Emergency Department Triage Nurses' Scope of Practice: An Observational Study

AIM: To explore emergency department triage nurses' scope of practice and activities related to their triage role and management of patients located in emergency department waiting areas. DESIGN: Exploratory, descriptive, observational study using naturalistic decision making. METHODS: Data were collected using semi-structured non-participant observation: researchers recorded their observations using a lapel microphone and recorder from 8 January to 7 May 2025. Fifteen triage nurses from three emergency departments in Melbourne, Australia were observed for 2 to 2.5 h each. Audio-recordings were transcribed verbatim and analysed using deductive content analysis. The HIRAID emergency nursing framework (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) was used as the coding frame. RESULTS: Participants had a median of 10 (interquartile range 7.5-21) years nursing and 5 (interquartile range 3.2-13) years triage experience. During a total of 33 observation hours, there were 303 interactions, including 237 interactions with 169 different patients; the remainder were with carers or other clinicians. In total, 1183 tasks were coded ranging from 12 to 128 tasks per triage nurse. The most common tasks were: taking a history (n = 475); post-triage communication with patients, carers and other clinicians (n = 288); patient assessment including vital signs and focussed assessments (n = 165); and interventions including medications and psychological care (n = 134). All elements of taking a history, identifying red flags and assessment were more common during the triage process, with few instances during post-triage care. Interventions (medication administration, psychological care), diagnostics (pathology, imaging, urinalysis) and communication with patients, carers and other clinicians occurred during both triage and post-triage care. CONCLUSION: Triage nurse practice is complex, multifaceted and extends beyond triage category allocation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The traditional perspective that triage and post-triage care are linear and clearly divided is not fit for purpose in contemporary triage practice. IMPACT: The scope of triage nurses' practice both in the context of triage of incoming patients and care of patients in ED waiting areas is poorly understood. The role of triage nurses extends far beyond rapid assessment and triage category allocation and triage nurses use a breadth of expertise and skills to maintain safety, promote comfort and expedite emergency care for patients in ED waiting areas. History, red flags and assessment were more likely during the triage process than post-triage, but interventions, diagnostics and communication spanned both triage and post-triage care. Future triage and waiting area models of care and educational preparation of triage nurses should be co-designed with triage nurses and consumers, so they reflect care as delivered rather than care as imagined. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.