Structural empowerment of triage nurses in the redirection of low-acuity patients in a Swiss emergency department: a mixed-methods convergent pilot study

Similar to most high-income countries, almost 30% of consultations in Swiss hospital emergency departments (EDs) involve patients with low-severity levels. Redirecting patients with low-severity conditions to non-hospital facilities has proven effective internationally in reducing ED overcrowding, wait times, and improving patient satisfaction without compromising safety. Specifically, this study aims to understand the conditions under which the patient redirection role is exercised in triage. We conducted a mixed method study among ED triage nurses (n = 23) in an urban teaching hospital in Western Switzerland. Data collection combined non-participant observation and semi-structured interviews. Data were analyzed through a systematic coding process where common themes across the studies were identified. Structural empowerment assessed using the Conditions of Work Effectiveness Questionnaire-II evaluated six dimensions on a 5-point Likert scale (opportunities, access to information, organizational support, access to resources, formal power, informal power). Quantitative results showed high scores for opportunities and informal power, while access to information and organizational support was significantly lower. These trends converged with the qualitative data, with triage nurses describing real autonomy, but constrained by a lack of clinical feedback and variable interprofessional support. Although exploratory, our findings highlight the importance of organizational initiatives focusing on feedback loops, interprofessional support and continuous learning processes. Future research should transition from cross-sectional studies to longitudinal designs to assess the temporal impact of organizational changes, such as implementing formal feedback mechanisms on structural empowerment levels.