Patient Safety Concerns When ED Nurses Have Poor Working Environments
February 1, 2024 3 minutes read
By Stacey Kusterbeck
There is growing evidence that physicians and nurses are concerned about the emergency medicine workforce. Almost half (47%) of emergency medicine programs had unfilled positions in the 2023 U.S. Match, according to a recent study.1 Emergency nurses report significantly higher rates of burnout, job dissatisfaction, and intent to leave the job compared to inpatient nurses, another study found.2
K. Jane Muir, PhD, FNP-BC, and colleagues conducted a study to find out how emergency nurses report the quality of their work environment and what this suggests about the quality and safety of patient care.3 The researchers analyzed survey data on 746 emergency nurses and data from the American Hospital Association Annual Hospital Survey on hospital characteristics. More than half (58%) of emergency nurses reported high burnout, 39% were dissatisfied with their jobs, and 27% intended to leave their jobs in the next year. ED nurses working in “better” (compared to “mixed”) and “mixed” (compared to “poor”) environments were less likely to report poor patient care quality outcomes and less likely to give their hospital a poor patient safety grade.
The varying quality of ED nurse work environments is a safety concern. “It poses a threat to the safety and well-being of patients in need of emergency services. It also threatens the well-being of the emergency nursing workforce,” notes Muir, a postdoctoral research fellow at the University of Pennsylvania’s Center for Health Outcomes and Policy Research.
Conversely, hospital investments in better nurse work environments are associated with higher patient quality and safety reports. “There is increasing support for higher-quality nurse work environments through safer nurse staffing levels. This is gaining traction from healthcare industry leaders and CEOs,” Muir reports.
When nurses and physicians working in the same hospitals are asked to rate top interventions that would improve their well-being, both clinician groups endorse safer nurse staffing levels, according to a different study.4 Efforts to improve nurse work environments in ED should focus on these things, according to Muir:
- Supportive nursing leadership (e.g., escalation of clinician safety concerns about workplace violence);
- Strong interprofessional collaboration. “Poor nurse staffing impacts physicians’ well-being as well,” Muir notes;
- Safer nurse staffing levels.
“We are at a critical point for the emergency workforce. The need to retain and recruit clinicians in a high-stress setting is of urgent importance,” Muir underscores.
The ED setting has some unique and unavoidable characteristics that contribute to a challenging work environment for nurses, such as unpredictable patient volume and acuity. EDs also tend to serve higher rates of patients with health inequities and socioeconomic disparities. “All these factors exacerbate ED staff burnout, turnover, and low job satisfaction,” says Andrew Furman, MD, MMM, FACEP, vice president of clinical evidence and safety solutions at ECRI.
Addressing these issues requires a systemwide approach with patient safety at the forefront. “The problems are not just ED problems but are a consequence of the entire healthcare system,” he says.
Data on adverse events, staffing, workload, and employee engagement should be assessed to identify areas of concern and their causes. “Perspectives from human resources, clinical, operational, facilities, quality, technology, and patient experience teams should be included,” Furman suggests.
REFERENCES
- Preiksaitis C, Krzyzaniak S, Bowers K, et al. Characteristics of emergency medicine residency programs with unfilled positions in the 2023 Match. Ann Emerg Med 2023;82:598-607.
- Turnbach E, Coates L, Vanek FD, et al. Emergency nurses’ well-being in Magnet hospitals and recommendations for improvements in work environments: A multicenter cross-sectional observational study. J Emerg Nurs 2023; Jul 26:S0099-1767(23)00156-3. doi: 10.1016/j.jen.2023.06.012. [Online ahead of print].
- Muir KJ, Sloane DM, Aiken LH, et al. The association of the emergency department work environment on patient care and nurse job outcomes. J Am Coll Emerg Physicians Open 2023;4:e13040.
- Aiken LH, Lasater KB, Sloane DM, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum 2023;4:e231809.
There is growing evidence that physicians and nurses are concerned about the emergency medicine workforce. Almost half (47%) of emergency medicine programs had unfilled positions in the 2023 U.S. Match, according to a recent study. Emergency nurses report significantly higher rates of burnout, job dissatisfaction, and intent to leave the job compared to inpatient nurses, another study found.
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