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Clinical Initiatives Nurse

Background

The Clinical Initiatives Nurse (CIN) role was originally introduced into major NSW Emergency Departments in 2002. The Aims for the CIN role in 2002 included:

  • Providing education and advice to patients and their family’s whilst waiting to be seen
  • Facilitate the reassessment/re-triage processes in the ED waiting room
  • Assessing patients and constructing a plan of care for each patient in consultation with a senior emergency medical officer.

In 2009 The Garling Special Commission of Inquiry into Acute Care services added CIN roles into all EDs who had >25 000 ED presentations in 2007-2008. CIN was declared to be a vital position, caring for people waiting in EDs for medical reviews. The report noted that the CIN position was frequently re-deployed during `busy periods’ which was the `very time’ that it was most needed to `provide close observation of patients in the waiting room and initiation of treatment where required’.

In 2010 NSW Health and the Ministerial Taskforce for Emergency Care commissioned a review of the role. All sites that have CIN funding were consulted; and Emergency Department clinicians decided on the key elements of the role. This resulted in the development of a NSW state-wide CIN role.

The role

The primary purpose of the CIN role is to provide nursing care to patients in ED waiting rooms. The care delivered by the CIN is prioritised in the following way:

  • Maintenance of an ED nursing presence in the waiting room to facilitate a safe clinical environment
  • Communication with patients and carers regarding ED processes, waiting times and provision of relevant education on their health issues
  • Assessment of patients following triage with a view to:
    • Initiate of diagnostics or treatment
    • Escalation of care, where required
    • Appropriate referral of patients

Resources for clinicians

CIN presentations

Powerpoint presentations for use by facilitators. These relate to the chapters of the resource manual.

CIN videos

These videos are to be used throughout the CIN learning process as referenced in the CIN manuals. However, they can be used as standalone videos for self-reflection, group discussion and education.

The first 5 videos below were developed by S McCarthy (POWH ED) and F Trede (SESIAHS Diversity Health) in 2005 for ED staff training and is part of the “In Their Shoes” communication training series. It has been used with permission for the CIN program.

This short video depicts reassessment of a lady in an Emergency Department (ED) waiting to be seen by a treating clinician. The reassessment fails to uncover some important information with creates some further complications.

This short video depicts a typical Emergency Department scenario where family members are concerned about their loved one and the extended delay for treatment they are experiencing.

Depicts someone presenting to an Emergency Department (ED) for assessment and treatment of a limb injury.

This video demonstrates a strategy for 'rounding' an entire waiting room by a CIN.


This video depicts reassessment of a patient waiting to be seen by a treating clinician by a CIN.

“Limb Assessment Presentation (Complete)”

This is the complete joint / limb assessment movie in one go. Individual videos are available for each area of the body covered in this complete video below.

“The Shoulder Joint”

This video focuses on the assessment and identification of abnormalities of the shoulder joint.

“The Elbow Joint”

This video focuses on the assessment of the elbow joint and the identification of potential injuries.

“The wrist and hand”

This video focuses on limb assessment and identification of possible injuries of the wrist and hand.

“The knee joint”

This video focuses on the assessment of the knee joint.

“The foot and ankle”

This video focuses on the assessment and identification of abnormalities of the foot and ankle.

Patient resources

The CIN brochure and poster are also available in other languages:

Further Information

For further information please contact the ECI team.

© Agency for Clinical Innovation 2021