Background Intraosseous (IO) access is a life‐saving procedure for obtaining vascular access when other standard routes fail. Despite its clinical significance, nurses often lack sufficient knowledge, confidence, and experience to perform effectively. Aim This is an integrative review that examined nurses’ knowledge of the IO access and their self‐perceived clinical experience and identified factors influencing their competence, attitudes, and utilization in emergencies. Methods A literature search was conducted across seven international electronic databases, published between 2010 and July 2025, encompassing quantitative, qualitative, and mixed‐methods research designs. A total of 27 studies met the inclusion criteria and were included in the final synthesis. Data were integrated thematically to examine patterns in knowledge levels, clinical exposure, barriers, and practical training. Results Most studies identified six key themes: gaps in nurses’ anatomical, clinical, and safety knowledge related to IO access; low utilization despite positive perceptions; and the need for standardized, competency‐based education to support nurses’ roles in emergency vascular access. Although IO access was recognized as a vital intervention, its use remained low due to insufficient training, limited autonomy, and organizational barriers like equipment shortages and unclear protocols. Educational and simulation‐based programs consistently enhanced knowledge, skills, and confidence, but ongoing reinforcement was necessary to maintain competence. Conclusion Nurses’ preparedness for IO access remains inadequate despite generally positive attitudes toward its use. Incorporating mandatory simulation‐based IO training into undergraduate and continuing nursing education, along with structured competency assessments and supportive clinical guidelines, is recommended to enhance confidence, procedural safety, and consistent clinical use. Future research should focus on developing validated evaluation tools and examining the long‐term effects of nurse‐performed IO access on patient outcomes. Emerging research emphasizes the need for standardized competency frameworks and institutional policies to enable nurses to assume expanded roles in emergency vascular access.
Al-Jabri et al. (Thu,) studied this question.