Experiences of stress in Accident and Emergency nurses S. Helps Just what is it about being a nurse in A & E that is stressful? How are A & E nurses affected by occupational stress and what do they think should be done to reduce it? This study sets out to provide some preliminary answers to these questions. Factors relating to the physical working environment and lack of staff were the most frequently reported hassles and stressors. Saving lives and helping patients get better was reported as the greatest source of satisfaction. Nurses suggested a variety of ways in which occupational stress could be reduced, including employing more staff, providing a ‘time out’ room and debriefing after traumatic events. Implications for future research and intervention are discussed. INTRODUCTION Occupational stress in Accident and Emergency: definitions and previous studies Lazarus and Folkman (1984) cogently stated that ‘life without stress would be an exercise in boredom’. But what is stress and how much stress is a good thing? Stress is one of those words that we use on a daily basis, but if anyone asked us to define it, we would all probably give a different answer. In the scientific literature, stress has been seen either as a response to something in the environment, or as the stimu- lus that caused the response. Currently, a widely accepted definition is the relationship between Sarah L. Helps BSc, Clin. Psy. D, Chartered Clinical Psychologist, Belgrave Department of Child Psychiatry, King’s College Hospital, Denmark Hill, London SE5 9P6, UK Manuscript accepted I I July I996 Accident and EmergencyNursing (I 997) $48-53 0 Pearson Professional Ltd I997 individuals and their environment that is appraised as taxing or exceeding their resources and endangering their wellbeing (Lazarus & Folkman 1984). There exists a huge body of literature relat- ing to occupational stress (defined as ‘negative environmental factors or stressors associated with a particular job’ by Cooper and Marshall (1976)). It is widely accepted that stress is an inevitable aspect of daily life and that a certain amount of stress is necessary to help us go about our daily lives. It is also accepted that nursing is an inherently stressful occupation (Health Education Authority 1988) and many studies have been carried out to identify the stressors specific to being a nurse. Unfortunately, there has been little published research relating to the stress of working within the specialty of Accident and Emergency (A & E). Of the literature that does exist, studies have been carried out in both the USA and Canada. For example, in 1983 Burns et al car- ried out a postal survey of 160 emergency nurses in and around Pittsburgh, USA. They found that nurses were initially attracted to emergency department (ED) nursing because it provided them with intellectual stimulation, opportunities for learning and offered variety and excitement. Nurses in the sample identi- fied the following factors as stressful: l Inadequate staffing levels. 0 Apathetic physician staff 0 Emergencies l Arrests and fatalities l Uncontrolled patient volume 0 Nurse-doctor interactions 0 Unresponsive nursing/hospital leadership Burns et al also asked the nurses to identify sources of occupational satisfaction. The most commonly cited sources related to patient improvement, progress and recovery. In line with these findings, Hawley (1992) reported staffing practices, intergroup conflict (e.g. difficulties in communicating with other nurses, doctors and patients), role conflict, lack of support from supervisors, poor working conditions and organizational structure as fre- quent stressors to ED nurses. Some of the stressors identified, such as inadequate staffing levels and a lack of support, have been identified in the general nursing lit- erature (Bailey et al 1980, Cole 1992, Wicker 1993), but others (for example, uncontrolled patient volume, patient violence and inappro- priate attenders) appear to be pertinent solely to the A & E department. So, what are the sources of stress specific to British A & E nursing and are they comparable to those iden- tified in the USA and Canada?