Effects of the four-hour operational standard.

The Department of Health's four-hour operational standard for waiting times in emergency departments (EDs) was introduced in 2001 to speed up treatment and improve the patient experience. Studies and media reports have shown, however, that the standard has increased pressure on ED staff, particularly nurses. This article refers to an analysis of the literature in an attempt to determine whether the implementation of the standard has been beneficial or detrimental to nurses' work, and offers advice to help nurses meet it with minimum stress.