Ambivalence in nurses' use of the early warning score: A focussed ethnography in a hospital setting

Rikke R Mølgaard, Lone Jørgensen, Erika F Christensen, Mette Grønkjaer, Siri L Voldbjerg

Research output: Contribution to journalJournal articleResearchpeer-review


Aim: This study describes and explores the influences in registered nurses’ use of early warning scores to support clinical decisions in a hospital setting. Design: A focussed ethnography allowed for the investigation of registered nurses’ clinical practices in two wards in a Danish University Hospital. The study adhered to the ‘Standards for Reporting Qualitative Research’. Methods: Participant observation and ethnographic interviews were conducted from March 2019 to August 2019. Ten registered nurses were observed and interviewed, and four physicians were interviewed. Data were analysed using LeCompte and Schensul's ethnographic analysis. Findings: The findings show the registered nurses’ ambivalence towards the early warning score as a decision support system. Early warning score monitoring created a space for registered nurses to identify and initiate optimized care. However, when early warning scores contradicted registered nurses’ clinical judgments, the latter were given priority in decisions even though elevated scores were not always accounted for in the situation. Moreover, we found unspoken expectations in the collaboration between physicians and registered nurses, which influenced the registered nurses’ workloads and decisions regarding early warning scores. Conclusion: Registered nurses’ clinical judgment is essential to clinical decisions on the care and safety of patients if used combined with the early warning score. Interprofessional collaboration between registered nurses and physicians about the early warning score is challenged. Future research may address this challenge to explore how it should be operated as a collaboration tool. Impact: The study adds knowledge to the evidence base of registered nurses’ use of early warning score and the advantages and challenges associated with the use of these scoring systems. The study may provide valuable knowledge for the future development of policies or implementation strategies.

Original languageEnglish
JournalJournal of Advanced Nursing
Issue number5
Pages (from-to)1461-1472
Number of pages12
Publication statusPublished - May 2022


Dive into the research topics of 'Ambivalence in nurses' use of the early warning score: A focussed ethnography in a hospital setting'. Together they form a unique fingerprint.

Cite this