Improving the ED working environment: A qualitative study of coping strategies used by emergency department clinicians and proposed solutions to ameliorate occupational stressors

Ms Elizabeth Elder1, Dr  Amy Johnston2,3, Professor Marianne Wallis4,5, Professor Julia Crilly5,6

1School of Nursing & Midwifery, Griffith Health, Griffith University, Gold Coast, Australia, 2Department of Emergency Medicine, Princess Alexandra Hospital Metro South Health, Brisbane, Australia, 3School of Nursing Midwifery and Social Work, University of Queensland Woollongabba , Brisbane, Australia, 4School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia, 5Menzies Health Institute Queensland, Griffith University , Gold Coast, Australia, 6Department of Emergency Medicine, Gold Coast Hospital and Health Service , Gold Coast, Australia

Introduction: Emergency departments (EDs) are known to be high-stress working environments. Exposure to stress can elicit coping strategies with strategies used often dependent on the stressor (1), and based on self-appraisal of the perceived potential risk or threat (2). Broadly, coping can be classified into adaptive and maladaptive with strategies being either problem or emotion-focused (2).

Aim: The aim of this study was to explore workplace-based coping strategies used by ED clinicians and detail their proposed solutions to improve their working environments.

Methods: Twelve semi-structured interviews with ED clinicians working in a public ED in south-east QLD were conducted. An inductive thematic approach was used for analysis.

Results: Participants reported both emotion and problem-focused coping strategies however emotion-focused strategies were discussed more frequently.  Emotion-focused strategies included: seeking support and venting. Problem-focused strategies included: planning, and standardizing approaches to care. Although discussion around coping tended to focus on emotion-focused strategies, solutions proposed by clinicians typically centered on trying to address the problems rather than improving or enhancing staff coping. Strategies to improve the working environment focused on resolving issues relating to resourcing, workplace violence, and interventions to encourage team cohesiveness.

Conclusion: Exposure to occupational stressors continues to be an issue for staff working in ED. Currently staff use a variety of strategies when exposed to occupational stress. Developing and implementing strategies that are tailored and responsive to the unique demands of ED is warranted if exposure to occupational stressors is to be managed.


  1. Israel BA, House JS, Schurman SJ, Heaney CA, Mero RP. The relation of personal resources, participation, influence, interpersonal relationships and coping strategies to occupational stress, job strains and health: A multivariate analysis. Work & Stress. 1989;3(2):163-94.
  2. Folkman S. Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology. 1984;46(4):839-52.


Elizabeth is a credentialed emergency nurse with a passion for education, research and clinical practice.  Believing research is the juncture of clinical practice and academe Elizabeth enrolled in her PhD in 2016. Areas of research interest include staff perceptions of their working environments and stress and coping of ED clinicians