272 mance indicators and patient satisfaction. Emergency NPs have resulted in reduced patient waiting times [8] and total length of stay [9], reduced numbers of patients not waiting for treatment [10], increased patient and staff satisfaction [11–14] and improved cost-effectiveness [15]. Although NPs have been suggested as suitable procedural skills educators for junior medical staff [16], there is concern that emergency NPs may limit training opportunities for junior medical staff and medical students due to competition for low acuity patients [1]. As part of the Australian Government’s response to the medical workforce shortage [17], a dramatic increase in funding for medical school places will result in an increase in the number of interns by as much as 90% by 2012 [18]. With EDs already under pressure due to senior staff shortages [18], access block and high demand [19], it is unclear whether EDs will have the capacity to support increasing numbers of medical graduates. In this context, NPs may offer certain advantages; however, it is unclear how NPs are perceived by emergency medical staff. As highlighted by others [16], medical endorsement for the NP role is pivotal to their successful implementation in EDs throughout Australia. Compared to the UK, Canada and the USA, Australia has been slow to introduce the NP role. Inadequacies of the traditional nursing model and the traditional medical model as the basis for NP practice have sparked a paradigm shift among some, with the emergence of the Shuler Nurse Practitioner Practice Model [20]. This model builds on the Anderson Model [21] from the late 1970s, which emphas- ised joint decision making in the context of a holistic approach to the person being treated. The Shuler Model is more wellness-orientated and acknowledges that the prac- tice of NPs is a blend of nursing and medicine and provides a framework from which NPs can delineate their health provider role from one that is solely nursing or medical. Through this model, the NP role can address deficiencies in traditional care delivery roles and augment health care. There has been some resistance from medical staff in Australia to the introduction of such practitioners, despite the theoretical advantages. In 2008, St. Vincent’s Hospital Melbourne was contracted by the Commonwealth of Australia’s Depart- ment of Health and Ageing to conduct a capacity analysis of EDs. Using interview methodology, this Emergency Medicine Capacity Assessment Study (EMCAS) sought to identify the capacity and strategies of EDs and staff to support increasing numbers of medical graduates. As part of this project participants were asked about their perceptions of NPs and their value in addressing the medical workforce shortage facing EDs. This part of the project reports the perceptions of NPs by ED medical staff. Int J Emerg Med (2010) 3:271–278 Methods Project oversight The methodology of this study has previously been described in detail [22]; however, in brief the study proceeded as follows. The EMCAS was conducted by St. Vincent’s Hospital Melbourne, overseen by a Steering Committee which reviewed interview questions, pilot data collection, national data collection and data analysis phases. Interviews Interview questions were developed by a Fellow of the Australasian College for Emergency Medicine (FACEM) with input from a researcher/psychologist and a project officer experienced in interview methodology and work- force planning. Face validity of draft interview items was ensured through iterative feedback between project staff and the Steering Committee. Further refinement of ques- tions and methodology was undertaken using a pilot sample of doctors employed at St. Vincent’s Hospital Melbourne. Data from this sample were excluded from final analyses. The final interview schedule included up to 160 items for ED Directors/Directors of EM Training (DEMT) and up to 97 items for registrar and intern participants. Using a semi-structured telephone interview, the data items sought graded responses using Likert scales or ordinal multi- category scales to enable quantitative statistical analysis. Open-ended questions were used to elicit qualitative responses. Four questions specifically related to NPs; ED Directors were asked whether they had NPs on staff, and both ED Directors and DEMT were asked to rate their agreement to two attitudinal statements regarding NPs which were answerable on a Likert scale: “Nurse practi- tioners can replace interns in the ED”, and “Nurse practitioners can replace postgraduate medical years 2, 3 or later in the ED”. Finally all interviewees were asked the open-ended question, “Do you have any comments on the role of NPs in the ED?”. Nationwide study A quota sample of doctors were recruited which included ED Directors, DEMT, advanced trainees in EM or prevocational doctors (interns) who had completed at least half their EM rotation. For the larger Australian States, participants were drawn from a quota sample of two city, two metropolitan and two provincial hospitals of each State/Territory. Hospital selection was based on those that were deemed most representative of other city/metropoli-