Nursing Burnout

Those of us who graduated from nursing school and started their first job were full of dreams, aspirations, and had every intention of making a difference. Now fast forward five years; these same nurses have been on their feet for 16 hours and have not had time to eat or use the bathroom since leaving their homes this morning. The call lights will not stop going off long enough for them to give report to the oncoming nurses and once again they are late for their children’s dance recitals or soccer games. They can forget about trying to squeeze a yoga class in this week. I understand what it is like to rush to your car feeling as if some important task was forgotten; was Mr. Smith’s tube feed restarted, did room 8 receive their pain medication? Nurses all over the world are experiencing “burnout”. To avoid burnout, nurses must properly care for themselves by separating work from personal life, knowing when to say no, and making time for enjoyable activities to manage stress, because we cannot provide quality patient care if we are neglecting ourselves.

Staff nurses have great responsibilities in caring for patients. Often, these nurses experience heavy workload. Heavy patient load and stress contributes to burnout. Why is burnout important to discuss in relation to nurses? Burnout affects the performance of the nurse and the quality of care he or she provides to the patient. Therefore, it is imperative that staff nurses decrease the possibility of burnout and increase or maintain excitement and enjoyment in the field of nursing. If nurses do so, they will find joy in their work and quality of patient care will be increased. Contributors to burnout and

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

The term burnout, according to Catalano, is a continuing depletion of energy and strength combined with a loss of motivation and commitment after prolonged exposure to high occupational stress (2015). When a unit or facility is understaffed, not only do the nursing staff get burnt out, the patients also don’t receive the quality of care they deserve. Due to the increase in workload, nursing staff are more prone to making mistakes and medical errors and sometime times do not fellow facility policies. The nurse-patient ratio aspect sometimes gets overlooked at and that could lead to possible medication errors, lack of communication, falls, neglect, abuse and/or death may occur. Sometimes, it become so overwhelming people turn to leave the workforce all together. When nurses and CNA workload increase, they become frustrated and unhappy, and the desire to leave

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

This issue is important to address because having an increased workload can have detrimental issues such as mental frustration and physical exhaustion. The conclusion of this study is that it calls for action to take place in the health care system. It is important to investigate these problems, so there can be modifications made by management to the health care systems to overall decrease the nursing shortage.

With the passing of the Affordable Care Act, a rise in patient care was expected however there were several factors that weren’t expected. One such factor was the number of patients that had chronic illnesses that had been ignored for so long due to not having insurance. The care for these critically ill patients caused an increased strain on nurses and other health care professionals. The increased stress on workers caused them to consider an alternative career. Workplace stress is has contributed to an increase amount of depression and burnout in nurses, which caused a ripple effects of call outs, nurse shortage, and more burnout. Another factor that was not considered was the increased amount of paperwork that has been added. According to the new regulations of the Affordable Care Act, “190 million additional hours of paperwork annually” (heritage.com) has been added which inadvertently has reduced the amount of one on one patient time. This again, is another factor that will contribute to the burnout of the healthcare professionals.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

The issue of healthcare personnel scarcity continues to be an ongoing challenge across the globe. Invariably, nurses are at the pinnacle in the delivery of quality care in any healthcare setting. The ever-increasing demands for care stem from a patient populace that is emergent, growing older and needing more care due to the escalating shift in their disease process. Hence, nurses are torn between balancing an overloaded schedule, working extra hours and maintaining astuteness and professionalism. This transcends to compromised patient care, nursing burnout makes it difficult for them to experience the rewards of caring for patients in the way they had expected; thereby, adding to the shortage of

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

Improving or maintaining high job satisfaction is paramount for medical facilities, it is key for nurse retention. Hospitals must inquire and study the importance of job satisfaction and how it relates specifically to appropriate patient assignment (Carayon & Gurses, 2008). Once again, proper NTP ratios will improve job satisfaction, improve quality of care and safety and save healthcare dollars when properly implemented. It has been significantly recorded among medical journals and research, which implies or states factually, that the greatest improvement of job satisfaction was due to adequate staffing (i.e. NTP ratios) (Tellez, 2012).

Most people may experience some stress at some point in their lives due to various reasons. According to Nazari, Mirzamohamadi, and Yousefi (2015), occupational stress is the main cause of stress in a person’s life, and the study showed that more than 80% of nurses reported having higher levels of stress compared to other occupations (Nazari, Mirzamohamadi, & Yousefi, 2015). Some research showed ICU nurses are more prone to occupational stress and burnout than nurses who work at different wards (Nazari et al., 2015). The purpose of this paper is to find out why ICU nurses experience more stress and burnout than nurses in other areas, such as Med-Surg unit, and to find out possible coping mechanisms to prevent them.

Barry Hill (2017) performed studies related to the quality of care that patients receive and what factors are associated with those perceptions. One area that was noted to be of importance and directly related to quality of care provided to patients is staff dissatisfaction and burnout. This study also found that longer shifts contributed to increased amounts of emotional exhaustion leading to decreased quality of care for patients. Addressing staffing needs early and intervening can decrease the amount of nurse burnout and dissatisfaction that is often seen. This study has shown that hiring additional competent nurses reduces medication errors, falls, infections, wounds, and decreases hospital litigation costs, while improving staff morale, patient experience and care, and cost-effectiveness for the hospital.

The nursing shortage is no longer a projected problem in the healthcare industry in the United States, this problem is present and is not phasing out anytime soon. Addressing this challenge would improve job satisfaction, reduce burnout in the profession and ultimately improve retention.

Nurses, always involved in patient care, sometimes experience detrimental effects with prolonged stress or “burnout” during their career throughout the years. Burnout is defined as an extended response to physical or emotional stressors. Some examples of these stressors are; memories of witnessing death, patient and family suffering, emotional stress of losing patients, feeling emotionally and physically drained, or emotional disconnect from staff which can all contribute to burnout. As a result, nurses can experience; exhaustion, anxiety, dissatisfaction and low capacity. Overall, burnout can have negative effects not just on the emotional and physical health of nurses but also on; patient satisfaction, outcomes and mortality of nurses and patients. Although, there are ways to reduce or prevent these negative effects of burnout from manifesting. For example, nurses can apply interventions to reduce these risks including; staff support, onsite counselors and psychiatrists for nurses and salary increases and reimbursement opportunities for nurses through clinical ladder programs. Nurses can also start by just saying no to certain requests, being aware of their tolerance level, by taking care of themselves and having fun outside of work. On the other hand, others do not think nursing burnout is fatal and nurses just need a break from their job to initiate change. Although, the issue of burnout is prevalent in nurse’s careers which need to be addressed more in society in