Emergency nurses bring skill, resilience, and compassion to every shift. Leaders can help create conditions where they can thrive.
Insights from Client Advocates at Tipton Health
In this article, you’ll learn:
- What makes emergency nursing so demanding
- What nurses need to feel supported at work
- How the work environment can affect burnout and patient care
- How Pathway can help support emergency nurses
The emergency department is a place where you never know what’s coming next.
One minute, an emergency nurse may care for someone with a minor injury. The next, that same nurse is responding to a life-threatening trauma. Patients wait, families need answers, beds fill up, and another ambulance arrives.
Emergency nurses care for people on some of the hardest days of their lives. They need to communicate with empathy, recognize changes in a patient’s condition, make quick decisions under pressure, and have a team they can count on.
Emergency nursing takes clinical expertise, quick judgment, critical thinking, teamwork, and nurse resilience. Even highly skilled, resilient nurses need a supportive workplace.
ER work is hard. The environment matters.
Emergency nurses can’t control how many patients arrive, when a critical patient comes through the door, or how quickly the department fills. But their work environment can either help them manage those demands or make a difficult job harder.
Research shows that the support emergency nurses receive at work can make a difference.
A 2023 study of 746 emergency nurses in 221 New York and Illinois hospitals found that 58 percent reported high burnout, 39 percent were dissatisfied with their jobs, and 27 percent intended to leave within a year. Nurses in better work environments were less likely to report these outcomes and more likely to rate patient care quality and safety favorably.
A separate study of 11,743 nurses at 60 Magnet® hospitals, including 1,585 emergency nurses, found that emergency nurses at the same hospitals were more likely than inpatient nurses to report insufficient staffing, an unfavorable work environment, and little confidence that management would address patient-care concerns. The findings reinforce why a supportive nursing work environment matters in both Magnet® and Pathway to Excellence® organizations.
When asked what could improve their well-being, 91.4 percent identified better staffing and 86.7 percent identified uninterrupted breaks. Both are important to nurses’ well-being, yet providing them consistently can be challenging in a busy emergency department.
What does a supportive ER environment look like for emergency nurses’ well-being?
Research points to several factors that matter, including:
- Enough people to handle the work
Staffing needs to match patient volume and complexity, with enough people to respond when the department suddenly fills up. - Time to step away
An uninterrupted break gives nurses a chance to eat, relax, and reset. It’s not a luxury; it’s part of sustaining the people doing the job. - A team that has your back
Nurses need to know who they can count on, especially when the department gets busy. Clear communication and strong collaboration matter. - Leaders who listen and act
Nurses need to know that when they raise a concern, someone will listen and follow through. Listening is a start, but following up and addressing concerns shows nurses that their voices matter. - A voice in patient care
Nurses need a meaningful voice in decisions that affect their patients and their practice. They need to know they can raise concerns and be heard. - The ability to provide good care
Nurses want to do the job they came to do: care for patients well. The right resources, support, and opportunity to speak up can help make that possible.
A healthy environment doesn’t decrease the pressure of emergency nursing. It gives nurses the support, resources, and voice they need to manage it.
Putting support into practice through Pathway
A 2025 study of 188 emergency nurses in New Jersey reinforces the connection between workload, the environment, and burnout. Seventy-two percent reported moderate to complete burnout, while 34 percent reported sustained or complete burnout. Higher workloads were associated with greater odds of burnout, while unsupportive practice environments were associated with even higher odds.
This is where Pathway to Excellence® comes in. The Pathway framework focuses on six standards that help organizations create a healthy work environment for nurses:
- Shared decision-making: Giving nurses a voice in issues that affect their work and patient care.
- Leadership: Ensuring nurse leaders are accessible, responsive, and willing to act.
- Safety: Supporting both patients and nurses in a high-acuity, unpredictable setting.
- Quality: Focusing on safe, evidence-based care, even under pressure.
- Well-being: Providing support, resources, and opportunities to recover, not simply asking nurses to be more resilient.
- Professional development: Helping nurses continue to build the expertise and confidence their work requires.
The goal isn’t simply to make nurses feel better about their work. It’s to create conditions that allow them to participate, grow, speak up, and provide high-quality care.
Supporting the nurses behind the care
Emergency nursing asks a lot of nurses. They must stay focused as the pace shifts, make sound decisions under pressure, and care for patients and families during some of their most difficult moments. Those demands won’t change. But the support nurses receive can.
Leaders can help by creating a practice environment where nurses have a voice, can rely on their team, and have opportunities to debrief, recover, and recharge after difficult experiences.
As Jennifer Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC, 2022 President of the Emergency Nurses Association, put it: “Emergency nursing is a complex profession, so it’s important for all of us to focus on recharging.”
Resilience will always be part of emergency nursing. Creating conditions that help nurses recharge, recover, and keep doing this important work is also part of leaders' job.
References:
- The 746-emergency-nurse study, Muir, K.J., et al. (2023). “The association of the emergency department work environment on patient care and nurse job outcomes.” JACEP Open, 4(5).
- The 2025 New Jersey emergency nurse study, Brassington, S., et al. (2025). “Impact of Registered Nurse Staffing, Workload, and the Practice Environment on Burnout in Emergency Nurses.” Journal of Emergency Nursing, 51(4), 684–691.
- The Turnbach study, “Emergency Nurses’ Well-Being in Magnet Hospitals and Recommendations for Improvements in Work Environments: A Multicenter Cross-Sectional Observational Study.” Turnbach, E., et al. (2024). Journal of Emergency Nursing, 50(1), 153–160.
- ANCC Pathway to Excellence program
More resources for emergency nurses:
- Emergency Nurses Association
- Journal of Emergency Nursing
- Board of Certification for Emergency Nursing
- ANCC Pathway to Excellence – Application/Standards Information
Frequently Asked Questions
What factors contribute to burnout among emergency nurses?
Emergency nursing involves high patient volumes, unpredictable demand, time pressure, and frequent exposure to trauma and difficult patient situations. Staffing and workload can exacerbate that strain. A 2025 study of emergency nurses in New Jersey found that higher workloads were associated with increased odds of burnout, while unsupportive practice environments were linked to even higher odds.
What do emergency nurses need to support their well-being?
The basics matter: adequate staffing, time for uninterrupted breaks, supportive colleagues and leaders, and opportunities to recover after difficult cases. Nurses also need to feel they can raise concerns and have a meaningful voice in decisions that affect patient care and their practice. Support isn't just about helping nurses cope with stress. It's about creating working conditions that make the demands of emergency nursing more manageable.
How does the nursing work environment affect emergency nurses?
The work environment can shape how nurses experience the demands of emergency care. Supportive environments are linked to lower burnout and greater job satisfaction, whereas poor practice environments can add to the strain nurses already face. These effects can extend beyond nurses, influencing perceptions of patient care quality and safety.
What can nurse leaders do to create a healthier environment for emergency nurses?
Focus on what leaders can influence: address staffing and workload, enable meaningful breaks, support teamwork, and support emergency nurses. Give nurses regular chances to raise concerns, shape decisions, and solve patient-care problems. Brief debriefs after difficult cases can help them process events before moving on. These steps won't make the emergency department predictable, but they can make it more supportive.
