Abstract
AIM: To explore Registered Nurses' experiences and perceptions of using the National Early Warning Score in the U.K. as part of the recognition and management of acute adult patient deterioration. DESIGN: Hermeneutic Phenomenological design. METHODS: Sixteen Registered Nurses from a U.K. NHS hospital were interviewed using an interpretative phenomenological approach (2019-2020). RESULTS: Registered Nurses' use of NEWS highlighted 3 risk areas: delegation of vital sign monitoring to unregistered staff leading to uncertainty and delayed escalation, junior nurses' over-reliance on NEWS and deference to expertise, and senior nurses' self-management of deteriorating patients. The workplace culture revealed frequent compromises and limited learning opportunities. CONCLUSION: When using NEWS, failure to recognise associated risks threatens patient safety. Wrong decisions at the three 'pinch points' may lead to missed chances in preventing deterioration. Incorrect judgements may lead to unrecognised patient deterioration or inappropriate management leading to preventable adverse events. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The way in which NEWS is used by healthcare professionals brings inherent patient safety risks. Addressing education gaps and fostering a supportive culture in nursing, valuing and enhancing nurses' clinical judgement, is crucial for mitigating these risks and ensuring patient safety. IMPACT: The study deepens understanding of nurses' use of NEWS and identifies components affecting the recognition of patient deterioration. REPORTING METHOD: Adherence to the EQUATOR guidelines SRQR confirmed. PATIENT OR PUBLIC CONTRIBUTION: Service user involvement was included within the design of the study and ethical approval.