Shortcuts in knowledge mobilization: An ethnographic study of advanced nurse practitioner discharge decision-making in the emergency department.

AIM To understand how advanced nurse practitioners use knowledge to inform their discharge decision-making in the emergency department. BACKGROUND Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department. DESIGN An ethnographic study was undertaken in an emergency department in the North of England. METHOD Data were collected by observation (n = 5) and semi-structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes. FINDINGS In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision-making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge. DISCUSSION Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring. CONCLUSION Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision-making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department. IMPACT The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision-making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence-based discharge decision-making.