Universiteit Leiden

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Research project

Occupational health in the Emergency Department: A study on work-related factors and health/well-being in nurses and doctors in 19 Emergency Departments in the Netherlands.

This project examines work-related factors and health/well-being in emergency care nurses and doctors in the Netherlands and aims to answer the following research questions: (1) How are job demands (e.g. work-time demands) and job resources (e.g. autonomy, social support, recovery) related to health/well-being (e.g. burnout, PTSD) in an ED setting? (2) Is a positive health and safety climate in a hospital a prerequisite in order to successfully implement interventions to prevent/reduce stress-related health outcomes and enhance well-being? (3) What type of interventions are most effective in promoting health and wellbeing among ED staff and what is the role of process variables (e.g. participation of the employees in development and implementation of the interventions, managerial support for interventions, readiness for change) in the effectiveness of interventions?

Nathal de Wijn
Stichting IZZ
Europees Sociaal Fonds
Stichting Arbeidsmarkt Ziekenhuizen (StAZ)
Participating hospitals

In collaboration with: Stichting IZZ, Amphia Ziekenhuis and supported by: Nederlandse Vereniging van Ziekenhuizen (NVZ), Nederlandse Federatie van Universitair Medisch Centra (NFU), Ministerie van VWS, Ministerie van SZW, Nederlandse Vereniging van Spoedeisende Hulp Verpleegkundigen (NVSHV), Nederlandse Vereniging van Spoedeisende Hulp Artsen (NVSHA).


Shortage of staff, high work demands, aggression and violence are augmenting problems in the emergency care (Johnston et al., 2016). These issues can affect the health and well-being of emergency nurses and doctors. In fact, previous research shows a high prevalence of stress-related health outcomes  such as burnout, symptoms of Post Traumatic Stress Disorder and sleep problems in emergency staff  (Adriaenssens, de Gucht, & Maes, 2012, 2015; Ferguson, Shoff, McGowan, & Huecker, 2018; Laposa, Alden, & Fullerton, 2003; Li, Cheng, & Zhu, 2018). Furthermore, stress-related health outcomes in emergency staff are related to decreased job satisfaction, absenteeism and turnover intention in a setting where qualified personnel is scarce (Gates, Gillespie, & Succop, 2011; Laposa et al., 2003; Tarcan, Tarcan, & Top, 2016; Van Bogaert, van Heusden, Timmermans, & Franck, 2014).  Adding recent developments with regard to  overcrowding in the Emergency Departments (ED’s) in the Netherlands and an aging population, it is expected that these problems will only increase in the future. It is therefore important to explore possible solutions to prevent stress-related health outcomes  in ED staff and increase health and well-being.  However, up to now research in the ED has mainly focused on prevalence of work related stressors (e.g. work demands, overcrowding, aggression and violence) and stress-related health outcomes (e.g. burnout, PTSD), and direct relations between the two. Little do we know about potential buffering effects of job resources (e.g. autonomy, social support, recovery) that could weaken these relationships and prevent ED staff from developing stress-related health problems. Furthermore, whereas multiple reviews (Basu, Qayyum, & Mason, 2017; Johnston et al., 2016) conclude that stress levels in the ED are high, research on actual interventions and their effectiveness is scarce.


In September 2016 Amphia hospital, Stichting IZZ and Leiden University united to explore the current situation on occupational stress in ED’s in the Netherlands, stimulate the development and implementation of interventions in these ED’s, and assess the effectiveness of these interventions. Nineteen hospitals (including 4 university hospitals) in the Netherlands decided to take part in the study, leading to a study population of more than 1,200 emergency doctors and nurses. The project includes yearly measurements (2017, 2018, 2019) conducted through surveys and interviews with members of the ED staff and management. At each measurement point, hospitals receive feedback on their situation regarding work factors and well-being of their staff in comparison to other hospitals and reference groups, and general and department specific advice on possible interventions to reduce stress. In addition, active exchange of best practices between the ED’s is stimulated in regularly held ‘’inspiration sessions’’ attended by representatives from the ED’s involved.  Furthermore, in 2018 all hospitals had the opportunity to improve their organizational health and safety climate by participating in an intervention provided by Stichting IZZ. In 2019 we will evaluate which (and to which extent) interventions led to significant positive changes in the work factors and well-being of ED staff and what role process variables (e.g. active participation of staff in development and implementation, managerial support) and the health and safety climate within the hospital play in the implementation and effectiveness of interventions.

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