|1. Difference of confidence between senior and junior nurses in caring for ACS patients||Senior nurses note that the mistakes made were minimal||
“If there is a case of ACS, as far as I know, it is handled by senior nurses. Based on our experience, the senior has only a minimal error rate once ... (P4)
“Expertise maybe depends on the experience of handling ACS. Our nurses, ventilator and defibrillators are already here in 24 hours. It is important, we must know where we work. We learn to understand what is happening and must know the procedure to avoid mistakes.” (P8)
|Junior nurses are less confident and more confused||
Generally, the juniors activities include administering an intravenous infusion, providing something, just like that. Here, we need a fast response, 4 minutes or 5 minutes, junior nurses often get doubt and face obstacles to follow the speed.” (P4)
“I am still afraid and confused to do collaboration, because I just joined the ED.” (P9)
“If there are too many patients, usually for treating ACS patients, I consult with a more senior nurse.
I help the patient as much as I can do such as apply an infusion therapy or ECG. Sometime I got less confident because I have little experience about the ECG procedure.” (P11)“Even junior nurses held bachelor degree, they cannot be guaranteed in understanding ACS, this may happened because they were newbies as emergency nurses, so we as senior nurses should hold more roles and guide them.” (P15)
|2. Limitation for performing professional nursing practice||Limited authority to address triage decision making||
“There is an emergency physician. So sorry, it seems that our presence are ignored. We have to waiting for the physician order...” (P2)
“So, who is the responsible person for determining ACS patients in the first priority, or the second priority? It is a right of the physician, nurses have limited authority. If the doctor is wrong, however, the nurse has to straighten it up.” (P7)
|Limited chance of nursing documentation||
“The medical record will be carried by the cardiologist lead to difficulties to completed the nursing documentation as the forms have to filled are incorporated in the medical record.” (P12)
“Then another constraint is the patient' medical record is often be carried by the physician .” (P15)
|3. Unclear nursing job description||The job duties still overlap||
“Sometimes, we experience overlapping of tasks. In some parts, nurses completing duties that should have be conducted by physicians, even though nurses do not want to do that actually. However, because our goal is patient safety, most nurses still keep on that, here there is a problem.
The main obstacle that we still do a lot of action that really is not our job as nurses.” (P9)
“I should deliver an infusion therapy, injection, and suturing the wound. Those aren’t my duties, the tasks are merely delegated verbally, unwritten.” (P11)
“In the pre-conference session conducted regularly, you also have to manage the work tasks, divide it and delegate it to other nursing staff.
I just ask myself, is it my duty? dividing the task should be involved in head of ward responsibility,
not me…, whose job is it?” (P5)
|Male nurses do more urgent services than female nurses||
“… I think the men job was blur. In emergency field, as you can see, always male allocated here. There is limited number of female nurses in the emergency ward” (P4)
“If another room needs resuscitation help, usually we are nurses of men who often come, female nurses a little dodge.” (P12)