Since nursing’s earliest beginnings, concepts central to the focus of nursing have included person, health, environment, and nursing. ¹³ Florence Nightingale defined nursing as an art and a science that would take charge of the personal health of the person. ¹⁴ She emphasized the importance of the interrelationship between the individual and the environment, astute observation, proper communication skills, and accurate record keeping. This perspective has contributed to the foundation of a knowledge base unique to nursing and continues to be relevant today.

This historical orientation is maintained within the American Nurses Association’s (ANA’s) landmark document Nursing: A Social Policy Statement.¹ The document delineates the nature and scope of nursing practice and the characteristics of nursing specialization. It is further used as a framework for understanding nursing’s relationship with society and nursing’s obligation to those receiving nursing care. The policy statement was revised in 1995 to represent clinical nursing practice as it has evolved and to set directions for the future. Some values and assumptions that serve as the underpinnings of this document were named: (1) humans manifest an essential unity of mind, body, and spirit; (2) human experience is contextually and culturally defined; (3) health and illness are human experiences; and (4) the presence of illness does not preclude health, nor does optimal health preclude illness. ²

The most recent revision, Nursing’s Social Policy Statement, provides the contemporary definition of nursing: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, and populations.³ Nursing care is provided in many care settings and includes professional responsibilities such as patient assessment, nursing diagnosis, outcome identification, care planning, implementation of the plan, and outcome evaluation. Of all the members of the health care team, emergency nurses frequently have the most intensive and extensive contact with the patient. Emergency nurses also function in the role of patient advocate and coordinator of the multidisciplinary team.

Nursing’s scope of practice is dynamic and evolves with changes in the phenomena of concern, in an expanding knowledge base about various patient interventions, and in political, legal, and cultural patterns in society. ² Although nursing and medicine share many concepts such as illness and helping, unique phenomena vary according to the focus and applied practice of each discipline. Phenomena are observable events or facts, able to be explained or predicted through systematic observation. ² The phenomena of central concern for nursing are human responses to illness or injury (e.g., dyspnea, pain, and alteration in consciousness).

This approach to practice is reflected in the use of the nursing process, which serves as an organizing framework for nursing practice in a variety of care settings. Although all nurses are responsible for practicing in accordance with this framework, the application may vary because nursing is practiced by nurses who are generalists, nurses who are specialists, and nurses in both basic and advanced practice. With each level, nurses are able to perform at the continuum from novice to expert. ⁵ In addition, emergency nurses have chosen to develop expertise in the specialty practice of emergency care.

The specialty practice of emergency nursing emerged within the past 35 years. Emergency nursing is distinct due to the characteristics of the emergency patients, environment, and specific body of knowledge required. ¹² Reflecting the emphasis on and need for emergency nursing care, the Emergency Department Nurses Association (EDNA) was chartered in December, 1970, primarily by the organizing efforts of two emergency nurses, Anita Dorr in New York and Judith Kelleher in California. In 1985 the association name was changed to the Emergency Nurses Association (ENA).

The specialty practice of emergency nursing is guided by the association’s vision and mission statement: “ENA leads the way in knowledge, resources, and responsiveness for emergency nurses, their patients and families.”⁸ The vision and mission are accomplished by directing the association’s members to do the following:

Furthermore, the ENA Code of Ethics expects the emergency nurse to do the following⁸:

The first edition of the Core Curriculum for Emergency Nursing, published in 1975, identified a body of knowledge necessary for emergency nursing practice. Emergency nurses must possess a broad scope of knowledge and skills to care for those with a variety of health problems. Standards of Emergency Nursing Practice (1983) provided a foundation for the growth of emergency nursing. In 1991 ANA published Standards of Clinical Nursing Practice.⁴ These practice and professional performance standards helped clarify and support the ability to define nursing practice in all areas where nursing care was delivered.

During the 1990s these standards shaped nursing practice and provided a framework for emergency nurses and ANA to foster a collaborative approach to defining the practice of nursing. In 1992 practice standards from the ANA were incorporated into the Standards of Emergency Nursing Practice to further delineate the role and function of the emergency nurse, enhance the quality and consistency of emergency nursing care, and provide criteria to evaluate the quality of emergency nursing practice. The ENA adapted the ANA definition of nursing found in Nursing: A Social Policy Statement to include the diagnosis and treatment of human responses to actual or potential, sudden or urgent, physical or psychosocial problems that are primarily episodic and acute in nature.

The following standards of emergency nursing practice are authoritative statements developed by the ENA that (1) reflect the values and priorities for emergency nurses, (2) provide direction for professional emergency nursing practice, and (3) provide a framework for evaluation of the practice. ¹²

Emergency nursing does not occur in a vacuum. Collaborative practice brings together health care professionals with distinct and complementary knowledge and skills (e.g., prehospital providers, emergency department physicians and nurses, trauma surgeons, respiratory therapists, radiologists, and pharmacists) to enhance the delivery of emergency care. This practice can address complex patient needs within a framework of quality, cost, and access. The primary commitment is to the patient, family, groups, and the community. ¹¹ This commitment is directed to clinicians, managers, and health care organizations through ENA’s position statement, Autonomous Emergency Nursing Practice⁹:

Coalitions are fundamental for creating successful changes within patients, families, groups, and communities. Commonly a joint purpose or activity or clinical dilemma may result in the formation of a permanent or temporary team that is likely to embrace collaborative practice. Coalitions may be built around any issue and on any scale, from neighborhood to national impact. The Emergency Nurses Association’s Procedural Sedation Consensus Statement was successfully drafted following the formation of a coalition of professional organizations. ⁹ Successful coalition building is more likely to occur when the following are present¹⁵:

Emergency nurses are actively involved in community education programs because they serve to reduce the risk and consequences of disease, illness, and injury. The ultimate outcome is achieved through primary, secondary, and tertiary prevention. ⁹