Issues

Emergency department nurses’ narratives of burnout: Blurring of roles and professional identity

By Debbie Hetherington , Co-Authors: Dr Gillian Murphy, Nathan J Wilson, Dr Kathleen Dixon

Australian nurses are exposed to ongoing stressful work situations with emergency department nurses facing unique stressors: including traumatic emergency cases (World Health Organization [WHO], 2019). Constant exposure to such stressful events presents the potential for the emergency department nurse to develop emotional coping response mechanisms that run counter to their professional identity as a nurse, such as a loss of compassion towards others.

Exposure to ongoing stress at work may result in burnout, which has been defined as a condition that is the result of chronic workplace stress that has not been productively managed (WHO, 2019). There is growing research relating generally to burnout in hospital settings (Adriaenssens et al. 2011; Hunsaker & Heaston, 2015; Maslach, 2001). Research about burnout specific to emergency department nurses is, however, scant. With reported retention rates among emergency nursing staff decreasing, it was time to focus on the experiences of the emergency department nursing cohort to explore the challenging issues they face at work. Qualitative research methods are valuable in providing in-depth explanations of complex experiences to understand unexpected and unique events and experiences (Smith & Osborn, 2008). A narrative method was selected as Australian nurses have not been previously asked to discuss burnout, nor explicitly seeking their experiences about what it means to them and/or how they are affected. The collective narrative revealed that participants experienced daily competing and conflicting personal and professional demands. These demands can negatively influence emergency department nurses’ personal and professional lives. All the emergency department nurses discussed a love for their jobs and expressed a belief that their true vocation was working as an emergency department nurse. Despite the negative experiences inherent in emergency department nursing that the participants discussed, they strongly identified as emergency department nurses. A key finding was the gradual merging of their personal and professional boundaries and roles after their exposure to the emergency department working environment. The emergency department nurses in this study had a strong sense of identity shaped by the environmental context in which they worked. They frequently spoke about their passion for emergency department nursing, and they demonstrated a belief that their experiences were strongly associated with their sense of self. However, after working within the emergency department and being exposed to what they believed was sometimes a volatile environment, participants talked about how this passion had shaped them. It had led them to believe that the rigorous demands of emergency department nursing were part of their innate person. They believed they would act within the expectations of the role, in personal and professional situations, and consequently, their identity and self-awareness had been shaped and boundaries blurred by the passion and exposure to form a professional nursing identity that had also become part of their person. Professional identity is an important part of an emergency department nurse’s career as it affects their attitudes and behaviours in the work setting and beyond. As such, understanding how they viewed themselves was an important part of this research. Dutton et al. 2010 stated that professional identity is created from attitudes, values, motives, and experiences, which are used to define the individual in the professional world. The way the emergency department nurses viewed themselves in their roles shaped their professional identities. This information offers a useful insight to reflect and consider the emergency department nurses’ position and how they developed their passion for, and identity as, an emergency department nurse. Through the creation of these professional roles and boundaries, participants seemed able to claim purpose and meaning for themselves. However, a range of workspecific pressures, such as the escalation of aggression within the emergency department, challenged their strongly held professional identity, which culminated in the participants believing they were possibly facing burnout.

Primary Author: Debbie Hetherington is a Master of Research (MRes) candidate at Western Sydney University School of Nursing & Midwifery. Co Authors: Associate Professor. Nathan J Wilson, Dr Kathleen Dixon & Dr Gillian Murphy References

Adriaenssens, J., De Gucht, V., Van Der Doef, M., & Maes, S. 2011. Exploring the burden of emergency care: Predictors of stress-health outcomes in emergency nurses. Journal of Advanced Nursing, 67(6), 1317–1328. Dutton, J., Roberts, L., & Bednar, J. 2010. Pathways for positive identity construction at work: Four types of positive identity and the building of social resources. Academy of Management Review, 35(2), 265–293. Hunsaker, S., & Heaston, S. 2015. Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency nurses. Journal of Nursing Scholarship, 47(6), 186–194. Maslach, C. 2001. What have we learned about burnout and health? Psychology & Health, 16 (5), 607–611. Smith, J., & Osborn, M. 2008. Qualitative psychology: A practical guide to methods (2nd ed.). London, England: Sage. World Health Organisation. 2019. Mental Health: Mental health evidence and research. Retrieved from who.int/ mental_health/evidence/burnout/en/