Emergency nursing practice: a review of challenges, competencies, and strategies to improve patient outcomes

Background: Emergency nursing requires timely clinical assessment, effective decision-making, and coordinated care within demanding practice environments. Crowding, staffing constraints, and gaps in professional support may affect care delivery and patient outcomes. Objective: To summarize evidence on challenges affecting emergency nursing practice, relevant competencies, and improvement strategies, with particular attention to their reported relationships with patient outcomes. Methods: A preliminary narrative synthesis was undertaken using six selected published reviews: two systematic reviews and four scoping reviews. Findings were organized into practice challenges, professional competencies, improvement strategies, and outcomes. Study counts were reported separately because overlap between the reviews’ underlying studies was not assessed. Results: The individual reviews included between 16 and 105 studies or papers. Prominent challenges included crowding, inadequate staffing, delayed assessments, and unmet fundamental care needs. A review of 23 studies identified seven advanced practice competency domains spanning clinical care, assessment, collaboration, leadership, documentation, and decision support. Educational interventions generally supported improvements in clinical practice behaviors, while advanced nursing models showed potential benefits for treatment timeliness and patient satisfaction. However, observational designs, heterogeneous interventions, and limited controlled evaluations restricted causal interpretation and generalizability. Conclusion: Strengthening emergency nursing requires alignment between organizational resources, role-specific competencies, and practice improvement strategies. Improvements in professional behavior and care processes should be distinguished from demonstrated patient benefits. These findings remain provisional pending completion of the proposed scoping review.