A Framework for Standardizing Emergency Nursing Education and Training Across a Regional Health Care System: Programming, Planning, and Development via International Collaboration



      The challenges related to providing continuing education and competence management for emergency nurses are not unique to any one organization, health system, or geographic location. These shared challenges, along with a desire to ensure high-quality practice of emergency nursing, were the catalyst for an international collaboration between emergency nurse leaders in Region Zealand, Denmark, and nurse leaders and educators from a large academic medical center in Boston, Massachusetts. The goal of the collaboration was to design a competency-based education framework to support high-quality emergency nursing care in Region Zealand. The core objectives of the collaboration included the following: (1) elevation of nursing practice, (2) development of a sustainable continuing education framework, and (3) standardization of training and nursing practice across the 4 emergency departments in Region Zealand.


      To accomplish the core objectives, a multi-phased strategic approach was implemented. The initial phase, the needs assessment, included semi-structured interviews, a self-evaluation of skills of all regional emergency nurses, and a survey regarding nursing competency completed by emergency nurse leadership. Two hundred ninety emergency nurses completed the self-evaluation. The survey results were utilized to inform the strategic planning and design of a regional competency-based education framework.


      In 18 months, and through an international collaboration, emergency nursing education, training, and evaluation tools were developed and integrated into the 4 regional emergency departments. Initial feedback indicates that the education has had a positive impact. The annual competency day program has continued through 2021 and is now fully institutionalized within the regional emergency nursing continuing education program. Furthermore, use of this innovative education framework has expanded beyond the emergency department to other regional nursing specialties.

      Discussion and Conclusion

      Through this unique collaboration with regional and international participants, a sustainable, regional emergency nursing education program was developed that has elevated and standardized the practice of emergency nurses in Region Zealand, Denmark. This program development can serve as a model for region-wide or health care system–wide collaborations in other countries.

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        • Harding A.D.
        • Walker-Cillo G.E.
        • Duke A.
        • Campos G.J.
        • Stapleton S.J.
        A framework for creating and evaluating competencies for emergency nurses.
        J Emerg Nurs. 2013; 39: 252-264https://doi.org/10.1016/j.jen.2012.05.006
        • Zaleski M.E.
        ENA Position Statement: emergency nurse orientation.
        J Emerg Nurs. 2019; 45: P551-P555https://doi.org/10.1016/j.jen.2019.07.008
        • Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine
        The Future of Nursing: Leading Change, Advancing Health.
        National Academies Press, Washington, DC2011
        • Penz K.
        • D’Arcy C.
        • Stewart N.
        • Kosteniuk J.
        • Morgan D.
        • Smith B.
        Barriers to participation in continuing education activities among rural and remote nurses.
        J Contin Educ Nurs. 2007; 38: 58-66https://doi.org/10.3928/00220124-20070301-03
        • Bell S.A.
        • Oteng R.
        • Redman R.
        • et al.
        Development of an emergency nursing training curriculum in Ghana.
        Int Emerg Nurs. 2014; 22: 202-207https://doi.org/10.1016/j.ienj.2014.02.002
      1. Sjaelland R. About Region Sjaelland. Accessed September 13, 2021. https://www.regionsjaelland.dk/kampagner/english/Sider/default.aspx2021

      2. Sjaelland R. Hospitals and departments in Region Zealand. Accessed September 13, 2021. https://www.regionsjaelland.dk/Kampagner/English/Hospitals/Sider/default.aspx2021

        • McCoy C.A.
        • Castner J.
        Logic models for program evaluation in emergency nursing.
        J Emerg Nurs. 2020; 46: 12-15https://doi.org/10.1016/j.jen.2019.11.005
        • Holliman C.J.
        • Kirsch T.D.
        • Green G.B.
        • Wolfson A.B.
        • Tom P.A.
        Guidelines for evaluation of international emergency medicine assistance and development projects.
        Ann Emerg Med. 1997; 30: 811-815https://doi.org/10.1016/S0196-0644(97)70054-4
        • Thomas T.L.
        Developing and implementing emergency medicine programs globally.
        Emerg Med Clin North Am. 2005; 23: 177-197https://doi.org/10.1016/j.emc.2004.09.005
      3. U.S. Department of Health and Human Services. Decision tool: am I doing human subjects research? Accessed September 13, 2021. https://grants.nih.gov/policy/humansubjects/hs-decision.htm

        • Emergency Nurses Association
        Emergency Nursing Core Curriculum.
        Saunders, 2007
        • Benner P.
        • Sutphen M.
        • Leonard V.
        • Day L.
        A new approach to nursing education.
        In: Educating Nurses: A Call for Radical Transformation. Jossey-Bass, 2010: 81-91
        • Curley M.A.
        Patient-nurse synergy: optimizing patients’ outcomes.
        Am J Crit Care. 1998; 7: 64-72https://doi.org/10.4037/ajcc1998.7.1.64
        • Emergency Nurses Association
        Emergency Nursing: Scope and Standards of Practice.
        Emergency Nurses Association, 2011
        • Knowles M.S.
        • Holton E.F.
        • Swanson R.A.
        The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development.
        Taylor and Francis, 2005
        • Ali J.
        • Adam R.
        • Butler A.K.
        • et al.
        Trauma outcome improves following the advanced trauma life support program in a developing country.
        J Trauma. 1993; 34: 890-899https://doi.org/10.1097/00005373-199306000-00022
        • Arnold J.L.
        International emergency medicine and the recent development of emergency medicine worldwide.
        Ann Emerg Med. 1999; 33: 97-103https://doi.org/10.1016/S0196-0644(99)70424-5
        • Arnold J.L.
        • Holliman C.J.
        Lessons learned from international emergency medicine development.
        Emerg Med Clin North Am. 2005; 23: 133-147https://doi.org/10.1016/j.emc.2004.10.001
        • Holliman C.J.
        • Vanrooyen M.J.
        • Green G.B.
        • et al.
        Planning recommendations for international emergency medicine and out-of-hospital care system development.
        Acad Emerg Med. 2000; 7: 911-917https://doi.org/10.1111/j.1553-2712.2000.tb02070.x
        • Kirsch T.D.
        • Holliman C.J.
        • Hirshon J.M.
        • Doezema D.
        The development of international emergency medicine: a role for US emergency physicians and organizations.
        Acad Emerg Med. 1997; 4: 996-1001https://doi.org/10.1111/j.1553-2712.1997.tb03667.x
        • Weiner S.G.
        • Totten V.Y.
        • Jacquet G.A.
        • et al.
        Effective teaching and feedback skills for international emergency medicine “train the trainers” programs.
        J Emerg Med. 2013; 45: 718-725https://doi.org/10.1016/j.jemermed.2013.04.040
      4. Cussen M. International Emergency Medicine Program Sustainability: An Instrumental Case Study Exploring the Dynamics of IEM Program Institutionalization. Master’s thesis. Northeastern University; 2021

        • Clem K.J.
        • Thomas T.L.
        • Wang Y.T.
        • Bradley D.
        United States physician assistance in development of emergency medicine in Hangzhou, China.
        Ann Emerg Med. 1998; 32: 86-92https://doi.org/10.1016/S0196-0644(98)70103-9
        • Hsu E.B.
        • Dey C.C.
        • Scheulen J.J.
        • Bledsoe G.H.
        • Vanrooyen M.J.
        Development of emergency medicine administration in the People’s Republic of China.
        J Emerg Med. 2005; 28: 231-236https://doi.org/10.1016/j.jemermed.2004.07.014
        • Ban K.
        • Mannelli F.
        • Messineo A.
        • et al.
        Building a trauma center and system in Tuscany, Italy.
        Int Emerg Med. 2006; 1: 302-304https://doi.org/10.1007/BF02934765
        • Ban K.M.
        • Pini R.
        • Sanchez L.D.
        • et al.
        The Tuscan emergency medicine initiative.
        Ann Emerg Med. 2007; 50: 726-732https://doi.org/10.1016/j.annemergmed.2007.05.023
        • Ban K.M.
        • Mannelli F.
        • Mooney D.P.
        • et al.
        Developing a pediatric trauma system in Tuscany, Italy: a case study in transformative change.
        J Trauma. 2011; 71: 1442-1446https://doi.org/10.1097/ta.0b013e31820f926f
        • Pirrallo R.G.
        • Wolff M.
        • Simpson D.E.
        • Hargarten S.W.
        Analysis of an international emergency medical service train-the-trainer program.
        Ann Emerg Med. 1995; 25: 656-659https://doi.org/10.1016/S0196-0644(95)70180-X
        • Aghababian R.V.
        • Levy K.
        • Moyer P.
        • et al.
        Integration of United States emergency medicine concepts into emergency services in the new independent states.
        Ann Emerg Med. 1995; 26: 368-375https://doi.org/10.1016/S0196-0644(95)70088-9
        • Bayleygne T.M.
        • Shahar A.
        • Tsadic A.W.
        • et al.
        An international training program to assist with establishing emergency medicine in Ethiopia.
        Ann Emerg Med. 2000; 36: 378-382https://doi.org/10.1067/mem.2000.110012
        • Keyes C.
        • Rodríguez-Gomez G.
        • Quesada-Rodriguez D.
        • Waller J.
        The Costa Rican emergency medicine residency: design and implementation of a new specialty training program in Central America.
        Ann Emerg Med. 1999; 34: 790-795https://doi.org/10.1016/S0196-0644(99)70108-3
        • Doezema D.
        • Sklar D.P.
        • Roth P.B.
        • Rodolico M.P.
        • Key G.
        Development of emergency services in Costa Rica: a collaborative project in international health.
        JAMA. 1991; 265: 188-190https://doi.org/10.1001/jama.1991.03460020038011
        • Erickson T.B.
        • Vanrooyen M.J.
        • Werbiski P.
        • Mycyk M.
        • Levy P.
        Emergency medicine education intervention in Rwanda.
        Ann Emerg Med. 1996; 28: 648-651https://doi.org/10.1016/S0196-0644(96)70088-4
        • Oteng R.A.
        • Donkor P.
        The Ghana emergency medicine collaborative.
        Acad Med. 2014; 89: S110-S111https://doi.org/10.1097/ACM.0000000000000319
        • Ciottone G.R.
        • Old A.
        • Nicholas S.
        • Anderson P.D.
        Implementation of an emergency and disaster medical response training network in the commonwealth of independent states.
        J Emerg Med. 2005; 29: 221-229https://doi.org/10.1016/j.jemermed.2005.01.023


      Shelley Calder, Director, Magnet Program, Beth Israel Deaconess Medical Center, and Nurse Education Consultant, Emergency Medicine International Projects, Harvard Medical Faculty Physicians, Boston, MA.


      Bettina Tomczyk is Healthcare Specialist Consultant, Department of Primary and eHealth Care, Region Zealand, Denmark.


      Meaghan Elizabeth Cussen is Director of Operations, Emergency Medicine International Projects, Harvard Medical Faculty Physicians, Boston, MA.


      Gitte Juul Hansen is Nurse Educator, Emergency Department, Zealand University Hospital, Køge, Region Zealand, Denmark.


      Tom Jimmy Hansen is Nurse Director, Emergency Department, Nykøbing Falster Hospital, Region Zealand, Denmark.


      Jette Jensen is Nurse Director, Anesthesiology Department, Holbaek Hospital, Region Zealand, Denmark.


      Poul Mossin is Nurse Director, Emergency Department, Zealand University Hospital, Køge, Region Zealand, Denmark.


      Bettina Andersen is Nurse Manager, Emergency Department, Zealand University Hospital, Køge, Region Zealand, Denmark.


      Christina Orsted Rasmussen is Nurse Educator, Emergency Department, Nykøbing Falster Hospital, Region Zealand, Denmark.


      Peter Schliemann is Senior Consultant & Project Manager, Region Zealand, Denmark.