Registered nurses' perceptions of safe care in overcrowded emergency departments.

AIMS AND OBJECTIVES: To explore registered nurses' perceptions of safe practice in care for patients with an extended length of stay in the emergency department.

BACKGROUND: Extended length of stay and overcrowding in emergency departments are described internationally as one of the most comprehensive challenges of modern emergency care. An emergency department is not designed, equipped or staffed to provide care for prolonged periods of time. This context, combined with a high workload, poses a risk to patient safety, with additional medical errors and an increased number of adverse events. From this perspective, it is important to extend our knowledge and to describe registered nurses' experiences of safe practice.

DESIGN: A qualitative, inductive and descriptive study.

METHODS: Qualitative interview study carried out in five emergency departments. Data were analysed using a qualitative content analysis with a latent approach.

RESULTS: Patient safety meets obstacles in the clinical environment involving experiencing deficiencies regarding patient safety in the clinical setting and the impact of working procedures and routines. Moreover, nurses are challenged in their professional responsibilities involving balancing essential nursing care and actual workload; it is common to experience emotional reactions based on feelings of loss of control.

CONCLUSIONS: From the nurses' perspective, a prolonged stay in the emergency department may lead to negative consequences for both patient safety and care as well as registered nurses' psychosocial experiences. An extended length of stay significantly reduces the level of nursing and caring that registered nurses can perform in the emergency department.

RELEVANCE TO CLINICAL PRACTICE: This study indicates that emergency departments should review their procedures to avoid both deviations from normal practice and moral stress among registered nurses. This can contribute to an increased understanding and insight about the challenge of patient safety in an emergency department setting.