Introduction: Medical and technologic developments entailnew competence demands in emergency health care, and itfollows that head nurses must recognize and create prerequisites,as well as evaluate the competence of registered nurses. The aimof this study is to describe head nurses’ conceptions of emergencynursing competence needs and their responsibility for creatingprerequisites of competence development in emergency nursing.

Methods: A 24-item questionnaire was sent to all the headnurses (N = 79) of all the existing emergency departments inSweden. The response rate was 73%, and in the analysis ofthe data, descriptive statistics were used.

Results: According to the head nurses, basic nursing educationdoes not provide sufficient emergency nursing competence.Consequently, there is a need for supplementary formalemergency nursing education. Furthermore, most of the headnurses have inadequate strategies for evaluating competencedevelopment, and economic and personnel resources areinsufficient to meet the educational needs. A minority of the headnurses consider that they have full responsibility for creating theprerequisites of the competence development of nurses.

Discussion: To ensure sufficient nursing competence inemergency health care organizations, there is a need to establishcompetence demands in emergency nursing and evaluate strategiesfor competence development. The establishment of a Swedishemergency nurses association would be important for thedevelopment of national guidelines of emergency nursing as wellas to facilitate the interpretation and concretizing of rules andlegislation and to promote questions related to research, development, and education in emergency nursing. With nationalguidelines and recommendations, the head nurses’ responsibilitiesfor the development of nurses’ skills would be clarified.