

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study.

AIM: To evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students' generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants' satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module. BACKGROUND: Following the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated. DESIGN: A mixed methods study incorporating quasi-experimental and qualitative components. METHODS: We recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants' post-intervention satisfaction, experiences and opinions. RESULTS: Post-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings. CONCLUSIONS: This study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students' learning outcomes. Further studies should include a control group, evaluate students' knowledge and skills, and retention of knowledge to confirm the true impact of such training.

Factors influencing emergency nurses' infection control practices related to coronavirus disease 2019 in Korea.

BACKGROUND: When an infectious disease breaks out, emergency nurses are the front-line specialists. Infection control by emergency nurses is important to minimize the risk of infectious disease and to improve the infection control practices of emergency nurses. Therefore, it is crucial to identify the factors influencing infection control practice related to COVID-19. METHODS: For this cross-sectional study design used survey methods for data collection, a questionnaire survey was conducted with 161 emergency nurses working in five hospitals selected through convenience sampling. Data were collected from November 10 to November 26 in 2020. RESULTS: Infection control practice related to COVID-19 was affected by the infection prevention environment (ß = 0.24, p = .002), monitoring of wearing Personal Protective Equipment (ß = 0.19, p = .006), knowledge about COVID-19 (ß = 0.18, p = .009), perceived severity related to COVID-19 (ß = 0.18, p = .010), and perceived barrier related to COVID-19 (ß = -0.15, p = .033). CONCLUSION: Creating safe infection prevention measures and revitalizing personal protective equipment monitoring are necessary to improve infection control practices. A systematic infection control education program is needed to improve knowledge about COVID-19, emphasize its perceived severity, and identify and eliminate perceived barriers.

Implementing a Resilience Bundle for Emergency Nurses: An Evidence-Based Practice Project.

INTRODUCTION: Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy. METHODS: Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation). RESULTS: A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys. DISCUSSION: Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.

Fallen angels and forgotten heroes: A descriptive qualitative study exploring the impact of the angel and hero narrative on critical care nurses.

BACKGROUND: During the COVID-19 pandemic, the use of the labels 'heroes' and 'angels' to describe nurses (and especially critical care nurses) became prevalent. While often well intentioned, the use of these labels may not be the most positive image of nurses and the nursing profession. Critical care nurses have not previously been given the opportunity to provide their perceptions of the angel/hero narrative and the impact this may have on their practice and working environments. OBJECTIVES: The objectives of this study were to explore the perspectives of critical care nurses and discover their perceptions about the angel/hero narrative and its impact on their clinical practice, safe working environments, and professional development during the COVID-19 pandemic. METHODS: A semistructured qualitative virtual interview study was conducted with critical care nurses from the United Kingdom, Australia, and North America. Digital audio data were transcribed verbatim. Thematic analysis of the transcribed data was performed. The COREQ guidelines were used to report the study. FINDINGS: Twenty-three critical care nurses located in the United Kingdom, Australia, and North America participated. Four themes were synthesised: history repeating, gender stereotypes, political pawns, and forgotten heroes. CONCLUSIONS: Critical care nurses did not perceive the hero and angel labels positively. Participants were concerned about unrealistic expectations, potential safety workplace risks, and poor remuneration related to these narratives. Participants perceived that context and intention were important in the interpretation of these narratives; they spoke with pride about their work and called for improved representations of their role, recognition, and work conditions.

Swedish emergency nurses' experiences of the preconditions for the safe collection of blood culture in the emergency department during the COVID-19 pandemic.

AIM: To describe how Swedish emergency nurses experience the preconditions of providing safe care during the COVID-19 pandemic when collecting blood culture in the emergency department. DESIGN: A qualitative exploratory design using content analysis with a manifest approach. METHOD: Semi-structured interviews were conducted with 13 emergency nurses working in the emergency department. RESULTS: The analysis resulted in one main category: unprecedented preconditions create extraordinary stress and jeopardize safe care when collecting blood culture. This main category includes four additional categories: organizational changes, challenges in the isolation room, heavy workload creates great stress, and continuous learning. CONCLUSION: The COVID-19 outbreak has made the emergency department a workplace where constant changes of routines combined with new information and reorganization risk jeopardize safe care during blood culture sampling. Accordingly, high workload and stress have been identified as a reason for emergency nurses not following guidelines. It is therefore necessary to optimize the preconditions during blood culture sampling and identify situations where there are shortcomings.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives.

BACKGROUND: Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. AIMS: To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. RESEARCH DESIGN: A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. ETHICAL CONSIDERATIONS: The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. FINDINGS: The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. CONCLUSIONS: Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

The Feasibility of a Pediatric Distance Learning Curriculum for Emergency Nurses During the COVID-19 Pandemic: An Improving Pediatric Acute Care Through Simulation Collaboration

Introduction: To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative. Methods: Kern's 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists. Results: Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P =.018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P =.016). Feedback included a shortened intervention and including physician participants. Discussion: A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses’ knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope. © 2022 Emergency Nurses Association

Emergency Nurse Consensus on Most Effective and Accessible Support Strategies During COVID-19: A Delphi Study.

INTRODUCTION: Emergency nurses face significant risk for stress-related complications while working during the COVID-19 pandemic. However, there is limited empirical evidence on the effectiveness and accessibility of support strategies for nurses in this novel situation. Expert consensus may help fill this knowledge gap. Therefore, the study objective was to gain expert consensus from emergency nurses on the most effective and accessible strategies during the COVID-19 pandemic. METHODS: This 2-round Delphi study recruited an online expert panel from emergency nurses practicing during the COVID-19 pandemic within a single Mountain West health system spanning 9 urban and rural emergency departments. Over 10 weeks in the summer of 2021, participants completed 2 sequential surveys to rate and rank employee-led and employer-led support strategies collated from a literature review. RESULTS: Of 327 recruitment emails sent, 28 nurses joined the expert panel. Emergency nurses reached a consensus on preference for employee-led self-care activities, including enhancing social well-being and strengthening emotional well-being. None of the employer-led strategies reached group consensus regarding high effectiveness, accessibility, and the likelihood of participation. Additionally, emergency nurses favored in-person support strategies over other delivery methods. DISCUSSION: Numerous studies have explored the impact of the COVID-19 pandemic on health care workers. Although experts and researchers seek to determine the best support strategies, this study highlights how emergency nurses wish to be supported. Employers can tailor support strategies for maximum effect by understanding health care worker perceptions and preferences.

Emergency nurses' attitudes, perceptions about personal protective equipment and willingness to care for COVID-19 patients: A descriptive, cross-sectional study.

AIMS: This study investigated emergency nurses' attitudes and perceptions about personal protective equipment and their association with the willingness to care for COVID-19 patients. BACKGROUND: Emergency nurses are at increased risk for COVID-19 infection as frontline workers and must wear personal protective equipment while attending suspected and confirmed COVID-19 patients. METHODS: In September 2021, 188 nurses in four emergency departments completed online questionnaires. RESULTS: Multivariable logistic regression demonstrated that as perceptions of COVID-19 infection risk increased by 1 point, 26% of nurses were willing to care of COVID-19 patients. The willingness to care for COVID-19 patients increased in their attitudes by 1.16 point and perceptions by 1.08 points about PPE. CONCLUSIONS: Perceptions of the risk of infection exposure and confidence in safety of personal protective equipment are associated with nurses' willingness to care for COVID-19 patients. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to assess nurses' needs for safety and provide a supportive climate to mitigate their concerns regarding infection risk and encourage nurses' willingness to care for patients. Nurse managers should provide precise guidelines on correct personal protective equipment use. Repetitive training on personal protective equipment should be provided to encourage nurses' adaptation to its use.

Implementation of a nurse-led alternate care site for the management of the surge of patients with COVID-19 in an Italian emergency department.

BACKGROUND: To accommodate and separate the large numbers of patients going to hospital with COVID-19, many EDs had to create new pathways for patients. We describe the outcomes of patients treated in a nurse-led alternate care site (ACS) at our hospital. METHODS: This was a retrospective study of outcomes of patients managed at the ACS of 'San Bassiano' Hospital ED, Bassano del Grappa, Italy between 9 March and 16 April 2020. Self-presenting patients aged 5 years and older, suspected of having COVID-19, were initially diverted to the ACS. Patients with a National Early Warning Score ≥5 or with a desaturation ≥4% after the walking test were sent back to the main ED COVID-19 path for further evaluation and medical attention and were not further followed up. In the ACS, patients received a CXR, blood samples and a nasopharyngeal swab to test for SARS-CoV-2, and were sent home. An emergency physician reviewed the results later and called the patient back 5-6 hours later with instructions to return for medical evaluation of abnormal findings, or to seek their general practitioner's attention. Patients received a follow-up phone call 15 days later to learn of their course. RESULTS: A total of 487 patients were fully managed in the ACS and discharged home. Of the 392 (80.5%) patients with no abnormalities after the workup and instructed to stay at home, 29 reattended the ED in the next 15 days, and 13 were admitted. Among the 95 patients asked to return and receive medical attention, 20 were admitted and of those discharged, 3 reattended the ED within 15 days. At 15 days, no patient was deceased or received invasive ventilation; one admitted patient received non-invasive ventilation. CONCLUSIONS: A nurse-led ACS diverted a substantial proportion of patients from main ED resources without associated negative clinical outcomes.

Emergency Nursing-Care Patient Satisfaction Scale (Enpss): Development and Validation of a Patient Satisfaction Scale with Emergency Room Nursing.

This study aimed to develop and validate an emergency nursing-care patient satisfaction scale to measure patient satisfaction with emergency room (ER) nursing. Patient satisfaction scales for ER nursing have been validated without considering the perspectives of the healthcare system or cultural background of the country. Moreover, although nursing care is changing with COVID-19, no scale has been specifically designed to assess patient satisfaction with ER nursing. The study population included patients who visited five ERs in Japan (March to December 2021) (n = 135). The rating scales were provided to patients who visited the ER and gave consent, and the patients were asked to reply. In the process of validating the scale, exploratory and confirmatory factor analyses of the construct and criterion validity were conducted. The confirmatory factor analysis results showed a factorial structure consisting of four factors. The domain and summary scores demonstrated good-to-excellent internal reliability (Cronbach's range = 0.81-0.89). This patient satisfaction scale was designed and validated from the perspective of the Japanese healthcare system and cultural backgrounds. This scale may be useful for developing assessments and interventions to improve patient satisfaction with ER nursing.

Emergency Department pandemic preparedness: Putting research into action

Emergency nurses are experts at responding rapidly to change. Their everyday practice involves constant assessment and prioritisation of a dynamic workload to meet the needs of patients across the spectrum of illness and injury. When COVID-19 arrived in Aotearoa New Zealand in February 2020, staff in hospitals around the country rushed to prepare for the wave of infected patients seen overseas. Emergency nurses' ability to adapt to unanticipated situations whilst working in an overcrowded and resource-constrained system made them important contributers to COVID-19 pandemic planning. Finding myself in the unique position of having just completed novel research into the perspectives of emergency nurses around pandemic preparedness, I felt a responsibility to ensure these perspectives were included in the pandemic response at the busy tertiary emergency department where I worked. Key findings from my prior research included the importance of managing the fear nurses felt about getting sick when caring for patients and of spreading disease to their family, friends, or to other vulnerable patients within their care.

Professional and psychological perceptions of emergency nurses during the COVID-19 pandemic: A qualitative study.

AIM: To explore the changing roles and responsibilities, difficulties, feelings, and coping strategies of emergency nurses during the COVID-19 pandemic. METHODS: This study was conducted as a qualitative study using a phenomenological approach. A total of 12 emergency nurses were recruited using purposive sampling from a COVID-19-designated hospital in Konya, Turkey for qualitative study. Data were collected through semi-structured individual interviews in January 2021. The data were analyzed using the content analysis method with the MAXQDA 2020 software program. The study conforms to the consolidated criteria for reporting qualitative research checklist. RESULTS: Four theme categories emerged from the data analysis: (a) "Increasing roles and responsibilities as an emergency nurse"; (b) "Difficulties of working in pandemic conditions"; (c) "Emotional responses in the pandemic"; and (d) "Strategies for coping with the effects of the pandemic". In this study, it was determined that emergency nurses had increased roles and responsibilities due to physicians being in the background, fulfilled their roles and responsibilities in a chaotic working environment, experienced many positive and negative feelings together or gradually, and applied individual coping strategies. CONCLUSIONS: This study indicated that emergency nurses fulfilled their increasing roles and responsibilities on the frontlines in a chaotic working environment during the pandemic. Despite many negative feelings, it was determined that they tried to show psychological adjustment and resilience with a strong professional commitment and social support.

Nurses' experiences of emergency department triage during the COVID-19 pandemic in Indonesia.

PURPOSE: To explore the experiences of nurses working in emergency departments in selecting and triaging patients during the COVID-19 pandemic. DESIGN: Descriptive phenomenology was applied in this study. METHODS: Data were collected from nurses working at hospitals in Indonesia using snowball sampling and telephone interviews. A total of 10 emergency nurses participated, and Colaizzi's method of data analysis was applied. FINDINGS: Six themes and 10 subthemes emerged. The main themes were "extreme challenges in triage," "feeling of responsibility under uncontrolled spread and infection," "physical and psychological exhaustion," "discovering strategies under difficult circumstances," "looking for positive reinforcement," and "optimism in togetherness." Nurses had to deal with the challenge of COVID-19 in the ED triage, interestingly so, the nurses they have shown the development of professional responsibility. Nurses are also experienced in finding patient selection and triage strategies and the sense of optimism that may influence strategy and practice during the COVID-19 pandemic. CONCLUSIONS: This findings identify nurses' experiences in dealing with the extreme challenges of emergency department triage as well as their associated strategies and optimism. CLINICAL RELEVANCE: Providing support to emergency nurses, improving emergency department triage, and community empowerment are suggested as strategies to improve nursing care during the COVID-19 pandemic.

National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States.

INTRODUCTION: The goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. METHODS: We generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. RESULTS: Weighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DISCUSSION: By quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.

Is COVID-19 the straw that broke the back of the emergency nursing workforce?

OBJECTIVES: To explore the intentions of Australian emergency nurses to remain in or leave emergency nursing after the first year of the SARS-CoV-2 (COVID-19) pandemic. METHODS: Sub-study of a survey of Australian emergency nurses about the impact of COVID-19 on their work, life and career. This sub-study focused on future career intentions, especially intentions to remain in or leave emergency nursing. RESULTS: There were 398 eligible responses. 48.2% of respondents reported that they intended to leave emergency nursing within 5 years. Nurses in EDs who received COVID positive patients were more likely to express an intention to leave ED nursing (P = 0.016). Having directly cared for a COVID positive patient was not statistically associated with intention to leave ED nursing (P = 0.17). Excluding nurses aged >60 years, there was no statistical difference in expressed intention to leave ED nursing between age groups (P = 0.32), nurses with/without a higher qualification (P = 0.32) or number of years in ED nursing (P = 0.54). Intention to leave emergency nursing was associated with not feeling more connected to their emergency nursing colleagues (P = 0.03), the broader ED team (P = 0.008) and their organisation (P = 0.03) since the onset of the pandemic. CONCLUSION: The data suggest that approximately 1 year after the onset of the COVID-19 pandemic in Australia, a high proportion of ED nurses intend to leave ED nursing within 5 years, which will exacerbate pre-existing shortages. Active strategies to address this are urgently needed.

Delivering an online course in emergency nursing education during the pandemic: What are the effects on students' learning?

BACKGROUND: Online learning emerged as an auxiliary approach in 2013 when MOOCs were imported and popularized in Chinese universities, particularly in the duration of pandemic outbreaks worldwide. World health organization (WHO) had recommended online education to keep social distance which still needs further evaluation. This study aimed to examine whether an open online course is superior to conventional education in emergency nursing during the COVID-19 pandemic. METHODS: Two groups of conventional education students (CG) and two groups of students participating in an online course that utilized an application (called SuperStar) as the SuperStar Group (SSG) were studied to compare their abilities in the process of new knowledge acquisition. The SSG was divided into a blended group (S1) and an online group (S2). The emergency nursing course was scheduled in 16 independent classes, which contained stochastic tests at least eight times. RESULTS: The CG group showed better performance on the final exam than the SSG group, but there was no statistically significant difference. The CG group obtained better scores on the memory capacity tests while the SSG had better scores on the application capacity tests. The SSG group scored higher on the later tests during the process of education compared to the CG group. CONCLUSIONS: Comprehension of an emergency nursing course was stronger in the SSG group than in the CG group. Horizontal comparison of subentry tests discriminated between the groups, with a better trend for the SSG group in application ability. There are potential effects on chronological learning through the use of the online course for emergency nursing education, not only during COVID-19 but also in the post-pandemic era.