Exploring interventions used in emergency departments to reduce occupational stressors and or improve staff coping: A scoping review of the literature

Ms Elizabeth Elder1, Dr.  Amy N. B. Johnston2,5,6, Prof. Marianne Wallis2,4, Prof. Julia Crilly2,3

1School of Nursing & Midwifery, Griffith University, Southport, Australia, 2Menzies Health Institute Queensland Griffith University , Southport, Australia, 3Department of Emergency Medicine  Gold Coast Hospital and Health Service , Southport, Australia, 4School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia, 5School of Nursing Midwifery and Social Work, University of Queensland , Brisbane, Australia, 6Department of Emergency Medicine Princess Alexandra Hospital Metro South, Brisbane, Australia

Introduction: Emergency departments (EDs) are stressful places to work (1). Staff are exposed to many occupational stressors and rely on varying coping strategies (2). Exposure of ED staff to occupational stressors has been linked to increased absenteeism and burnout, higher staff turnover and low staff morale (3). The aim of this review was to examine and synthesize existing evidence relating to interventions designed to reduce the impacts of occupational stressors and/or improve ED staff coping.

Methods: The review involved searching five databases using terms related to stress/or, coping, and emergency department for papers published in English from 2007-2017. Study quality of quantitative studies was assessed using National Health and Medical Research Council Level of Evidence Guidelines (5).

Findings: A total of 45 studies met criteria for review inclusion. The level of evidence of included studies varied from level I (n = 1) to IV (n = 11). Interventions discussed in the literature that targeted occupational stressors included organizational/environmental redesign, policy/protocol change and staff education. Interventions targeted towards improving coping strategies of staff included mindfulness, debriefing and relaxation techniques. Most studies reported some degree of positive effect/s on either reducing exposure to occupational stressors and/or improving staff coping.

Conclusion: This review highlights the limited existing literature relating to interventions designed to ameliorate a wide range of occupational stressors experienced by ED clinicians. The findings of this review support the need for additional research to underpin and guide interventions designed to address occupational stressors and or improving coping strategies used by ED clinicians.


  1. Basu S., et al. Occupational stress in the ED: a systematic literature review. EMJ. 2017;34(7):441-7.
  2. Abraham LJ., et al. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments. EMA. 2018.
  3. Ahwal S. & Arora S. Workplace Stress for Nurses in Emergency Department.
  4. Arksey H. & O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8.
  5. National Health & Medical Research Council. NHMRC Levels of evidence and grades. Canberra 2009.


Elizabeth is a credentialed emergency nurse with a passion for education, research and clinical practice.  Believing research is the juncture of clinical practice and academe Elizabeth enrolled in her PhD in 2016.