The Fight To Reduce Nursing Burnout

Nursing Burnout Poster

"The Fight To Reduce Nursing Burnout: Are you doing your part?"

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Joanne Ostapovitch

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FLEx Project Dissemination

My FLEx project looked at the issue of burnout and the need for nurses to improve their self-care in practice. Since my first year I have witnessed nurses not taking their breaks, coming to work sick, and getting off work late. Aside from this I also saw fatigue and the look of burnout in several nurses and knew that something had to be done about it. For my FLEx project, I began by gathering evidence behind burnout so that I could eventually use it to educate nurses. After thoroughly searching for research articles and evidence-based information on burnout, I was able to find numerous data to backup my own personal understanding of burnout being an issue for many nurses. Areas I researched with regards to burnout included its history in Canada and internationally, current research studies for burnout in nursing as well as other professions, the factors, causes and consequences of burnout, and the interventions and preventative strategies required for at-risk nurses to take. In order to provide nurses with the most information and have the greatest impact on burnout awareness and prevention, I created an informative poster that included all of my research information. As well, I have created bracelets that represent self-care and supporting the fight against burnout. By contacting a member of the Provincial Council of CARNA, Kerry Hubbauer, I was able to collaborate and work alongside her to create a way for me to pass along my informative materials. The poster and bracelets must pass approval by CARNA before acceptance is given to showcase them at Nurse’s Week and other relevant nursing conferences. Once I have met with Mrs. Hubbauer on April 13th I will await CARNA’s approval and continue in my efforts to raise awareness around nursing burnout and the prevention against it.

Poster Content

THE FIGHT AGAINST NURSING BURNOUT ARE YOU DOING YOUR PART? HISTORICAL BACKGROUND Back in Florence Nightingale’s era there was much talk of “obedience”, in which “nurses had to deal with hierarchical power relations and were accountable to a physician” (Berghs, Dierckx & Gastmans, 2006, p.119). Throughout the years there has been an equalization of the power struggle between men and women; however there is still an ongoing issue. These issues deem relevant as shown in research by Almberg et al. (1997), which suggests “women experience burnout more often than their male counterparts because they become more emotionally involved” (as cited in Gillespie & Melby, 2003, p.843). It is factors such as this that have caused nursing burnout to be on the rise. In a recent study by Dong, Hee & Lei (2010) it was stated that “burnout has been a significant nursing issue worldwide over the past 30 years” (p.844). Further research has found that “occupational stress is reported to be increasing in many countries” including “North America, Canada, England and Wales, the Philippines, Singapore, Holland, Australia, and New Zealand” (Hall, 2005, p.6). BURNOUT IN OTHER PROFESSIONS “The prevalence of severe burnout in western countries ranges between 4-10% in the working population” (Shirom, 2005). As for high-risk professions the rate of burnout is increased significantly. The burnout rate for “physicians is estimated to be 22% in USA, 27% in the UK, and 20% in Germany” (Maslach et al., 2001; Linzer, Visser, Oort, Smets, McMurray, & de Haes, 2001). “Among teachers, burnout rates vary between 30%-40%” (Bauer, Stamm, Virnich, Wissing, Kriston, Muller, et al., 2005; Jarvis, 2002). Regardless what job a person has, they are at risk of burnout as it has been shown to be in an issue across all professions (Awa, Plaumann, & Walter, 2009). (Kallay & Vladut, 2010, p.264) According to the employment standards laid out by the Government of Alberta, “an employee is entitled to at least 30 minutes of rest (break) in each shift longer than five consecutive hours of work. Likewise, employees are entitled to certain minimum days of rest”. Within this standard it is also laid out that an employee is only to work a maximum of 12 hours in a day. It is crucial these standards are in place but the next question that arises is: are these standards providing enough work/rest balance for employees to help prevent burnout? PERSONAL VS EXTERNAL FACTORS OF BURNOUT Research by Farup, Hall-Lord & Nordang (2010) shows that burnout is related to personal and external factors. Personal factors that increase likeliness of burnout include: - low self-esteem - unrealistic expectations - weakened sense of coherence - excessive conscientiousness - a high level of education - lack of hardiness - avoidant coping style and gender (woman more likely to burnout). External factors linked to increased rates of burnout include: - uncertainty about continued employment - discrepancy between requirements and resources - large workloads - lack of influence on workplace - uncertainties concerning procedures and reporting - type of workplace - job attitudes (role ambiguity and conflict) - poor management and supervision - working shortages - financial pressures EFFECT OF REORGANIZATION AND DOWNSIZING In a research study by Farup, Hall-Lord & Nordang (2010), the effects of unit reorganizations and downsizing on nursing burnout was studied over a 30 month period. Even nurses that had sufficient work experience developed an unexpected and significant degree of burnout. The only likely explanation of burnout on these units was as a result of the reorganizations and downsizing taking place. EFFECT OF LEADERSHIP QUALITIES Research by Kanste (2008) measured leadership qualities in 660 nurses and nurse managers in Finland. After all data was collected it was evident that a strong connection between leadership qualities and burnout rates. Those individuals who exhibited active, transformational leadership techniques experienced far less burnout than those exhibiting passive leadership. Furthermore, this study concluded that nurses and nurse managers with active and transformational leadership qualities are better protected against burnout. NURSING SCHOOL A PRECURSOR In a study carried out on nursing students, burnout was correlated with gender, age, marital/partner status, fatigue, recovery time from stress, work demands and quality of sleep. This study also indicated that “a significant proportion of nursing graduates reach the end of their university training in a dangerously fatigued state”. This then stems the question of “how nursing graduates can reasonably be expected to recover from this state as they progress into the environment of even more demanding and enduring stress” as graduate nurses and future RNs? (Lushington, Rella & Winwood, 2009, p.895) CONSEQUENCES OF BURNOUT To name a few: - Job dissatisfaction - Impaired patient care - Fewer interactions with colleagues and clients - Reduced productivity and efficiency - Physical and mental dysfunction (i.e. depression, sleep disorders) (Kallay & Vladut, 2010, p.260-271) NURSE’S VIEWS ON BURNOUT In the 2005 National Survey of the Work and Health of Nurses it was reported that 54% of nurses state they “often arrive early or stay late to get work done”, 62% state they “often work through breaks to complete workload”, 67% state they are given “often too much work for one person”, 45% state “not enough time to do what is expected in job” and 57% say there is “too much to do, to do everything well” (Stats Canada, Chart 3.7, p.42). CHART OF WORK-RELATED STRESS (A network approach to work-related stress) Figure 1. Perceived causes of stress in nurses, derived from causal paths to stress. The diagram shows directions of each path, the mean strength of each path (as scored by the nurses) and the frequency of each path as a cause of stress. (Muncer, Taylor, Green & McManus, 2001) STRATEGIES AND INTERVENTIONS FOR BURNOUT General Resolutions for burnout: (As found in research by Kallay & Vladut, 2010) - “employees who had a development plan for their work and received formal performance appraisals for their job had significantly higher engagement levels than those who did not” (Robinson, Perryman,& Hayday, 2004). - “Another action that can improve work engagement is to offer and promote the use of mental health services; this can help employees respond to personal and work problems and reduce interfering obstacles” (Attridge, 2009). - “At the organizational level, interventions may include job redesign, ensuring a better fit of the employee with the work environment, the training of managers, improving working conditions, creating a supportive corporate culture, or providing practical support on-the-job” (Bakker, 2008; Attridge, 2009; Macik-Frey, Quick, & Nelson, 2007). Strategies specifically laid out for nursing burnout: (As found by Dong, Hee & Lei, 2010) - Management should utilize effective and appropriate programs for nursing staff in an effort to increase their levels of work engagement. - Establishment of a committee for advocating against burnout (should consist of nurse executives, nurse managers and nurse experts) - Heightening awareness among nursing managers and staff through education programs and in-services on burnout. - Establishing more health facilities and opening up more units to help resolve nursing shortages and in-turn burnout. - Increased reward and appreciation of nursing efforts by fellow staff and management - Empowering nurses to help improve their sense of personal accomplishment - Movement of management towards a “life-work balance” to highlight the importance of nurses’ personal life and working harder to meet their specific shift preferences. - Starting mentor programs to help new staff and new graduates transition easier. - Maintaining a nurturing work environment to reduce stress levels and help nurses admit to mistakes easier. - Developing and strengthening individual nursing coping strategies Other research recommends that “emotional exhaustion... should be screened for early detection and prevention of burnout” (Basim & Onder, 2008, p. 521). NEED FOR SELF CARE Self care is crucial in preventing burnout, as research in the March 2010 edition of AACN has shown. Research findings in the article “Self-care vital to nurses’ health promotion” found that the areas nurses showed the most weakness in was managing stress and carrying out physical activity. This shows that there is a huge need for management to develop holistic nursing interventions to encourage self care in their staff. A few examples of interventions this study suggested was to encourage nurses to engage in massage, reflexology and/or imagery. This study only provided a few examples but imagine all of the ways we can reduce our levels of stress and improve our physical fitness. The ways of preventing burnout are endless, and it starts with you! A great motto that was provided in this research article and that should be followed by all nurses is: “Care for yourself as you care for your patients” CURRENT AIM FOR REDUCING BURNOUT As the research clearly shows, there is a huge need to increase awareness in nurses of the causes and preventative strategies of burnout. CARNA Practice standards and guidelines have been implemented to help establish and “guide” healthy nursing practice, but as just a guideline it is still each nurses sole responsibility to follow these guidelines in their own practice. The plan of shifting knowledge to nurses about taking charge of their self-care is through information provided in this poster as well as the self-care bracelets to preventing burnout. The bracelets we have developed have a “healthy me = healthy u” logo to help nurses advocate for their own health. By wearing these bracelets, nurses are saying that they agree to taking care of their own health as they would their patients. In time, we hope that this trend will catch on to other nurses and improve burnout levels currently seen in practice settings. FUTURE RECOMMENDATIONS - Increasing awareness in nurses to improve their levels of self-care (nursing staff) - Better staffing on units and reduction of overtime (management, unions) - Encouragement of sick days to reduce pressure of working when ill (nursing staff, management, unions) - Increased advocation for burnout staff to stay home or undergo an investigation of reasoning for the burnout (management, union) - Increased recognition of outstanding nurses and safe nursing efforts (Management, CARNA) - Initiating a reduced number of hours that nurses can work per shift and pay period (AHS) - Getting increased government funding for AHS (Government of Alberta) In order to make further changes and improvement with self-care in nursing, it is a recommendation to continue to educate and help nurses advocate for their health through distribution of more bracelets and having nurse leaders teach and advocate for new nurses. REFERENCES Basim, N. & Onder, C. (2008). Examination of developmental models of occupational burnout using burnout profiles of nurses. Journal of Advanced Nursing, 64(5), 514-523. doi:10.1111/j.1365-2648.2008.04818.x Canadian Nursing Association. (2010). Nursing Fatigue and Patient Safety. Retrieved October 18, 2010 from http://www.cna-nurses.ca/CNA/practice/safety/default_e.aspx Dong, W., Hee, K. & Lei, W. (2010). A review of research and strategies for burnout among Chinese nurses. British Journal of Nursing (BJN), 19(13), 844-850. Retrieved from EBSCOhost. Farup, P. G., Hall-Lord, M. & Nordang, K. (2010). Burnout in health-care professionals during reorganizations and downsizing. A cohort study in nurses. BMC Nursing, 98-14. doi:10.1186/1472-6955-9-8 Gillespie, M., & Melby, V. (2003). Burnout among nursing staff in accident and emergency and acute medicine: a comparative study. Journal of Clinical Nursing, 12(6), 842-851. Retrieved from CINAHL Plus with Full Text database. Google Search Engine (2011). Google images. Retrieved from http://images.google.ca/imghp?hl=en&tab=wi Government of Alberta (2011). Hours of work, rest periods and days of rest. Retrieved from http://employment.alberta.ca/SFW/1031.html Hall, E. (2005) Nurse burnout in high stress health care environment: prognosis better than Expected?. Working Paper 05/01. Department of Management, University of Otago, Dunedin, New Zealand. (Unpublished) Kallay, E. & Vladut, C. I. (2010). Work stress, personal life, and burnout. Causes, consequences, possible remedies. Cognitie, Creier, Comportament/Cognition, Brain, Behavior, 14(3), 261-280. Retrieved from EBSCOhost. Kanste, O. (2008). The association between leadership behaviour and burnout among nursing personnel in health care. Nordic Journal of Nursing Research & Clinical Studies / Vård i Norden, 28(3), 4-8. Retrieved from EBSCOhost. Lushington, K., Rella, S. & Winwood, P. (2009). When does nursing burnout begin? An investigation of the fatigue experience of Australian nursing students. Journal of Nursing Management, 17(7), 886-897. Retrieved from EBSCOhost. Muncer, S., Taylor, S., Green, D., & McManus, I. (2001). Nurses' representations of the perceived causes of work-related stress: a network drawing approach. Work & Stress, 15(1), 40-52. Retrieved from EBSCOhost. Self-care vital to nurses' health promotion. (2010). AACN Bold Voices, 2(3), 14. Retrieved from EBSCOhost. Wilkins, K. (2006). Findings from the 2005 National Survey of the Work and Health of Nurses. Catalogue no. 83–003-XIE. Ottawa, Canada: Statistics Canada and the Canadian Institute for Health Information.

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