Measuring ‘Need for Recovery’ as an indicator of staff well-being in the emergency department: a survey study

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>The Need for Recovery (NFR) Scale is an 11-item questionnaire that assesses how work affects intershift recovery. Items are summated to form a score with a maximum value of 100. Previously reported scores range from 38 in nurses to 55 in miners. This study aimed to determine the NFR Score among ED staff and to identify whether the NFR Score was associated with characteristics potentially implicated with recovery from work.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Staff in a single ED in the South West of England (annual attendances of 93 000) were asked to complete an electronic questionnaire incorporating the NFR Scale plus additional items relating to demographic, work-related and well-being characteristics, in their own time during January 2018. Descriptive statistics are presented, including median NFR Scores and associations with additional characteristics. Thematic analysis of free-text comments from an open-ended question was undertaken.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>One hundred and sixty-eight responses were obtained (80.3% capture). Median NFR Score across all staff groups was 81.8 out of 100.0 (95% CI 72.7 to 81.8). Shift duration exceeding 12 hours, dissatisfaction with work–life balance and self-reported perceptions of burnout were associated with significantly elevated NFR Scores. Themes resulting from the open-ended question were ‘barriers to intershift recovery’ and ‘coping with work’.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The NFR Scores in this study exceeded scores reported elsewhere and were associated with some demographic, occupational and well-being characteristics. The NFR Scale has utility to measure the need for intershift recovery among ED staff. A larger study is warranted to identify specific determinants of recovery and to provide recommendations.</jats:p></jats:sec>

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

“…The reported rates of distress and trauma do not take account of any pre-existing psychiatric morbidity or historical factors that may predispose doctors to developing mental health difficulties in these circumstances. [63][64][65][66] Data were gathered with regard to historical trauma, one of the most significant predictors of mental health difficulties long-term. Furthermore, while the sample size is large, any self-reporting measure is open to selection bias.…”

Need for recovery amongst emergency physicians in the UK and Ireland: a cross-sectional survey

“… 35 36 Our findings are, however, congruent with our own feasibility work completed in a single-centre UK ED, reporting a median NFR Score of 81.8 in all staff groups. 21 The impact of rising patient numbers and overcrowding on UK and Ireland EDs is commonly reported, 38 39 but our findings are the first to illustrate the impact of high work demand on physicians’ need to recuperate from work and the modifiable factors which can mitigate this fatigue.…”

“… 28 Following a minor amendment to one question to increase applicability to the study population (from ‘after the evening meal, I generally feel in good shape’ to ‘after my breaks, I feel fresh to continue my work’), feasibility work in a single UK centre demonstrated a Cronbach’s alpha of 0.79, and found that the NFR Scale was acceptable and user friendly. 21 …”

“…28 Following a minor amendment to one question to Open access increase applicability to the study population (from 'after the evening meal, I generally feel in good shape' to 'after my breaks, I feel fresh to continue my work'), feasibility work in a single UK centre demonstrated a Cronbach's alpha of 0.79, and found that the NFR Scale was acceptable and user friendly. 21 A patient and public involvement consultation was conducted at the UK Emergency Medicine Trainee Association Conference (Cardiff, December 2018), using a semistructured question guide for mixed focus groups to review a proposed participant survey. A key element of this consultation explored the use of a burnout inventory within the proposed study; concerns relating to respondent fatigue, length of survey and assessment of questions using a Likert Scale indicated that such an inventory was not universally acceptable to emergency physicians.…”

“…A single-centre study assessing the utility of the NFR in an emergency department (ED) population reported a high response rate (80%) and completion time of less than 10 min while gaining insight into shift patterns, work–life balance and well-being. 21 This might suggest that the method of questioning used in the NFR Scale and emphasis on recovery as opposed to more emotive questioning could be beneficial in improving response rates and reducing respondent fatigue in repeat usage. As such, NFR may provide a valuable option for regular evaluating of staff well-being and identifying opportunity for early intervention in busy EDs.…”