It is a typical scene at the Prince of Wales Hospital trauma and emergency centre, with queues of gurneys double-parked along the walls. This is where accident victims and patients suffering strokes, heart attacks and other acute conditions are brought for urgent treatment. A high-stress environment for the injured, the centre's tense atmosphere is exacerbated by anxious family members, the arrival of new patients and noise. A middle-aged woman is plucked from the crowd and wheeled behind the curtains into the advanced emergency nursing practice (AENP) room. There, two nursing students are introduced to the patient by Josephine Chung, a deputy director of the AENP Programme. One student takes charge and the patient, under delicate probing, both literal and figurative, outlines how she was injured. Diagnosis is key to the role of an advanced emergency nurse practitioner. 'How was your foot injured? Where were you? In what position? What did you step on? Do you feel pain here? How about here? How high were you when you stepped down?' the student nurse asks. The probing continues but is interrupted by the patient, who asks: 'Am I going to see a doctor?' With practised ease, Chung explains the procedure. 'For minor cases, we examine each patient and get to the bottom of the injury,' says the AENP pioneer in Hong Kong, who has treated more than 2,000 patients. 'Then we will take things step by step and care for your foot. If there is a need, we will X-ray or stitch up your foot. Along the way, we consult a doctor.' The patient is reassured - repeating that the laceration on her foot is, indeed, very minor - and Chung and her two students carry on with their diagnosis. Chinese University's accident and emergency medicine academic unit at the Prince of Wales Hospital is the first in Hong Kong to offer a one-year, part-time postgraduate diploma or a two-year, part-time master of science in advanced emergency nursing practice. The traditional role of a nurse is to follow doctors' orders on how to care for patients, but AENPs are given greater responsibility. Unit director Professor Timothy Rainer said it aimed to train a team of AENPs to help cut waiting times at the accident and emergency departments, which were facing an acute shortage of medical staff. 'There are insufficient trained medical staff to meet current emergency demands in Hong Kong,' Rainer said. 'The ratio of medical staff to patients in emergency departments in Hong Kong is between half and a quarter that of top centres in the UK, Australia, Singapore and North America.' Too few medical students were being trained to meet service needs, and there would be no improvement for many years, if at all. Waiting times were often prolonged in emergency departments, and when they became shorter it was probably due to a reduced quality of care. Rainer said the Hospital Authority had supported the expansion of nursing services by developing the new role of advanced nurse practitioner as well as the model of nurse-led clinics. The clinics will be piloted in emergency departments in each of the seven clusters of hospitals in accordance with their service needs and care-delivery models. One hospital in each of five clusters have signed up for the trials so far - Pamela Youde Nethersole Eastern Hospital, United Christian Hospital, Kwong Wah Hospital, Prince of Wales Hospital, and Tuen Mun Hospital. 'The introduction of AENP roles to Hong Kong is a considerable advancement over current practice,' Rainer said. 'AENPs should help to efficiently and safely reduce unnecessary waiting times for specific groups of patients with minor illness and injury. 'An advanced emergency nurse practitioner is an experienced emergency nurse who has undertaken additional education to enable them to assess, investigate, diagnose and treat defined groups of patients according to clinical protocols and also independently of doctors. Such practitioners will allow medical staff to be released to give more contact and quality time to expertly manage more complex cases.' Chung said the role of the AENP was introduced to Hong Kong through funding from Michael Kadoorie for an exchange programme in 2003 between nurses in England and Hong Kong. 'While in the UK, Hong Kong nurses observed how AENPs helped with the A&E flow and thought it would apply well to Hong Kong,' she said. 'In 2006, I was one of the two nurses selected to go to England to take a nine-month AENP course. When I came back, fully licensed, we ran into a conundrum: there was no real protocol between the Hospital Authority and my role. 'As an AENP in England, I would have the power to discharge patients. But in Hong Kong, I work within the limitations of HA policy. In future, because of the new programme, we will have more qualified AENPs.' All applicants to the course must have a recognised bachelor's degree and be an experienced nurse. The postgraduate diploma includes 24 units of core modules. Each unit is 13 hours. The master's programme is a continuation of the postgraduate diploma programme and requires students to complete 37 units of core modules. Students put theory into practice during the 156 hours of clinical practicum, while classes are normally held on weekdays at the Prince of Wales Hospital. 'The course is very practical,' Chung said. 'We cover such things as anatomy, procedures and orthopaedics. For nurses thinking about joining, this role has greater responsibility and is very different from a traditional nurse's work, requiring in-depth decision-making. 'Places like England, America and Australia rely heavily on their AENPs for accident and emergency care. In Asia, the role of the AENP is in its infancy. Many hospitals do not recognise AENPs. 'In Singapore, there is a small number, similar to Hong Kong. Hopefully, with this course and the interest it is creating, more hospitals will adopt the AENP role into their A&E centres.' After completing a year of study, students are recognised by the Institute of Advanced Nursing Studies and, after two years of emergency clinical experience, the nurse will receive a certificate from the institute. The inaugural AENP programme has 15 part-time students, and relevant experience was a critical entry requirement. Most students have nearly 10 years of practical experience in the emergency field. 'As an AENP nurse, one has to have confidence,' says student Mabel Leung, who works at Princess Margaret Hospital. 'There is an ongoing challenge to apply knowledge, experience and skills in a clinical environment. Practice makes perfect.' AENP student Ian Cheung from Princess Margaret Hospital nods his head in agreement. 'More than that, this is a part-time course,' he says. 'You have to be committed. You need to study in your own time, and this takes up a big part of your life.' Lo Wai-kit, a nurse at Prince of Wales Hospital, became interested in the programme after observing how efficient and effective Chung had been. 'This course is really a journey of personal development and patient care,' Lo says. 'In the past, because of policy, nurses did not have the skill set or responsibility to diagnose patients. Josephine has changed the mindset of many, and if more colleagues have knowledge, then we can apply this and help the patients.'