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Key occupational stressors in the ED: an international comparison
  1. Jaimi H Greenslade1,2,
  2. Marianne Wallis3,
  3. Amy N B Johnston4,5,
  4. Eric Carlström6,
  5. Daniel B Wilhelms7,8,
  6. Julia Crilly9,10
  1. 1 Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
  2. 2 Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  3. 3 School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore, Queensland, Australia
  4. 4 Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  5. 5 School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
  6. 6 Health and Crisis Management and Policy, Sahlgrenska Academy, Goteborgs Universitet, Goteborg, Sweden
  7. 7 Department of Medical and Health Sciences, Linkopings Universitet, Linkoping, Sweden
  8. 8 Department of Emergency Medicine, Universitetssjukhuset i Linkoping, Linkoping, Sweden
  9. 9 Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
  10. 10 Department of Emergency Medicine, Gold Coast Health, Southport, QLD, Australia
  1. Correspondence to A/Prof Jaimi H Greenslade, Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; jaimi.greenslade{at}


Background The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden).

Method This was a cross-sectional survey of staff working in eight hospitals in Australia and Sweden. Data were collected between July 2016 and June 2017 (depending on local site approvals) via a printed survey incorporating the 15-item ED stressor scale. The median stress score for each item and the frequency of experiencing each event was reported.

Results Events causing most distress include heavy workload, death or sexual abuse of a child, inability to provide optimum care and workplace violence. Stressors reported most frequently include dealing with high acuity patients, heavy workload and crowding. Violence, workload, inability to provide optimal care, poor professional relations, poor professional development and dealing with high-acuity patients were reported more commonly by Australian staff. Swedish respondents reported more frequent exposure to mass casualty incidents, crisis management and administrative concerns.

Conclusions Workload, inability to provide optimal care, workplace violence and death or sexual abuse of a child were consistently reported as the most distressing events across sites. The frequency with which these occurred differed in Australia and Sweden, likely due to differences in the healthcare systems.

  • staff support
  • psychology

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  • Collaborators Thom; Ogilvie Abraham; Louisa Xu, Hui (Grace) Elder, Elizabeth Hughes, James Hughes Magnusson, Monica A.

  • Contributors JHG, MW and JC designed the study, interpreted the data and drafted the manuscript. MW, AJ, EC, DW and JC collected the data. JHG analysed the data. All authors critically revised the manuscript for important intellectual content and approved the final version.

  • Funding This study was supported by an Emergency Medicine Foundation grant (EMSS-410R22-2014).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval to conduct the study at the Australian sites was obtained from the Gold Coast Hospital and Health Service Human Research Ethics Committee (HREC/14/QGC/173) and the Griffith University Human Research Ethics committee (NRS/15/16/HREC). The Regional Ethical Review Board in Linköping (permit number 2018/563-32 based on 2017/371-31) approved the protocol for the Swedish sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.