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Staff perceptions of the emergency department working environment: An international cross-sectional survey

Journal article
Authors J. Crilly
J. H. Greenslade
A. Johnston
Eric Carlström
O. Thom
L. Abraham
D. Mills
M. Wallis
Published in EMA - Emergency Medicine Australasia
Volume 31
Issue 6
Pages 1082-91
ISSN 1742-6731
Publication year 2019
Published at Institute of Health and Care Sciences
Pages 1082-91
Language en
Keywords coping, emergency department, morale, stress, survey, working environment, article, child, child sexual abuse, coping behavior, cross-sectional study, death, emergency ward, employee, employment, female, human, male, morality, nervousness, perception, professional standard, regression analysis, skill mix, statistics, thinking, work environment, workload
Subject categories Health Care Service and Management, Health Policy and Services and Health Economy


Objectives: The aims of this study were to describe clinical staff perceptions of their ED working environment and to explore associations between staff demographics, coping styles and the work environment. Methods: A cross-sectional study was conducted in one Swedish ED and two Australian EDs in 2015–2016. Descriptive statistics were used to explore stressors, coping styles and aspects of the working environment for the combined cohort and the cohort split by age, sex, professional role, years of employment in the ED and country. Regression analyses examined the impact of coping style and demographic characteristics on staff perceptions of the working environment. Results: Two hundred and six ED staff completed the survey (response rate: 64%). Factors most stressful for ED staff included death or sexual abuse of a child, heavy workload and poor skill mix. Staff perceptions of the working environment differed based on age, sex, country, tenure and job role. Regression analysis of perceptions of the work environment on demographics and coping strategies revealed that negative coping strategies were associated with low self-realisation, high workload, high conflict and high nervousness. Active coping and positive thinking were associated with increased self-realisation. Positive thinking was associated with lower levels of conflict. Conclusions: Employees engaging in positive coping strategies had more positive perceptions of the work environment, while those engaging in maladaptive coping strategies reported negative perceptions of the work environment. These data suggest that strategies that promote the use of active coping and positive thinking should be encouraged and warrant further research in the ED. © 2019 Australasian College for Emergency Medicine

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