Work climate is the quality of the work environment perceived by employees, which productivity, motivation and employee behavior affects. In the case of healthcare, it also influences the effectiveness or quality of patient care (1). The appropriate working climate is conducive to better organization of work and the proper functioning of the departments. Emergency Units employees are a very vulnerable group to the occurrence of stress. This stress can be related to both emergency situations and the need to make quick and appropriate decisions. With a good working climate, there is less risk of confusion, misunderstandings or organizational errors (1). The COVID-19 pandemic has contributed to an increase in the number of people hospitalized and situations where healthcare workers are tired, burned out, and therefore reflective and irritable. Such situations have a destructive effect on teamwork. Literature reports that a high level of care can be found in places where workers are supported by their employers (2). Considering the responsibility and constant traumatic situations faced by Emergency employees, they may develop post-traumatic stress disorder and depression. (3). A very important issue is the support that employees should receive from decision-makers, but they should also support each other and work as a team. Milton et al. Pointed to opportunities to improve attitudes among ED team members through specific organizational changes and learning from each other (4). During the COVID-19 pandemic, people were isolated from each other and only going to work often gave a sense of “normality” and the possibility of contact with other people (5). Lasalvia et al. found that one year after the COVID-19 outbreak, nurses were most likely to experience anxiety and depression, while residents were most likely to experience burnout (in terms of low work performance). Working in intensive care units was associated with an increased risk of developing severe emotional exhaustion and a cynical approach to work (6). A study by Norkiene et al. which was carried out in the UK and Lithuania, showed that psychosocial support for health professionals should be provided to prevent burnout and loss of personnel during a pandemic, as half of the study participants from two countries with different histories and health systems reported similar proportions of participants considering a career change. If these people acted as intended, it could cause serious problems with staff and healthcare in the UK and Lithuania. The threat of enormous staff shortages in such critical specialties is concerning (7). In studies by Teo et al. teamwork and a sense of appreciation at work were shown to be protective in nature and to serve as targets for the development of organizational interventions to alleviate expected underperformance among frontline health professionals. (8). The impact of a negative psychosocial work environment has been identified as a contributing factor in the occurrence of errors and adverse events in hospitals. Rasmussen et al. showed that the work environment, poor patient safety climate and increased cognitive demands were significantly correlated with adverse events (9). A key element of the literature review by Johnston was that perceptions of the work environment varied by clinical staff and study site, but the high level of autonomy and teamwork balanced the stress of high pressure and heavy workload (10). There are not many instruments to assess the work climate in health care. Most of the work is about the organizational work climate of nurses in the dimension of safety climate or ethical climate. Not much is about work climate in emergency services (1–9). This paper helps to understand the limitations of the work climate and can contribute to improving the work climate in the work of Emergency Health Services. This research allows to discover the elements which limit the work climate.

The study, using the Work Climate Scale in Emergency Services: Abridged Version, was divided into 4 Factors. Work satisfaction was 33.41 (SD = 1.52), productivity / Achievement of aims averaged 26.95 (SD = 1.11), Interpersonal relationships averaged 16.16 (SD = 1.39) and Performance at work averaged 18.07 (SD=1.24). The obtained factors show some similarities to those obtained in previous studies (Table 5).

The first factor of them was responsible for job satisfaction. In a job satisfaction study, Chinese authors showed average job satisfaction, measuring it on a scale of 1–6. Among the sociodemographic variables, the occupation, education, professional status, length of service, annual income and frequency of night shifts had a significant impact on the level of job satisfaction. Stress at work, the work-family conflict, and the doctor-patient relationship also had a significant impact on job satisfaction (14). Based on the results of the study by Janicijevic et al. it can be seen that employee satisfaction, e.g., with salaries, has almost no impact on patient satisfaction (15) Linn et al. in their study they showed that hospital staff have difficulties meeting the needs of their patients if their own needs are not being met (16). Similar conclusions have also been noted by Hasenfeld et al. (17). In their own research, the respondents highly rated the Factor 1 claim that they strive to achieve successful outcomes. In the study of Javanmardnejad et. al. it has been shown that nurses working in emergency departments do not feel happy. In addition, the findings suggest that their happiness was related to their economic status and closure of duties (18).

In their own research, the respondents highly rated the Factor 1 claim that they strive to achieve successful outcomes. It follows that satisfaction is possible as long as you work on your success every day.

In a study by Joo et. al. show that Korean nurses experience a poorer security climate compared to other countries. One suggestion is to increase the satisfaction of nurses through organizational communication and to promote communication at the organizational level so that individual healthcare professionals are aware of their organisation's vision and policy (19). Similar results were obtained in the broadcasts of Poursadeqiyan et al. and Borhani et al. (20, 21).

Work satisfaction (F1) is one of the factors influencing the working environment in research conducted among the professionals of an emergency department. Work satisfaction has been shown to be related, inter alia, with burnout, ethical sensivity and leadership (22, 23).

Considering Factor two, there is little research that focuses on Productivity and Achievement of aims. In their work, Bipp et al. see a positive relationship between progress in achieving goals and commitment to work, in particular in the case of employees who have achieved goals related to the approach to results that they have planned (24). Mahmoudi et al. showed in their work that when considering achievement motivation and self-efficacy in private and university hospitals, significant differences were observed (25). Setting goals is related to self-confidence, motivation and autonomy, which is mentioned in her work (26, 27). Respondents rated the aspect of Factor 2 the highest, which was responsible for saying that they work group is known for its productivity. The problem Productivity / Achievement of aims (F2) of nurse practitioner and resident physician appeared in the McDonnell study (28).

Factor three focused on Interpersonal relationships. In the work of Orehek et al. it has been shown that interpersonal relations and the pursuit of a goal are closely related (27). Lee et al. stresses that patient safety is threatened by medical errors and adverse events related to misunderstandings among healthcare providers. In addition, the authors note that different relationships between team members lead to different collaborative behaviors, which may impact patient safety outcomes by altering team communication (29). Note the conclusions of Fernandez et al. that effective teamwork is essential to ensure safe and effective healthcare (30). Well-functioning teams adapt to rapidly changing patient factors and the environment, preventing diagnostic and therapeutic errors (31). Interpersonal relationships (F3) are considered in the dimension of communication, teamwork, leadership and decisionmaker (32–34). Our research has shown that satisfaction with the cooperation in the worhplce was rated the highest of the entire Factor 3. In the studies of Eiche et al. Satisfaction with the work of paramedics in the German EMS is low. Dissatisfaction with payment and organizational issues is widespread. The performance mindset is high, but the fear of failure is common. Current and future efforts to create an attractive working environment should reflect these findings (35).

In Factor four, Performance at work was rated. Randhawa et al. in their work, they showed a significant positive relationship between self-effectiveness and work efficiency, which suggests that the higher the self-efficacy specific for a given job, the higher the work efficiency of employees will be (31). Aboagye et al. emphasized that during the pandemic, absenteeism was to a large extent related to work efficiency. In addition, factors that interfere with performance at work must be constantly corrected including working on several jobs, which has a destructive effect on the quality and efficiency of work (36). Performance at work (F4) was described, among others, by in the works of Staempfli et al. heavy workloads, exposure to violence and conflict, and patients with a high medical condition contribute to the difficult working environment for emergency department nurses around the world. Emergency services representatives around the world report low nurse satisfaction and high levels of burnout (37).

Robinson et al. in his research, he compared the effects of productivity, efficiency and overall performance differences between lone assistants and working with residents in the emergency room. Another study found that increased productivity with decreased productivity was reported among Attendants when working with residents. Taking into account aspects related to working with residents, greater effectiveness was observed in group work than in individual work. (38). In a study by Kang et al. In the United States, emergency departments are constantly under pressure to improve operational efficiency and quality in order to obtain financial benefit and maintain a positive reputation. Depending on the structural and operational characteristics of ED, various factors can affect the relationship between performance and quality (39). Karmi et al. showed in the study that the productivity and quality of professional life of emergency nurses were at a moderate and relatively normal level, respectively. The research shows that scientific advancement does not improve the quality of professional life. It is necessary to put in place a plan to improve the productivity and quality of working life of nurses. Such plans should be implemented at the hospital level at every hospital level. The role of creating an environment suitable for a high quality of life plays a key role in the emergency department. It is necessary to conduct more developed research in this environment. (40).

Through the COVID-19 pandemic, research has limitations in interacting with study participants. In addition, when assessing the pre-pandemic research, we can see the impact of the difficult period on the results of research in the EHS group. Considering the number of countries that took part in the survey and the number of people, this number is not very large, but the survey can be successfully repeated on a larger group of employees. The abridged scale is a new tool for assessing the work climate in emergency medical services. There are no studies with the use of the scale, except for the validation study, therefore in the discussion the authors referred to the research on the organizational climate conducted in professional groups with similar working conditions, mainly nurses.

In response to the purpose of the research, the work climate of EHS during COVID-19 Pandemic in 14 countries was assessed using the Abridged Version of the Work Climate Scale in Emergency Health Services. The study of the climate at work shows that countries have different priorities at work, but not all of them. By answering the research questions one by one, we can say that the average climate score at work was 33.41 (SD = 1.52) at the range 24–120. It has been concluded that the emergency services staff investigated here perceive the score of the organizational climate to be low, which is represented by the low score of factors like: work satisfaction, productivity / achievement of aims, interpersonal relationships, performance at work. This raises concerns about the working conditions of emergency services staff as a low perception of work climate indicates that these conditions may not be sufficiently satisfactory to provide them with an adequate work process. This may have an impact on the quality of the health services offered. For this reason, the study of the working climate is important not only for emergency medical services personnel, but also for managers. Work climate analysis allows to verify the quality of the work environment and to determine whether and to what extent the work climate should be improved. to ensure good working conditions and good quality care. Further studies are needed to identify and clarify the specific of work climate in the emergency medical services group.

The highest average level of work satisfaction (Factor 1) was demonstrated for workers from Canada and the lowest for workers from San Marino. For Factor 2, the highest average level was again recorded in Canada and the lowest for the residents of San Marino. In Factor 3, related to Interpersonal relationships, the highest average scores were given by employees from Netherland, while the lowest for interpersonal relationships was given by the residents of San Marino. Performance at work (Factor 4) was rated the highest by the residents of England, while the lowest was recorded by participants from Turkey.

The abbreviated version of the scale reduces the time needed to complete the study, but at the same time retains its value, as mentioned in their study by Lozano-Lozano et al. (1). It is very important to conduct research on the working climate, as it can help to improve and eliminate elements that have a destructive effect on employees. Nowadays it is hard to work with the burden of a pandemic, but at the same time it should be remembered that decision-makers have a very large impact on improving the climate and quality of work in their hospitals.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Conceptualization: JK-B and SK. Methodology: WM-D and SK. Software: AF and BO. Formal analysis: GW and SG. Resources: KV. Data curation: MR and VL. Writing—original draft preparation: EB and JK-B. Writing—review and editing: WM-D, SK, and JK-B. Visualization: GW, WM-D, and JK-B. Supervision: DR. Project administration: JK-B. All authors have read and agreed to the published version of the manuscript.

Author BO was employed by European Specialist Nurses Organization. Authors KV was employed by Advancing Nursing LLC and MR was employed by Critical Care Nurses Association of the Philippines, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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