Emergency Nurses


The emergency department is usually characterized by a chaotic working environment, with the enormous workload imposed on nurses due to the considerable number and critical condition of patients. Therefore, emergency department nurses tend to adopt to the task-oriented approach and distance themselves from the core of the nursing profession, namely caring. This paper discusses how this shift can be reversed with the help of the application of Jean Watson’s Theory of Human Caring. In this regard, the key postulates, as well as challenges for its implementation in the emergency department, are emphasized.

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How Can the Shift Towards Task-Oriented Approach From Caring Model In Emergency Nursing Be Reversed?

Working in an emergency room and having to deal with the common issue of overcrowding make it very difficult for nurses to maintain a personal relationship with patients at times. Nursing is associated with building a human-to-human relationship; however, in the fast pace conditions, it can become easy for medical attendants to adopt a very task-oriented mindset. Therefore, as is maintained by Jean Watson’s Theory of Human Caring, emergency nurses could provide better care if they had more time, were less rushed as well supported by the hospital management in creating a favorable working environment.

It is critical to remind nursing professionals about the caring approach as the guiding principle of the nursing profession. According to Noel (2010), numerous academic centers, as well as healthcare facilities, follow the postulates of Watson’s Theory of Human Caring. This theory provides medical attendants with the structure that not only recommends prioritizing a caring attitude but also discusses fundamentals for philosophical and moral deeds along with correspondent analysis. Thus, Watson’s Theory of Human Caring increases nurses’ awareness of the definition and elements of caring thereby explicating what the nursing profession is about.

Indeed, the concept of caring, which should be given priority over the task-oriented approach, has to be discussed with consideration of the impacts that numerous cultural factors may have on its realization. According to Foss Durant, McDermott, Kinney, and Triner (2015), “caring science integrated across administrative, operational, and clinical areas within a Medical Center appears to contribute to meaningful patient quality and health outcomes” (p. 136). Moreover, the caring practice should cover all patients disregarding their race, gender, or class. Nevertheless, caring is perceived differently by the representatives of various cultures and religions, that is why nurses have to be flexible in delivering culturally sensitive care. I think that it is the key ethical responsibility of a nurse to be a caring professional, irrespective of the division he/she works in. One may argue that legally the decrease in the level of care, or other words compassion, cannot be easily proved. However, I am assured that patients feel this shift very acutely and negatively perceive a “robotic” attitude adopted by nurses.

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Caring science is centered on three main guiding principles. Firstly, medical attendants are responsible for the co-creation of nurturing-healing-caring environments (Foss Durant et al., 2015). This principle implies nurturing of authentic connection between nurses and patients, his/her family, or caregivers. Secondly, nurses have to foster trusting-collaborative-helping relationships (Foss Durant et al., 2015). Thus, this principle indicates the importance of attention to compassion, empathy, and loving-kindness. It also presupposes insight and inquiry across several central relationships, namely the ones with herself/himself, the patients, their families, and the communities where the nurses operate. Thirdly, medical workers are the facilitators of honoring healing, wholeness, and health including careful consideration of the emotional, spiritual, and psychosocial needs of the patients (Foss Durant et al., 2015). It also requires nurturing total well-being and health as well as co-creation of health plans and solutions by integrating both objective and subjective data.

It is not sufficient to only determine the main elements of caring science, as there is a need to measure caring with the help of several indicators. Foss Durant et al. (2015) underlined that these factors involve awareness, adoption, integration, and transformation. Awareness and adoption implied spread, awareness, education, as well as staff practices and behaviors. The latter two meant establishment of the specialized council to integrate and transform the existing gaps in the caring attitude. Education, awareness, and spread include staff education and resources, unit-level education, incorporation of Watson’s theoretical milestones into the daily practice, and discussion of real-life cases during the meetings. Additionally, Douglas (2011) draws attention to the complexity of measuring the level and quality of care. The author argues that the Caring Ability Inventory is a validated tool, which can allow the management to identify the major issues associated with caring (Douglas, 2011).

Besides, several interventions also foster effective healthcare in medical settings. In this regard, Norman, Rossillo, and Skelton (2016) state that nurses must train active listening, accept differences, adapt the environment to the patient’s needs, be hopeful, humor and informing, induce collaboration, enhance discussions and promote expression. Moreover, the interventions may include reassurance, quick response, storytelling, showing concern, and support for the patient’s family. In addition, it is usually essential to reevaluate and redefine the patient care models and care delivery systems as well as core philosophies and intentions.

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One of the disadvantages that can be suggested by the opponents of the caring model prioritizing in the emergency department is related to the escalated costs. The fast-paced working environment and constant pressure do not allow nurses to be more caring in their daily tasks. Hence, some of them began to perceive patients as numbers and perform nursing duties with a robotic attitude. Nevertheless, nurses believe that the increase in the time spent per patient will provide more freedom for them to return to the fundamental nursing principle, in particular caring. However, a greater amount of time for each patient is directly linked to the characteristics of healthcare facilities and their financial performance. Besides, they may insist that an emergency department is a place where there is no extra time to provide exceptional care, as patients are in a critical condition and require definite, structured, and quick reactions from the nurses. Therefore, opponents may argue that in the emergency department task-oriented approach is more appropriate. However, nursing is the profession where human-to-human interactions are the foundation of healing. Therefore, a patient expects to get a caring not robotic attitude when suffering physically and emotionally even in emergency cases.

Another concern may be expressed by those who view love and caring attitude in emergency departments as a way of increasing compassion fatigue and burnout. Emotional, physical, and spiritual exhaustion is the outcome of enduring suffering (Mazzotta, 2015). For example, I experienced the tendency that my colleagues to try to be emotionally detached from the patient to keep their emotional state untouched. Otherwise, this constant secondary traumatic stress will lead to refusal from the profession. Irritability, anxiety, and lack of compassion may be the result of compassion fatigue and similarly a decrease in a caring attitude.

The above-stated arguments may seem partially truthful in case one forgets about the nursing calling, which is to deliver love and proper care. To continue following a caring attitude as the fundamental concept in nursing, the hospital management must conduct regular assessments of the psychological state of emergency department nurses to be able to intervene in time. Nurses frequently are unaware of the symptoms of compassion fatigue, which prevents them from demonstrating a caring attitude. Therefore, healthcare leaders are responsible to ensure that support systems and resources are available to promote the well-being of emergency department nurses (Mazzotta, 2015). Furthermore, medical attendants should be provided with sufficient space and opportunities to choose personal coping mechanisms, including exercise, spiritual practices, and meditation. In their turn, managers must help nurses to fight the feelings of guilt, sadness, anger, and helplessness to prevent the negative consequences of compassion fatigue and the inability to deliver human-to-human support.

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Concerning the aforementioned facts, certain recommendations on how to enhance caring among nurses may be offered. Norman et al. (2016) identify ten practices that should be taught to nurses. Thus, caring processes include loving kindness, authentic presence, faith, trust, and spirituality. Moreover, openness to miracles, creativity, honoring, and assisting highly matter. It is a core of the nursing practice to demonstrate kindness, sustain a deep belief system and be authentically present (Watson & Brewer, 2015). One should also emphasize the paramount importance of thinking and acting beyond self-ego. A patient should be assured that he/she can trust the nurse during medical service delivery thereby expressing both positive and negative feelings.

The chaotic environment of the emergency department and greater acuity of patients’ conditions prevent nurses from practicing effective caring. To improve care in the emergency department, it is critical to survey the nurses to understand what caring means to them and what factors affect caring in the emergency department. Enns and Sawatzky (2016) report that holistic care and advocacy are the main issues in their study that involved the participation of emergency department nurses. The key factors that adversely impact the ability to practice a caring attitude were lack of time, workload, low-level self-care, and shift work. At the same time, the majority of respondents indicated that poor management support was the major impediment to care. Therefore, to advocate for caring as a unifying concept in nursing, it is necessary to address the aforementioned hindrance factors. Caring is a central concept in nursing but it is directed not only toward patients but also toward creating a favorable working environment where retention will be increased.


To conclude, the issues of high workload and lack of time, and insufficient support of hospital management in addressing the nurses’ concerns prevent emergency nurses from proving caring, which is the fundamental concept in nursing. A hectic working atmosphere in the emergency department makes medical workers more distanced from the caring rules and closer to task-oriented behavior. Watson’s ten caring principles are aimed at reminding nurses about the core elements of caring and their proper application. Finally, exceptional support of the management should be directed towards evaluating the current perception of caring by medical attendants with the view of addressing their concerns and improving the caring attitude at large.

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