Job Satisfaction Among Emergency Room Nurses: A Literature Review

Introduction and Search Process

The literature exhibited particular gaps with regard to the initial problem under consideration. The starting point was the difficulties of emergency room nursing care and the jeopardy to morale and job satisfaction that stems from on-the-job exposure to the emergency room setting. Patients were often very badly hurt, but they were just as often in need of routine medical care for common, albeit uncomfortable, conditions. Treating patients in emergency room settings frequently meant dealing with people who were violent toward those attempting to care for them. In addition, much of the available literature — for no apparent reason — was based on data and studies from non-American hospitals and emergency rooms. Dwindling resources in some locations meant fewer staff members to handle the same workload in general hospitals and emergency rooms alike. Physicians were often the focus of these studies rather than nursing staff.

Balancing the preponderance of some kinds of studies against the dearth of others, a pattern emerged that indicated a productive line of research: job satisfaction of emergency room nurses in American hospitals. The search narrowed to the following key terms: American hospital emergency rooms, emergency rooms, emergency room care, emergency care, emergency nurse, job satisfaction, job stress, job burnout, job fatigue, job turnover, workload, work engagement, and psychosomatic symptoms. Gradually, a mosaic of literature was compiled that illustrated the need for more research on job satisfaction and staff morale among nurses who practice in the emergency rooms of American hospitals.

Purpose of the Literature Review

The reasons underlying staff morale and job satisfaction for nurses working in the emergency rooms of American hospitals are not entirely clear. A considerable degree of generalization has occurred — from nursing staff providing different types of care in a variety of settings to staff providing emergency room nursing care specifically. Sweeping assumptions have been made about staff morale and job satisfaction that tend to disregard the very different types of work these nurses perform and the distinct practice demands they face across several settings. This literature review was designed to gather research information about the different contributions made by settings that are both similar to and dramatically different from what is encountered in American hospital emergency room care.

How the Literature Review Shaped the Research Proposal

The relationship between hospital climate and job satisfaction was an unexpected finding. Among the several attributes associated with hospital climate, the standout factor was having the opportunity for professional development. Some of the job dissatisfaction identified was expressed by CNAs and LPNs, who do not experience many opportunities or avenues for professional advancement. An important related finding was that registered nurses often expressed dissatisfaction with not being able to spend more time caring for patients, while LPNs and CNAs felt they were spending too much time on patient care with very few alternatives — particularly in terms of staff development opportunities.

Experience with emergency room nursing care and the accuracy of accompanying work expectations were also linked to higher job satisfaction. In other words, nurses who did not have accurate expectations about what emergency room nursing entailed were more likely to be dissatisfied with their jobs and to experience lower morale. These two findings — the role of professional development and the importance of realistic job expectations — meaningfully shaped the direction and focus of the resulting research proposal.