Morale, stress and coping strategies of staff working in the emergency department: a national and international comparison.

Can workplace stressors in emergency departments be better understood?

Grant ID: EMSS-410R22-2014

Project Summary

Workplace stress in the emergency department (ED) is an internationally recognised issue. It is important to understand how ED staff cope with the stressors within their working environment. The overall aim of this study was to describe and compare the impact of the working environment and varied coping strategies amongst medical and nursing staff working in Emergency Departments (ED) in Australia and Sweden.


A cross-sectional study was undertaken and involved surveying medical and nursing staff from Queensland and Swedish EDs. Findings indicate that employees engaging in positive coping strategies had more positive perceptions of the work environment, while those engaging in maladaptive coping strategies reported negative perceptions of the work environment. Staff rated the death or sexual abuse of a child as most stressful, followed by workplace violence and heavy workload. Staff used a large range of coping strategies, and these were similar across Australian sites. Ratings of the work environment differed for Swedish and Australian clinicians; Swedish respondents reported lower use of negative coping strategies, lower use of avoidance style coping and higher use of positive thinking.

The study was the first multi-site and multidisciplinary examinations of Australian ED staff perceptions and has helped improve our understanding of staff stressors and coping strategies as well as highlighted similarities across different EDs.

Further research outside the scope of this grant is planned, with interest from additional sites and countries.

Leveraged Funds

- Griffith University Health Practice Innovation Member's research profile development funding; Emergency Medicine Australasia: $2,500
- Griffith University Internal staff development fund: $1,500


Elder, E., Johnston, A.N., Wallis, M. and Crilly, J., 2020. The demoralisation of nurses and medical doctors working in the emergency department: A qualitative descriptive study. International emergency nursing, 52, p.100841.

Greenslade, J.H., Wallis, M., Johnston, A.N., Carlström, E., Wilhelms, D.B. and Crilly, J., 2020. Key occupational stressors in the ED: an international comparison. Emergency Medicine Journal, 37(2), pp.106-111.

Xu, H.G., Johnston, A.N., Greenslade, J.H., Wallis, M., Elder, E., Abraham, L., Thom, O., Carlström, E. and Crilly, J., 2019. Stressors and coping strategies of emergency department nurses and doctors: a cross-sectional study. Australasian emergency care, 22(3), pp.180-186.

Greenslade, J.H., Wallis, M.C., Johnston, A., Carlström, E., Wilhelms, D., Thom, O., Abraham, L. and Crilly, J., 2019. Development of a revised Jalowiec Coping Scale for use by emergency clinicians: a cross-sectional scale development study. BMJ open, 9(12), p.e033053.

Crilly, J., Greenslade, J.H., Johnston, A., Carlström, E., Thom, O., Abraham, L., Mills, D. and Wallis, M., 2019. Staff perceptions of the emergency department working environment: An international cross‐sectional survey. Emergency Medicine Australasia, 31(6), pp.1082-1091.

Elder, E., Johnston, A.N., Wallis, M., Greenslade, J.H. and Crilly, J., 2019. Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study. International emergency nursing, 45, pp.17-24.

Abraham, L.J., Thom, O., Greenslade, J.H., Wallis, M., Johnston, A.N., Carlström, E., Mills, D. and Crilly, J., 2018. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different‐sized departments. Emergency Medicine Australasia, 30(3), pp.375-381.

Johnston, A., Abraham, L., Greenslade, J., Thom, O., Carlstrom, E., Wallis, M. and Crilly, J., 2016. Staff perception of the emergency department working environment: Integrative review of the literature. Emergency Medicine Australasia, 28(1), pp.7-26.

Conference Proceedings/Abstracts:
- Crilly J. Understanding emergency department staff perceptions of their working environment, stress and coping. Beijing Nursing Association Symposium. 25th May, 2018. Beijing, China (Invited Speaker)
- Crilly J. What stresses health care staff out and how do they cope? 6th SEHA International Nursing, Midwifery and Allied health Conference. 29th September 2017, Abu Dhabi, UAE (Invited speaker).
- Abraham, L., Johnston, A.N.B., Thom, O., Greenslade, J., Wallis, M., Carlstrom, E., Mills, D., Crilly, J., "Morale, stress and coping strategies of clinical staff working in emergency departments: A comparison of two different departments", International Conference for Emergency Nurses; Sydney, Australia, Oct 2017.
- Crilly, J., Greenslade, J., Johnston, A.N.B., Carlstrom, E., Thom, O., Abraham, L., Mills, D., Wallis, M., "Staff perceptions of the working environment in the emergency department: an international cross-sectional study", ACEM ASM, Sydney, Australia, Nov 2017. (Oral presentation)
- Johnston, A.N.B. Abraham, L., Greenslade, J., Thom, O., Carlstrom, E., Wallis, M., Crilly, J.C. Staff perception of the ED working environment: integrating literature to support ED specific workplace interventions for clinical staff. 13th International Conference for Emergency Nurses, 2015, Brisbane, Australia. (oral presentation)
- Johnston, A.N.B., Abrahams, L., Greenslade, J., Thom, O., Wallis, M., Crilly, J. Staff perception of working environments in Emergency departments; strategies, techniques and outcomes for undertaking an integrative review of the literature. Inaugural Gold Coast Nursing and Midwifery Symposium, 5th Sept 2015, Gold Coast University Hospital, Southport QLD where it was awarded “Best research presentation”.


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Ogilvie Thom

Co Investigators:
Prof Julia Crilly
Prof Marianne Wallis
A/Prof Eric Carlström
Dr Louisa Abraham
Dr Amy Johnston
A/Prof Jaimi Greenslade


Collaborating Institutions


  • ICEN 2017: Morale, stress and coping strategies of clinical staff working in Emergency Departments: A comparison of two different departments

  • Media

  • Griffith Uni media_ 29 November 2017
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