Implications for practice and research

• There is a dissonance between providing minimal and adequate nursing care in emergency units and meeting 4 h treatment targets.

• Qualitative research can add important information about the impact for patients and nurses on meeting 4 h treatment targets.

• Future research needs to focus on factors that impact on emergency practice and the relationship to targets such as triage, access and bed block.

Context

Many emergency departments (ED) are expected to discharge patients within a set time frame, usually 4 h; referred to as waiting targets. These targets were introduced to resolve perceived excessive waiting times in the ED. These targets do not take into consideration increases in ED presentations and the complexity of patient problems. Overcrowding in EDs often results in patients waiting in ambulances, and therefore other ambulances may be unable to …