Workplace aggression as cause and effect: Emergency nurses’ experiences of working fatigued

https://doi.org/10.1016/j.ienj.2016.10.006Get rights and content

Highlights

  • Fatigue compromises nurses’ personal lives and creates a toxic unit environment.

  • Fatigue compromises safe patient care.

  • Below-adequate staffing levels are a major source of fatigue.

  • Lateral violence (workplace bullying) is both a cause and effect of fatigue.

Abstract

Introduction

Emergency nursing requires acute attention to detail to provide safe and effective care to potentially unstable or critically ill patients; this requirement may be significantly impaired by physical and mental fatigue. There is a lack of evidence regarding the effects of fatigue caused by factors other than a sleep deficit (e.g., emotional exhaustion). Fatigue affects nurses’ ability to work safely in the emergency care setting and potentially impacts their health and quality of life outside of work.

Methods

This was the qualitative arm of a mixed methods study; we used a qualitative exploratory design with focus group data from a sample of 16 emergency nurses. Themes were identified using an inductive approach to content analysis.

Results/discussion

The following themes were identified: “It’s a weight on your back;” “Competitive nursing;” “It’s never enough;” “You have to get away;” and “Engagement as a solution.”

Conclusions

Our participants reported high levels of fatigue, which compromised patient care, had a negative effect on their personal lives, and created a toxic unit environment. They reported lateral violence as both the cause and effect of mental and emotional fatigue, suggesting that unit culture affects nurses and the patients they care for.

Section snippets

Introduction and background/literature

Fatigue has the potential to affect nurses’ ability to provide safe and effective patient care as well as their health and quality of life outside of work. Nurses must be attentive enough not only to recognize their own potential for making errors, but also to identify and mitigate the errors of others [9]. Research findings connect some of the world’s worst disasters with fatigue: both the Chernobyl nuclear reactor catastrophe and the Challenger Space Shuttle disaster were linked to human

Methods

In this mixed-methods study, mixing occurred at the data-collection stage to provide a fuller exploration and more useful answers to the research questions. The overall aim of both arms of the study was to explore the effects of fatigue in emergency nurses on both cognition and work experience. The quantitative study [30] was an exploratory correlative design that used an online survey of emergency nurses (N = 1506) to explore the relationship between fatigue and cognitive function. The study

Results/discussion

Participants reported that consequences of working fatigued included inattentive, inefficient, and unsafe patient care (including both commission and omission errors), interpersonal conflicts (including lateral violence), emotional exhaustion and burnout, and low morale. The findings of this study support existing literature, bring several new and compelling factors to the understanding of work-related fatigue in emergency nurses, and draw new lines of association to other phenomena.

The

Conclusions

Fatigue as described by our sample of emergency nurses is an overwhelming mental and emotional exhaustion caused in part by overwork, extended shifts, and lack of breaks from the unpredictable demands typical of most ED settings. Participants made a clear distinction between “tiredness” as the consequence of a lack of sleep, and the mental and emotional fatigue that negatively effects the professional and personal environment. The high levels of fatigue reported by these emergency nurses

Acknowledgements

The authors wish to acknowledge Leslie Gates for her assistance with this study, and the members of the Institute for Emergency Nursing Research Advisory Council (Michael D. Moon PhD, RN, CNS-CC, FAEN, Kathleen E. Zavotsky PhD, RN, Hershaw Davis, MSN, RN, and Anita Smith PhD, RN) for their review of this manuscript.

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