Expanded Roles and Competency Gaps of Emergency and ICU Nurses During Armed Conflict in Gaza

AIM: To explore the expanded roles, task shifting, competency gaps, and adaptive strategies of emergency and intensive care unit nurses in Gaza's government hospitals during armed conflict, and to identify barriers and lessons relevant to international nursing standards. BACKGROUND: Armed conflicts severely disrupt healthcare systems and demand expanded nursing roles and competencies, especially for emergency and intensive care nurses. METHODS: A descriptive, qualitative design was used, employing semi-structured key informant interviews and a focus group with senior nurses, supervisors, and academic leaders from all operating governmental hospitals in Gaza. Data were thematically analyzed, following COREQ guidelines and information power principles. RESULTS: Fourteen nurses and ten senior stakeholders participated, offering diverse clinical and academic perspectives. Eight key themes emerged: role expansion, psychological impact, adaptation, core competencies, training, systemic barriers, teamwork, and support systems. Nurses assumed essential and some advanced clinical duties and autonomous decisions in response to staff shortages and resource scarcity. Despite some advanced nursing skills, gaps persisted in pediatric, burn, and mental health care. Solidarity, mentoring, and nongovernmental-supported leadership helped sustain care delivery, revealing both nursing resilience and entrenched system challenges. DISCUSSION: These findings highlight urgent gaps and opportunities to strengthen nursing competencies, education, and policy to ensure resilient care in conflict-affected settings. CONCLUSION: Nurses in conflict-affected ICUs and emergency departments demonstrated notable adaptability and role expansion but faced critical gaps in preparedness and institutional support. Their experiences call for enhanced training and clear policy frameworks tailored to conflict settings. IMPLICATIONS FOR NURSING: The study calls for integrating conflict-nursing skills, ethical decision-making, and psychosocial support into policy and education to build nurse autonomy and conflict-readiness in Palestine and beyond.