An update to the Emergency Nursing
Standards of Canadian Practice
Laila Brown, Leslie Conlon, Holly Feist, Paul Lacey, Heather Leonard, Barb McGovern, Heather Peddle-Bolivar,
Janet Roth, Sherry Stackhouse, Kandice Usher-Vansickle, and Erin Vanallen
Introduction
The 2025 NENA Emergency Nursing Standards of
Canadian Practice document was revised in response to
the evolving landscape of emergency nursing environments and practice in Canada. A shift in societal and healthcare
priorities within the emergency department (ED) resulted in the
addition of the following concepts within the emergency nursing
standards: equity, diversity, inclusion, and accessibility (EDIA);
intersectionality; overcrowding; and violence language.
A standards document is required due to the complex nature
of emergency care that requires the nurse to attain a specialized
body of knowledge, skills, and competencies (Healthdirect,
2021; Little et al., 2021). This was accomplished over a 2-year
period by a group of dedicated NENA members, who reviewed
current trends and issues unique to emergency nursing practice.
This article outlines the updates to the NENA standards, and
discusses the methods and resources utilized. The standards
help guide and shape competencies and are arranged into four
overarching domains. These domains organize the framework
for the novice-to-expert ED nursing practice.
Methods
In June 2023, a call for volunteers was requested of the NENA
membership to update the NENA Emergency Nursing Scope
and Standards of Canadian Practice document last published in
2018. A group of approximately 20 ED nurses from seven provinces and territories collaborated, bringing a true pan-Canadian
perspective. These members represented a diverse clinical practice background, including ED staff nurses, clinical and academic educators, and managers from emergency departments
and urgent care centres.
An environmental assessment included relevant publications
and articles, industry reports, news articles, and expert opinions,
to identify emerging patterns and challenges to the practice of
ED nursing. When developing the standards, the working group
considered different practice environments across the country in
which emergency nurses practise, from remote nursing stations
to tertiary care centres. Subsequently, a critical literature review
was performed to delve deeper into select issues. This allowed
for the development of a robust, contemporary, and contextually
relevant ED Standards document.
A review of existing standards and theoretical frameworks
from associations and national emergency bodies, such as
the Canadian Association of Emergency Physicians (CAEP),
the Emergency Nursing Association (ENA), and Canadian
Association of Critical Care Nurses (CACCN), was conducted
for this update.
Based on this analysis, the NENA working group determined a
theoretical framework was required as the basis for the revisions
to the existing standards. After collaboration and discussion,
consensus was obtained that the Canadian Nurses’ Association
(CNA) framework would provide a strong foundation for the
development of broad, overarching emergency nursing standards for ED nurses in all practice settings across Canada.
The working group incorporated, revised, and synthesized this
research into various drafts. Working within deadlines, the final
draft was presented to the NENA Board of Directors and general membership. Feedback was considered for integration into
the final version, which was approved by the Board.
Key differences
The working group reviewed the existing title, NENA
Emergency Nursing Scope and Standards of Canadian Practice,
and removed the word Scope to be consistent with other international emergency nursing bodies. This resulted in the creation of the first edition of the Emergency Nursing Standards of
Canadian Practice. Scope refers to the regulatory aspects of nursing practice, which are set out by the legislation defining controlled acts and provides the authorizing mechanisms for such
acts, whereas the word standard refers to a benchmark for the
nurse to meet when carrying out nursing practice.
In this edition of the Standards, the content was organized into
four overarching domains including Clinical Practice, Relational
Practice, Professional Development, and Legal Considerations.
New graphics were included to represent the frameworks and
conceptual models. This use of graphics increases clarity and
readability (see image below).
The next task of the association is to update the NENA
Emergency Nursing Competency Based Practice Framework,
which will act as a companion to guide ED nurses in meeting the
NENA emergency standards.
To serve as a backdrop for emergency nursing quality care and
patient advocacy, intersectionality was identified as a relevant,
person-centred concept. The inclusion of the wheel of privilege
and power (Immigration, Refugees and Citizenship Canada
[IRCC], 2022), demonstrates that those depicted on the
ISSN: 2293-3921 (print) | ISSN: 2563-2655 (online) | https://doi.org/10.29173/cjen
Print publisher: Pappin Communications http://pappin.com | Online publisher: University of Alberta www.library.ualberta.ca/publishing/open-journals
Canadian Journal of Emergency Nursing · Vol. 48, No. 3, Fall 2025 5
periphery have less privilege or power
and, therefore, experience greater stigmatization and bias, which can impact
access to healthcare, health equity, and
overall patient experience.
It was essential to highlight the increasing trend of violence experienced by ED
nurses, including exposure to patients
experiencing intimate partner violence
and human trafficking. Given this phenomenon, self-care is essential for emergency nurses.
The environmental phenomenon of ED
overcrowding and capacity was essential
to include in the updates, as this requires
specific navigation and support. Multiple
factors were identified that contribute to
ED overcrowding, which may have medicolegal implications for the ED nurse.
Conclusion
This edition of the ED standards document is a cornerstone resource for ED
nurses, healthcare leaders, and organizations, with a focus on improving and
advancing ED nursing practice throughout Canada. Built on essential theoretical foundations that are central to ED
practice, it fosters a contextual comprehension of ED nursing and establishes
standards for professional practice in the
field. This resource (Appendix 1), which
is beneficial across the novice-to-expert
continuum of ED nurses, will be available on the NENA website.