How triage nurses use discretion: A literature review

Abstract

Discretion is quintessential for professional work. This review aims to understand how nurses use discretion when they perform urgency assessments in emergency departments with formalised triage systems—systems that are intended to reduce nurses’ use of discretion. Because little research has dealt explicitly with this topic, this review addresses the discretionary aspects of triage by reinterpreting qualitative studies of how triage nurses perform urgency assessments. The review shows (a) how inexhaustive guidelines and a hectic work environment are factors that necessitate nurses’ use of discretion and (b) how nurses reason within this discretionary space by relying on their experience and intuition, judging patients according to criteria such as appropriateness and believability, and creating urgency ratings together with their patients. The review also offers a synthesis of the findings’ discretionary aspects and suggests a new interactionist dimension of discretion.