• Lisa A Wolf, Cydne Perhats, Altair M Delao, and Paul R Clark.
• Institute for Emergency Nursing Research Emergency Nurses Association, Des Plaines, IL, United States. Electronic address: lwolf@ena.org.
• Int Emerg Nurs. 2017 Jul 1; 33: 48-52.

IntroductionEmergency nursing requires acute attention to detail to provide safe and effective care to potentially unstable or critically ill patients; this requirement may be significantly impaired by physical and mental fatigue. There is a lack of evidence regarding the effects of fatigue caused by factors other than a sleep deficit (e.g., emotional exhaustion). Fatigue affects nurses' ability to work safely in the emergency care setting and potentially impacts their health and quality of life outside of work.MethodsThis was the qualitative arm of a mixed methods study; we used a qualitative exploratory design with focus group data from a sample of 16 emergency nurses. Themes were identified using an inductive approach to content analysis.Results/DiscussionThe following themes were identified: "It's a weight on your back;" "Competitive nursing;" "It's never enough;" "You have to get away;" and "Engagement as a solution."ConclusionsOur participants reported high levels of fatigue, which compromised patient care, had a negative effect on their personal lives, and created a toxic unit environment. They reported lateral violence as both the cause and effect of mental and emotional fatigue, suggesting that unit culture affects nurses and the patients they care for.Copyright © 2016 Elsevier Ltd. All rights reserved.

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