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Burnout and retention crisis in Emergency Medicine threatens the safe delivery of emergency care, new report finds

10 January 2024

New research from the University of Bath, in conjunction with the Royal College of Emergency Medicine (RCEM), has found the safe delivery of emergency care is now under serious threat, due to a severe burnout and retention crisis in Emergency Medicine.

The research published today (10 January 2024), was led by clinical psychologist Dr Jo Daniels, University of Bath, in collaboration with RCEM and colleagues at UWE Bristol and the University of Bristol.

The research finds that A&Es have been and continue to be under unprecedented pressure, exacerbated by chronic underfunding, lack of sustained investment and a shortfall of beds. This has placed a significant burden on A&E staff and RCEM members that has led to a severe burnout and retention crisis – dating back a decade.

This is evidenced by a University of Bath IPR report from February 2023 which concluded that as many as one in seven healthcare workers were actively trying to leave the NHS.

A&Es and their staff – our membership – provide an essential frontline service, delivering urgent and emergency care to anyone who needs it 24/7, all year round. A&Es rely on the health and wellbeing of staff to function well and provide optimum care and service to the nation.

Urgent action is needed to address the serious burnout and retention crisis among Emergency Medicine staff. A failure to address these issues will likely result in poor outcomes for patients and staff.

NHS England, Trusts and healthcare leaders must focus on four key areas: environment; culture; psychological wellbeing; leadership. Actions include improving access to hot, healthy food, cultivating a better culture through civility and respect, better access to mental health and psychological support, and quality leadership training so leaders are empowered to deliver organisational and cultural change – among others.

Dr Adrian Boyle, President of the Royal College of Emergency Medicine said:

“Working in Emergency Medicine can, by its very nature, be a high pressure and stressful job. Our members, and their colleagues, who go above and beyond for their patients day in day out, should not also have to battle a system which is meant to be there to nurture and support them. We thank Dr Daniels, her team, and all the clinicians who gave their time to take part in this important piece of research.

“What it reinforces is that the NHS must get better at caring for its workforce – its people are its greatest asset, and everything must be done to ensure their welfare. This research will now be shared with policymakers and will form part of the College’s advocacy work to help inform and bring about the cultural shift that is so needed in our A&Es.”

Speaking at the Northern Emergency Medicine Conference in Newcastle yesterday (9 January 2024), Dr Adrian Boyle, RCEM President, presented some of the findings in this report in a session titled ‘How to survive and thrive in Emergency Medicine’.

Lead author Dr Jo Daniels of the University of Bath explained: “At a time of national crisis in the NHS, with over-stretched resources leading to long waiting times for patients and burnout for staff, our study asked what more could be done to improve the current challenges of staff retention.

“A common thread that emerged across our interviews was the critical importance of leadership in hospitals. Those in leadership positions are powerful agents of change, and have pivotal influence over team functioning, staff wellbeing and patient outcomes. However, lines of accountability and communication with executive management needs to be clarified, opened up and improved.

“A new focus on leadership training and ongoing support for those in leadership roles will be critical to this. Given its central importance and the scope for leadership improving wellbeing at work, we have a prime opportunity now to address the problems which force staff to leave the workforce. Harnessing the potential in our leaders is where our focus should now lie.”

Moving ahead, the team involved in the study will also work with the professional bodies to help improve training and policies.

Dr Daniels added: “We have outlined specific steps that can be taken by NHS trusts, but we need to start with recognition of how important this role is, and how vital it is that those in leadership positions are supported to lead. Without strong leadership, we can expect poor outcomes for all.”

To address and tackle these systemic issues the government and policymakers must:

  1. Increase bed availability to match demand, improve flow, reduce ambulance waiting times and reduce pressure on staff.
  2. Increase investment in health and social care services to tackle exit block, protecting the most vulnerable of our ED patients and ensuring a safe pathway out of the ED and to communities.
  3. Increase investment in the workforce through recruitment and retention: financial support for the recruitment of consultant posts, driven by the safe staffing ratios reflecting expected standards in a Western developed nation.
  4. Mandate collection of EM workforce attrition data: professional bodies require high quality granular data on attrition and retention at a national level in order to develop policies and intervention that can understand and feasibly address retention.

The Royal College of Emergency Medicine #ResuscitateEmergencyCare campaign lays out the priorities that must be adopted to tackle the crisis facing our members and Emergency Medicine:

For more information read our briefing The impact of staff burnout and how to improve retention.

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