Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study

Exploring the lived experiences of diagnostic radiographers after transitioning to non-emergency imaging settings

INTRODUCTION

The demand for diagnostic imaging in emergency clinical settings has increased in recent years, placing pressure on the available workforce. However, challenges including staff shortages and inflexible shift patterns may prompt radiographers to leave emergency settings. This study explores the lived experiences of radiographers who have transitioned to non-emergency settings and factors that might influence their decision to return.

METHODS

A descriptive phenomenological approach was used. Semi-structured interviews were conducted with 12 diagnostic radiographers working in the UK, who had transitioned to non-emergency settings within the last one to five years.

RESULTS

Participants provided insight into (1) the past: reasons for transitioning, (2) the present: current thoughts on wellbeing and professional development, and (3) the future: possibility of returning to the emergency setting. Occupational pressures including excessive workloads, physical exhaustion, and time constraints leading to moral distress, were commonly cited reasons for transitioning to non-emergency setting. Since transitioning, participants reported improvement in their physical and mental well-being, renewed job satisfaction, and enhanced work-life balance. Career advancement opportunities, a better work environment, competitive salaries, and improved mental health support, could encourage a return to the emergency setting.

CONCLUSION

This study highlights the valuable learning experiences that emergency settings offer diagnostic radiographers, greatly enhancing their skills and overall competence. However, challenging work conditions can lead to job dissatisfaction and burn out. Instead of leaving the profession altogether, some radiographers found renewed satisfaction by transitioning to non-emergency settings. The majority of participants would consider returning to emergency imaging under the right conditions.

IMPLICATIONS FOR PRACTICE

Flexibility regarding work arrangements, career advancement opportunities, competitive salary offers, and improved mental health support through interventions such as debriefing, could help retain radiographers in emergency settings.

Psychosocial working conditions and violence prevention climate in German emergency departments - a cross-sectional study

BACKGROUND

Emergency departments (EDs) are high pressure work environments with several psychosocial job demands, e.g., violence, and job resources, e.g., colleague support. So far, the perceptions of working conditions have been compared between doctors and nurses, but there is limited knowledge regarding their respective supervisors. In addition, the violence prevention climate has not been assessed in German EDs before. Thus, the current study focuses on differences in the perceptions of working conditions and the violence prevention climate between the groups of doctor-supervisors, doctor-employees, nurse-supervisors, and nurse-employees within the ED. Further analyses regarding the association between social relations and pressure for unsafe practices are performed, including the moderating role of belonging to one of the aforementioned groups.

METHODS

A cross-sectional online survey was carried out among N = 370 participants, who were doctors or nurses from German EDs. The Questionnaire for Psychosocial Risk Assessment (QPRA) and the Violence Prevention Climate Scale (VPCS) were applied. Kruskal-Wallis tests were performed for group comparisons, followed by a hierarchical multiple linear regression model and moderation analyses.

RESULTS

Statistically significant differences between the groups were found for eight out of 13 variables. The highest number of significant pairwise comparisons was found between the groups of doctor-supervisors and nurse-employees. High job demands regarding work intensity and work interruptions became apparent across all groups. Nurse-employees reported the highest social and emotional demands as well as the highest pressure for unsafe practices regarding violence prevention, significantly differing from the other groups on these variables. The variables of supervisor support and social stressors were found to be significantly predictive of pressure for unsafe practices. Furthermore, there was no moderating effect of belonging to one of the above-mentioned groups in the relationships between variables of social relations and pressure for unsafe practices.

CONCLUSIONS

Differences found in the current study can help tailor preventive measures according to the needs of distinct professions and positions in order to improve working conditions and the violence prevention climate in EDs. Furthermore, supervisor support should be strengthened while social stressors should be resolved in order to decrease pressure for unsafe practices regarding violence prevention.

Leadership training in emergency medicine: A national survey

Background

Emergency medicine (EM) is a uniquely stressful environment in which leadership training could improve individual and team performance, patient outcomes, well-being, and EM career intentions. The primary aim was to evaluate EM-specific leadership training (EMLeaders) compared to no leadership training. A secondary comparison was with other forms of leadership training.

Methods

An online survey was distributed to Royal College of Emergency Medicine (RCEM) members in England. Three groups were recruited: those who reported receiving EMLeaders training, no training, and other training. Information was collected on group demographics, job roles, responses to 14 leadership knowledge and skills items, well-being at work, and EM career intentions.

Results

A total of 417 responders (177 EMLeaders, 148 no training, 92 other training) were largely representative of RCEM members, although the EMLeaders group were at less senior career grades. Although all groups provided generally positive responses, EMLeaders demonstrated more positive ratings for seven of 14 leadership items relative to no training (all p < 0.05): knowledge about clinical leadership, application of clinical leadership, empowerment to make decisions, managing the emergency department environment, ability to influence the EM environment, confidence in leadership, and confidence in facilitating teams. The other training group demonstrated superior ratings for five of seven of the same items, except empowerment to make decisions and ability to influence the EM environment. Direct comparison of EMLeaders with other training identified ability to influence the EM environment as a unique benefit of EMLeaders (p < 0.05), while knowledge about clinical leadership favored other training (p < 0.05).

Conclusions

EMLeaders improved many aspects of perceived leadership knowledge and skills, but there was little evidence of impact on well-being or EM career intentions. EMLeaders particularly appears to enhance perceived ability to influence the EM environment. Considering that the EMLeaders group were generally earlier in their career, the findings are promising and can inform the refinement of future EM-specific training.

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.

Tailored leadership training in emergency medicine: qualitative exploration of the impact of the EMLeaders programme on consultants and trainees in England

BACKGROUND

Emergency medicine (EM) consultants are expected to provide leadership to facilitate optimal clinical results, effective teamwork and learning. To foster leadership skills, the Emergency Medicine Leadership Programme (EMLeaders) was launched in 2018 by the Royal College of Emergency Medicine (RCEM), Health Education England and National Health Service England. A mixed-methods evaluation of EMLeaders was commissioned to assess the impact at the strategic, team and individual levels. This paper reports the qualitative evaluation component.

METHODS

Qualitative data collected from 2021 to 2022 were drawn from an online survey of RCEM members in England, which included four open questions about leadership training. At the end of the survey, participants were asked to share contact details if willing to undertake an in-depth qualitative interview. Interviews explored perceptions of the programme and impact of curriculum design and delivery. Data were analysed thematically against the Kirkpatrick framework, providing in-depth understanding.

RESULTS

There were 417 survey respondents, of whom 177 had participated in EMLeaders. Semistructured interviews were completed with 13 EM consultants, 13 trainees and 1 specialty and associate specialist doctor. EMLeaders was highly valued by EM consultants and trainees, particularly group interaction, expert facilitation and face-to-face practical scenario work. Consultant data yielded the themes: we believe in it; EM relevance is key; on a leadership journey; shaping better leaders; and a broken system. Challenges were identified in building engagement within a pressured workplace system and embedding workplace role modelling. Trainees identified behavioural shift in themselves following the programme but wanted more face-to-face discussions with senior colleagues. Key trainee themes included value in being together, storytelling in leadership, headspace for the leadership lens and survival in a state of collapse.

CONCLUSION

The development of leadership skills in EM is considered important. The EMLeaders programme can support leadership learning but further embedding is needed.

Trauma systems in high socioeconomic index countries in 2050

Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.