Coping with occupational stress in an accident and emergency department

Kingston Regional Hospital's Accident and Emergency Department (A&E), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8%) of the total population (n = 33) of health personnel working in the A&E. The participants were 15 (53.6%) doctors, eight (28.6%) registered nurses and five (17.8%) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the A&E was three years, range 0.5-22 years. Eighteen (60%) rated the A&E as "stressful". The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p < 0.05). The number of behavioural symptoms experienced was associated with age (p < 0.05). The majority (89.2%) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and "extracurricular" activities in buffering the effects of stress. Nurses were more likely to be "burned out" than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful.