Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study.

Mrs Hui (Grace) Xu1,2,3, Dr Amy Johnston2,4,5, Dr Jaimi Greenslade6,7, Professor Marianne Wallis2,8, Ms Elizabeth Elder3, Professor Julia Crilly2,4
1Department of Emergency Medicine, Logan Hospital, Meadowbrook, Australia, 2Menzies Health Institute Queensland, Griffith University, , Australia, 3School of Nursing and Midwifery, Griffith University, , Australia, 4Department of Emergency Medicine, Gold Coast Health, Southport, Australia, 5Department of Emergency Medicine, Princess Alexandra Hospital, Ipswich, Australia, 6Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Herston, Australia, 7Faculty of Medicine, The University of Queensland, Herston, Australia, 8School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia

Background: Emergency Departments (EDs) are stressful workplaces in which to work. Emergency staff are exposed to high levels of stress around excessive workload, and time pressures associated with meeting care time targets (1, 2). In low socio-economic areas, EDs have high demand for GP-like services. Some ED staff experience low job satisfaction and eventually seek leave (3). Little research addresses workplace components that ED staff find stressful and how they cope with such stressors. This study describes perceptions of working environment from ED staff based in a busy ED in a low socio-economic outer-urban region.
Methods: This cross-sectional descriptive study was conducted in 2017 in a public teaching hospital ED in Queensland. Clinical staff responded to the 4-part survey that captured their perceptions of workplace stressors, work environment and coping strategies. Descriptive and comparative data analyses were undertaken.
Results: A total of 161 of the 400 invited nurses and doctors responded to the survey (40% response rate). Respondents were relatively young (median age: 32 years) with a median of three years ED experience. Staff reported high workload, moderate self-realisation, and low levels of conflict and nervousness. Heavy workload, poor skill-mix and overcrowding were ranked as high stress, high exposure (daily) events. The death or sexual abuse of a child and inability to provide optimal care were ranked highly stressful but occurred less commonly. Coping strategies most often used were: trying to keep life as normal as possible; considering different ways to handle the situation; and considering how they handled previous problems.
Conclusion: This young cohort of ED staff, with limited ED experience, are exposed to various levels of modifiable and non-modifiable stressors. This presents challenges and opportunities around promoting positive staff perceptions of this unique working environment and for introducing site-specific interventions in future.

Grace (Hui) Xu is a Nurse Practitioner, academic, nurse researcher and staff wellness advocator in a teaching hospital emergency department (ED) within Queensland Health. She provides emergency care to adults and children who present the ED within the Ambi-Care model of care service. She also works as an academic and research staff member at Griffith University School of Nursing and Midwifery and Menzies Health Institute Queensland. Grace started to develop her research capacities in 2017 with the support of some experienced ED researchers. Her passion in promoting staff wellness drives her interest in becoming a key driver and stakeholder of the Staff Wellness Committee in her ED.

Dr Amy Johnston currently holds a conjoint position between University of Queensland and Metro South ED (based at Princess Alexandra hospital). She works across academic and healthcare environments to conduct research as well as supporting clinicians to develop the skills and confidence to participate in, and conduct research projects relevant to their clinical work. Amy is a neurobiologist and nurse with a particular interest in Emergency Department service delivery and patient flow. Her research experience includes co-authoring in excess of 70 publications, 98 abstracts, and supporting 10 PhD students towards their PhD qualifications.