Occupational stress in the ED: What matters to nurses?

Summary 

Background

Nurses working in emergency departments are frequently confronted by stress-evoking incidents that can potentially lead to both short and longer term psychosocial and physical effects. The aim of this study was to determine which stress-evoking incidents Western Australian emergency department nurses perceive as most significant, whether demographic characteristics affect these perceptions, and to discuss current debriefing practices in emergency departments after stress-evoking incidents.

Methods

A cross-sectional descriptive study was undertaken using non-parametric testing to identify and rank workplace stressors and determine whether demographic sub-groups ranked the identified stressors differently. Three hundred Western Australian emergency nurses from metropolitan, regional and rural emergency departments were invited to complete a three-part questionnaire with a response rate of 52%. Nurses were asked to rank groups of stressors which had been identified from the literature and briefly discuss their experiences of debriefing related to stress-evoking issues in the workplace.

Results

Violence against staff was the top ranked stressor, with workload and skill-mix ranked second. Dealing with a mass casualty incident, the death/sexual abuse of a child, and dealing with high acuity patients were all closely ranked at third, fourth, and fifth, respectively. A statistically significant difference was found in the paediatric death/sexual assault stressor and number of years emergency department experience, as well as the acuity stressor and number of years emergency department experience. Two out of every five respondents reported having personally sought debriefing while almost 60% reported that workplace debriefing is not routinely offered after a stress-evoking incident in their workplace.

Conclusion

Western Australian emergency department nurses ranked violence, excessive workload and poor skill-mix as their most significant workplace stressors. Nurses stated that debriefing after stress-evoking incidents in the workplace should be mandatory not optional, and should be conducted by professionals with specific debriefing and counselling skills.

Keywords: Emergency nursing, Stress, Critical incident stress debriefing, Burnout, Professional