Patient-related stressful situations and stress-related outcomes in emergency nurses: A cross-sectional study on the role of work factors and recovery during leisure time

Emergency nurses are frequently exposed to patient-related stressful situations, making them susceptible to emotional exhaustion and symptoms of post-traumatic stress disorder. The current study aims to assess differential effects of patient-related stressful situations (emotionally demanding situations, aggression/conflict situations, and critical events) on stress-related outcomes in emergency nurses, and to identify moderating factors based on the Job Demands-Resources model and the Effort-Recovery model (job demands, job resources, and recovery experiences during leisure time). A cross-sectional study was carried out among nurses working in the emergency departments of 19 hospitals in the Netherlands (N = 692, response rate 73%). Data were collected by means of an online survey. Multiple hierarchical regression analyses were performed, controlling for sociodemographic variables. The frequency of exposure to patient-related stressful situations was positively related to stress-related outcomes, with emotionally demanding situations and aggression/conflict situations mainly explaining variance in emotional exhaustion (β = 0.16, p < .01, ∆R² = 0.08, and β = 0.22, p < .01, ∆R² = 0.13), whereas critical events mainly explained variance in post-traumatic stress symptoms (β = 0.29, p < .01, ∆R² = 0.11). Moderating effects were found for within worktime recovery and recovery during leisure time. Work-time demands, autonomy and social support from the supervisor were predictive of stress-related outcomes irrespectively of exposure to patient-related stressful situations. As patient-related stressful situations are difficult if not impossible to reduce in an emergency department setting, the findings suggest it would be worthwhile to stimulate within worktime recovery as well as recovery experiences during leisure time, to protect emergency nurses from emotional exhaustion and symptoms of post-traumatic stress. Furthermore, this study underscores the importance of reducing work-time demands and enhancing job resources to address stress-related outcomes in emergency nurses. Practical implications, strengths and limitations are discussed.