“Sometimes my job is like doing a quiz but never getting the answers”: Emergency nurses' experience of patient outcome ambiguity – a survey study

INTRODUCTION: Emergency nursing involves rapid decision-making, undifferentiated patient presentations, and limited opportunity for follow-up, often leaving patient and family outcomes unknown. Although outcome ambiguity has been linked to occupational distress, its nature and impact remain poorly understood. Existing knowledge is largely inferred from broader research on burnout and secondary trauma, leaving a gap in understanding how 'not knowing' shapes the professional and personal lives of emergency nurses. OBJECTIVES: This study aimed to explore the frequency, scope, and impact of ambiguity relating to patient and/or significant others' clinical, personal, and social outcomes, and to identify strategies used by emergency nurses to mitigate its effects. METHODS: A 17-item online survey was analysed using descriptive and inferential statistics and reflexive thematic analysis of free-text responses. RESULTS: Almost all participants (99%) reported experiencing outcome ambiguity, most related to whether a patient survived or died. Negative impacts were reported on professional practice (74.8%) and personal life (84.9%). Three themes describing ambiguity salience were identified in free-text data: the impact of extreme events, the vulnerability of paediatric patients, and impacts on the clinician self. CONCLUSION: Outcome ambiguity is pervasive in emergency nursing and affects both professional practice and personal wellbeing. Rare but extreme cases carry disproportionate emotional weight, highlighting the inseparability of clinical, emotional, and ethical dimensions of emergency nursing. Addressing ambiguity is critical to supporting emergency nurses' wellbeing.