Author: Andrew Tabner, Graham Johnson / Codes: SLO11 / Published: 23/09/2020

Paper Title

Measuring ‘Need for Recovery’ as an indicator of staff well-being in the emergency department: a survey study

Paper Authors

Blair Graham, Laura Cottey, Jason E Smith, Mark Mills, Jos M Latour

Link to Paper

What is already known on this subject

The Need for Recovery (NFR) Scale has previously been used to assess workers’ subjective need for physical and psychological recuperation following a period of work on a scale from 0, indicating no detectable NFR Score, to 100, indicating maximum NFR Score. A large study developing this scale documented an average NFR Score of 38 within the general population in the Netherlands. The negative effects of increased NFR Score are cumulative and include increased risk of occupational burnout and adverse health outcomes.

What this study adds

This is the first study to evaluate the use of the NFR Scale among ED staff. The study shows a baseline score of 81.8 out of 100 among ED staff. This is higher than any previously reported scores in other populations. Further research is needed to define the NFR among ED staff nationally.

Study Design

Single centre survey study

What was assessed?

Need for Recovery scale (providing numerical rating 0-100) and free-text responses to situation-specific questions


One hundred and sixty-eight responses were obtained (80.3% capture). Median NFR Score across all staff groups was 81.8 out of 100.0 (95% CI 72.7 to 81.8). Shift duration exceeding 12 hours, dissatisfaction with work–life balance and self-reported perceptions of burnout were associated with significantly elevated NFR Scores. Themes resulting from the open-ended question were ‘barriers to intershift recovery’ and ‘coping with work’.

Authors’ Conclusion

The NFR Scores in this study exceeded scores reported elsewhere and were associated with some demographic, occupational and well-being characteristics. The NFR Scale has utility to measure the need for intershift recovery among ED staff. A larger study is warranted to identify specific determinants of recovery and to provide recommendations


Single centre

Potential for unauthorised/duplicate survey completions

Our Take Home

The Need for Recovery scale is a great tool for gathering information in the ED, and could be used in an iterative fashion to support the analysis of changes as part of a QI methodology. The NFR in ED staff is higher than in all previously reported groups from any profession by some margin; this is both an impressive demonstration of staff resilience in being able to recover from shifts and attend the next shift, and a huge marker that change is required. 

RCEM Curriculum Coverage

CC8, CC9, CC20, CC25

Online Learning

TERN RCEM learning webpage

Supporting References

  1. Trainee 40% outflow rate
    • Health Education England. (2013). Emergency Medicine: Background to HEE proposals to address workforce shortages. Retrieved from. 
  2. Aging seafarers
    • Bridger RS, Brasher K, Dew A. Work demands and need for recovery from work in ageing seafarers. Ergonomics 2010;53:1006–15. doi:10.1080/00140139.2010.493958
  3. EMTA surveys
  4. Consultant survey reference