A review of past research on doctors, nurses and other staff in emergency departments (ED) found plenty of sources of stress, but only a handful of studies on interventions to offset the constant strain.

"Emergency department staff experience high volumes of work, and have to make quick decisions under pressure which carry a significant burden of responsibility,” said lead author Subhashis Basu of the University of Sheffield in England.

“Excessive stress may result in poor physical and psychological health; loss of job satisfaction and workers leaving their profession,” Basu told Reuters Health by email. Stress-heavy workplaces may be less productive and have more staff turnover, he added.

To investigate the main causes of work stress in the ED and any trials of methods to combat that stress, the study team reviewed 25 studies found on health databases and Google Scholar.

Many studies mentioned high work volume and long hours, as well as having little control over work, as sources of stress for ED workers.

Some studies also emphasized that workers may have more stress because they don't receive enough support at work, are not paid enough and are not adequately recognized for their work.

The researchers also found that compassion fatigue, a type of overload that results in having less concern or empathy for others, is common in the ED.

Workers experienced compassion fatigue for many of the same reasons they felt job stress, such as high job demands and having little control, the researchers write in the Emergency Medicine Journal.

Workers also said that having work “targets,” such as a rule that patients must be seen within four hours, could add greatly to job stress.

The researchers only found two studies of interventions meant to help reduce job stress in the emergency department.

One involved aromatherapy and massage sessions for nurses in a single ED and it was found to reduce anxiety.

A program teaching mindfulness and other emotional skills was found not to reduce job stress.

Other interventions, including a “buddy system,” exercise programs and increasing workers’ contact with their families were described or proposed but had not been studied.

“For too long the medical profession has neglected the study of its own personnel and focused on patient care,” said Manit Arora, a surgeon and lecturer at University of New England in Armidale, Australia, and University of Queensland in Brisbane who studies burnout among health professionals.

“Now more and more we are realizing that the mental and physical health of doctors is critical to patient care,” said Arora, who was not involved in the study.

Arora said job burnout is very common and has serious consequences. “Burnout doctors are more likely to have medical and psychological problems, abuse drugs and alcohol and higher rate of suicide,” he said.

Work hours need to be regulated, Arora said. Stress workshops, more days off, more education and group bonding sessions can also help to tackle the issue of job stress, he added.

“Interventions to support employees include reducing work intensity, improving workers' control over how they do their job and helping staff feel more valued for their efforts,” Basu said.