Identifying modifiable causes of stress in clinicians and administrators working in New South Wales psychiatric emergency care centres, 2023–24: a qualitative study

Abstract

Objectives

To examine the experiences of people in various disciplines working in New South Wales psychiatric emergency care centres (PECCs) to identify factors that influence their wellbeing and how they are managed.

Study design

Qualitative study; semi-structured interviews.

Setting

Eleven of twelve New South Wales PECCs, NSW Health.

Participants

Thirty-five nurses, psychiatrists, psychiatry registrars, social workers, occupational therapists, and NSW Health staff working in or with management oversight of PECCs.

Main outcome measures

Experiential relativist framework analysis of the experiences of people working in PECCs.

Results

The overarching finding was that working in PECCs involved conflicting, concurrent demands. Three major themes were identified: interactions with the patient: relational work is both meaningful and difficult; interactions with the health care system: conflicting expectations regarding the management of suicide risk causes overwhelming anxiety; and interactions with the hospital: the hospital asks for whatever it needs in the moment, causing clinicians to feel that it does not understand the PECC care model. Two protective factors and processes were also identified: a clear treatment framework reduces uncertainty, enhancing clinician satisfaction and continuity of care for patients; and working in a collaborative team with a flat hierarchy enhances satisfaction and autonomy.

Conclusion

People working in PECCs experience tension and, at times, considerable anxiety arising not just from the intense emotional demands of crisis care but also from the conflicting demands and expectations of the system in which they work. This tension reduces staff wellbeing and retention, and consequently patient care. These negative effects can be reduced by team cohesion and having a clear treatment framework.