A Comprehensive Narrative Review: Training and Competency Development for Health Assistants Supporting Nursing-Led Procedures in Emergency Medicine: Focus on Point-of-Care Ultrasound, Wound Management, and Vascular Access
Abstract
Background: The escalating demands on Emergency Departments (EDs) worldwide necessitate innovative workforce models to enhance efficiency and maintain quality of care. Expanding the scope of practice for Health Assistants (HAs)—including Nursing Assistants, Emergency Medical Technicians, and Patient Care Technicians—to support nursing-led advanced procedures represents a promising but complex strategy. Aim: This narrative review synthesizes current evidence (2015-2024) on the training, competency development, and integration of HAs in supporting three critical nursing-led domains in emergency medicine: Point-of-Care Ultrasound (POCUS), wound management, and vascular access. Methods: A systematic search of PubMed, CINAHL, Scopus, and Google Scholar was conducted. The narrative synthesis analyzed themes of joint training program structures, competency assessment frameworks, patient safety outcomes, and implementation barriers. Results: Evidence indicates that structured, simulation-based training programs for HAs in defined procedural support roles are feasible and can improve department throughput and nurse satisfaction. However, successful integration hinges on robust interprofessional education, clear competency frameworks, and addressing significant barriers, including regulatory variability, resistance to role expansion, and resource limitations for ongoing training. Conclusion: Strategically deploying trained HAs to support emergency nurses in specific procedural tasks is a viable response to ED crowding. It requires a systematic approach co-developed by nursing, medicine, and hospital leadership, emphasizing standardized training, rigorous competency verification, and continuous quality assurance to ensure patient safety and team efficacy.
Full text article
References
Adhikari, S., Schmier, C., & Marx, J. (2015). Focused simulation training: emergency department nurses’ confidence and comfort level in performing ultrasound-guided vascular access. The Journal of Vascular Access, 16(6), 515-520. https://doi.org/10.5301/jva.5000436
Alanazy, A. R. M., & Alruwaili, A. (2023, August). The global prevalence and associated factors of burnout among emergency department healthcare workers and the impact of the COVID-19 pandemic: a systematic review and meta-analysis. In Healthcare (Vol. 11, No. 15, p. 2220). MDPI. https://doi.org/10.3390/healthcare11152220
Alexandrou, E., Ray‐Barruel, G., Carr, P. J., Frost, S., Inwood, S., Higgins, N., ... & Rickard, C. M. (2015). International prevalence of the use of peripheral intravenous catheters. Journal of hospital medicine, 10(8), 530-533. https://doi.org/10.1002/jhm.2389
Amick, A. E., Feinsmith, S. E., Davis, E. M., Sell, J., Macdonald, V., Trinquero, P., ... & Barsuk, J. H. (2022). Simulation-based mastery learning improves ultrasound-guided peripheral intravenous catheter insertion skills of practicing nurses. Simulation in Healthcare, 17(1), 7-14. DOI: 10.1097/SIH.0000000000000545
Austin, E. E., Blakely, B., Tufanaru, C., Selwood, A., Braithwaite, J., & Clay-Williams, R. (2020). Strategies to measure and improve emergency department performance: a scoping review. Scandinavian journal of trauma, resuscitation and emergency medicine, 28(1), 55. https://doi.org/10.1186/s13049-020-00749-2
Bagley, K. (2022). Development and implementation of an ultrasound-guided peripheral intravenous catheter education program for critical care nurses. Dimensions of Critical Care Nursing, 41(4), 182-189. DOI: 10.1097/DCC.0000000000000528
Bahl, A., Haddad, L., Hoerauf, K., Mares, A., & Alsbrooks, K. (2023). The clinical and economic burdens of infiltration and extravasation with peripheral intravenous catheters: a contemporary narrative review. Int J Nurs Health Care Res, 6, 1436. www.doi.org/10.29011/2688-9501.101436
Bhargava, V., Su, E., Haileselassie, B., Davis, D., & Steffen, K. M. (2022). Ultrasound education improves safety for peripheral intravenous catheter insertion in critically ill children. Pediatric research, 91(5), 1057-1063. https://doi.org/10.1038/s41390-021-01568-6
Buswell, M., Lumbard, P., Prothero, L., Lee, C., Martin, S., Fleming, J., & Goodman, C. (2016). Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence. Emergency Medicine Journal, 33(1), 61-70. https://doi.org/10.1136/emermed-2014-203941
Calcutt, T., Brady, R., & Liew, K. (2022). Paediatric ultrasound‐guided vascular access: Experiences and outcomes from an emergency department educational intervention. Journal of Paediatrics and Child Health, 58(5), 830-835. https://doi.org/10.1111/jpc.15848
Carr, P. J., Rippey, J. C., Budgeon, C. A., Cooke, M. L., Higgins, N., & Rickard, C. M. (2016). Insertion of peripheral intravenous cannulae in the emergency department: factors associated with first-time insertion success. The journal of vascular access, 17(2), 182-190. https://doi.org/10.5301/jva.5000487
Crisanti, A. S., Earheart, J., Deissinger, M., Lowerre, K., & Salvador, J. G. (2022). Implementation challenges and recommendations for employing peer support workers in emergency departments to support patients presenting after an opioid-related overdose. International Journal of Environmental Research and Public Health, 19(9), 5276. https://doi.org/10.3390/ijerph19095276
Farhani, F., Shahrbanian, S., Auais, M., Hekmatikar, A. H. A., & Suzuki, K. (2022). Effects of aerobic training on brain plasticity in patients with mild cognitive impairment: a systematic review of randomized controlled trials. Brain Sciences, 12(6), 732. https://doi.org/10.3390/brainsci12060732
Graig, L., Alper, J., & Friedman, K. (Eds.). (2020). Building the workforce we need to care for people with serious illness: proceedings of a workshop.
Grover, L., & Fritz, E. (2022). Unlicensed assistive personnel in ambulatory care: A systematic integrative review. Nursing Management, 53(10), 28-34. DOI: 10.1097/01.NUMA.0000853232.62593.6f
Hewitt, J., Alsaba, N., May, K., Noon, H. S., Rennie, C., & Marshall, A. P. (2023). Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature. Australian Critical Care, 36(4), 628-639. https://doi.org/10.1016/j.aucc.2022.08.002
Hoskins, M. J., Nolan, B. C., Evans, K. L., & Phillips, B. (2023). Educating health professionals in ultrasound guided peripheral intravenous cannulation: A systematic review of teaching methods, competence assessment, and patient outcomes. Medicine, 102(16), e33624. DOI: 10.1097/MD.0000000000033624
Jørgensen, R., Laursen, C. B., Konge, L., & Pietersen, P. I. (2021). Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), 83. https://doi.org/10.1186/s13049-021-00897-z
Katz, J., Powers, M., & Amusina, O. (2021). A review of procedural skills performed by advanced practice providers in emergency department and critical care settings. Disease-a-Month, 67(1), 101013. https://doi.org/10.1016/j.disamonth.2020.101013
King, N. M., Habeeb, M., & Helps, S. (2023). The contribution of physician associates or assistants to the emergency department: A systematic scoping review. JACEP Open, 4(3), e12989. https://doi.org/10.1002/emp2.12989
Kroezen, M., van Dijk, L., Groenewegen, P. P., & Francke, A. L. (2011). Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature. BMC health services research, 11(1), 127. https://doi.org/10.1186/1472-6963-11-127
Mailhot, T., Maheu-Cadotte, M. A., Bourbonnais, A., Sillner, A. Y., Charchalis, M., Rodriguez, D., & Lavoie, P. (2023). Unlicensed assistive personnel’s involvement in delivering care to persons with or at risk of delirium: a scoping review protocol. JBI evidence synthesis, 21(6), 1327-1336. DOI: 10.11124/JBIES-22-00248
Manley, K., Martin, A., Jackson, C., & Wright, T. (2016). Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study. BMC health services research, 16(1), 368. https://doi.org/10.1186/s12913-016-1616-y
Melton III, J. D., Blind, F., Hall, A. B., Leckie, M., & Novotny, A. (2016). Impact of a hospitalwide quality improvement initiative on emergency department throughput and crowding measures. The Joint Commission Journal on Quality and Patient Safety, 42(12), 533-542. https://doi.org/10.1016/S1553-7250(16)30104-0
Omoya, O. T., De Bellis, A., & Breaden, K. (2023). Emergency department staff perceptions of their roles in providing end of life care. Australasian Emergency Care, 26(2), 126-131. https://doi.org/10.1016/j.auec.2022.09.001
Pourmand, A., Caggiula, A., Barnett, J., Ghassemi, M., & Shesser, R. (2023). Rethinking traditional emergency department care models in a post-coronavirus disease-2019 world. Journal of emergency nursing, 49(4), 520-529. https://doi.org/10.1016/j.jen.2023.02.008
Rasouli, H. R., Esfahani, A. A., Nobakht, M., Eskandari, M., Mahmoodi, S., Goodarzi, H., & Farajzadeh, M. A. (2019). Outcomes of crowding in emergency departments; a systematic review. Archives of academic emergency medicine, 7(1), e52.
Sarre, S., Maben, J., Aldus, C., Schneider, J., Wharrad, H., Nicholson, C., & Arthur, A. (2018). The challenges of training, support and assessment of healthcare support workers: A qualitative study of experiences in three English acute hospitals. International journal of nursing studies, 79, 145-153. https://doi.org/10.1016/j.ijnurstu.2017.11.010
Soni, N. J., Schnobrich, D., Mathews, B. K., Tierney, D. M., Jensen, T. P., Dancel, R., ... & Lucas, B. P. (2019). Point‐of‐care ultrasound for hospitalists: a position statement of the Society of Hospital Medicine. Journal of hospital medicine, 14(1), E1-E6. https://doi.org/10.12788/jhm.3079
Steinwandel, U., Gibson, N. P., Rippey, J. C., Towell, A., & Rosman, J. (2017). Use of ultrasound by registered nurses—a systematic literature review. Journal of Renal Care, 43(3), 132-142. https://doi.org/10.1111/jorc.12191
Stone, R., Walker, R. M., Marsh, N., & Ullman, A. J. (2023). Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: a systematic integrative literature review. Australasian emergency care, 26(4), 352-359. https://doi.org/10.1016/j.auec.2023.06.001
Thamm, C., Teleni, L., Chan, R. J., Stone, L., & Mccarthy, A. L. (2019). Nurse-led interventions for cancer patients in emergency departments: Systematic review. Collegian, 26(2), 311-319. https://doi.org/10.1016/j.colegn.2018.08.005
Trinkoff, A. M., Yoon, J. M., Storr, C. L., Lerner, N. B., Yang, B. K., & Han, K. (2020). Comparing residential long-term care regulations between nursing homes and assisted living facilities. Nursing outlook, 68(1), 114-122. https://doi.org/10.1016/j.outlook.2019.06.015
Williams, D., Fredendall, L. D., Hair, G., Kilton, J., Mueller, C., Gray, J. D., ... & Kim, J. (2022). Quality improvement: implementing nurse standard work in Emergency Department fast-track area to reduce patient length of stay. Journal of Emergency Nursing, 48(6), 666-677. https://doi.org/10.1016/j.jen.2022.07.009
Wilson, N. J., Pracilio, A., Morphet, J., Kersten, M., Buckley, T., Trollor, J. N., & Cashin, A. (2023). A scoping review of registered nurses' delegating care and support to unlicenced care and support workers. Journal of clinical nursing, 32(17-18), 6000-6011. https://doi.org/10.1111/jocn.16724
Yankam, B. M., Adeagbo, O., Amu, H., Dowou, R. K., Nyamen, B. G. M., Ubechu, S. C., ... & Bain, L. E. (2023). Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities. Pan African Medical Journal, 46(1). https://www.ajol.info/index.php/pamj/article/view/270059
Authors
Copyright (c) 2024 Hussain Ali Al Zaid, Sami Naif Alanazi, Fahad Mobarak Alqahtani, Ahmed Hashim Ahmed Alzahrani, Saleha AIi Brik AAesh, Mariam Mohammed Hassan Aljehani, Salma Mohammed Hassan Aljohani, Arif Mohammed Almotari, Melaf Mohammed Abdullah Alotaibi, Samiah Saleh Alanzi, Abdulrazaq Nafia Alanazi, Mariam Ahmad Aldoukhi
This work is licensed under a Creative Commons Attribution 4.0 International License.