title: Workplace aggression as cause and effect: Emergency nurses' experiences of working fatigued.
abstract: BACKGROUND
  Emergency nursing requires acute attention to detail to provide safe and effective care to potentially unstable or critically ill patients; this requirement may be significantly impaired by physical and mental fatigue. There is a lack of evidence regarding the effects of fatigue caused by factors other than a sleep deficit (e.g., emotional exhaustion). Fatigue affects nurses' ability to work safely in the emergency care setting and potentially impacts their health and quality of life outside of work.
  
  
  METHODS
  This was the qualitative arm of a mixed methods study; we used a qualitative exploratory design with focus group data from a sample of 16 emergency nurses. Themes were identified using an inductive approach to content analysis.
  
  
  CONCLUSIONS
  The following themes were identified: "It's a weight on your back;" "Competitive nursing;" "It's never enough;" "You have to get away;" and "Engagement as a solution."
  
  
  CONCLUSIONS
  Our participants reported high levels of fatigue, which compromised patient care, had a negative effect on their personal lives, and created a toxic unit environment. They reported lateral violence as both the cause and effect of mental and emotional fatigue, suggesting that unit culture affects nurses and the patients they care for.
authors.affiliation: Institute for Emergency Nursing Research Emergency Nurses Association, Des Plaines, IL, United States. Electronic address: lwolf@ena.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Wolf
authors.affiliation: Institute for Emergency Nursing Research Emergency Nurses Association, Des Plaines, IL, United States.
authors.forename: Cydne
authors.initials: C
authors.lastname: Perhats
authors.affiliation: Institute for Emergency Nursing Research Emergency Nurses Association, Des Plaines, IL, United States.
authors.forename: Altair M
authors.initials: AM
authors.lastname: Delao
authors.affiliation: University of Louisville School of Nursing, Louisville, KY, United States; Norton Healthcare Institute for Nursing, Kentuckiana Chapter, Louisville, KY, United States.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D016529:Emergency Nursing; D005221:Fatigue / Q000150:complications / Q000209:etiology* / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000592:standards; D036301:Qualitative Research; D000078329:Workforce; D017132:Workplace / Q000523:psychology* / Q000592:standards
keywords: Fatigue; Lateral violence; Nurse retention; Nursing environment; Workplace bullying