274 Int J Emerg Med (2010) 3:271–278 Table 2 ED Directors’ and DEMTs’ level of agreement about whether NPs can replace the interns in the ED Strongly disagree Disagree Neutral Agree Strongly agree Not applicable Total NPs can replace the interns in the ED n 8 % 13.1 NPs can replace the PGY 2, 3 or latera in the ED n 12 % 19.7 27 44.3 27 44.3 4 6.6 4 6.6 17 27.9 15 24.6 1 1.6 0 0.0 4 6.6 3 4.9 61 100 61 100 PGY postgraduate year a Excludes trainees For example: “NPs definitely have a role in the ED but my two have not defined their role, when I ask one what she does she can’t tell me: she tells me that what she does is governed by her scope of practice and when I ask her what that is she gives me a large book and when I ask her to give me an A4 summary of what she does it never happens”. “We have some NPs and we find them to be very useful but they are limited in their ability to do things, they need clearly prescribed roles and types of patients to deal with, and they are very good at this”. “They have a role that is well defined, they work well but are protocol driven, do not work independently. An important adjunct but not a solution”. “I think there is a very defined role and it is a useful role to have if the ED can provide support and supervision”. “They do have a role but at this stage they are still relatively new so their impact and best role is still to be determined”. Theme 2: scope and appropriateness of practice Many participants responded with comments related to the scope of practice of NPs, the appropriateness of this and the specific tasks that they may perform. While some com- ments were related to the number and variety of suitable tasks, other comments were related to limitations within the role, suitability to undertake specific tasks such as education/training for other staff or geographic locations that were most suitable for the role. For example: “…very useful in limited minor cases, interns and RMOs [resident medical officers] can do much more complex cases”. “NPs are mainly useful for quick in and quick out, minor operations, they can be useful here, interns can’t make these decisions”. “I think NPs are still finding their place in the ED, people use them in different ways, they are good if they have their scope of practice well defined and that being limited to the skills they have e.g. in my ED an NP does not see a chest pain because there is no point because a doc has to see the patient anyway but for lacerations where it can be quickly done by the NP and the patient goes home, this is good otherwise it can be a waste of time”. “The government should embrace them as they are great for fast track and other core services”. “NPs serve a role as seeing the minor walking wounded but they can’t assess the patients that junior staff and interns are capable of seeing. They can see minor cuts, fractures etc. but they can’t assess chest pains and abdominal pain etc. and other procedures that doctors can do e.g. pneumothorax, chest tubes etc. I think they have a role in the fast track area but that’s about it”. “The NPs because of their limited role become very good at what they are doing: they see the minor spectrums of illness e.g. muscle injury or patients with clear management pathways”. “They can be valuable not just with their specialist skills but they can be very valuable teachers partic- ularly with helping international graduates develop their skills”. “Personally I see no role for them in urban EDs, a huge role for them in the rural settings but no role in our ED. I have worked with an NP in another State and because their roles are so specific they can’t practice outside of them”. “I think they are empowering and a great training resource for junior doctors”. Theme 3: separation/overlap of NP role and medical roles Some interviewees responded with comments regard- ing the NP role in the context of medical roles within the