Reimagining resuscitation leadership: The nurse-led model in an emergency department

Background: Emergency Departments across the world continue to face increasing patient acuity, operational strain, and resource limitations. These pressures amplify the need to examine how resuscitation care can be optimized. Although early CPR, high-quality chest compressions, and timely defibrillation are well-established predictors of survival, overall cardiac arrest outcomes remain poor globally. A recent meta-analysis found the average adult out-of-hospital cardiac arrest survival rate to be approximately 8.8%, underscoring the ongoing need for innovations in resuscitation practice. Nurse-led resuscitation (NLR) refers to a model in which registered nurses lead Advanced Cardiac Life Support (ACLS) during cardiac arrest, allowing physicians to concentrate on high-impact interventions and procedures that require technical expertise. However, there is limited empirical evidence describing how this model functions in practice. A published scoping review mapped global evidence on NLR in emergency departments and revealed a critical gap: despite promising findings, most research to date remains simulation-based, with limited real-world evaluation. An examination of patient outcomes and an understanding of how NLR is experienced by frontline clinicians is essential for supporting education and implementation and guiding policy integration. Objectives: Examine outcomes of rates of return of spontaneous circulation (ROSC), survival to hospital admission and survival to hospital discharge and how they compare to national benchmarks. Explore experiences of cognitive load, communication, and leadership among nurses and physicians participating in a NLR model. Methods: An explanatory sequential mixed-methods study was developed in response to the scoping review. Phase 1 was a quantitative analysis of secondary cardiac arrest data examining rates of ROSC, survival to admission, and survival to discharge at a study site with an established NLR model. Phase 2 involved qualitative interviews with nurse- and physician-leaders to explore cognitive load, communication, and leadership. Results: Preliminary quantitative analysis shows consistently favourable trends across outcome indicators (ROSC, survival to admission and survival to discharge), with no measures declining under the nurse-led resuscitation model. Qualitative analysis produced themes describing clinicians’ perceptions of roles, cognitive load, team coordination, and organizational dynamics. Integration is ongoing but will aim to determine the mechanisms by which NLR may influence cognitive load, team dynamics and resuscitation quality. Implications and lessons learned: This ongoing mixed-methods research will provide the first real-world examination of nurse-led resuscitation outcomes and team processes. The study’s integrated design will offer actionable insights into how nurse-led models function within interprofessional teams and their potential to inform future workforce models, training, education and policy related to advanced resuscitation leadership in the emergency department.