Poor Morale in Emergency Room (ER) Nurses

¶ … poor morale in emergency room (ER) nurses and identify an empirical approach and research question involving factors that can improve morale in ER nurses. Interestingly enough, the United States "has the most expensive healthcare system in the world, [yet] 47 million Americans have no health insurance. Healthcare is the country's largest economic sector…. Four times larger than national defense… yet millions cannot afford to take care of their health needs" (Farrell, 2009, 1). Despite being an international leader in science and technology, what has happened to the entire healthcare system in America? Fifteen years ago the subject was at the forefront of the new Clinton Administrator, but now, despite technological advances and increased modernization, America finds hospital emergency rooms stretched far beyond any reasonable capacity, the inability for many doctors to afford adequate malpractice insurance, costs for procedures escalating, and even those with insurance unable to afford the basic standards of healthcare. Indeed, even with the nation spending 20% of the total budget on healthcare, there seems no end in sight ("What's Wrong With America's Healthcare? 2006; Newman, 2008).

ER nurses supply care in an assortment of settings. At the extreme end of the continuum they must swiftly assess and then stabilize patients who have life-threatening conditions and also be prepared to care for less critical situations. Of course in the ER care is provided along the total age range from infants to the elderly. Thus, nurses in the ER need to be prepared for a fast-paced changing environment. Although most ER nurses work in hospitals they are also found in a variety of other situations ranging from urgent care centers to prisons to sporting events. The workload of ER nurses constitutes a major issue for the morale and efficiency of ER nursing staff as well as the clinical outcome of the patient and patient satisfaction.

There is a great deal of empirical research outlining the factors that can lead to poor morale in ER nurses. Burnout and not feeling appreciated are major contributors to poor morale in ER nurses and are most affected by the nurse's perception of being overburdened by a harsh and demanding workload (e.g., Freeman & O'Brien-Pallas, 1998; Aiken et al., 2002). Carayon and Gurses (2005) outlined four categorizations of workloads in nursing that could affect morale: the unit-level, the job-level, the patient -level, and the situation-level workload. The four levels are not mutually exclusive. For instance, the situation and patient-level areas are embedded within the job-level and the job-level workload can be categorized under the unit-level. Thus, the unit-level would be the macro-level, whereas situation and patient levels could be thought of as micro-levels (Carayon & Gurses, 2005).