Is it time for speciality streaming for emergency nursing students?

​A focus on emergency care in the third-year of a nursing degree would prepare pre-registration nurses to meet the high demands of the specialty from day one

A focus on emergency care in the third-year of a nursing degree would prepare pre-registration nurses to meet the high demands of the specialty from day one.

Despite nursing degrees, training in the ED often begins the first day of the job. Now could be
the time to streamline ED training. Picture: iStock

Any emergency nurse (EN) will tell you that their learning truly began the day they first started work in an emergency department (ED). Despite all the training during a nursing degree course, it is only when an EN is exposed to the waiting room or the ambulance bay of the ED that they can start relating clinical theory to the reality of injured and sick adults and children at their most vulnerable.

Learning in the ED

The fact that nursing is now an all-graduate profession has provided so many positives for the advancement of clinical practice and understanding patients’ needs, especially when considering how healthcare has developed over recent years in response to changing patient expectations and demand.

Despite the benefits of a degree programme, the opportunity to access an emergency care setting as an undergraduate nurse is one that can be missed due to the increased variety of clinical placements on offer and the number of nursing students who need them. What is now happening is that some newly registered nurses apply for jobs in an ED having never had experience of working in one.


If we want to pursue the ultimate goal of nurse education, namely a programme that provides pre-registration students with guaranteed exposure to such clinical placements and produces suitably educated and clinically shrewd ENs, it may be time to consider reconfiguring the provision of degree programmes for students who wish to specialise in emergency care.

Perhaps after the first two years of a modular-degree programme that covers medicine, surgery, orthopaedics and theatres, third-year students should be able to stream into an emergency care and pre-hospital nursing specialty and focus on the skills and competencies required for this field.

Programme modules would cover core skills such as triage assessment, traumatic wound closure, drugs and pharmacology, paediatric assessment and resuscitation room practices, with placements focused in EDs, urgent care centres and out-of-hours GP services and maybe even elective placements in pre-hospital environments such as ambulance services, air ambulances, cruise ships and army medical services. The last two suggestions may seem obscure but so many skills that can be reinvested into everyday emergency care can be learned from these environments.

What could be done

Significant restructuring would be needed; Health Education England would need to remodel educational expectations, universities would need to refashion courses and alternative clinical environments would be needed to accommodate new students, but nothing is insurmountable if there is sufficient demand for the benefits that such change may offer.

ENs could finish their nursing degrees with a set of skills that are intrinsically geared to their clinical practice, and intense exposure to front line clinical care would ensure they are prepared for practice in the specialty.

Any development of this nature would take many years to put into practice, but emergency care specialists and education providers need to debate the issue. Emergency care is no longer provided just by nurses in the ED; such days are part of the sepia-tinted past.

Emergency care is now provided in a variety of environments by skilled practitioners with an ever-widening scope of practice; and educational pathways need to evolve to meet the needs of the profession and the patients we care for.

About the author

Robert Shelswell is a freelance emergency care nurse practitioner in Brixham, Devon.

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