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The Emergency Department (ED) is an incredible and complex environment. There are constantly packed waiting rooms, nurses’ stations bustling with activity, and medic phones ringing. There is no shortage of excitement, and for those employed there, the work is rewarding. However, there is a glaring problem.
An insidious epidemic of burnout and occupational stress is lurking. This is not a new idea; many have written on this before. But it is a problem that is worsening. Job satisfaction for nurses is plummeting in EDs across the world. Fulfilling shifts are often far outnumbered by shifts of brutal exhaustion and disappointment.
Insufficient equipment and supplies, verbal and physical aggression, and overcrowding are some of the stressors nurses encounter daily. Grueling shifts full of assault, degradation, and unsafe ratios are becoming the new “normal”. Nurses are leaving the bedside because these conditions contribute to burnout.
What is burnout?
Burnout is a psychological condition that results from working under chronic stressors.1 It leads to a lack of empathy and passion. There are some specific criteria for burnout:
Depersonalization
Decreased feelings of fulfillment
Emotional exhaustion
Burnout is common in healthcare. This is partially because of overcrowding, poor staffing, and unsupportive leadership.3 Even if nurses do not identify as being “burned out”, many report high occupational stress which can eventually become burnout. This can cause physical symptoms for nurses including headaches, fatigue, and insomnia.3 Depression, anxiety, and varying levels of social dysfunction can also occur.
Impact of Burnout
Burnout is historically known to cause negative outcomes. These include:
Increased staff turnover
Staff dissatisfaction
Absenteeism
Patient dissatisfaction
Increased errors
Longer hospital stays
Burnout causes an inability to provide effective nursing care. This means that burnout does not impact nurses alone. Patients will also face adverse effects.
Combating burnout
With conditions as harsh as these, what can ED nurses do to help themselves? Ultimately, administrators hold the responsibility for improving the conditions in which nurses work. Until administrators change work conditions there are some interventions available to help nurses cope. The following interventions have proven beneficial and worth implementing routinely.
Improving coping mechanisms
Healthy coping mechanisms can give people the necessary skills to handle stress.
Resilience training
Teaching and strengthening resilience can result in an improvement in mental capacity.
Cognitive behavioral interventions
Behavioral interventions help with appropriate reactions to stress at work.
Meditation and mindfulness
By centering oneself and engaging with inner feelings meditation can improve how stress is perceived.
Exercise and yoga
Movement can lead to enhanced emotional intelligence, reduced depersonalization, and increased self-efficacy.
Professional development programs
Classes on professionalism and goal setting have been shown to increase satisfaction with careers and boost self-image.
Reiki and massage
Therapeutic touch has demonstrated stress-reducing benefits.
Stress is inevitable, but the perception of stress can be changed. If ED nurses can manage the stress they encounter productively they may feel more in control. This improved coping can decrease burnout and improve job satisfaction.
Summary
All nursing is stressful, but the ED has unique challenges. Working under straining conditions daily is taxing and nurses are often pushed to the brink of their capacities. This results in burnout and decreased quality of patient care. There is a lot of work to be done by hospital administrators to improve the workplace environment.
Appropriate coping mechanisms can decrease the incidence of burnout and improve quality of life. Physical activity, mindfulness practices, and therapeutic touch have been shown to lessen stress for healthcare workers. Nurses should use these methods of combating burnout so they can continue to serve patients in the most effective way possible.
References
1. Portero de la Cruz S, Cebrino J, Herruzo J, Vaquero-Abellán M. A multicenter study into burnout, perceived stress, job satisfaction, coping strategies, and general health among emergency department nursing staff. J. Clin. Med. 2020; 9(4): 1007. https://doi.org/10.3390/jcm9041007
2. Medeiros de Oliveira S, Vinicius de Alcantara Sousa L, do Socorro Vieira Gadelha M, Barbosa do Nascimento V. Prevention actions of burnout syndrome in nurses: an integrating literature review. Clinical Practice & Epidemiology in Mental Health. 2019;15(1):64-73. doi: https://doi.org/10.2174/1745017901915010064
3. Lee M, Cha C. Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis. Sci Rep. 2023;13(1). doi: https://doi.org/10.1038/s41598-023-38169-8
4. Abraham LJ, Thom O, Greenslade JH, et al. Morale, stress and coping strategies of staff working in the emergency department: a comparison of two different-sized departments. Emergency Medicine Australasia. 2018;30(3):375-381. doi: https://doi.org/10.1111/1742-6723.12895
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