The emergency department (ED) is typically the most active, energetic, and hectic area of a hospital. Those of us that work in EDs are attracted to that vibe—the energy, challenges, and rewards it can bring. Caring for people on one of the worst days of their lives, working with their loved ones, helping reduce their anxieties, and providing hope and understanding is what emergency clinicians do very well.
It's Not You ... It's Me: Impact of Patient Care on the ED Clinician's Psyche
In an ED, the clinician is on their feet and walking around for most of the 10—12 hour shift. The high-energy requirement, coupled with exposure to illness, fear, and traumas, and the occasional inability to save someone despite heroic attempts, all in the same shift, can take its toll on the clinician’s body and mind.
An emergency clinician does not have a set appointment schedule, or a way to plan ahead for the types of illnesses that will be requiring care the next day. ED clinicians are prepared to care for every level of acuity of disease and human condition, literally, at all times. Since a patient with a “simple” arm laceration requiring sutures can be followed by a car accident victim requiring lifesaving interventions, clinicians become experienced in zooming in and out of the intensity of medical care, and in communicating what they are doing with the patient to their loved ones.
The mental exercise of adjusting intensities of focus throughout a shift, and walking for miles around the ED while caring for patients in different rooms, leads to fatigue, which then can lead to sleep disruptions after the shift. Studies have shown that sleep deprivation and fatigue can cause cognitive impairment, diminished processing speed, and a general dulling of responses (Williamson and Feyer 2000). While none of these are excuses for a poor attitude or poor patient care, they certainly color interactions with patients and colleagues.
Successful hospital systems and clinician groups are mindful of a work-life balance, and promote wellness to minimize and prevent the undesired sequelae of stress.