title: Examining the sources of occupational stress in an emergency department.
abstract: BACKGROUND
  Previous work has established that health care staff, in particular emergency department (ED) personnel, experience significant occupational stress but the underlying stressors have not been well quantified. Such data inform interventions that can reduce cases of occupational mental illness, burnout, staff turnover and early retirement associated with cumulative stress.
  
  
  OBJECTIVE
  To develop, implement and evaluate a questionnaire examining the origins of occupational stress in the ED.
  
  
  METHODS
  A questionnaire co-designed by an occupational health practitioner and ED management administered to nursing, medical and support staff in the ED of a large English teaching hospital in 2015. The questionnaire assessed participants' demographic characteristics and perceptions of stress across three dimensions (demand-control-support, effort-reward and organizational justice). Work-related stressors in ED staff were compared with those of an unmatched control group from the acute ear, nose and throat (ENT) and neurology directorate.
  
  
  RESULTS
  A total of 104 (59%) ED staff returned questionnaires compared to 72 staff (67%) from the acute ENT/neurology directorate. The ED respondents indicated lower levels of job autonomy, management support and involvement in organizational change, but not work demand. High levels of effort-reward imbalance and organizational injustice were reported by both groups.
  
  
  CONCLUSIONS
  Our findings suggest that internal ED interventions to improve workers' job control, increase support from management and involvement in organizational change may reduce work stress. The high levels of effort-reward imbalance and organizational injustice reported by both groups may indicate that wider interventions beyond the ED are also needed to address these issues.
authors.affiliation: Sheffield Occupational Health Service, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK, Subhashis.basu@sth.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Basu
authors.affiliation: Emergency Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK.
authors.forename: C
authors.initials: C
authors.lastname: Yap
authors.affiliation: School of Health and Related Research, University of Sheffield, Regent St, Sheffield S1 4DA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mason
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000150:complications / Q000209:etiology / Q000523:psychology; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D004739:England; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000592:standards*; D015279:Organizational Culture; D010465:Perception; D017009:Professional Autonomy; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology*; D011795:Surveys and Questionnaires; D000078329:Workforce; D017132:Workplace / Q000523:psychology / Q000592:standards
keywords: Emergency services; NHS workforce; occupational stress; perceived work stressors; stress; well-being; work place stress.