Emergency! The Problems Facing the U.S.’s Most Stressful Department Part I: The Plight of the ED Nurse

Emergency! The Problems Facing the U.S.’s Most Stressful Department

Part I: The Plight of the ED Nurse


Over the past decade, the CDC reports that the number of patients in emergency departments across the country has risen by 20%, yet the number of available emergency centers has fallen by 15%.[1] Already one of the most stressful public places, the ED does not need the additional pressure of low staff numbers, long wait times, and administrative nightmares, yet these stressors are becoming a reality in U.S. hospitals. Whether your client is a medical professional or a patient on the receiving end of ED care, legal cases abound in this stressful environment, and the various factors involved need to be understood to explain where and how things can go wrong.

In the first of this three part series, the focus will be on those who deal with the stress of the ED on a daily basis: nurses. Below are the specific difficulties they face, and the long-term consequences these difficulties can have.


Demanding Work Environment

            While all RNs are used to unpredictability on the job, nurses in the emergency department are faced with a range of cases far more varied and random. Unlike those working in a clearly structured, specialized ward, ED nurses must have knowledge of all areas of medicine to quickly determine the status of any patient, be it an infant or a middle-aged woman.[2] The high-stakes pressure can be nerve-wracking and emotionally draining, and the fast-paced nature makes it easier to overlook conditions or make simple – but deadly – mistakes. In addition, ED nurses are more likely than other types of nurses to develop health conditions, such as post-traumatic stress disorder, due to the nature of their work.


Workplace Violence

Studies consistently show that verbal abuse, threats, and physical assaults are common in emergency departments.[3] Due to the large influx of unstable patients under the influence of alcohol or drugs, or suffering from psychiatric disorders, ED nurses are the most frequent targets of assault in a healthcare setting.[4] In a recent survey of ED nurses in Pennsylvania, 97% reported verbal abuse, 94% reported physical threats, and 66% had been physically assaulted.[5] In 2011, a report by the Emergency Nurse Association found that 54% of ED nurses surveyed had been verbally abused and 11% had been physically abused in a single week.[6] With less than 3.6% of the aforementioned nurses feeling safe from the possibility of violence at work, a serious problem is apparent.[7]


Undervalued Experience

A final concern about ED nurses is that their value is rarely fully appreciated. Despite their unusual challenges, pay is no higher than it is for other nurses, and with low incentives, more nurses leave the ED than nurses of any other department.[8] Clinical experience is undervalued, if not outright ignored, by hiring administration since less tenured employees cost less, and this often leads to a less qualified staff treating the acutely ill and injured.[9] Because there is no prestige and protection for nurses in the ED, the most skilled members don’t stay long, leading to a less cohesive and stable department.


The struggle ED nurses face daily is exacerbated by other difficulties that have emerged in the U.S. health system within the past decade. The question asked in the next article will hone in on one of the most severe concerns: what happens when the ED is operating over capacity?

[1] Pexton, Carolyn, “Issues and Solutions for Today’s Emergency Department,” iSixSigma, n.d. https://www.isixsigma.com/industries/healthcare/issues-and-solutions-todays-emergency-department/

[2] Margolis, Robin Elizabeth, “Issues Facing Emergency Room Nurses,” Houston Chronicle, n.d., http://work.chron.com/issues-facing-emergency-room-nurses-27053.html

[3] Aldridge, Jeff, “Emergency Department Security: Overview,” Securty Assessments International, http://www.saione.com/edservices_overview.htm

[4] Ibid.

[5] Ibid.

[6] Margolis, “Issues Facing Emergency Room Nurses”

[7] Aldridge, “Emergency Department Security”

[8] Margolis, “Issues Facing Emergency Room Nurses”

[9] Paine, Thomas, “How to destroy a great ER: A step by step guide,” KevinMD.com, Apr. 19, 2016, http://www.kevinmd.com/blog/2016/04/how-to-destroy-a-great-er-a-step-by-step-guide.html