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The global nursing shortage poses a critical challenge to healthcare systems. Emergency department (ED) nurses face high occupational stress due to demanding environments and strained patient-family interactions. Chronic stress impairs resilience and health, contributing to burnout and attrition. Understanding ED nurses' stressors and resilience is vital for workforce stability.
To identify core elements and interrelationships of occupational stressors and resilience among ED nurses in Zhejiang Province, China, using network analysis, and to explore intervention strategies.
Cross-sectional study.
From November 2024 to January 2025, data were collected from 990 ED nurses in 26 hospitals across 11 cities. Measures included a demographic questionnaire, the Chinese version of the Stressor Scale of Emergency Nurses, and the Resilience Structure Scale for Healthcare Professionals. Network analysis was conducted to illustrate the interconnections between stressors and resilience factors, while accounting for significant sociodemographic covariates.
A total of 990 nurses participated in the study. Violence-related stressors, such as physical assault and witnessing aggression, were the most prominent nodes in the stressor network. Key resilience elements included reframing patient or family criticism positively and timely emotional regulation. Bridge analysis highlighted ‘viewing criticism as encouragement’ as a crucial link connecting stress and resilience.
ED nurses work under intense stress from violence and scrutiny, which undermines resilience. Strengthening key resilience factors—especially cognitive reframing and emotional regulation—may buffer stress and enhance coping. Bridge nodes offer targeted points for intervention.
None.
This study clarifies the network of occupational stressors and resilience in ED nurses, identifying key intervention targets. It supports interventions focusing on cognitive adjustment, emotional regulation and interpersonal support to build resilience and reduce stress.
To evaluate the effectiveness of targeted interventions in optimising Beyond-Use Date (BUD) management and workload distribution to reduce intravenous (IV) medication errors and improve patient safety in a resource-limited hospital setting.
This study employed a pre- and post-intervention observational design.
A four-month intervention was conducted at a large tertiary hospital in China, following a baseline assessment of IV medication practices. The intervention included the establishment of BUD guidelines, redistribution of staff workloads and targeted training sessions. IV preparation and administration errors were observed in Pharmacy Intravenous Admixture Services (PIVAS) centers and medical wards, and changes in error rates were recorded.
In the PIVAS center, IV preparation errors decreased from 0.19% to 0.12%. Medical wards showed a decrease in administration errors from 38.3% to 30.0%, with improvements noted in areas such as adherence to BUD and storage protocols. The intervention demonstrated significant improvements in medication safety by enhancing BUD compliance and balancing workloads.
The implementation of structured BUD guidelines, workload optimisation, and training significantly reduced IV medication errors, highlighting the effectiveness of management-driven interventions in improving safety practices within hospital settings.
This study underscores the importance of BUD management and balanced workloads in reducing medication errors, contributing to safer and more efficient IV medication administration.
This study addresses the challenge of medication errors in resource-constrained healthcare environments, providing evidence that structured management interventions can enhance patient safety. The findings are relevant to healthcare providers and managers in similar settings.
This study follows the TIDieR and STROBE guidelines for structured reporting.
No patient or public contribution.
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