Morale, stress and coping strategies of clinical staff working in Emergency Departments: A comparison of two different departments

Dr Louisa Abraham1, Dr Amy Johnston2, Dr Ogilvie Thom3, Dr Jaimi Greenslade4, Professor Marianne Wallis5, Professor Eric Carlstrom6, Dr Donna Mills3, Professor Julia Crilly2

1Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 2Dept Emergency Medicine Gold Coast Health And Menzies Health Institute Qld  , Southport, Australia, 3Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia, 4Royal Brisbane and Women’s Hospital and School of Medicine, The University of Queensland, Brisbane, Australia, 5University of Sunshine Coast, Sippy Downs, Australia, 6The Sahlgrenska Academy, University of Gothenberg, Gothenberg, Sweden

Background: Clinical staff in Emergency Departments (EDs) report increasing workloads associated with staff shortages, increased patient numbers and acuity, client and visitor violence, and pressure to adhere to time targets in determining patient disposition. This study describes and compares staff perceptions of their ED working environment across two different EDs within QLD Australia.

Methods: A survey assessing workplace stressors, coping strategies, and the workplace environment, was distributed to clinical staff working in two Australian EDs in 2015-2016 using a cross-sectional research design. Descriptive data were reported for each survey measure by professional role (nurses and physicians) and study site.

Results: ED nurses and doctors (N=146) completed the survey (response rate: ~65%). Despite geographical variation, medical and nursing staff in both EDs had similar range of gender, age and years of clinical experience. Staff reported moderate levels of workload and a moderate belief that their department supports their professional growth (self-realization). Staff reported low levels of conflict and low levels of nervousness or tension. The death or sexual abuse of a child was rated most stressful, followed by workplace violence and heavy workload. Staff used a large range of coping strategies; thinking out different ways to handle the situation, talking the problem over with family or friends, and keeping a sense of humour were most commonly reported. Findings were similar across sites and professional groups; although nurses reported slightly higher workload and higher levels of stress around workplace violence, and the provision of quality care.

Conclusion: Staff stressors and coping strategies are similar across EDs and professional roles. The work environment is generally perceived positively. However, stressors are common and a range of coping strategies are applied. There is a need to support staff within ED working environments to ensure professional longevity.


Louisa Abraham is an advanced trainee in Emergency Medicine currently working at the Royal Brisbane and Women’s Hospital. She attended medical school in the UK before moving to Australia in 2011, initially working in ED and ICU in the Sunshine Coast.  She is enthusiastic about undertaking interdisciplinary research to provide high quality evidence-based care for patients and clinical staff, and believes that holistic clinical teams can provide the best outcomes for research, staff, consumers and health managers.

Amy Johnston is a conjoint research fellow in Emergency Care, based between Gold Coast Health and Menzies Health Institute Queensland/School of Nursing and Midwifery Griffith University, seconded from a senior lecturer position at Griffith University. She is deeply committed to bringing research skills and outcomes to emergency staff. She is a widely published and cited academic and registered nurse with experience in a range of research techniques. Her love of clinical research is heartfelt and (hopefully) infectious. She is involved in HDR student supervision and onsite development of ED staff research skills.