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NUR3004 Preparing for practice | Burnout in Nursing

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Introduction

Most people spend a substantial amount of their time performing work-related tasks throughout their life.An individual’s job is of principal importance to their self-worth, identity and life. It therefore has the capability to enhance one’s wellbeing to great measures and also the potential to damage it. The concept of burnout suggests that at one point the person was fully committed and engaged in their work and that they strongly liked it. It mentions that the employees’ energy and capacity to work shrinks over time especially when the environment is demanding and does not provide the necessary resources (Korunka et al., 2010). Burnout is therefore the physical, mental and emotional exhaustion or the stress related to one’s job. It is basically the widening of the gap between one’s the demands of the job and the individual (Ndawula, 2016).In a composite organizational situation, nursing is an inevitably stressful and demanding occupation. A stressor like burnout can adversely impact on patient care and safety, nurse’s wellness and wellbeing as well as on the health institution as a whole (Ndawula, 2016).This report discuss the influences of burnout and its effects on the various stakeholders such as the patients, the nurses and the hospital (Abadi et al., 2017). It also brings to light an existing strategy to address burnout and makes suggestions on improvement of the strategy. The report is directed towards a health organization or hospital and aims at reducing the probability of incidence of burnout among nurses and addressing the existing job related exhaustion to enhance the quality of health care provided.

Description of Burnout

Burnout occurs as a process that comprises of three major aspects; depersonalization, emotional exhaustion and reduced personal accomplishment.

Emotional exhaustion: this is a result of brain over-activity due to increased emotional demands. Being overwhelmed by tasks at work brings about feelings of frustration and emotional unrest. This may affect one’s ability to concentrate leading to poor performance in their work.

Depersonalization: this refers to a detached, cynical or negative response to clients or care recipients (Korunka et al., 2010). A pessimistic outlook towards one’s job as a nurse hinders the creation of a meaningful relationship between him or her and the patient. This negatively affects the quality of care received as well as the care recipient’s satisfaction.

Personal accomplishment: nurse’s overtaxing and exhaustion affects the outcome of each patient’s care in an undesirable way which makes the nurse feel unsatisfied with their work. Continuous dissatisfaction diminishes one’s confidence in their ability to carry out their jobs effectually which leads to the belief that they can no longer provide quality care to the patients. Declined personal accomplishment may even lead to job resignation by some nurses (Montgomery et al., 2015).

Causes of Burnout in Nursing

The Nursing workload

Nurses have terrific duties and deal with massive challenges. They are therefore very prone to developing stress, sometimes more than other health care providers (Ndawula, 2016). The roles of the contemporary nurse ranges from care giving to the responsibilities of a teacher, a communicator, advocate, a decision maker and manager. In care provision the nurse has to take into account the diverse aspects of a patient’s life such as cultural, spiritual, emotional, physical and developmental factors. As a teacher the nurse provides knowledge to the patients that is essential to their health and wellbeing and communicates the same to the clients’ families to enhance healing (communicator). Also, in the course of providing health care, the nurse takes into account the rights of the patient and makes legally abiding decisions for him or her in the instance that they are unable to do the same for themselves (Kozier, 2008). Although interrelated, all these roles are very crucial to the outcome of the patient’s health which puts a lot of pressure on the nurses. The various roles and responsibilities associated with this profession makes it complex and demanding which could lead to burnout (MacPhee, Dahinten & Havaei, 2017).


Rural and Remote Nurses – Professional Isolation

Rural areas are generally the parts of a country that are based far from its urban centers. They are characterized with extensive land uses, sparse populations dispersed over big distances as well as economic and social diversity. Rural and remote nurses therefore may have a hard time carrying out their daily activities due to the large distances between places. The notion of sparsely distributed populations means that there are fewer people in these regions let alone people who are involved in the same profession. Rural and remote nurses thus experience lone working and professional isolation as there may be no other nurses nearby to share useful work-related ideas with. Additionally, there are not enough professional development programs in rural areas which leads to underdevelopment of skills and lack of growth in one’s career (Wang, Liu & Wang, 2015).

With the knowledge of the hardships in rural environments, very few health care providers are willing to seek out job opportunities in these regions. This leaves remote and rural areas understaffed and huge amounts of work for the available care providers. Rural and remote nurses have to undertake various tasks in diverse fields (Mills, Birks & Hegney, 2010). They require a wide-ranging knowledge and skills necessary to function effectively in varied sections such as mental health, acute, aged, primary care provision, palliative, peri-operative, emergency and all other departments where they are needed (Francis, 2012). Hence, rural and remote nurses have incredibly large workloads and spend a lot of time in their work stations. Lack of programs to improve one’s capability in their chosen career and huge workloads are major causes of mental, physical and emotional exhaustion and depersonalization among these nurses. These nurses may also experience reduced personal accomplishments and job satisfaction due to lack of specialization in rural and remote areas which also contributes to burnout.

Conflicting Values

In some cases, the organizational values and the personal values of the nurse do not conform. The beliefs and expectations of the health institution on how nursing should be carried out and those of the nurse differ which makes the nurse feel alienated. In certain cases, the nurse may decide to give up their beliefs and values and work in line with those of the organization. This, however, consequently leads to these nurses feeling frustrated and discontented with their jobs. Continuous dissatisfaction compromises patient care which affects the outcome of the care recipient’s health (Bragg & Bonner, 2014).

Nurses feel a need to be involved in the making of decisions concerning their work. When the organizational policies, rules, regulations and principles relative to a nurse’s work are made without his or her participation, the nurse feels a loss of control of their work which may increase job related stress. Consideration of the inputs and contributions of nurses during the decision making process has a positive impact on their performance and patient care (Graham-Dickerson et al., 2013). Autonomy is also important in nursing as it enhances feelings of trust. Entrusting the nurses to make good decisions in accordance with their knowledge and nursing ethics has a positive impact on the execution of their work (Ndawula, 2016). This also advances the nurse’s confidence and makes him or her feel valued while saving time that would be lost in consulting matters in which the nurse is equipped and is perfectly capable of resolving. Hospitals should therefore have policies that encourage nurses to be involved in the decision making process related to issues about their jobs or the health and wellbeing of their patients.

Conflicting values between the nurse and the organization may lead to role ambiguity. Role ambiguity is the situation whereby the individual is not completely sure of what their role in the institution is and what is expected of them. If the nurses do not have clear goals and responsibilities within the organization, they may end up feeling unfulfilled with their occupation which leads to poor job performance(Ndawula, 2016).

Impacts of Burnout

Patient

Nurse burnout leads to depersonalization and detachment of the nurse from his or her patients. As a result, their no formation of a trusting and expressive relationship which adversely affects the quality of health care provided. A meaningful relationship between the care recipient and provider ensures that the client is able to express all his or her concerns about their health and raise the necessary questions (Salyers et al., 2017). This enables the nurse to clearly understand the condition of the patient and offer effective health care. Patient care is compromised by burnout among nurses and they are not satisfied by the treatment they receive at the end of the process.

Poor quality care also increases morbidity and mortality rates in a country. It has adverse impacts on the health of the patients who receive health care as the exhausted nurse may make mistakes during care provision. The probability of re-admittance of the patient in hospital is enhanced as the patient’s condition worse. Some mistakes are irreversible and may lead to the death of the patient

Hospitals

Burnout among nurses affects the efficiency and effectiveness of care provision. It also impacts on patient satisfaction in a negative way, continuous burnout may impact on the reputation of the health care organization through interpersonal channels. Eventually, damaged reputation affects the quantity of patient care due to lack of trust which affects the income capability of the institution. With reduced income, the corporation may not be able to offer adequate remuneration to its workforce which may further progress burnout.

Moreover, work-related stress among nurses may lead to absenteeism and turnover issues in the organization. Some nurses may decide to resign from the job due to constant frustration and displeasure and go on in search of better and more fulfilling employment opportunities. The hospital may face a nursing workforce crisis which unfavorablyaffects its performance and continuity (Privitera et al., 2014).

Nurses

Work related stress causes neuroendocrine response which produces physiologic reactions that may cause illness (Salvagioni et al., 2017). For instance, making a mistake and losing the patient in the process can have adverse effects on the nurse’s mental health and may lead to depression. Burnout also causes many nurses to consider giving up the profession while a percentage of them may actually carry on with this consideration. They realize that the stress related to their work is not worth it even after years of studying to accomplish it (Suner-Soler et al., 2014).

Preventing burnout

Optimism: the nurses should strive to focus on the positive areas in their profession instead of paying too much attention to the negative aspects (Chang & Chan, 2015). Identification of the exact job stressors and finding positive ways to respond to then is important in the nursing profession. In addition, the nurse should focus on remembering why is it that they chose their career and enjoyed their work at some point in time. As mentioned earlier, the conception indicates that the individual was very attached to their job and liked it intensely. Finding a way to remain curious and motivated can help prevent burnout (Hall et al., 2016).

Activities outside of work: being engaged in activities that are not related to work keeps the mind off of work for a while. They enable one to re-energize for working hours and have something to look forward to whenever the work is too stressful. These activities may include physical activities, one’s hobbies and even yoga which reduces the likelihood of depersonalization and mental exhaustion (Alexander et al., 2015).

Approach to Address Burnout

Educational Programs

Many health organizations come up with training programs for their health personnel in order to help tackle the work-related issues that can be solve the aspects that can be modified and requires a lot of effort from the staff, such as workload. It is also a method of addressing burnout as it enhances professional development and gives the nurses an opportunity to interact and share ideas.Training has been identified as having the ability to alleviate such job demands that cannot be changed easily (Vander Elst et al, 2016). To control the workload, managers monitor administrative tasks, consider the number of patients in the hospital and the care they require and relate this the each nurse’s shift. The organization then endeavors to keep the number of patients and that of nurses at a reasonable level to ensure that the patients obtain the quality health care they deserve (Houck, 2014).

Psycho-educational programs for nurses helps improve their resilience for their jobs. Health organizations have taken to making such programs available for nurses and other health care workforce whereby the individuals come up with personalized plans for stress management. Positive self-care behaviors are taught to the nurses (Kravits et al., 2010). This program entails features such as:

  • Introducing the nurses to wellness plans and stress diaries which helps them to track the causes of their stress. A problem is better addressed when its root causes have been identified. The programs also portray the importance of self-care to the nurses. Very often nurses can be caught up in their work and the concern for their patients that they completely disregard their own health and wellbeing. Such a program therefore reminds the nurses that they can care for their clients better if they are in the best health conditions themselves (Adams & Putrino, 2010)

  • In a psycho-education program, techniques such as affirmative intention nursing, deep breathing practices, grounding exercises, progressive relaxation of muscles and other coping strategies are made familiar to the nurses as stress management options

  • Guidance for developing and completing a wellness plan and desired imagery practices are also taught to the nurses to help them manage work-related stress.

Use of educational programs to help the nurses cope with burnout is an effective approach as it equips them with the necessary knowledge to cope with work-related stress. However, it does not address the real causes of the stress. Through the educational approach to stress management, the organization provides the nurses with the skills and techniques required to manage the stress but does take care of the root of the problem thus this strategy may not be effective in addressing burnout.

Improvement to the Approach

Collaboration and Teamwork

Improving the practice environment for nurses enhances quality care, improves job satisfaction and reduces burnout. Encouraging team-work and collaboration among the health care providers especially effective nurse-physician relationship is very important in creating a better environment for the nurses. Working together is basically unavoidable in a hospital setting. The organization should thus be intent ondevelopment of positive and significant relationships among its health care providers. Sometimes, physicians are dismissive, rude and intimidate the nurses which creates an unproductive connection between the two groups. Health institutions should discourage such negative behavior and ensure that these health professionals view nurses as competent colleagues and collaborators (O’Daniel & Rosenstein, 2008).

Addressing Nursing Workload

The educational approach does not discuss reduction of the nurses’ workload or increasing nursing staff. It only takes into account ways in which their work can be done more efficiently. Overworking nurses due to shortage of staff or other reasons is a major contributor to work-related stress. The organization can improve the nursing environment by ensuring that it employs sufficient nurses to care for the patients. This encourages specialization among nurses which heightens the quality of care. With enough personnel at the hospital the nurses can avoid long working shifts and have time to rest and get involved in other activities outside of work. These activities may include exercising and self-care behaviors which are revitalize the nurses (Henry, 2014).

Conclusion

In summary, this report addresses the issue of burnout among nurses. It describes burnout as physical, emotional and mental exhaustion which is composed of three major facets, that is, depersonalization, emotional exhaustion and reduced personal accomplishment. Emotional exhaustion refers to the over activity of the brain as a result of amplified emotional demands which leads to unrest and frustrations. Depersonalization, on the other hand is detachment from one’s patients. This affects the quality of care provided as the nurses have a pessimistic outlook towards their jobs. Personal accomplishment is the job satisfaction that one derives from carrying out their job effectively. Burnout among nurses have a negative impact on the patients, the hospital organizations as well as the nurses themselves. It adversely affects the quality of care offered to the clients which increases the probability of further morbidity and the possibility of mortality. This effects the health organization by damaging its reputation and reducing the quantity of health care which ultimately diminishes its income. Burnout may cause illnesses and sometimes job loss for some nurses. It can however be prevented through optimism and engaging in helpful activities outside of work. Institutions address burnout mainly by educational programs to help the nurses deal with the workload and manage the stress. This approach can be enhanced by improving the nurses’ working environment for instance by encouraging teamwork and collaboration. Also, reducing their workload by increasing the number of nursing personnel in the organizational is a suitable tactic to help them manage stress.

References

Abadi, M. B. H., Akbari, H., Akbari, H., Gholami-Fesharaki, M., & Ghasemi, M. (2017). The association of nursing workloads, organizational, and individual factors with adverse patient outcome. Iranian Red Crescent Medical Journal, 19(4).

Adams, K., & Putrino, J. (2010). Expressive writing to promote self-care. Interactive podium presentation at the 11th Annual Oncology Nursing Society Institutes of Learning. Orlando, FL.

Alexander, G. K., Rollins, K., Walker, D., Wong, L., & Pennings, J. (2015). Yoga for self-care and burnout prevention among nurses. Workplace health & safety, 63(10), 462-470.

Bragg, S. M., & Bonner, A. (2014). Degree of value alignment: a grounded theory of rural nurse resignations. Rural and remote health, 14(2), 2648-2658.

Chang, Y., & Chan, H. J. (2015). Optimism and proactive coping in relation to burnout among nurses. Journal of Nursing Management, 23(3), 401-408.

Francis, K. (2012). Health and health practice in rural Australia: where are we, where to from here?. Online Journal of Rural Nursing and Health Care, 5(1), 28-36.

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Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11(7), e0159015.

Henry, B. J. (2014). Nursing Burnout Interventions. Clinical Journal of Oncology Nursing, 18(2).

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