Barriers to implementing advanced skills in trauma and emergency nurse specialist practice

Abstract

Background: A postgraduate specialist programme in trauma and emergency nursing is offered to help address the high burden of injuries and emergencies in the South African healthcare system. The trauma and emergency nurse specialists’ advance skills and expertise have been associated with improved patient outcomes, yet they continue to face barriers that constrain the full scope of their practice.
Aim: This study aimed to explore and describe the perceptions of trauma and emergency nurse specialists on barriers to skill implementation.
Setting: The study was conducted in the trauma and emergency departments of a tertiary hospital providing Level I services and a district hospital providing Level II services at two public hospitals in the Western Cape province, South Africa.
Methods: An exploratory-descriptive qualitative design with purposive maximum variation and snowball sampling was utilised. Semi-structured interviews were conducted with 10 specialist nurses among a population of 33 with a post-registration qualification in Medical and Surgical Nursing Science: Trauma and Emergency. Thematic analysis of data was carried out and adherence to the criteria of dependability, credibility, transferability and confirmability ensured trustworthiness in the study.
Results: Three themes emerged, which include uncertainty regarding legal accountability and specialised practice responsibility, oppressive practice environments not conducive to skill implementation and the disregard for trauma and emergency nurse specialists’ role and value of specific skills.
Conclusion: Job descriptions and scope of practice (SOP) are not adapted after specialist training in trauma and emergency nursing, resulting in a lack of recognition of specialised skills by the interdisciplinary team and management, uncertainty among these specialist nurses about what they are allowed to do with their new skills and a subsequent inability to practice in their full capacity in service of the population in need.
Contribution: Improved utilisation of the specialised practice of these trauma and emergency nurse specialists within their expanded scope to cope with the high burden experienced in the emergency rooms of South Africa.