Assessments Under Pressure: Interviews With Triage Nurses in Emergency Departments: An Exploratory Descriptive Qualitative Study

Abstract

Aims: To understand the experiences and decision-making practices of registered nurses when assessing acuity at triage in emergency departments. Design: The study utilised a qualitative exploratory-descriptive design. Methods: Purposive sampling recruited 11 registered nurses with triage experience from across the United Kingdom. Semi-structured online interviews, incorporating practice-based vignettes, were conducted between April and November 2024. Thematic analysis was selected to analyse the data. Results: Three themes were identified: (1) Pressurised decisions, highlighting the effects of overcrowding, staffing shortages and operational burdens; (2) Holistic assessments, revealing the shift from structured to intuitive decision-making as nurses gain experience; and (3) Confidence, competence and emotional wellbeing, illustrating the psychological impacts of triage and the importance of experience and support. Conclusions: This study provides novel insight into how triage nurses navigate acuity assessment in high-pressure environments. It shows how experience, training and institutional culture influence decision-making and wellbeing. It identifies key areas for targeted intervention. Implications for the Profession and/or Patient Care: Triage nurses face substantial cognitive and emotional strain, which may compromise assessment quality and safety. Findings highlight the urgent need for structured triage training, protected time for assessment and access to wellbeing and peer support systems. Impact: What problem did the study address?: A need for current literature exploring the practices and experiences of triage nurses. What were the main findings?: Triage nurses experience significant environmental and emotional pressures, develop decision-making strategies through experience and require enhanced training and support to ensure safe, effective care. Where and on whom will the research have an impact?: Findings are relevant to emergency departments internationally, triage nurses, nurse educators and healthcare leaders. Reporting Method: This study adheared to COREQ reporting guidelines, and a copy of the checklist is attached as Data S1. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.