Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff

Job Satisfaction Among Nurses Employed in Supplementary Healthcare Models, a Qualitative Descriptive Study

AIM

This study explored workplace satisfaction for nurses employed in the supplementary employment models.

DESIGN

A qualitative descriptive methodology was used.

METHODS

Data were collected using individual semi-structured interviews with 10 nurses employed in supplementary employment models. A thematic analysis was used.

FINDINGS

Analysis revealed four key themes related to job satisfaction: (1) Professional development, education, and training shape job satisfaction; (2) The influence of variability in work practice environments; (3) Distant work relationships affect communication and organisational support and (4) Work flexibility. These themes collectively illustrate the complex interplay of factors impacting nurses' experiences and job satisfaction in supplementary employment.

CONCLUSIONS

Supplementary employment models provide nurses with valuable flexibility and employment opportunities. However, there are barriers for nurses in communicating with organisational leadership through formal channels and in their contribution to improve the work environment and team culture with wards and departments. To improve job satisfaction for nurses employed in supplementary roles, strategies are needed to enhance access to education and training, strengthen communication and connection with clinical teams and leadership, and establish effective feedback mechanisms.

Psychological Well-Being Among Nursing Staff in an Emergency Department: A Mixed-Methods Study

INTRODUCTION

Emergency departments worldwide are faced with in-hospital crowding and fast-paced admissions, creating an increasingly high workload for health care personnel. In recent years, emergency departments have also experienced an increase in emergency admissions, resulting in burdened workplaces. This has led to debates about nurses' work environment and mental well-being. This study aimed to gain knowledge on the prevalence of depression, anxiety, and stress, as well as insight into the factors influencing the mental well-being of the nursing staff in a Danish emergency department.

METHODS

This is a mixed-methods study with an explanatory sequential design. A questionnaire (the Depression, Anxiety, and Stress Scale - 21 Items) was sent to nursing staff (N = 146) in a large emergency department in the Region of Southern Denmark. Afterward, a smaller sample participated in semistructured interviews. The quantitative data were analyzed using descriptive statistics, the Mann-Whitney U test, and the chi-square test. In the qualitative part, a thematic analysis was performed.

RESULTS

Completed surveys were received from 78 nursing staff (53.4%). Overall, the nursing staff reported severe to extremely severe levels of depression (14.1%), anxiety (23.1%), or stress (47.2%) within a week before completing the survey. Higher levels of psychological distress were significantly associated with fewer years of clinical experience and having previously experienced or received treatment for depression, anxiety, or stress. Ten staff members later volunteered to participate in the interviews. The qualitative results formed 3 themes: (1) high work pace and responsibility, (2) professional community and nursing identity, and (3) culture with an increased focus on mental well-being.

DISCUSSION

The nursing staff reported high mental strain, especially in the forms of high stress and anxiety levels. They explained that their mental health was affected by overcrowding, a pressured work environment, and lack of resources.

Well-being interventions for emergency department staff: 'necessary' but 'inadequate' - a phenomenographic study

INTRODUCTION

Stress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being. This study therefore aimed to understand their experiences of these interventions.

METHODS

Semi-structured interviews were carried out with nine members of staff from different professional backgrounds at a tertiary trauma centre in the UK between June and July 2023. The inclusion criteria were staff who had worked in a National Health Service ED setting in the UK for more than 12 months. Participants were asked about their experience and perceptions of well-being interventions delivered in the workplace. A phenomenographical approach was applied to analyse the narrative data.

RESULTS

The findings resulted in seven qualitatively different but related categories. Participants experienced interventions to be: (1) necessary due to their stressful working environment; (2) beneficial in supporting their well-being; (3) feasible in an ED setting; (4) inadequate due to lack of quality and accessibility; (5) improving with increased acceptability and support; (6) restricted by clinical and organisational factors; and (7) ambiguous in definition, measurement and individual interpretation. Space for facilitated reflection and role modelling by leaders were felt to be important.

CONCLUSIONS

Job demands simultaneously necessitate and restrict the provision of adequate interventions to support well-being in the ED. These demands need to be addressed as part of wider organisational change including the provision of self-care facilities and opportunities, protected time for facilitated reflection, high-quality and accessible learning opportunities for personal and professional development, training for staff delivering well-being interventions and positive role modelling by leaders.

Investigating the impact of a multicomponent positive participatory organisational intervention on burnout in New Zealand emergency department staff: a prospective, multisite, before and after, mixed methods study

INTRODUCTION

The well-being of healthcare workers (HCWs) is critical to providing excellent care. Recent evidence concerns the well-being of emergency department (ED) HCWs in New Zealand, with high levels of burnout found in a 2020 survey. This threat to providing high-quality acute care warrants improvement interventions. The causes of burnout are complex and multifactorial, the solutions are not straightforward.

METHODS AND ANALYSIS

A prospective, multisite, before and after, mixed methods study assessing a multicomponent intervention, adaptable to local context, that targets three organisation levels (the individual, the group and the system levels) and meaningfully involves frontline HCWs may reduce HCW burnout and improve HCW well-being. Individual HCWs will choose from three individual-level psychological interventions and participate in those most appropriate for them. Local champions will decide which group-level intervention their ED will use. The system-level intervention will build capacity and capability for quality improvement (QI) with QI training and the establishment of a Quality Improvement Learning System. This system-level intervention has several important features that may ultimately empower HCWs to contribute to improving the quality of ED healthcare.We will enrol nine EDs, from which there will be at least 900 HCW participants. EDs will be enrolled in three waves from March 2023 to April 2024, with interventions taking place in each ED over 12 months.Methods of assessment will include baseline and repeat survey measures of burnout and well-being. Process evaluation at each ED will provide details of context, the intervention and the fidelity of the implementation.

ETHICS AND DISSEMINATION

Ethics committee approval was provided, with locality approval at each site.Individual site feedback will be provided to each ED and executive leadership. Dissemination of findings will be through publication in peer-reviewed journals, presentation at national and international scientific meetings and through national healthcare quality bodies.

TRIAL REGISTRATION NUMBER

Australia New Zealand Clinical Trials Registry (ACTRN12623000342617).

Resource loss a significant issue for healthcare professionals: A case study of an Australian regional hospital

Healthcare professionals report poor overall well-being, with many citing mental health concerns and stress as contributing factors. Given that healthcare professionals are crucial to the sustainability of the health sector, examining the factors affecting their well-being at work is essential. This paper reports the findings of research conducted in an Australian regional public hospital, utilising the conservation of resources theory to examine the factors (similarities and differences) that influence the resource loss of healthcare professionals (nurses, medical professionals, and allied health professionals). Qualitative semi-structured interviews were conducted with 43 healthcare professionals of varying roles, and participant perspectives revealed two themes contributing to a resource-poor work environment: 'occupational demands and obstacles' and 'barriers to effective teams'. These challenges caused individual resource loss, and as stress arises from resource depletion, each turn of the stress spiral left the individuals and organization with fewer resources to counteract the loss, causing loss spirals to intensify in momentum and scale. The findings of this research emphasise the importance of executing a proactive approach to well-being initiative implementation to support resource investment and assist in creating a more nurturing healthcare work environment that fosters resource creation and sustenance for healthcare professionals.

What can be done about workplace wellbeing in emergency departments? 'There's no petrol for this Ferrari'

Workplace wellbeing encompasses all aspects of working life. Peak health organisations recognise that poor workplace wellbeing is costly, both to individuals and to the organisation, and the value in promoting healthy workplaces. Workplace wellbeing improves when its barriers are acknowledged and addressed, and protective factors are promoted. The Emergency Department (ED) is a place of intense and challenging activity, exacerbated by high workloads and overcrowding. This impacts negatively on patient care, staff safety and wellbeing. We held focus groups across four EDs to discuss barriers and enablers to wellbeing and found four core themes: Workplace Satisfaction; Barriers to Wellbeing; Organisational Culture that Prioritises Staff Wellbeing; Self-care and Self Compassion. From this, and existing literature, we collaboratively developed a contextualised staff wellbeing framework titled: 'Staff Wellbeing Good Practice Framework: From Surviving to Thriving, How to Protect your Wellbeing in the Emergency Department' that emphasises their values of Competence, Connection and Control.

Emergency department workforces' experiences and perceptions of well-being from an international perspective: a scoping review

OBJECTIVES

To identify and present the available evidence regarding workforce well-being in the emergency department.

DESIGN

Scoping review.

SETTING

The emergency department (ED).

DATA SOURCES

CINAHL, MEDLINE, APA PsycINFO and Web of Science were searched with no publication time parameters. The reference lists of articles selected for full-text review were also screened for additional papers.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

All peer-reviewed, empirical papers were included if: (1) participants included staff-based full-time in the ED, (2) ED workforce well-being was a key component of the research, (3) English language was available and (4) the main focus was not burnout or other mental illness-related variables.

RESULTS

The search identified 6109 papers and 34 papers were included in the review. Most papers used a quantitative or mixed methods survey design, with very limited evidence using in-depth qualitative methods to explore ED workforce well-being. Interventions accounted for 41% of reviewed studies. Findings highlighted pressing issues with ED workforce well-being, contributed to by a range of interpersonal, organisational and individual challenges (eg, high workloads, lack of support). However, the limited evidence base, tenuous conceptualisations and links to well-being in existing literature mean that the findings were neither consistent nor conclusive.

CONCLUSIONS

This scoping review highlights the need for more high-quality research to be conducted, particularly using qualitative methods and the development of a working definition of ED workforce well-being.

Prevalence and Determinants of Workplace Violence Against Pediatric Emergency Healthcare Workers and Its Effect on Their Psychological Resilience

The study aimed to determine the prevalence and risk factors of workplace violence (WPV) against pediatric emergency healthcare workers and evaluate the relationship between WPV and psychological resilience. This study is cross-sectional and correlational. According to the results, the prevalence of WPV was 69.8%, and its distribution was as follows: verbal abuse (56.9%), bullying/mobbing (37.6%), physical abuse (12.8%), and sexual abuse (2.2%). Being single/separated/divorced/widowed (odds ratio [OR]: 1.85, 95% confidence interval [CI]: 1.03-3.30), being a physician (OR: 4.74, 95% CI: 1.73-12.96), being a staff member (OR: 2.57, 95% CI: 1.10-5.99), routine direct physical contact with patients/clients (OR: 2.77, 95% CI: 1.40-5.48), and lack of encouragement to report WPV (OR: 3.76, 95% CI: 2.01-7.01) were independent predictors of WPV (P < .05), and WPV was found to be associated with low psychological resilience. Arrangements related to violence prevention, preparation, and intervention should be made and maintained in all pediatric emergency departments.

Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses

BACKGROUND

Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence.

METHODS

A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department.

RESULTS

Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of 'toughness') CONCLUSION: Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.

Maintaining a safe environment in emergency department waiting rooms

Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses.

The occupational therapy process in workplace wellness: A qualitative study of client experience

BACKGROUND

Occupational therapy presently has a limited presence within the workplace wellness industry and the profession's contribution within this area of practice is not fully understood. Occupational therapy's holistic, occupation-based, and client-centered approach has the potential to provide a valuable contribution to the field of workplace wellness.

OBJECTIVE

To explore the experience of organizational employees participating in a workplace wellness program centered in the occupational therapy domain and process.

METHODS

Six occupational therapy workplace wellness program participants completed in-depth semi-structured interviews one month after program completion followed by deductive thematic analysis of transcripts.

RESULTS

Three themes emerged (sustainable change across context, process matters, and therapeutic relationship supporting wellness), along with subthemes, describing the participant experience.

CONCLUSIONS

The structured and individualized process of occupational therapy delivered within a workplace wellness program was appreciated by participants as a means of addressing workplace wellness and providing sustainable wellness results.

Work Related Demands and Resources as Predictors of Well-being at Work Among Healthcare Workers in Switzerland

OBJECTIVE

The aim was to examine the effects of work-related demands and resources on well-being at work among employees in Swiss hospitals.

METHODS

Self-reported survey data from 1840 employees of six hospitals/clinics were analyzed using multivariate linear regression analyses (all professions included).

RESULTS

Of all demands, work-life imbalance had the strongest negative effect on well-being at work. The most relevant resource varied depending on the dimension of well-being: for job satisfaction it was good leadership, for work engagement job decision latitude and for satisfaction with relationships at work social support at work. The resources were more relevant for well-being at work than the demands. They also buffered against the negative effects of the demands.

CONCLUSIONS

To enhance well-being at work in hospitals, it is necessary to enable a good work-life balance and to strengthen work-related resources.

Meeting the wellness needs of emergency department clinicians: A scoping review of interventions

BACKGROUND

Emergency Departments are stressful work environments that can adversely affect clinicians' wellbeing. The purpose of this scoping review was to report wellness interventions evaluated in Emergency Departments and clinicians' experience of these interventions.

METHODS

Five data bases were searched using a modification of Arksey and O'Malley's framework. PRISMA guidelines for scoping reviews were employed to report the findings. The review included only peer-reviewed articles and had no date or language restrictions applied.

RESULTS

Nine studies met inclusion criteria. Interventions included tactile massage, hypnosis, mindfulness, happiness practice, resiliency, meditation, and video-based debriefing. Three key themes emerged following data extraction and analysis: The value of mindfulness; One size doesn't fit all; and Enablers and Barriers.

CONCLUSIONS

Successful wellness programs must be relevant to Emergency Departments and staff need to be involved in the development and application of these programs to achieve maximum benefit. For long term benefits and sustainability, the strategies must be supported by senior hospital management.

Factors Influencing Perioperative Nurse Turnover: A Classic Grounded Theory Study

Perioperative nurse turnover rates range from 12% to 18.8%, and approximately 75% of perioperative managers reported at least one vacancy in 2021. Perioperative leaders are challenged to mitigate nurse turnover effectively because factors contributing to a nurse's decision to leave their job are not well defined. The purpose of this qualitative study using classic grounded theory was to explore perioperative nurses' turnover decision-making processes. We used social media to recruit participants and then conducted 26 interviews to collect data. We completed comparative analysis of the data and developed the Perioperative Nurse Turnover Decision-Making Theory, which describes the influence of the dimensions of perioperative nurse well-being (ie, physical and emotional well-being, career development, work-life balance, compensation, workplace culture) on their decision to leave an OR position. Perioperative leaders should consider the nurses' decision-making process when developing and implementing interventions aimed at reducing turnover.

"I love the job…" Thriving in nursing: A qualitative interview study with framework analysis

BACKGROUND

Burnout is a well-known issue among nurses in critical care settings, including emergency nurses. There are decades of research indicating that emergency nurses experience burnout in their work. However, many nurses have long careers in emergency settings, which suggests that burnout is not the only outcome for nurses. Thriving may also be part of nurses' experiences. The Model of Thriving at Work includes external factors (autonomy, climate of trust and respect, and information sharing) and internal factors (knowledge, personal outlook, and relationships). Thriving is characterized by the concepts of vitality and ongoing learning. Previous researchers suggest that thriving fits with some nurses' experiences, based on validated questionnaires. However, thriving has not been investigated among nurses using interview approaches.

AIMS

This article explores nurses' experiences of thriving and assesses the fit of Spreitzer et al.'s Model of Thriving at Work with nurses' experiences.

STUDY DESIGN

Qualitative interview study, using framework analysis.

METHODS

Eleven nurses, from a single site, completed semi-structured interviews. These interviews explored nurses' workplace experiences, both positive and negative.

RESULTS

Participants reported experiences that fit with the Model of Thriving at Work, consisting of vitality, ongoing learning, and external and internal factors. Nurses hesitated to describe themselves in positive ways, referring instead to being 'not burnt out'. Nurses could, however, readily identify qualities of thriving in others, and viewed those nurses as aspirational. In addition to the Model, participants highlighted their emotional burden, workload, and ethical issues as important contributors to thriving. The Model could potentially be expanded to include these factors.

CONCLUSIONS

Thriving at work could be part of a range of emergency nurses' workplace outcomes. External and internal factors contribute to thriving. Healthcare leaders could support thriving among emergency nurses by fostering a positive work environment.

Pediatric emergency nurses' workplace violence experiences: A qualitative study

INTRODUCTION

Workplace violence is a crucial problem experienced by health workers who serve at the emergency service. The identification of emergency nurses' workplace experiences is of importance to the prevention of violence and the development of solutions.

PURPOSE

This study was performed to identify the workplace violence experiences of the nurses working for the pediatric emergency units.

METHOD

A total of 20 nurses who experienced violence at the emergency service participated in the study that was conducted as qualitative research. The data were collected with the semi-structured interview form and were evaluated by using thematic analysis.

RESULTS

Five themes, namely, "the characteristics of violence", "the causes of violence", "the approach during/after the violence", "the consequences of the violence for the person", and the "consequences of the violence for the profession", were identified. Nurses stated that they often experienced verbal violence due to patient relatives' unmet expectations, the failure of patient relatives to understand treatments and practices, and the heavy workload, they endeavored to eliminate violence by trying to communicate with perpetrators of the violence, calling the security staff, and reporting the violence to their managers, and they were individually and professionally affected by the violence.

CONCLUSION

Nurses are negatively affected by workplace violence. Pediatric emergency nurses should be supported with training programs and policies to be developed for the prevention and solution of violence.

Burnout Syndrome among Staff at an Emergency Department during the COVID-19 Pandemic

OBJECTIVE

The aim of this current study was to identify the prevalence of burnout manifestation in a sample recruited from the emergency department of a hospital. Moreover, we aimed to assess the role of professional experience, age, and the professional category in shaping burnout manifestations.

RESULTS

The results showed that higher proportions of burnout symptoms were reported by resident physicians, nurses, and physicians whereas lower proportions were encountered in the orderly group. Moreover, the results revealed a significant difference between men and women in the nurse group concerning depersonalization; men presented higher levels of depersonalization compared with women. Concerning emotional exhaustion and depersonalization, multiple comparisons showed differences among the professional categories.

CONCLUSIONS

The implications of these results for preventing burnout syndrome are discussed.

A multidisciplinary, cross-sectional survey of burnout and wellbeing in emergency department staff during COVID-19

Background

Emergency department (ED) staff are at-risk of burnout, poor wellbeing and increased stress that can impact patient satisfaction, staff morale and retention. The aim of this survey was to determine level of burnout, stress and satisfaction with current employment role in ED during COVID-19.

Methods

A multisite cross-sectional survey captured ED employment data, wellbeing, burnout (Maslach Burnout Inventory), stress (Health Professions Stress Inventory), work environment (WES-10) and Caring for COVID-19 Patients questions.

Results

The response rate of 44.2% (n = 177) represented all healthcare disciplines. Only 58.8% (n = 104) of participants were happy in their role, satisfaction was low, burnout was high (M 71.0, SD 17.1) as was level of stress (M 90.6, SD 16.5). Nurses and allied health staff were more stressed than their medical or support staff colleagues. Participants perceived discriminatory behaviours from friends and family in caring for suspected or infected COVID-19 patients.

Conclusions

ED staff are a vulnerable group. Programmes to promote wellbeing, personal resilience, and self-care together with personal and professional growth are needed to build individual capability and a culture of organisational resilience, particularly in the context of the COVID pandemic.