A scenario, just a scenario:

Midnight, a cold night shift, 15 degrees Celsius. You are the in-charge nurse in the emergency department. There are more than 40 cases not yet seen by the doctor and they are waiting in A&E for hours. Ten of them are staying in the outdoor area as they are ‘Covid’ with RAT positive. Two to three groups of angry patients and relatives are scolding your junior nurse in front of the nurse station. Long queue in triage, four stretchers, one wheelchair and some walking cases are waiting. In the Resuscitation Room, a 54-year-old gentleman is yelling for his severe chest and back pain, and the case doctor and nurse are waiting for the radiologist’s reply for permission of CT. Phone call from fire service, a motorcyclist is being sent to A&E as he was hit by a 15-ton lorry. A supporting staff rushes to you telling you that a dead looking, sweating gentleman seems not breathing in the cubicle.

Stress, fatigue is common to Emergency nurses.

A cross-sectional study (1) was done in Xi’an concerning emergency nurses’ fatigue. 346 nurses from emergency departments of six grade III A hospitals in Xi’an were recruited. A questionnaire including different scales, the Chinese Perceived Stress Scales, the Social Support Rating Scale, and the General Self-Efficacy Scale, was administered. It was found that emergency nurses were in a high fatigue level. Nurses’ mechanical and repetitive work operations, as well as physical night shift patterns, were all contributed to their stress and fatigue. The authors suggested that we should not only pay attention to the patient and the nursing care delivered, but also focus on the staff psychosocially, which is directly related to the quality of medical service.

From the above case scenario, it seems that it is just a typical night shift during COVID-19.

The novel Severe Acute Respiratory Syndrome – Coronavirus 2 (COVID-19) first emerged in December 2019 and has subsequently proliferated around the world. COVID-19 has posed a devastating impact over the world, particularly the health care system. A local study from The Polytechnic University of Hong Kong (2) was conducted to explore Hong Kong nurses’ stress level and PTSD during the outbreak of COVID-19. An online survey, supported by AHKNS (Association of Hong Kong Nursing Staff), was completed by Hong Kong nurses. Perceived Stress Scale and Davidson Trauma Scale were included to evaluate the perceived stress level and PTSD respectively. The results indicated that Hong Kong nurses were under high levels of stress and having degrees of PTSD during COVID-19 outbreak.

In Taiwan, an emergency nurse-led stress-reduction program was conducted.(3) This programme was conducted in the emergency department of a major university hospital in northern Taiwan. The study was conducted in two aspects: 1) online; 2) and person-to-person group brainstorming activities. The questionnaire in three parts was delivered: stress levels, causes of stress and needs. Nurses' stress levels before and after COVID-19 pandemic was evaluated. Nurses were asked to pick the five most important things that needed to be managed with priority by their managers. Furthermore, two more open questions were asked about their causes of stress and their needs. In the first stage, online-survey and brainstorming activities reveal to the managers about the source of nurses’ stress and the way to address their needs. In the second stage, person-to-person group brainstorming activities were done weekly among the managers, demonstrating the results of the survey and telling what the managers had done to meet up the nurses; needs found in the survey.

Based on the findings of online surveys and group discussions in the staff meetings, after the first survey, the interventions of Cycle 1 were reached. As the stress level of staff remained high in Cycle 2, on top of the interventions provided in Cycle 1, additional interventions were provided in Cycle 2 in response to nurses’ emotional and social distress and the interpersonal conflicts with colleagues. The result shows that there was a reduction in the nurses' work-related stress after implementing the improvement interventions. The author suggested that inviting frontline nurses to participate in intervention development while building a good partnership between nurses and managers was critical to the success of this program.

Emergency department is always a busy venue as all cases do not come on schedule. Meeting patient needs while keeping all patients and staff healthily is always the priority. Attention may need to put on emergency nurses’ stress and care for our colleagues.

Reference

1. Wu, C., Ge, Y., Xu, C., Zhang, X., & Lang, H. (2020). A correlation study of emergency department nurses' fatigue, perceived stress, social support and self-efficacy in grade III A hospitals of Xi'an. Medicine, 99(32), e21052.

2. https://research.polyu.edu.hk/en/publications/hong-kong-nurses-stress-level-and-post-traumatic-stress-disorder-

3. Yang, B. J., Yen, C. W., Lin, S. J., Huang, C. H., Wu, J. L., Cheng, Y. R., ... & Hsiao, F. H. (2022). The effects of an emergency nurse‐led stress‐reduction project during the first 120 days of the COVID‐19 pandemic in Taiwan. Journal of Nursing Management, 30(2), 367-374.