Organizational support for mitigating work-related stress among emergency department staff: a cross-sectional study of level 5 hospitals in Nairobi County, Kenya

Abstract

The Work-related stress among emergency department staff is a global concern, yet little empirical evidence exists on how organizational support and staff perceptions shape stress outcomes in African emergency care settings. Prior studies in Kenya have focused mainly on clinicians, overlooking non-clinical cadres, and have rarely compared hospital ownership models. Moreover, the mediating role of staff perceptions, central to Organizational Support Theory, has not been systematically tested in resource-constrained emergency departments. This study addressed these gaps by investigating work-related stress and the adequacy of organizational support among clinical and non-clinical staff in three Level 5 hospitals in Nairobi County (public, private, and faith-based). Using a cross-sectional convergent parallel mixed-methods design, quantitative data from 133 respondents were analysed in IBM SPSS, while qualitative data from open-ended responses and nine key informant interviews were thematically analysed in NVivo 14. Findings showed that 90.2% of staff experienced moderate to high stress (mean = 4.75/7.00), driven by heavy workload (57.9%), staffing shortages (44.4%), and resource inadequacy. Organizational support significantly predicted stress outcomes (β = 0.550, R² = 0.349, p < .001), yet emotional support and resource adequacy scored below the midpoint, and 60.2% of staff rated existing support as ineffective. Staff perceptions partially mediated the support–stress relationship, transmitting nearly half (49.6%) of the total effect, with management responsiveness and support effectiveness rated lowest. Counselling was underutilized due to confidentiality concerns, while informal peer networks emerged as the primary coping buffer. The study contributes novel evidence by extending Organizational Support and Job Demands–Resources models into African emergency care, incorporating non-clinical cadres and hospital ownership comparisons, and empirically confirming the mediating role of staff perceptions. Practically, the findings underscore that occupational stress in Nairobi’s emergency departments is structurally embedded and requires systemic interventions. Recommendations for healthcare administrators include annual staffing needs assessments, externally contracted employee assistance programs accessible across shifts, and equitable recognition frameworks to strengthen workforce resilience and retention. By integrating clinical and non-clinical cadres across hospital ownership models, the study advances methodological inclusivity and provides context-specific evidence to guide organisational reforms in African emergency care.