6 Strategies for Improving
ED Nurse Wellness

Table of Contents

Nine of 10 ED nurses report being stressed or anxious


and nearly the entire sample of ED nurses surveyed in a recent study exhibited some level of PTSD per nurse burnout statistics.3 Nurses experiencing burnout, STS, and PTSD often use disengagement and depersonalization as coping methods.3, 4 By necessity they become very task-focused rather than assessment focused.3 Nurse burnout and patient safety go hand in hand, as burnout can impede recognition of both patient decompensation and behavioral escalation.

STS and PTSD are linked with increased absenteeism and a mass exodus of highly skilled nurses. Almost half of ED nurses say they have considered leaving the profession.5 This exacerbates staffing problems. When nurses call in sick or quit, EDs are forced to work with suboptimal staffing and may rely on new to practice nurses who might be less experienced and inadvertently cause patient harm.

Organizations must employ systematic strategies to improve the conditions that contribute to burnout, STS, and PTSD. ED nurses shouldn’t have to feel like they are working on the frontlines of a battlefield.

Here are six strategies you can implement to improve ED nurse wellness
and enhance patient care.
Cultivate a strong support system, from the top down.

Managers must model transparency and be genuinely concerned for their staff if they want their staff to exhibit teamwork and compassion. Transformational leadership requires teamwork centered around achieving their organization’s goal.6

Unsupportive managers can play a significant factor in the nurses being at risk for compassion fatigue—losing their ability to nurture and care for patients.7 Workplace trauma is compounded when distressed nurses are dismissed by managers.3

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Authentic leadership—one in which managers cultivate open communication, respect, a non-punitive environment, and teamwork—is effective in reducing nurse burnout.4

Ensure each nurse has sufficient scheduled time away from the ED.

The more extended shifts or consecutive shifts nurses work, the less they feel they can provide safe care.3 Encouraging nurses to work overtime with bonuses contributes to burnout and lessens their ability to cope with trauma. The cumulative effect of routine exposure to trauma increases feelings of STS and PTSD.3 Nurses must be given time to recover.8

Rather than asking nurses to work extra hours, managers should encourage nurses to utilize paid time off.3
Critically assess staffing models.

The ability to manage critical patients requires not just enough presence and attention, but the staffing patterns that make this possible.9 Inadequate staffing by virtue of absolute numbers or inexperienced coworkers impedes assessment across the board and contributes to added nurse stress. Unsafe staffing forces nurses to feel they are compromising patient care.8 Nurse burnout hampers critical thinking and decision-making.4

Managers must conduct a critical assessment of departmental staffing and ensure that adequate personnel are scheduled. They must also have contingency staffing plans in place to account for sick day call-ins.
Train preceptors and managers in trauma processing.

Nurses should not be expected to quickly transition from a traumatic case to another patient. It is critical to provide debriefing opportunities for staff as they need them.

In fact, management can create a toxic work environment when they dismiss nurse stress.3 Nurses cope best when encouraged to process stressful situations with coworkers, especially when it is an informal debriefing.10

Managers should provide ED nurses with regular practical in-service trainings modeled after those provided to emergency responders, to help them cope with continual and traumatic stressors.10

Create safety plans that include immediate response strategies.8
ED nurses experience high rates of workplace violence and harassment is common place. Violence against nurses increases the risk of PTSD, absenteeism, and nurse turnover. In effect, these causes of nurse burnout decreases cognitive and emotional focus.11
Hospitals must reduce response time when ED nurses are threatened and consider employing a mental health counselor skilled in the de-escalation of violence. When nurses are harassed or a, management should provide immediate intervention including debriefing, counseling, and time off with workers’ compensation if they are injured.11, 12
Instead, managers should create hands-on, supervised onboarding programs that allow adequate time for nurses new to the ED environment to achieve competency in critical ED nursing functions2 such as the assessment of arriving patients at triage. Mentorship from skilled ED nurses can help less experienced nurses more successfully navigate chaos and trauma and should also foster a supportive work environment.3

Emerging technology such as artificial intelligence (AI) in medicine and healthcare has also shown to provide active learning opportunities which improves critical reasoning on the job while also improving nurse retention.13 An example of such technology includes KATE TM. KATE AI clinical decision support works silently in the background and supports ED nurses by notifying them of possible Emergency Severity Index (ESI) assignment undertriage or overtriage, as well as incomplete documentation or documentation errors.13

KATE has helped ED nurses decrease clinical errors at triage by 41% for high-risk patients.14

KATE is associated with a 30% improvement in ED nurse retention3,13,14,15

3 out of 4 nurses are
concerned about overwork
Overworked and unsupported ED nurses are at high risk of STS, PTSD, and burnout—yet three of four nurses are concerned about overwork, undermining their resilience and their ability to provide high-quality care.8

Implementing these six strategies should lead to reduced rates of STS, PTSD, and burnout and improved work culture, staff wellness, and patient outcomes.
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1. Lagasse J. Healthcare Workers Experiencing Burnout, Stress Due to COVID-19 Pandemic. 2020 Dec 8. From https://www.healthcarefinancenews.com/news/health– care-workers-experiencing-burnout-stress-due-covid-19-pandemic 2. Advisory Board Report. How Covid-19 will impact the nursing workforce. 2020 Oct 6. Washing– ton DC. 3. Wolf LA, Delao AM, Perhats C, Clark PR, Edwards C, Frankenberger WD. Traumatic Stress in Emergency Nurses: Does Your Work Environment Feel Like a War Zone? International Emergency Nursing. 2020 Sep; 52:100895. doi: 10.1016/j.ienj.2020.100895. Epub 2020 Aug 11. PMID: 32795958. 4. Wei H, King A, Jiang Y, Sewell KA, Lake DM. The Impact of Nurse Leadership Styles on Nurse Burnout. Nurse Leader. 2020 Oct;18(5):439. doi: 10.1016/j.mnl.2020.04.002 5. Cornwall L. RNnetwork 2018 portrait of a modern nurse survey. 2018 Dec 12. From https://rnnetwork.com/blog/rnnetwork-2018-portrait-of-a-modern-nurse-survey 6. Higgins, EA. The Influence of Nurse Manager Transformational Leadership on Nurse and Patient Outcomes: Mediating Effects of Supportive Practice Environments, Organizational Citizenship Behaviours, Patient Safety Culture and Nurse Job Satisfaction. Electronic Thesis and Dissertation Repository. 2015. 3184. https://ir.lib.uwo.ca/etd/3184 7. Hunsaker S, Chen HC, Maughan D, Heaston S. Factors that Influence the Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in Emergency Department Nurses. Journal of Nursing Scholarship. 2015 Mar;47(2):186-94. doi: 10.1111/jnu.12122. Epub 2015 Jan 20. PMID: 25644276. 8. Virkstis K, Herleth A, Langr M. Cracks in the Foundation of the Care Environment Undermine Nurse Resilience. Journal of Nursing Administration. 2018;48(12):597. doi: 10.1097/NNA.0000000000000687 9. Wolf LA, Perhats C, Delao AM, Clark PR, Moon MD. On the Threshold of Safety: A Qualitative Exploration of Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments. Journal of Emergency Nursing. 2017 Mar;43(2):150-157. doi: 10.1016/j.jen.2016.09.003. Epub 2016 Nov 8. PMID: 27836139. 10. Soravia LM, Schwab S, Walther S, Müller T. Rescuers at Risk: Posttraumatic Stress Symptoms Among Police Officers, Fire Fighters, Ambulance Personnel, and Emergency and Psychiatric Nurses. Frontiers in Psychiatry. 2021 Jan 19;11:602064. doi: 10.3389/fpsyt.2020.602064. PMID: 33542696; PMCID: PMC7851799. 11. Gates DM, Gillespie GL, Succop P. Violence Against Nurses and its Impact on Stress and Productivity. Nursing Economics. 2011 Mar-Apr;29(2):59-66, quiz 67. PMID: 21667672. 12. Starr KT. After a Physical Assault by a Patient: What Are Your Options? Nursing. 2019 Jun;49(6):12-13. doi: 10.1097/01.NURSE.0000554611.25772.c1. PMID: 31124846. 13. Bryant M & Faber A. 5 Key Innovations Driving Outcomes in a Pandemic. AHA Center for Health Innovation. (2021, February 11). https://youtu.be/UpHQeYMckow 14. Ivanov O, Wolf L, Brecher D, Lewis E, Masek K, Montgomery K, Andrieiev Y, McLaughlin M, Liu S, Dunne R, Klauer K, Reilly C. Improving ED Emergency Severity Index Acuity Assign– ment Using Machine Learning and Clinical Natural Language Processing. Journal of Emergency Nursing. 2021 Mar;47(2):265-278.e7. doi: 10.1016/j.jen.2020.11.001. Epub 2020 Dec 24. PMID: 33358394. 15. National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. 2019 Oct 23. Washington (DC): National Academies Press (US).

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