Burnout and coping strategies among healthcare professionals in the emergency departments of public and private tertiary hospitals in Karachi

Abstract

Objectives

To understand the experiences of burnout and coping strategies among healthcare professionals working in the emergency department of tertiary care public and private hospitals in Karachi.

Design

A qualitative exploratory design was employed.

Setting and participants

One public-sector and one private-sector tertiary care hospital located in Karachi, Pakistan were selected for this study. Audio-recorded in-depth interviews were conducted with a total of 15 healthcare professionals working in the emergency department, which were later transcribed verbatim and analysed inductively.

Results

The findings of the study identified two major themes contributing to burnout: individual and organisational themes, along with coping strategies used by healthcare professionals. Individual-level subthemes included emotional distress, arising from ethical dilemmas and constraints within the work environment, and work-life imbalance, where participants experienced difficulty maintaining personal well-being due to professional demands. Organisational-level subthemes included lack of leadership support and recognition, role conflict, inadequate resources, excessive workloads and exposure to workplace violence, all of which contributed significantly to burnout. Healthcare professionals reported both adaptive and maladaptive coping strategies. Adaptive strategies included positive reframing, peer support and relaxation techniques, whereas maladaptive strategies involved venting frustration and, in some cases, substance use to manage prolonged stress.

Conclusion

The findings revealed that the experience of burnout is caused by a range of interdependent factors at the individual and organisational levels. Multifaceted interventions are needed to address these issues such as national and emergency department staffing policies, mental health support, resilience training, workload management, flexible scheduling and the promotion of work-life balance.

Strengths and limitations of this study.

• To the best of our knowledge, this is among the first qualitative studies in Pakistan to explore the key themes contributing to burnout and the coping mechanisms used by healthcare professionals working in emergency departments.

• The study provides rich insights into providers’ experiences, including the challenges they encounter and their perspectives on potential remedial actions.

• The assessment was limited to one public and one private tertiary care hospital of a metropolitan city in Pakistan.

• The data on coping strategies were relatively limited compared with the extensive information collected on burnout experiences.

• The targeted participants were from the emergency department of the selected hospitals.

Introduction

Burnout is a major public health concern for health workers all over the world. Healthcare professionals, particularly doctors and nurses, may face demanding and threatening working conditions as a result of the nature of their employment, putting them at risk of developing negative health concerns.¹ Burnout was recognised as an occupational phenomenon by WHO in 2019, and it was included in the list of diseases in the 11th edition of the ‘International Classification of Diseases’.²

Globally, more than one-third of public health workers experience burnout, leading to serious adverse effects on both their mental and physical well-being.³ In low- and middle-income countries (LMICs) like Pakistan, the current healthcare system often carries complex and excessive workload.⁴ The prevalence of burnout syndrome among healthcare professionals ranges from 25% to 60%, affecting physicians, nurses and other supporting staff, and subsequently impacting both their professional performance and personal lives.⁴ According to the 2024 American Medical Association survey, burnout rates among healthcare specialties are as follows: emergency medicine (52.2%), hospital medicine (40.6%), family medicine (46.4%), paediatrics (42.1%), obstetrics and gynaecology (45.8%) and internal medicine (42%).⁵ The estimated prevalence of burnout in emergency departments (EDs) globally is notably high, ranging from 49.3% to 58%.⁶ The ED is a high-stress environment, often characterised by overcrowding, understaffing and inadequate resources, which are the key reasons for burnout, particularly in LMICs.⁶

Several factors contribute to burnout among healthcare professionals, which can be broadly categorised into individual and organisational themes.⁷ Under the individual themes, the subthemes include work-life imbalance and high self-expectations, both of which can lead to emotional exhaustion and reduced job satisfaction.^{4 7 8} Organisational themes also play a significant role; factors such as a fast-paced work environment, long working hours, a high volume of patients with complex needs and low pay scales create substantial pressure on healthcare professionals.^{4 7 8} Burnout has a wide range of consequences. For healthcare providers, it is associated with adverse health outcomes such as musculoskeletal disorders, depression and sleep disturbances, which negatively affect both quality of life and job performance.⁷ In turn, burnout compromises patient safety, contributing to increased medical errors that affect more than 251 000 individuals annually in the USA.⁹ From an economic perspective, burnout leads to higher absenteeism and staff turnover, increasing healthcare costs and placing additional strain on organisational resources. Overall, addressing burnout is essential for improving healthcare provider well-being, ensuring patient safety and maintaining the sustainability of the healthcare system.⁸

Despite being a significant public health concern affecting the health workforce, evidence on burnout in LMICs remains limited compared with high-income countries.⁶ Several studies have examined burnout among healthcare professionals in Pakistan10,17; however, only one study has specifically focused on burnout in EDs, highlighting a clear gap in the literature. A study conducted in Islamabad reported that 21% of healthcare professionals working in EDs experienced moderate to high levels of burnout. Nevertheless, this study primarily assessed the prevalence of burnout and did not explore the underlying experiences or contributing factors.

This study aims to understand the experiences of burnout and the coping strategies employed by healthcare professionals in the EDs of public and private tertiary hospitals in Karachi, providing insights to inform targeted interventions and national policy development.

Methodology

Country context

Pakistan is the fifth most populous country globally, with an estimated population of approximately 245 million.¹⁸ Pakistan has a Human Capital Index of 0.4, indicating substantial economic challenges. This ongoing crisis has severely impacted the education and health sectors, with a life expectancy of 66 years lower than that of other South Asian countries.¹⁸

Pakistan’s healthcare system comprises both public and private sectors, with provincial governments primarily responsible for health, except in federally administered areas. Services cover preventive, promotive, curative and rehabilitative care.³ Curative services are provided at secondary and tertiary levels, while preventive care is delivered through national programmes and primary healthcare facilities.³ The state operates a three-tiered healthcare system and various public health interventions. Some government and semi-government organisations, such as the armed forces and parastatals (eg, Sui Gas, WAPDA), provide healthcare to their employees, covering approximately 10% of the population.³

The healthcare system in Pakistan is under significant strain due to a combination of factors that contribute to the burnout among health workers. The country faces a critical shortage of healthcare personnel, particularly nurses, with only 5% holding a Bachelor of Science in Nursing or higher.¹⁹ This shortage is compounded by the growing burden of non-communicable diseases, poor maternal, neonatal and child health, which further stretch the already overburdened workforce.¹⁹ The doctor to patient ratio is concerning with one doctor serving 1300 patients and far exceeding the WHO’s recommended ratio of 1:1000 and nurse to patient ratio 1:20, whereas the Pakistan Nursing Council suggests a nurse-to-patient ratio of 1:10 in general wards and 1:2 in specialised areas.²⁰ Additionally, the doctor-to-nurse ratio is 1:2.7, which is far lower than the WHO standard.²⁰ These challenges are further exacerbated by a lack of essential supplies, equipment, advanced diagnostic tools and overcrowded public healthcare facilities that result in long wait times, limited resources and compromised quality care.¹⁹

Study design

The qualitative exploratory study was conducted from May to December 2022 in one tertiary care public hospital and one private hospital in Karachi. An exploratory design was employed in this study due to the limited information available on healthcare professionals’ experiences with burnout.²¹ This design enabled an in-depth understanding of participants’ perspectives, with data collected directly from participants rather than relying on pre-existing sources, ensuring that the findings accurately reflect the real-world experiences of ED staff. The study was guided by an interpretivist paradigm, rooted in symbolic interactionism and phenomenology, which asserts that value and theory-neutral facts do not exist, and that individuals’ perceptions shape the meaning and nature of objects.²² As Chen (1996) notes, this paradigm encourages researchers to explore lived experiences and to consider multiple interpretations of social contexts, thereby facilitating a deeper and more nuanced understanding of the phenomenon under investigation. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies checklist.²³

Study setting

The study was conducted in the EDs of tertiary care public and private hospitals in Karachi. The public hospital has a total capacity of 1000 beds, including 38 designated for the ED, while the private hospital accommodates 560 beds, with 60 beds allocated to the ED. Both hospitals serve a diverse patient population and provide tertiary-level emergency care; however, they differ in overall bed capacity, emergency bed availability and organisational structure, reflecting variations in patient volume, resources and service delivery models.

Study team

This study was conducted by the first author as her master’s thesis for the health policy and management degree requirement at Aga Khan University, Pakistan. This study was supervised by the health system experts WH and AT and subject expert BK. Each researcher has specific expertise for carrying out this study: WH and AT have experience in health system research, design and implementation of qualitative research and data analysis. BK is a professional psychologist with research proficiency. BMK is a master’s student with a public health and health policy background.

BMK (corresponding author) is the guarantor of this work and takes full responsibility for the integrity of the study and the accuracy of the data and analysis.

Target population

Participants included doctors, nurses and technicians, all of whom had a minimum of 1 year of experience in the ED of the respective hospital. Excluded from the study were medical, nursing and technician students, visiting consultants and non-clinical staff, such as security guards and housekeeping personnel.

Sample size

A total of 15 healthcare professionals (n=15) with at least 1 year of experience in the same hospital were enrolled in the study to ensure that participants had sufficient clinical experience to meaningfully reflect on the themes contributing to burnout and the coping strategies used to manage it. Of these participants, 8 were from the private hospital and 7 from the public hospital.

Interview guide

An interview guide was developed based on a thorough review of the literature to conduct in-depth interviews (IDIs) with healthcare professionals (online supplemental file online 1). This guide aimed to explore various aspects, including respondent characteristics, daily work routines, burnout experiences and coping mechanisms employed. The guide was pilot-tested on healthcare professionals working in EDs at hospitals other than the two selected for this study to ensure its validity. Based on participant feedback, no modifications were necessary, as the guide was found to be well-structured, comprehensive and logically sequenced.

Data collection and management

Purposive sampling was employed to select participants for the study. In coordination with department heads after approval, individuals meeting the criteria were invited to participate, ensuring diverse perspectives on the burnout. All selected participants (n=15) were provided written informed consent to participate in the study, including consent for audio recording and for anonymised quotations to be used in the publication. After collecting data from 15 participants, data saturation was achieved, as no new information or themes emerged.

The date and time for the in-person interviews were scheduled in advance. Study participants provided written informed consent on the day of data collection. The details of the consent form were thoroughly explained to participants prior to obtaining their signatures. This included the purpose and scope of the study, note-taking, audio recording, potential benefits, confidentiality of information and the withdrawal procedure. Basic demographic information, including age, gender, education and work experience, was collected before commencing the interview questions. The lead author, fluent in the local language, conducted all interviews. IDIs were held in a staff room within the ED to ensure participants’ comfort, with only the participant and the researcher present. Each interview lasted 45–60 min. Confidentiality was maintained by assigning identification codes to each study site and participant.

Data analysis

Information gathered from the IDIs was analysed using the inductive thematic analysis. After the transcription and translation of all the audio-recorded interviews, the researcher reviewed the transcripts and notes taken during interviews to gain familiarity with the data. Analysis was conducted manually. Codes were formulated and categorised into multiple categories under each overarching theme.

Trustworthiness

The key criteria for ensuring the quality of qualitative research include credibility, transferability, dependability and confirmability.²⁴ We achieved credibility through the involvement of healthcare professionals from different hospitals to ensure that the views reflect the actual drivers related to burnout. Sufficient time was spent in the field, engaging with study participants and acquiring comprehensive insights. To achieve transferability of our findings, data were collected from the healthcare professions of one public and one private tertiary care hospitals, making the findings applicable to other tertiary care facilities. Dependability was achieved by all researchers checking the transcripts to gain understanding of findings and confirm the point of saturation.

Patient and public involvement

None.

Results

As shown in table 1, the sample for this qualitative study consisted of 15 healthcare professionals from various roles, including nurses (n=6), resident doctors (n=3), senior medical officers (n=2), technicians (n=2) and nurse assistants (n=2). The gender distribution was balanced, with 53.3% male participants and 46.7% female participants. Ages ranged from 24 to 55 years, with most participants between 25 and 35 years. Participants held a wide range of professional qualifications, reflecting the heterogeneity of roles within the healthcare sector. These included intermediate-level certificates, nursing diplomas and generic nursing and advanced medical degrees, such as the Bachelor of Medicine, Bachelor of Surgery, Fellow of the College of Physicians and Surgeons and postgraduate master’s degrees. The diversity of qualification among participants indicates representation across a continuum of clinical roles and responsibilities, ranging from nursing personnel to specialised physician.

Table 1. Participants’ characteristics.

Participants	Total no. of participants	Gender	Age	Qualification	Designation	Years of experience
Nurses	6	Male (3) and female (3)	24–35	Generic nursing	Registered Nurse	1–6
Residents	3	Male (1) and female (2)	25–35	MBBS to FCPS	Resident	2–5
Physicians	2	Male (1) and female (1)	30–45	MBBS masters	Senior Medical Officer	>10
Technicians	2	Male (1) and female (1)	26–55	Intermediate	Technician	5–20
Nurse assistant	2	Male (1) and female (1)	25–35	Intermediate	Nurse Assistant	>5
Total participants	15

FCPS, Fellow of the College of Physicians and Surgeons; MBBS, Bachelor of Medicine, Bachelor of Surgery.

Each of the themes comprised sub themes derived from the interview findings as shown in table 2.

Table 2. Themes and subthemes of burnout and coping strategies.

No.	Themes	Subthemes
1	Individual factors contributing to burnout	Emotional Work-life imbalance
2	Environmental factors contributing to burnout	Lack of leadership support and recognition Conflicting roles Lack of control Lack of resources and high workload Workplace violence and poor security
3	Coping strategies	Adaptive coping strategies Positive reframing Peer support Relaxation activities Maladaptive coping strategies Venting frustration Substance abuse

Subthemes of individual themes contributing to burnout

Emotional distress

The majority of the nurse participants were of the view that the risk of burnout in healthcare professionals can be influenced by emotional distress. They described working in the emergency room as particularly challenging due to the high-pressure environment and constant exposure to traumatic situations. They further mentioned that healthcare professionals in emergency rooms regularly encounter life-threatening conditions, severe injuries and emotional toll of patient suffering which can lead to emotional exhaustion. The unpredictable nature of work, along with the urgency of decision making, often leaves little time for emotional processing, which can cause feelings of helplessness, sadness and frustration. The constant exposure to trauma, coupled with long shifts and fatigue, compounds these feelings, leading to emotional exhaustion.

In the emergency room, we strive to save every individual, but when these expectations are not met, it can result in significant frustration and emotional exhaustion, ultimately contributing to burnout. (Nurse, Private hospital)

Work-life balance

Both female and male participants reported struggling to balance work and personal life due to the intense demands of the workplace. They emphasised the unique challenges of managing professional obligations alongside domestic responsibilities, noting that these dual pressures often led to feelings of being overwhelmed. Participants described the constant juggling act between meeting work deadlines, handling family duties and fulfilling societal expectations, which contributed to emotional and physical exhaustion as well as social isolation.

A female doctor or clinician experiences a great deal of stress. When I return home, I must cook for my child and in-laws, and also dedicate time to them. However, people at both work and home often fail to acknowledge the effort required to manage these responsibilities and dismiss the challenges we face. (Doctor, Public hospital)

I become socially isolated due to my profession. My routine consists of going home, sleeping, waking up, and returning to the hospital, repeating the same cycle continuously. (Doctor, Private hospital)

Subthemes of organisational themes contributing to burnout

Lack of leadership support and recognition

During the interviews, most participants, regardless of gender, expressed that a lack of motivation from both staff and leadership contributes significantly to burnout. Despite the team’s consistent efforts and dedication, it is disheartening that their contributions are often unacknowledged, while mistakes are emphasised. This absence of recognition exacerbates feelings of depersonalisation and low personal accomplishment.

Lack of motivation from other staff and management is a trigger that increases burnout. We put our heart and soul into each shift; however, our efforts are not adequately acknowledged. (Nurse, Private hospital)

When a mistake is made by both a senior and a junior staff member, or when the error is committed by a senior who maintains a good rapport with colleagues, there is a tendency for observation or incident reports to be selectively directed toward those with whom the team does not share a close relationship. Even when both individuals are assigned to the same area, accountability is often imposed unevenly, favouring those with stronger personal connections. (Nurse, Public hospital)

Our leaders only notice our mistakes and fill out forms. When we perform well, there is no recognition or appreciation for our efforts. (Technician, Private hospital)

Conflicting roles

A few of the female nurses also mentioned that they were held accountable for a wide range of responsibilities, often facing blame for issues outside their direct concern. Whether it involves incomplete cleaning tasks, delays in procedures or a situation where the doctor is occupied with other patients which adds to their stress and workload. A few female nurses also reported being held accountable for a wide range of responsibilities, often facing blame for issues beyond their direct scope of work. This included incomplete cleaning tasks, delays in procedures or situations where a doctor was occupied with other patients, all of which added to their stress and workload.

There are many tasks expected to be handled solely by nurses. While it is positive that nurses are entrusted with responsibilities, assigning too much to them can be overwhelming. It is important that responsibilities are shared evenly to prevent burnout. (Nurse, Private hospital)

Lack of resources and high workload

During interviews, most participants, both women and men, revealed that understaffing and insufficient resources, including medical supplies and equipment, are ongoing challenges in both public and private hospitals, affecting nurses and doctors alike. As a result, staff are expected to perform under high pressure with limited support—whether in terms of personnel, time or equipment—which increases feelings of lack of control and hopelessness. These conditions can lead to emotional and physical exhaustion, ultimately affecting job performance and well-being. Additionally, a few nurses from private hospitals reported being assigned tasks outside their official job descriptions and expressed concerns about being held accountable for these additional responsibilities, further increasing physical and emotional strain.

The constant influx of patients, the severity of cases, and the limited resources often create an environment where it feels like control is slipping away. (Nurse, Public hospital)

We are doing dual documentation, as both manual and electronic records are being maintained, resulting in increased workload due to duplication. (Nurse, Private hospital)

These staffing shortages contribute to burnout, as nurses are overwhelmed with additional responsibilities that fall outside their professional scope, leading to increased emotional exhaustion and low personal accomplishment. (Technician, Private Hospital)

Workplace violence and poor security

During the interview, a female participant shared that they are frequently subjected to workplace violence due to long waiting, patient’s or family’s frustration due to severity of patient’s condition and poor security at the workplace. Verbal abuse, sometimes escalating to physical abuse, contributes to burnout, particularly emotional exhaustion.

Moreover, participants reported that security in public hospitals is inadequate compared with private hospitals. As a result, they are frequently exposed to threats to their safety, as the security personnel in public facilities often lack the necessary equipment and training to effectively protect healthcare staff. This ongoing stress leads to depersonalisation, where healthcare workers become emotionally detached and experience a decline in personal accomplishment, as they feel less effective in their roles.

People are very abusive; they do not treat nurses and doctors with respect. They use offensive language when they perceive patient care to be lacking, which is particularly unexpected and affects both men and women equally. (Nurse, Private hospital)

There was a child who took LAMA and bounced back with severe dehydration. Unfortunately, we didn’t have a bed at that time in Paeds ICU, so we referred them. The patient collapsed in an ambulance. Then the family starts shouting, and they have at least 60 attendants with them. We don’t have good security even though they don’t have any weapons. One of the attendants took scissors and gave a threat to everyone. The doctors and staff were moved from the area. (Nurse, Public hospital)

Coping strategies

During IDIs, participants were also asked about the coping strategies they employed to mitigate burnout. They reported various ways to cope with burnout, both in healthy and unhealthy ways. These are classified as adaptive and maladaptive coping strategies.

Adaptive coping strategies

Adaptive coping strategies are healthy and constructive methods for managing stress and preventing burnout. These strategies enable individuals to address challenges effectively while maintaining their emotional well-being.

Positive reframing

Respondent highlighted using positive reframing as a coping mechanism. Focusing on the rewarding aspect of work such as helping patients and making a difference.

A patient smiles when a patient is treated back and I am discharging him or her the warm blessings that I get from them, this motivates me, and I feel blessed that I’m working in a noble profession for a noble cause. (Doctor, Private hospital)

Peer support

During the interview, many women reported that they often rely on their friends and family for support when they feel the need to discuss work-related issues. This support provides emotional relief and helps them process stress as it helps individuals feel understood and less isolated in their struggle.

You are fortunate if you have a supportive family or peers with whom you can share your experiences after a tiring and stressful job. Fortunately, I have a safe space where I can vent and express all these feelings. (Nurse, Private hospital)

I don’t bring work-related stress home, nor do I displace my stress towards my children. I usually try to talk with my peers and share my feelings. (Doctor, Private hospital)

Relaxation activities

Female participants were reporting calming behaviours to reduce work-related stress. This practice ranges from listening to music and engaging in self-care activities like doing yoga or going to the gym and socialising with friends. These activities provide relief and help maintain their emotional and mental health amidst demanding work conditions.

I listened to music, and I think this thing is working well to release my stress. (Nurse, Private hospital)

Regular self-care routines, such as indulging in salon treatments and hanging out with friends, provide much-needed relief. Additionally, practicing yoga and prayer serve as essential remedies for maintaining mental peace and spiritual well-being. (Resident, Public hospital)

Maladaptive coping strategies

Maladaptive coping strategies are unhealthy and ineffective ways of dealing with stress that can worsen emotional well-being and contribute to burnout.

Venting frustrations

A few of the male healthcare providers also shared that they vent their frustrations and stress in an unprofessional manner in order to cope with the emotional strain of their demanding roles, such as complaining loudly in front of patients or colleagues or displaying anger or irritability towards others.

When I’m stressed, venting frustrations to others might seem like a quick fix, but I recognize it’s not the right approach. (Resident, Private hospital)

Substance abuse

During an interview, one male participant shared that they use smoking as a stress reliever, despite recognising its negative health effects. The nurse explained that smoking provides temporary relief due to the calming effects nicotine has on the brain, which help them relieve pressures experienced in the workplace and other aspects of life.

Smoking helps me, but this is not a good thing I know. People smoke it gives benefit to them, yeah, but I will not lie to you, perhaps it releases kind of pressure that sometimes I have in my workplace or other things. (Nurse, Private hospital)

Discussion

The study identified major themes of burnout and examined coping mechanisms used to manage it among healthcare professionals working in EDs of public and private hospitals in Karachi.

Conducting interviews with healthcare professionals provides nuanced insight into the multifaceted themes contributing to burnout. Through open dialogue, both individual and organisational themes emerge as significant influences. In the interview, participants reported experiencing emotional distress due to frequent patient deaths, which often left them feeling helpless. They also noted a conflict between their moral values, which emphasise spending adequate time with patients and families and organisational pressure that limits the time available for addressing these concerns. This discrepancy contributed to emotional strain and distress. These findings align with a systematic review on the Big Five personality traits and job burnout, which suggests that individuals with neurotic personality traits—characterised by feelings of guilt, anger and depression—are more prone to experience burnout.²⁵ Such feelings can lead to emotional exhaustion and depersonalisation.²⁵ Moreover, work-life imbalance significantly contributes to burnout among ED professionals. Studies highlight the impact of long hours, irregular shifts and limited personal time on burnout development in high-stress environments like ED. This imbalance disrupts personal life, amplifies stress and diminishes resilience, thereby increasing the risk of burnout among ED professionals. Addressing work-life balance is essential for mitigating burnout and enhancing the well-being of healthcare workers in the ED.²⁶

Workload emerged as a consistent contributor to burnout in the ED staff, primarily attributed to the constant patient influx and the inherently hectic environment. Several studies have confirmed that workload is the primary stressor in the ED.²⁶ However, participants in the private healthcare sector predominately reported high workloads as a result of excessive clinical documentation. During interviews, participants mentioned that they are performing double documentation in the ED, using both manual and electronic systems. In the coming years, the ED in the private hospital plans to transition to a paper-free system, but currently, the coexistence of manual and computerised documentation increases the workload for medical professionals, contributing significantly to burnout.

Insufficient leadership support and recognition were identified as key contributors to professional burnout. When healthcare personnel perceive a lack of support and appreciation from their employers, they often experience heightened stress, frustration and demotivation. The absence of recognition can further lead to disengagement and detachment, aggravating burnout. This finding aligns with previous research, which highlights that inadequate leadership support and lack of recognition are strongly associated with elevated burnout levels among healthcare professionals.²⁷

Role conflict was predominantly reported by nurses working in the private hospital of ED. They mentioned that their roles were not often clear, with numerous tasks expected of them. For example, the nurse is accountable if housekeeping fails to clean a particular area. Also, if some of the procedures or medication are delayed by the doctor, a nurse is responsible for this. While assigning additional responsibilities to nurses can be beneficial, it also presents significant challenges and may contribute to nurses’ turnover intentions. This finding is consistent with previous research, which suggests that unclear expectations and responsibilities increase the likelihood of nurses leaving their positions.²⁸

Furthermore, healthcare professionals in both public and private hospitals reported frequent encounters with workplace violence. They noted that patients’ families often verbally abuse them, and in some cases, the abuse escalates to physical aggression. Similar findings have been reported in the literature, indicating that workplace violence is common in EDs.²⁹ This violence is often attributed to a poor understanding of the triage process, which leads to patients and their families expecting immediate attention regardless of the severity of presenting complaints. Such misunderstandings result in dissatisfaction, which is frequently directed toward healthcare professionals.

Our study also revealed that healthcare professionals are informally using healthy and unhealthy coping mechanisms to manage their burnout. Some of the interventions were found to be effective, contributing to an improved quality of life, whereas some were interventions that were ineffective and had a negative impact on individuals’ well-being. Positive reframing was the most used coping strategy by healthcare professionals in the management of burnout in their workplace. The finding of this study aligns with the previous research that says healthcare professionals who used adaptive coping strategies such as seeking social support, engaging in self-care activities and practising positive reframing tend to experience lower levels of burnout.³⁰ Furthermore, our study also highlights the use of maladaptive strategies, consistent with research from China, some healthcare professionals used substances such as smoking to cope with anxiety and occupational stress, which can provide temporary relief but can negatively impact individual well-being.³¹

Conclusion

This study highlights key themes contributing to burnout among ED healthcare professionals and underscores the urgent need for systemic interventions. The findings suggest that addressing burnout requires comprehensive and multi-level measures, including implementation of national and ED staffing policies, improvements in workplace security, the provision of mental health support services, resilience and stress-management training, workload regulation, flexible scheduling and promotion of work-life balance. By linking the identified experiences to targeted interventions, this study provides actionable guidance for hospital administrators and policymakers aimed at enhancing workforce well-being and informing national health policy development.

Study implication

As the first qualitative study in Pakistan to examine burnout among ED healthcare professionals, this research provides important evidence to inform national policy and institutional practices. The findings underscore the need to prioritise healthcare professionals’ well-being through supportive leadership, adequate staffing and sustainable working conditions. Furthermore, these insights are highly relevant to other LMICs facing similar systemic challenges, offering guidance for context-specific and system-level interventions aimed at mitigating burnout in emergency care settings.

Data availability statement

Data are available upon reasonable request.