When the room will not thin out

An emergency room is supposed to be the place that can still move when someone is hurt or suddenly ill. Park Mi-jeong, in 2012, put it simply: swift, suitable treatment, and a first look that has to be right. By 2018, according to a 2019 release from the National Emergency Medical Center, visits in Korea had reached 10.61 million. That was up from 8.38 million in 2007 and 10.43 million in 2017, a 24.6 percent rise in ten years. Those figures are left with the 2019 release.

As the rooms came to be thought of as places where care comes quickly, people wanted that speed, and crowding grew heavier. Crowding, as Kim Won and Park Jun-beom noted in 2017, can get in the way of the care an emergency patient actually needs. It also piles work, and stress, onto the nurses who stay closest to the bedside. In the same years, more emergency patients were choosing general hospitals, and more people who were not in an emergency were coming in as well.

The work itself is not like a ward’s. A patient may need several services at once, and the nurse is often the one caught between physicians and other staff. On holidays and at night, Yoon Jeong-mi and Park Hyeong-suk wrote in 2014, the load is joined by violent risk and by verbal abuse, including from people who are drunk or already agitated. When admission is delayed, or a family member is missing and registration stalls, patients stay longer, and the stress deepens. That description of delayed stays is left with Kwak Eun-mi, Lee Ju-yeong, and Yoon Hui-jang, in 2020.

A habit of judgment, under pressure

Before a nurse can manage a room like that, someone has to see who cannot wait. Gottlieb and colleagues, in 2021, put the need for a clear judgment at the front of that work. Critical-thinking disposition is the personal inclination to trust, and actually use, one’s own judgment when a decision has to be made. Park Gwang-ok and Kim Jong-kyeong described it that way in 2013. Ludin, in 2018, treated it as the habit of thinking from evidence, and of looking carefully at a patient’s condition before acting.

Facione and colleagues, in 2000, separated the skill of thinking critically from the willingness to use it. Later writing keeps that pairing in view. Jeong and colleagues, in 2024, treat the disposition as a readiness to value one’s own judgment and to put it into practice. Manetti, in 2019, includes the more flexible work of organizing care, setting priorities, and changing a plan when the room changes. Richards and colleagues, in 2020, tie that habit to clinical reasoning in a setting that will not stay still.

Emergency nurses do ordinary nursing, but they also triage, join cardiopulmonary resuscitation, and give emergency drugs, as Kim and Yang noted in 2021. The plan does not invent a finding of its own about how strongly this habit predicts safer care. It only gathers earlier work — among them Kim Yang-sin in 2020, Lee Dong-suk and Park Ji-yeon in 2019, Je Nam-ju in 2021, and Polat and colleagues in 2019 — in which nurses with a stronger disposition were described as making decisions more efficiently, and as solving problems more readily in mixed clinical scenes.

Stress that does not stay in one shift

Job stress, in the definition used here from McCleese, Eby, Scharlau, and Hoffman in 2007, is the feeling that rises when a person’s traits and abilities no longer match what the job is asking. Na Yeong-do, in 2018, describes it as a physical, physiological, and psychological strain that grows from the fit, or the lack of fit, between a person and the conditions of the work. When it hardens, Kim Min-seong in 2016, and Ha Hye-jin and colleagues in the same year, warned that nurses may start to avoid patients, lose drive, and grow less alert to safety.

In the emergency room the causes sit close at hand: too much work, conflict with physicians, and strained relations with patients and families, as Han Yu-jin wrote in 2015. Many who walk in believe their own case is the most urgent, whatever the triage says. Patients want care at once; staff are bound by a classification system and by limited resources. Ko Jeong-ok, in 2013, described how that gap turns into conflict. Training meant to raise the quality of emergency nursing can add to the same load.

Among nurses more generally, Yang Hui-soon in 2013 pointed to pay, gender, age, whether someone has children, clinical career, shift pattern, time in the unit, position, and the number of night shifts. Yoon So-ra, in 2017, found job stress moving in the opposite direction from professional quality of life. Lee Jeong-min and Yeom Yeong-hui, in 2013, tied higher stress to lower compassion satisfaction; Kim Ja-suk and colleagues, in 2014, tied it to burnout and to secondary traumatic stress. Oh Eun-ju and Kim Yeong-soon, in 2015, found a strong positive link between verbal violence and job stress among nurses in tertiary hospitals. In emergency rooms themselves, Han Yu-jin in 2015 reported high stress, and Lee Gyeong-ju in 2018 reported a link with verbal violence. Kim Su-jeong, in 2016, found emergency-room stress higher than in other units, in a place where much of the work sits next to a patient’s life.

Safety work, and a study that has not yet been run

Patient-safety management, as Lee Geum-ok put it in 2009, is the systematic work of catching problems in hospital care before they do harm. A 2016 list from the Korea Institute for Healthcare Accreditation sets out what that looks like in practice: identifying patients, handling verbal and telephone orders, medication, procedures and surgery, a safer environment, infection, falls, pressure injuries, and crisis work. Hospital accreditation in Korea, in what Im Seon-ae and Park Min-jeong wrote in 2018, has been used since 2004 to push quality and safety. In 2015 the Patient Safety Act was enacted, with a focus on preventing incidents and stopping them from recurring, as Seo Je-hui wrote in 2016. The World Health Organization, in 2009, treated patient safety as the effort to keep the risk of unnecessary healthcare harm as low as it can be, work that has to involve every unit and every staff member.

An emergency room is a hard place to keep that promise. Alexander, Kinsley, and Waszinski, in 2013, described decisions made with limited information, in an unstable setting, around unstable vital signs or resuscitation, where the chance of an accident is high. Hong Eun-yeong, in 2023, noted that arrivals cannot be paced in a steady way, so the density of the room keeps changing. Chronic staff shortages and high severity make safe nursing harder, as Kwon Yong-eun wrote in 2020, and as Enns and Sawatzky wrote in 2016. In patient-safety figures for 2017 through 2021, gathered by Hong Eun-yeong in 2023, 43 percent of safety incidents that occurred in emergency rooms were described as preventable. That 43 percent is left with the 2017–2021 window in the 2023 account.

The 2025 plan is written as a descriptive survey, not as a finished trial. It would first describe nurses’ general characteristics, their critical-thinking disposition, their job stress, and their safety work; then look at differences in safety work by those characteristics; then at the correlations among stress, thinking, and safety work; and then at the influence of stress and thinking on safety work, using multiple regression. Disposition would be measured with Yoon’s 2004 tool, 27 items from “strongly disagree” to “strongly agree,” negative items reversed, a higher total meaning a stronger disposition. Stress would be measured with the 23-item nurse tool first developed by Gu Mi-ok and Kim Mae-ja in 1984 and revised by Ahn Mi-kyung in 2003. Safety work would be measured with Park Hyun-hee’s 2013 24-item questionnaire, built from 2007 evaluation items of the Korea Health Industry Development Institute that match the six International Patient Safety Goals. Collection was set for about a month, from May to June 2025. The plan hoped that, if thinking could be strengthened and stress handled more effectively, confidence and satisfaction might rise, and the quality of care with them. Those outcomes were not measured in the plan itself.

What the plan is meant to leave

The hope, plainly stated, is modest: to offer a base for later education that would help emergency nurses keep patients safer. The same Korean report, at fuller length, is on CampusDown.

Sources

1. Ministry of Health and Welfare, National Emergency Medical Center, 2019 (emergency-room visits for 2007, 2017, and 2018).
2. Yoon, 2004, critical-thinking disposition tool, 27 items. Gu Mi-ok and Kim Mae-ja, 1984, nurse job-stress tool, revised by Ahn Mi-kyung, 2003, 23 items. Korea Health Industry Development Institute, 2007, evaluation items aligned with the six International Patient Safety Goals; Park Hyun-hee, 2013, 24-item questionnaire.
3. Lee Geum-ok, 2009; Korea Institute for Healthcare Accreditation, 2016; Im Seon-ae and Park Min-jeong, 2018, on accreditation from 2004; Seo Je-hui, 2016, on the Patient Safety Act of 2015; World Health Organization, 2009.
4. Hong Eun-yeong, 2023, on preventable emergency-room safety incidents in 2017–2021. Kim Min-seong, 2016; Ha Hye-jin et al., 2016; Han Yu-jin, 2015; Kim Su-jeong, 2016; Yoon Jeong-mi and Park Hyeong-suk, 2014; Kwak Eun-mi, Lee Ju-yeong, and Yoon Hui-jang, 2020.
5. Facione et al., 2000; Park Gwang-ok and Kim Jong-kyeong, 2013; Ludin, 2018; Manetti, 2019; Richards et al., 2020; Jeong et al., 2024; Kim and Yang, 2021; Alexander, Kinsley, and Waszinski, 2013; Enns and Sawatzky, 2016.

Last updated: 14 November 2026