Emergency Departments (EDs) present an interesting dichotomy to the outside viewer.  EDs are highly stressful workplaces [1], beset by the impacts of occupational violence, increasing incidence and severity of drug and alcohol presentations and demanding workloads driven by burgeoning patient presentations [2], populational changes in the patients presenting (i.e. older patients with more comorbidities), resource shortages and an ageing workforce [3,4]. However, they are also a reliable safety net for all community members offering expert multi- and interdisciplinary care around the clock and as such are often seen as desirable first positions for graduates excelling in both medicine and nursing.

Thus, EDs present both an exciting challenge and a high-risk source of burn-out for healthcare professionals, new and experienced. Successfully walking the professional tightrope posed by these simultaneous challenges requires the delivery of excellent peer-professional and managerial (administrative) support and education, delivered in a timely manner to staff. Development of such clinical culture can be confronting for health services.

This study seeks to triangulate information from a range of sources: ED nurses’ survey data, focus group interview data and staff demographic data, to explore the nurses’ perceptions of their working environment and the ED culture in a unique ED in QLD. The ED, located within a busy metropolitan hospital, that has been the site of a range of specific interventions designed to ensure it meets Magnet excellence designation three times [5].

Objectives:

The overarching objective of this study is to document and understand current ED nursing staff perceptions of their working environment and the factors that ED nurses identify as important contributors to the development and maintenance of these perceptions. This objective will be achieved by triangulating evidence from 3 key sources. Thus the study will:

  1. Systematically review the components of the recent Best Practice Australia (BPA) Survey to extract key themes and staff responses;
  2. Collect and synthesise objective measures of staff satisfaction including de-identified ED nursing staff demographic data, such as sick leave, staff turnover and average employment duration;
  3. Undertake focus group interviews with ED nursing staff to explore qualitatively their perceptions of their working environment and factors that contribute to their perceptions; and
  4. Synthesise (triangulate) outcomes from 1, 2 & 3 to establish an overarching understanding of ED nursing staff perceptions of their working environment.

Expected outcomes and deliverables:

The successful applicant (scholar) would assist with objective 3 of this project. The scholar’s involvement could include interview transcription and coding of themes under our guidance. The scholar can expect to learn how to use transcription software and to develop a beginner’s understanding of how to undertake qualitative thematic analysis. Listening to the interviews will also provide the scholar with some valuable insights into the clinical nursing hierarchy in EDs and into the various roles and perspectives of staff undertaking quite different (‘junior’ and ‘senior’) roles in the ED. This would provide the scholar, who is keen to move into a critical care environment as a graduate nurse, invaluable insights into nursing management.

Qualitative research skills and the processes of thematic analysis are also critical techniques for any student who might wish to be involved in clinically-associated research consumption, implementation, translation or development. The student would be provided with support by PAH ED and UQ research staff to clinically contextualise this data. The scholar may have the opportunity to contribute to and co-author a publication from their research.  Scholars will be encouraged to present an oral presentation at the end of their project.

The project has the direct support of the PAH-emergency department Assistant Director of Nursing and aligns with the ED nursing research focus, as well as the primary focus of my research (ED staff engagement with workplace). The student would be supported by myself and by a Masters of research qualified research nurse.

Suitable for:

This project would suit a clinically focused student who has an interested in workplace management, acute care clinical environments such as an ED. It would also suit a student who is considering a role in health service management. We have several very capable  students who have identified interest in a summer project in the ED.

 


References:

  1. Burbeck, R., et al., Occupational stress in consultants in accident and emergency medcine: a national survey of levels of stress at work. Emerg Med J, 2014. 19: p. 234-238.
  2. Lowthian, J.A., et al., Demand at the emergency department front door: 10-year trends in presentations. MJA, 2012. 196(2): p. 128-132.
  3. Johnston, A., et al., Review article: Staff perception of the emergency department working environment: Integrative review of the literature. Emerg Med Australas, 2016. 28(1): p. 7-26.
  4. Boyle, A., et al., Emergency department crowding: time for interventions and policy evaluations. Emerg Med Int, 2012. 2012: p. 1-8.
  5. Drenkard, K., Magnet Momentum: Creating a Culture of Safety. Nurse Leader, 2011. 9(4): p. 28-46 19p.

Project members

I am happy to be contacted by students prior to them submitting an application if they would like further information: amy.johnston@uq.edu.au

Dr Amy Johnston

Senior Lecturer
School of Nursing, Midwifery and Social Work