To Boost HIV Screening, ED Nurses Need Institutional Support

Lucy Hicks

November 13, 2021

Insufficient HIV-related nursing education is a major barrier to implementing HIV screening efforts in emergency departments (EDs), according to a national survey of ED nurses. Nearly 43% of respondents said they had received "little" or "very little" HIV education as part of their professional development and practice.

This lack of continuing HIV education "often translated into attitudes that did not support the policy" of routine HIV screening in EDs, lead author Candace Elam, DNP, a family nurse practitioner at the Institute of Family Health in the Bronx, New York City, told Medscape Medical News. "But more than individual attitudes, what came out most clearly in the research was that organizational support for HIV screening in EDs was the one factor that could make or break whether an emergency nurse performs HIV screening," she said. This includes working routine HIV screening into ED workflows and providing resources to streamline screening and testing efforts.

In 2006, the Centers for Disease Control and Prevention (CDC) released guidance recommending routine HIV screening in all healthcare settings, including urgent care and EDs. Elam, who conducted the research as a student at Rutgers University School of Nursing in New Brunswick, New Jersey, noticed during her time as an ED nurse that, while her department had a policy supporting routine HIV screening, the practice was not consistent across all nursing staff. To find out how HIV screening varied nationally, Elam ran a national survey from October through December 2020, recruiting participants both by email outreach and Facebook.

In the 30- to 45-minute survey, respondents reported:

  • Demographic information

  • Knowledge of the CDC HIV screening recommendations

  • Workplace HIV screening policy

  • Self-reported performance of HIV screening

  • Beliefs and attitudes pertaining to HIV screening

Overall, 371 individuals from 43 states filled out at least some part of the survey, and 171 individuals completed it. Of the 251 individuals who answered whether their EDs routinely conducted HIV screening, 76.9% responded affirmatively. Overall, 28.5% of respondents thought HIV screening was "not important" or "not at all important." Nearly half — 47.6% — reported never offering HIV testing to all eligible patients regardless of risk factors, and only 14.3% reported offering testing all of the time. Only 25% of participants said they received "adequate" or "a lot" of HIV-related nursing education, and 42.9% reported "little" or "very little" education.

"For the most part, those of us working in hospitals, all the education that we get about HIV took place in school," Elam said. "So, if you went to school in the early 2000s or in the 1990s, you don't know much else." Elam noted that she keeps informed on HIV research issues because it is an area of interest, but the hospital she had worked at did not contribute much to her knowledge.

Elam also found that in practice there were several barriers to performing screening, such as lack of availability of a dedicated HIV educator, tester, or counselors; not knowing where to refer patients who had a positive HIV test result; and insufficient time to address positive HIV test results in ED practice.

"A lot of these things are outside an individual nurse's control," said Elam, and can result in missing patients who would benefit from care. Lisa Leimer, RN, a nurse at Primary Health Care in Des Moines, Iowa, works with patients after they have been diagnosed with HIV, but noted that many of her patients could have been identified earlier. "Once we get someone, you look back at medical records and you see that they have been in and out of the hospital," she said. "There's been multiple encounters," she said.

Prioritizing HIV screening in all healthcare settings and including HIV education for all medical professionals — not just nurses — could help in the continuing battle against HIV. "So much has changed in the world of HIV," she said. "We're trying to end the epidemic, and it could happen if we identified, diagnosed, and treated the people that are living with it."

Elam and Leimer have reported no relevant financial relationships.

Association of Nurses in AIDS Care (ANAC) 2021. Presented November 11, 2021.

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