It is unclear if emergency nurses or paramedics are accountable for patients in ambulances outside emergency departments, and RCN members want clarity on this

The RCN’s Emergency Care Forum seconded a debate at 2025’s congress, calling on RCN council to act on something close to every emergency department (ED) colleague’s heart – accountability of patients waiting outside hospitals in ambulances.

All ED staff are far too familiar with patients being forced to wait in ambulances for hours at a time because the department is overcrowded. This situation is uncomfortable, undignified and unacceptable for patients and staff, but ED nurses deal with it on a daily basis.

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At congress we called for accountability to be legislated, as currently it is unclear if we, as emergency nurses, are accountable for these patients or whether our paramedic colleagues are, making us all vulnerable.

‘Patients and hospital staff rely on ambulance personnel and emergency nurses recognising any deterioration or increased pain in patients and then communicating this’

Nurses often start triage, investigations and treatment on patients waiting in the back of ambulances outside EDs, while qualified paramedics wait with the patients until they can be admitted.

Legislation on accountability would support nurses’ work in challenging situations

Patients and hospital staff rely on ambulance personnel and emergency nurses recognising any deterioration or increased pain in patients and then communicating this, between services, to the relevant healthcare professionals.

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In a climate where all ED staff and paramedics are under huge amounts of pressure due to high demand, this is a high-risk scenario and one that could be detrimental to our patients’ treatments and health outcomes. 

The debate at congress was an emotional and passionate one, with many delegates sharing their own challenging stories and experiences, as well as concern over this matter. Everyone in Liverpool that day wanted clarity on exactly who is accountable for patients held in ambulances outside EDs and we hope the RCN can bring some clarity on this over the coming months.

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All emergency nurses are facing this dilemma so it would be a relief to have legislation in place to support our work in this challenging situation where we are often forced to put our practice at risk despite our absolute best efforts and intentions to care for our patients. 

Natalie Stringer is a member of the RCN Emergency Care Forum’s steering committee and ED sister/manager at Musgrove Park Hospital, Somerset