The role of optimizing nurses in emergency care decision making: A policy review

Nurses play a critical role in emergency departments, where timely and independent clinical decision-making is essential. However, their ability to make decisions is heavily influenced by the policy frameworks that govern their practice. This study aims to review and compare national policy frameworks that support nurses’ clinical decision-making in emergency care settings, with a focus on four countries. A structured policy review was conducted using six major databases and repositories, including PubMed, ScienceDirect, WHO IRIS, the Indonesian Ministry of Health, ICN, and PPNI. The search focused on documents published between 2014 and 2024. Following the PRISMA 2020 flow, four policy documents met the inclusion criteria and were selected for final synthesis, each representing Indonesia, Australia, the United Kingdom, and the United States. The findings reveal that while Indonesia has basic legal provisions for nursing roles, it lacks operational policies that enable clinical autonomy in emergency settings. In contrast, Australia, the United Kingdom, and the United States have more advanced frameworks that include protocol-based authority, standardized training, and structured interdisciplinary collaboration for emergency nurses. Strengthening Indonesia’s emergency nursing policies requires adopting best practices from countries with more developed systems. Expanding nurses’ clinical authority, formalizing competency-based training, and integrating decision-making protocols are essential to improve responsiveness and quality of care in emergency departments.