Support for Ratios for Aged Care

The College of Emergency Nursing Australasia (CENA), the peak professional association representing emergency nurses, unequivocally supports the Australian Nursing & Midwifery Federation’s campaign for Ratios for Aged Care. Residential aged care services provide care to one of our most vulnerable populations and the current nurse-to-resident ratios are woefully inadequate.

There is clear evidence that better levels of nurse staffing result in better patient outcomes and decreased risk of death and harm. The lack of nurse staffing in aged care not only places residents at risk of suboptimal care it also results in moving residents to emergency departments as aged care staffing does not enable nurses assess and manage residents who suffer clinical deterioration or an event such as a fall at their facility.

CENA Executive Director, Dr Julia Morphet highlights that “transferring older persons to emergency departments places them at unnecessary risk of harm”. “Movement to an unfamiliar environment is distressing for many older persons and their families and can cause delirium which is associated with increased risk of death.” “Being in an emergency department places older persons at higher risk of falls, pressure injuries, and unnecessary test and invasive procedures.”

CENA endorses that older persons deserve the best possible care which is not possible in the 2.86 hours of nursing care per day currently provided to residents. Nurse staffing in aged care warrants urgent attention and legislated nurse-to-resident ratios: make them law now.


Further information:

Dr Julia Morphet, Executive Director

College of Emergency Nursing Australasia

Future Emergency Nursing workforce, what is the evidence telling us?

Mrs Vanessa Gorman1

1The Royal Women’s Hospital, Melbourne, Australia

OBJECTIVE: High nursing turn-over, and low retention rates amongst the field of emergency nursing according to current evidence is a global phenomenon. How is the current evidence influencing managers and organisations to identify key factors that may improve not only retention, but recruitment, into the speciality of emergency nursing?

This study utilised a bibliographic search as well as the authors own experience when performing the integrative review.

26 articles were identified as meeting the criteria of the integrative review. Both national and international articles that met inclusion criteria were included.
4 key themes were identified that may impact on the recruitment and retention of emergency nurses: workplace environment, demands on emergency nurses, resilience, and education and training.
The key themes identified all impact on emergency nurse recruitment and retention, but the evidence is conclusive that a multi-level approach needs to be adopted internationally.

Emergency nursing recruitment and retention is a multi-faceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This study has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.


Vanessa commenced her emergency nursing career in 1996 and across her career in emergency nursing she has held positions such as Nurse Unit Manager, Senior Policy Advisor – Department of Health, and State Trauma Manager. Vanessa is the appointed Emergency Services manager at the Royal Women’s Hospital, Melbourne. Vanessa is an appointed member of the International Advisory Council for the Emergency Nursing Association (USA), and is appointed to the CENA membership committee. In 2017, Vanessa was awarded the Australasian Emergency Nurse of the year as she strives to improve emergency care for both patients, and the nursing workforce, through various quality projects.

Do consumers who identify as Muslim experience cultural sensitive care (CSC) in the Emergency Department (ED)? A scoping review

Amy Johnston1,5, Mingshuang Ding2,3, Omer Mohammed3, Debbie Massey4
1Department of Emergency Medicine, Princess Alexandra Hospital, Metro South,2School of Nursing, Faculty of Health, Queensland University of Technology,3Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital,4School of Nursing, Midwifery and Paramedicine, Faculty of Health, University of Sunshine Coast,5School of Nursing, Midwifery and Social Work, The University of Queensland

Background: Lack of awareness about cultural and religious values and beliefs of patients presenting to emergency departments (EDs) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade [1]. The changing face of Australian population requires that Australian health care consider carefully the dominant western cultural paradigm currently underpinning of health care delivery [2-5]. This is particularly critical in EDs, commonly the entry point into healthcare services
Objectives: This scoping review explored evidence of key components and impacts of cultural safe care (CSC) in EDs for staff and care consumers who identify as Muslim.
Methods: A systematic search using electronic (five databases) and heading searching methods for primary research published between 2006 and 2017 was undertaken; followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, the content was grouped and synthesized and tested for clinical salience using the six-staged Arksey and O’Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature.
Results: Three studies were included in the analysis.
Conclusion: Religious beliefs and practices are common. Such beliefs and practices could influence patients’ understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. They could also impact on care seeking behaviours and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in EDs locally and internationally. While many EDs may have procedure documents or staff care guides, it is unclear on what basis these have been developed, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers


Amy Johnston is a conjoint senior lecturer in Emergency Care, based between Metro South Emergency Department (PAH) and School of Nursing, Midwifery and Social Work, The University of Queensland. She is deeply committed to bringing research skills and outcomes to emergency staff. She is a widely published and cited academic and registered nurse with experience in a range of research techniques. Her love of clinical research is heartfelt and (hopefully) infectious. She is involved in HDR student supervision and onsite development of ED staff research skills.

Exploring interventions used in emergency departments to reduce occupational stressors and or improve staff coping: A scoping review of the literature

Ms Elizabeth Elder1, Dr.  Amy N. B. Johnston2,5,6, Prof. Marianne Wallis2,4, Prof. Julia Crilly2,3

1School of Nursing & Midwifery, Griffith University, Southport, Australia, 2Menzies Health Institute Queensland Griffith University , Southport, Australia, 3Department of Emergency Medicine  Gold Coast Hospital and Health Service , Southport, Australia, 4School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia, 5School of Nursing Midwifery and Social Work, University of Queensland , Brisbane, Australia, 6Department of Emergency Medicine Princess Alexandra Hospital Metro South, Brisbane, Australia

Introduction: Emergency departments (EDs) are stressful places to work (1). Staff are exposed to many occupational stressors and rely on varying coping strategies (2). Exposure of ED staff to occupational stressors has been linked to increased absenteeism and burnout, higher staff turnover and low staff morale (3). The aim of this review was to examine and synthesize existing evidence relating to interventions designed to reduce the impacts of occupational stressors and/or improve ED staff coping.

Methods: The review involved searching five databases using terms related to stress/or, coping, and emergency department for papers published in English from 2007-2017. Study quality of quantitative studies was assessed using National Health and Medical Research Council Level of Evidence Guidelines (5).

Findings: A total of 45 studies met criteria for review inclusion. The level of evidence of included studies varied from level I (n = 1) to IV (n = 11). Interventions discussed in the literature that targeted occupational stressors included organizational/environmental redesign, policy/protocol change and staff education. Interventions targeted towards improving coping strategies of staff included mindfulness, debriefing and relaxation techniques. Most studies reported some degree of positive effect/s on either reducing exposure to occupational stressors and/or improving staff coping.

Conclusion: This review highlights the limited existing literature relating to interventions designed to ameliorate a wide range of occupational stressors experienced by ED clinicians. The findings of this review support the need for additional research to underpin and guide interventions designed to address occupational stressors and or improving coping strategies used by ED clinicians.


  1. Basu S., et al. Occupational stress in the ED: a systematic literature review. EMJ. 2017;34(7):441-7.
  2. Abraham LJ., et al. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments. EMA. 2018.
  3. Ahwal S. & Arora S. Workplace Stress for Nurses in Emergency Department.
  4. Arksey H. & O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8.
  5. National Health & Medical Research Council. NHMRC Levels of evidence and grades. Canberra 2009.


Elizabeth is a credentialed emergency nurse with a passion for education, research and clinical practice.  Believing research is the juncture of clinical practice and academe Elizabeth enrolled in her PhD in 2016.

Staff wellbeing program

Mrs Elizabeth Bradbury1
Clinical Nurse Manager, Melbourne Health, North Warrandyte

The Royal Melbourne Hospital (RMH) is a state-wide trauma service seeing around 78,000 presentations annually. The ED management team recognises staff as our greatest asset and chose to invest in `Caring for the Carers’ by developing a wellbeing program which aligned strongly with our organisational vision to be `First In Care’ and to be an employer of choice.
The ED Leadership team worked in consultation with our the RMH Health & Wellbeing Coordinator to promote Compassion Fatigue workshops in 2017. The aim of these workshops was to increase staff education regarding psychological first aid, identify individual triggers and promote self-care strategies for staff. To compliment our wellbeing program we encouraged our nursing staff to join the MH peer support program, equipping and training this core group with skills to provide `real time’ support and care for clinical staff.
January 2018 marked the introduction of the Wellbeing Dog program which was trialled for 4 months at two days per week in our non-clinical space. The overwhelming response to this trial has now marked a Monday – Friday implementation with feedback from staff stating an increase in morale, reduction in stress and improved staff relationships.
Our ED Leadership Team is committed to the vision of being “First in Care” and an employer of choice. The introduction of our Wellbeing Program aims to promote mental health awareness, minimise the impact of OVA and trauma and implement staff support strategies. At RMH ED we fully acknowledge that these programs do not eliminate the volume, acuity and stress related to Emergency nursing, but we are very clear that we cannot achieve our vision without addressing the needs of the people that provide that care. We believe that we are getting a significant return on our most valuable assets through our innovative investments in wellbeing.

Liz Bradbury has over 30 years of emergency nursing experience. After completing her Post Graduate Emergency Nursing Certificate and a Diploma in Business, has progressed through CNS and ANUM roles and is currently the Clinical Nurse Manager in the Emergency Department at the Royal Melbourne Hospital.
Liz has dedicated years building teams and supportive environments to enhance the professional growth and development of her staff.
Liz has long advocated for a greater focus on wellbeing for Emergency Department nursing staff to support mental health, address the impact of occupational violence and aggression (OVA) and identify enablers for longevity in the emergency nursing role.
Liz has been involved in promoting and supporting departmental wellbeing tools to minimize impact of emergency trauma, Occupational Violence and Aggression (OVA) and aims for RMH ED to be recognised as an Employer of Choice

Breaking nursing silos: A collaborative approach to improving transitional care

Emma Staines1

1Clinical Nurse, Emergency and Trauma Center, Royal Brisbane and Women’s Hospital, QLD

The transfer of patients from emergency to the ward environment is a critical point in the patient’s journey, with wide ranging impacts on patient safety, patient flow, and staff relationships. Poor interdepartmental transitional care and nursing handover are associated with increased adverse events, errors, and poorer patient outcomes. Communication between emergency and inpatient departments must be clear, collaborative, and consistent, in order to ensure patient safety during this transitional point in their care. The Collaborative Care Enterprise (CCE) is a project developed at the Royal Brisbane and Women’s Hospital (RBWH) in 2017, specifically to address the relationship between emergency and inpatient nursing staff.

The CCE has been a collaboration between emergency and inpatient staff, bringing front-line nurses together to discuss issues and concerns related to transitional care, and forge actionable strategies for improved teamwork and patient care. Initiatives of the CCE include conducting education sessions regarding patient flow and scope of emergency care, inviting ward staff for structured walk-throughs of the department to increase understanding of departmental processes, and providing case studies of occasions when the transfer of a patient was concerning to ward staff.

The CCE has provided nurses in emergency and inpatient departments a platform for open dialogue regarding concerns, constructively discuss options for process and policy change, and develop a better understanding of their colleagues work environment. This has resulted in improved relationships and communication between departments, and process changes that have optimised transitional care for patients, such as facilitating ward staff to collect patients from emergency and collect data from the Emergency Department Information System.

Building on the success of the past six month, there are plans for the CCE to expand and incorporate other wards within RBWH, in order to further improve the safety of patients as they are transferred out of the emergency department.


Emma Staines is a Clinical Nurse in the Emergency and Trauma Center at the Royal Brisbane and Women’s Hospital. Emma holds post-graduate qualifications in Acute Care, Immunisation and Emergency Nursing and is currently undertaking her Master’s in Public Health, majoring in Disaster Health and Humanitarian Assistance. For the past year, Emma’s focus has been designing and implementing a quality improvement project targeted toward improving interdepartmental nursing team work, relationships and transitional care. Leading a multi-specialty nursing team, Emma is working toward breaking down departmental silos, turning clinical incidents in transitional care into practical change and thereby developing forward-thinking, professional, evidence-based clinicians.

The Melbourne Mobile Stroke Unit providing pre-hospital stroke care

Stroke patients benefit from early intervention. The Melbourne Mobile Stroke Unit (MSU) is the first pre-hospital stroke service in Australia. The MSU has an integrated on-board CT scanner and carries both acute stroke and ambulance personnel. The MSU aims to improve pre-hospital stroke triage, reduce the time to stroke treatment and provide improved access to comprehensive stroke centres through immediate on-site access to specialised staff and multimodal CT imaging.

Data, including time metrics, were prospectively collected on all MSU dispatches, and compared to national standards.

The MSU launched on 20th November 2017 and operates within a 20km radius of The Royal Melbourne Hospital, Australia, delivering patients to 8 primary and comprehensive stroke centres across the city. In the first 6 months of operation, the MSU was dispatched to 604 code stroke calls. 264 (44%) cases were attended, while 340 (56%) were cancelled pre-MSU arrival after an initial paramedic assessment. Of attended calls, 132 patients (50%) received a non-contrast CT scan and 68 (26%) received a Circle of Willis CT angiogram. The MSU delivered pre-hospital thrombolysis to 27 patients (39% of ischaemic stroke<4.5 hours); median scene-to-CT time 21 min, scene-to-needle 42 mins and onset-to-needle 108 mins were substantially faster than the Australian average of 27 min, 72 mins and 156 mins respectively. Additional MSU treatment included anticoagulation reversal (4 patients), blood pressure reduction (10 patients), seizure management (1 patient) and clinical trial enrolment for both haemorrhagic and ischaemic stroke (8 patients). The MSU has reduced inter-hospital transfers by diagnosing large vessel occlusions and neurosurgery candidates in the pre-hospital setting on 27 occasions (19% all stroke patients), bypassing initial hospitals for specialist centres.

The Melbourne MSU is achieving thrombolysis workflow consistent with comprehensive stroke centres. It has reduced onset-to-needle times and allowed additional patients to receive thrombolysis. Pre-hospital triage has removed transport delays from inter-hospital transfers.

Skye is a Nurse Practitioner and the Nursing Coordinator of the Melbourne Mobile Stroke Unit at The Royal Melbourne Hospital, Victoria. She has an extensive background in critical care nursing, holds a Master’s degree in nursing, and has completed 2 International stroke nursing courses, she is also the first Board Certified Advanced Neurovascular Practitioner in Australia. Skye is the co-chair of the Acute Stroke Nurses Education Network (ASNEN), an organisation dedicated to improving the delivery of evidence-based stroke care, education and networking opportunities for Australian stroke nurses. Her passion is improving hyperacute stroke care, stroke research and stroke education

Can a fridge magnet bleed? – adventures in mass casualty incident/novel health based exercises

A Very Bad Thing (VBT) has happened. Staff in the Emergency Department (and elsewhere in the hospital) are expected to respond and manage the VBT as they were trained and as detailed in their plans. Except these days it is difficult to find the time to train staff and anyway the plans can be disconnected from the reality of the ED environment.
A fundamental tenet of all emergency management arrangements is the requirement to exercise plans, procedures and/or personnel to ensure that organisations and individuals are capable of responding to significant incidents.

Over the past 12 years Don Garlick has been responsible for developing and delivering exercises to test the response of staff and processes at a large regional hospital in Victoria. This presentation will explore the successes, pitfalls and failures of actual emergency management exercises, providing delegates with practical insights into:

  • Developing ‘normal business’ fire training to incorporate low frequency-high consequence emergencies
  • Delivering five hospital based large Mass Casualty Incident exercises
  • Using performance indicators to monitor performance across time and fuel improvements
  • The rewards of collaborating with emergency services and emergency management agencies at a local and regional level
  • Finding opportunities to provide hospital staff with unique health based exercises such as decontamination and VMAT deployment

Don Garlick is the Manager: Emergency Management for Ballarat Health Services. In this role Don is responsible for the planning, training, response and recovery arrangements for BHS; a large regional, multi-campus service with over 4000 employees and over 500 patient/residential beds. Don is part of the Victorian state-wide health based emergency management exercise and training faculty, represents CENA on the FEMO program, and is involved in local, regional and state-wide emergency management committees.
Don holds a Masters in Emergency Management (Distinction), Advanced Diplomas of Public Safety & Business Management, Graduate Diploma of Critical Care and Cert IV’s in Fire Technology, Training & Assessment, Work Health & Safety, Frontline Management and a Cert II in Firefighting Operations.
He continues to work part time as an ANUM at the Ballarat Base Hospital Emergency Department.
In his spare time, he is a 30-year veteran CFA volunteer firefighter in a busy urban brigade and because he was a bit bored, recently joined the Royal Australian Army Nursing Corp as a Reserve Nursing Officer.

#Goodvibes: Improving staff moral in the Emergency Department

Andrea Lazo1, Amelia Rich1, Amanda Riley1
Emergencey Department, Box Hill Hospital

#Goodvibes: Recognition of the little things, can mean big things for staff morale in the Emergency Department. The unique combination of conflicting priorities such as patient acuity, KPI’s and department expectations has been documented to leave staff feeling burnt out, exhausted and sometimes undervalued. This is where #GoodVibes comes in to make a change. This has occurred through acknowledging the actions, dedications and the little things we do for one another.

Clerical, nursing, medical, PSA’s, security, volunteers and ISS cleaning services have all been brought together through recognising each other’s efforts through regular peer “shout outs” to thank each other for their help and support. Since conception in 2016, there has been over 700 documented shout outs.

As a unified team, we all want the same goals and that is to provide the best quality health care and well-being to our patients. With recognition for our accomplishments from our peers, we are able to come together and create a collaborative and positive team. Our team work is reflected in our patient’s outcome, and our greatest desire to become the best health professionals we can be.

This straightforward, inexpensive model of peer support has been evidenced to be adapted to other areas of nursing. #GoodVibes has the potential to increase a positive work place culture in emergency departments across Australia.

Shout out to those that make your work place great. Shout out to your colleagues who you appreciate. Shout out to those who work tirelessly. Shout out to make someone smile.

A thematic analysis of good vibes communicates that actions most appreciated involve unique skill sets. These include escalation of deteriorating patient, deescalating aggression, willingness to assist with any activity and the show of friendship and support in any situation.

A small thanks can have a big impact.

Low investment, high returns, high staff retention rate.


#GoodVibes is an initiative pioneered by Amelia Rich, Andrea Lazo and Amanda Riley since 2016 that has united staff in the Box Hill Emergency Department. This has occurred through acknowledging the actions, dedications and the little things staff do for one another. This leads to an increase in staff morale.

The authors of this presentation are Critical Care Registered Nurses who are highly dedicated to not only promoting a positive environment for patients and families, but also staff.
The idea for the project started on an ACEN cruise to Fiji where daily announcements were made and people on board could send a message to someone they knew. It had such a positive effect and everyone cheered when the announcements were heard. This led to the question – could they implement the idea in an emergency department? So they did, and here we are today.

Documented episodes of security presence in the clinical notes: a comparison with security records

Mrs Jill Duncan1, Mr Scott  Trudgett1, Dr Nathan Brown1,5, Mr James Hughes1,4, Dr David  Rosengren1,5, Dr Julia Crilly2,3
1Royal Brisbane and Womens Hosptal, Herston , Australia, 2Gold Coast Health, Qld , Australia, Southport, Gold Coast, Australia, 3Griffith University, Southport, Gold Coast, Australia, 4Queensland University of Technology, Kelvin Grove, Brisbane, Australia, 5University of Queensland, St Lucia, Brisbane, Australia

Background: Emergency departments (ED) are high risk settings for workplace violence (WPV). Almost half of the episodes of WPV in the ED are perpetrated by patients under the influence of substance misuse. A culture of underreporting of WPV exists in the ED. WPV has a significant impact, affecting staff, patients and visitors to healthcare settings. Communication of this risk is essential for the management of these patients and safety of all who enter the healthcare facility.
Aim: The aim of this study was to compare the documented presence of security in the clinical notes to security records to identify if reporting differences exist.
Methods: This retrospective observational study involved the analysis of ED data, security data and medical record data for alcohol-related patient presentations made to a level six tertiary referral ED in Queensland, Australia between April 2016 and August 2017. The documented security presence was compared between security records and ED records.
Results: Of the 680 alcohol-related ED presentations reviewed, there was considerable difference in reporting of security presence: 10.2 % reported in the security data, 3.4% reported in the clinical notes.
Conclusion: The limited documentation of WPV in the clinical notes has potential ramifications for members of the multi-disciplinary team in terms of risk management of these patients. Findings demonstrate a need to continue with organisationally supported strategies to minimise WPV and improve safety for staff and visitors to healthcare facilities.

Jill is an experienced Registered Nurse who has worked across many specialities at many different levels. The last eight years of her career she has worked in the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. She is currently working in a Clinical Nurse Researcher position, exploring the impact of alcohol related presentations on the emergency department as part of a multisite study.