Tehran University of Medical Sciences Health Technology Assessment in Action 2645-3835 10 1 2026 05 10 397 397 Jahanara Mamikhani Department of Economics, Faculty of Economics and anagement, Khomeinishahr Branch, Islamic Azad University, Khomeinishahr, Iran/ Iran Health Management Association, Tehran, Iran Shahram Tofighi Health Insurance Research Center (HIRC), Tehran, Iran/ Academy of Medical Sciences of the Islamic Republic of Iran, Tehran, Iran Yasaman Alikhani Health Insurance Research Center (HIRC), Tehran, Iran 2025 01 25 2025 05 12 Introduction: Core nursing competencies refer to the effective application of a person’s combination of knowledge, skills, and judgment in job. This study aimed to determine the essential competencies of nurses working in hospital emergency wards, considering the characteristics of the emergency workplace, using a new approach. Methods: A mixed-method study was conducted in 2023. Twenty-two experts were organized into two groups of five and two groups of six. Then, qualitative approaches were employed to collect data. Group brainstorming sessions identified the list of essential competencies and characteristics of the emergency workplace, while focus group discussions were used to finalize them. Ultimately, a fuzzy pairwise comparison matrix was applied using MATLAB 23.1 to weight and prioritize the competencies. Results: Eleven key items emerged as the main characteristics of the workplace, while thirteen were identified as the essential competencies of nurses in the emergency ward. The “unpredictability of clients” and “high levels of team discipline and autonomy” were rated as the most important workplace features. In terms of nursing competencies, “high scientific abilities and skill capacities in managing diverse care situations from infancy to elderly” also received the highest score. When incorporating the workplace characteristics into the evaluation, “speed of action, professionalism, and coordination” notably ascended to the top rank, while “responsibility” dropped to fourth. Conclusion: The characteristics of the workplace represented a more realistic rank of nurses’ competencies. Accordingly, emergency department nurse staff should be selected and evaluated based on competencies adapted to the characteristics of the workplace. https://htainaction.tums.ac.ir/index.php/hta/article/view/397 https://htainaction.tums.ac.ir/index.php/hta/article/download/397/221