Beyond hopes and prayers: Empowering nurses to close the AED access gap

Background: The American Heart Association and the Heart and Stroke Foundation of Canada (HSFC) promote widespread access to automated external defibrillators (AEDs) in high-risk environments. Hospitals, despite being among the highest-risk settings for cardiac arrest, are largely excluded from these initiatives. Nurses are often the first to recognize cardiac arrest, are ideally positioned to defibrillate; but are inconsistently supported to use AEDs across Canada. The National Emergency Nurses Association (NENA) is a partner in the Heart & Stroke Foundation of Canada’s Cardiac Arrest National Advisory Council (CA-NAC). The CA-NAC identified regulatory and legislative barriers to nurse-initiated AED use as a national priority. In response, NENA developed a position statement calling on provincial and territorial colleges to explicitly support nurse-initiated AED use when access to a prescriber is delayed or unavailable. This session will review recognition and management of cardiac arrest, examine clinical and operational cognitive biases that delay nurse-initiated defibrillation, and highlight emergency department initiatives that empower nurses to act rapidly. Methods: The CA-NAC, convened in January 2025, developed a five-pillars approach to improving care through: public readiness, equitable evidence-informed care, integrated systems, holistic survivor support, and data-driven improvement; and nurse-initiated AED use identified as a key action area. Concurrently, the NENA Professional Practice Committee conducted a jurisdictional scan of provincial and territorial nursing regulatory college documents, legislation, policies, and direct correspondence. Scope-of-practice provisions related to AED use for licensed practical nurses, registered nurses, and registered psychiatric nurses were categorized as explicitly authorized; authorized with conditions (e.g., employer policy, education, or orders); or restricted to delegation or emergency exceptions. Results: Publicly available guidance on nurse use of AEDs was identified in 83% (n = 12) of provinces and territories, with additional validation obtained through direct correspondence where needed. Substantial interjurisdictional variability was observed. Approximately one-third of provinces (BC, MB, PEI, and QC) explicitly authorize nurses to use AEDs at the regulatory level. In 58% of provinces and territories (AB, NB, NL, NS, SK, NWT/NU), AED use is permitted only with employer policy and education. Ontario remains the only province where AED use is excluded from nursing scope of practice except through delegation, medical directives, or the emergency exception. NENA’s position statement affirms that nurses with current Basic Life Support certification are competent to safely use AEDs and calls for emergency departments to train all nurses in AED or AED-mode defibrillation. Implications and lessons learned: Canadian nurses face inconsistent regulatory and institutional support for AED use despite strong evidence that early defibrillation improves survival. Greater regulatory clarity and national alignment are urgently needed to enable nurse-initiated AED use across hospital settings. Empowering nurses to defibrillate promptly aligns with existing competencies, reduces time to shock, and has the potential to significantly improve outcomes from in-hospital cardiac arrest. Nurses are the largest health-care workforce and are most often present to recognize and respond to cardiac arrest, yet variation in training and regulation limits their ability to perform life-saving defibrillation. Coordinated national action is needed to support nurse-initiated AED use when prescriber access is delayed. NENA calls on national partners to advocate for this change.