Meta-integration of qualitative research on the clinical work experiences of emergency department nurses

BACKGROUND: A growing body of evidence indicates that emergency department nurses are frequently exposed to high-intensity work-related stress, complex emotional demands, and occupational hazards in their clinical practice. These factors significantly influence their job satisfaction and retention intention. This meta-integrated qualitative study aimed to systematically examine the clinical work experiences of emergency department nurses, with a focus on identifying stressors, coping mechanisms, and emotional dynamics, in order to provide an evidence-based foundation for optimizing the emergency nursing work environment. METHODS: A qualitative systematic review was conducted. Electronic searches were performed across the databases CNKI, Wanfang, VIP, PubMed, CINAHL, Web of Science, Cochrane Library, Scopus, OVID, and SinoMed (CBM), covering all records from inception to 10 February 2025. Eligible studies focusing on the clinical work experiences of emergency department nurses were selected. Study quality was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Data were synthesized using a meta-integration approach. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 18 studies were included, yielding 40 individual findings that were classified into 8 thematic categories. These were further synthesized into three overarching integrative themes: (1) the Organizational–Clinical Stress Ecosystem, (2) Resilience-Building Mechanisms, and (3) the Duality of Professional Identity. CONCLUSION: Hospital administrators should prioritize the physical and psychological well-being of emergency department nurses. It is essential to assist nurses in adjusting to their work conditions by reducing night shift frequency, enhancing staffing ratios, and reinforcing diverse forms of support. Furthermore, providing more opportunities for skill development and professional training that integrates theoretical knowledge with clinical practice is recommended. Practical and evidence-informed management policies should be implemented to improve the sustainability of emergency nursing workforce retention. CLINICAL TRIAL NUMBER: Not applicable.