The meaning of work in a hospital emergency department.

This exploratory case study is set in a hospital emergency department. The broad research problem is to acquire a picture of life in an emergency department as seen by workers there. To this end, participant observation was carried out by the author. Because of the relatively unstructured nature of the research, generalizations were developed in a grounded theory fashion. -- The analysis is focused on staff attitudes and responses toward five types of patients: accident victims, medical patients, drunks, overdoses and drug cases, and nonemergencies. Four stages of the emergency career of each of these five patient types are discussed: initial contact, diagnosis and treatment, release, and post mortem. The treatment of each of these types of patients poses certain problems significant for "Emergency" staff. -- The most significant finding is that most patients violate the staff's concept of an emergency department as a quick repair, quick release treatment center for serious cases of recent onset. As a result of this discrepancy between staff expectations and reality, various strategies are used by workers to gain control over their work. Also, certain findings from previous studies of emergency departments are discrepant with the results of the present investigation. -- An attempt is made to explain why staff remain working in Emergency despite their dissatisfaction which stems from treating a majority of nonemergencies, working in an inadequate spacial layout and facing staffing shortages. The theory of commitment is offered as an explanation. -- Finally, practical and research implications are presented. The value of the present study in identifying typical situations in emergency departments is stressed