Introduction
The surge in nursing burnout, exacerbated by the COVID-19 pandemic, has led to an alarming trend of nurses leaving the profession. This issue has emerged as a critical challenge for healthcare systems globally. Burnout is a risk in any occupation, but nurses are particularly vulnerable due to the intense physical and emotional demands of their role.
Key indicators of nurse burnout include reduced job satisfaction, emotional exhaustion, and decreased performance and productivity, as outlined by Theofanidis et al. (2022). Physical manifestations of this burnout can range from headaches and weight changes to gastrointestinal issues and elevated blood pressure (Theofanidis et al., 2022). Moreover, the psychological impact is profound, often involving diminished self-esteem, feelings of apathy, depression, irritability, anxiety, and insomnia (Theofanidis et al., 2022). These burnout symptoms not only compromise nurses’ well-being but also directly affect patient safety, satisfaction, and overall care outcomes. While the acute phase of the COVID-19 crisis has passed, the healthcare sector now grapples with the enduring challenge of mitigating nurse burnout.
Literature Review
Before conducting a review, evidence-based (EB) questions were established, and PICO components and any exclusions were identified. Nurses in acute care settings were selected as the population, excluding per diem nurses. Burnout education or support was compared with no intervention or support for the intervention and comparison groups.
The Galen Library, MEDLINE, CINAHL, and PubMed were used to find articles. Articles over five years old were excluded. Keywords such as nurse burnout, patient safety, and turnover were utilized—the initial search produced over 700,000 literature articles. Additional search terms such as job satisfaction, work environment, intent to leave, and patient outcomes were added to reduce the number of articles. The number of articles decreased with the additional terms; however, there were still too many.
Dang et al. (2022) note that not all literature is found through database searching; evaluating and searching peer-reviewed journals by hand can be highly valuable. Multiple secondary sources were identified, although they were not used; the reference lists were used to identify articles that met the criteria for our EB question. For nurses, how does burnout support or education, in contrast to no such measures for burnout, influence job retention, job satisfaction, patient safety, or patient outcomes?
Al Sabei et al.’s Article
Burnout has recently increased among nurses, prompting researchers to wonder what might be causing it. Al Sabei et al. (2022) surveyed 2113 nurses with over a year of work experience from 21 hospitals in Oman using a quantitative, non-experimental research design to examine how interprofessional teamwork impacted burnout and the intent to leave. Developing a solid culture, checking in with staff to assess their well-being, and offering workshops or webinars were interventions that improved teamwork. By improving the work environment, making it more supportive, the desire to leave and burnout were reduced.
Results in this study were obtained through a cross-sectional study using tools such as the Assessment for Collaborative Environment. The study had limitations because it did not examine factors such as work-family conflicts or leadership styles to determine how they would affect burnout and the intent to leave. This study is of low quality and a level three study. Another limitation of the study is that inexperienced nurses were excluded. Irwin et al. (2021) found that new graduate nurses experience stress, which can lead to burnout. When resiliency training and support are utilized, nurses can cope effectively, decreasing stress and burnout and increasing retention.
Carthon et al.’s Article
One should note that there is a strong association between nurse burnout and patient satisfaction. Carthon et al. (2021) performed a non-experimental analysis to assess quantitative evidence. In particular, the researchers conducted a secondary data analysis of 463 hospitals across four states, including responses from 14,772 nurses (Carthon et al., 2021).
The authors relied on the Maslach Burnout Inventory to measure nurse burnout and the Hospital Consumer Assessment of Healthcare Providers and Systems survey to assess patient satisfaction. The study revealed a strong association between higher nursing burnout and lower patient satisfaction. A large sample size improves the generalizability of the findings to a larger population, a notable strength of the study (Superchi et al., 2019).
This research is classified as low-quality, level-three evidence. A notable limitation of the study is its reliance on cross-sectional data. While the large sample size and the use of established instruments add strength, the cross-sectional design limits the ability to establish causality between nurse burnout and patient satisfaction. In addition, the study’s focus on correlational analysis rather than experimental or intervention-based approaches limits its evidence level.
Kelly et al.’s Article
The focus of this article is to examine how nursing resilience can foster the detection of turnover and burnout. Kelly et al. (2022) aim to determine whether resilience is associated with nursing burnout, including both organizational and positional turnover. A quantitative, non-experimental survey was conducted 1 year apart in 2018 and 2019, using three hospitals within a single health system. The sample size comes from 1688 nurses. (Kelly et al., 2020)
The findings of the research show how organizational commitment, resilience-building tools, and the use of professional nursing organizations can aid in burnout prevention. Particularly, nursing workloads, staffing ratios, interdisciplinary communication tactics, stress support, and employee recognition. They found that interventions such as improving communication between providers and supporting staff during traumatic events could prevent burnout and, thus, turnover.
One limitation recognized is that they included only one state in the research, which prevents researchers from determining whether resilience is merely a reaction to unappealing work characteristics or environments (Kelly et al., 2020). The research is limited to one healthcare sector in one state, including 78 units across three large hospitals. The demographics, work conditions, technology, and regional practices may affect generalizability.
Kilroy et al.’s Article
The focus of my chosen article by Kilroy et al. (2021) is to promote an understanding of the importance of the High-Involvement work practice (HIWP) and its utilization to prevent burnout among nurses. They collected data from the Quebec Registration Board of Nurses. A survey was sent to some 6,500 nurses from 105 different hospitals, and 2,174 responses were received (Kilroy et al., 2021). Demographic information was obtained from the Quebec Registration Board of Nurses.
The study shows that education and training in emotional support can be effective, helping nurses learn to cope with stressors and work together to solve work-related problems. This can encourage employee retention and burnout among peers. Education related to job requirements, emotional support, or collaborative efforts to create an emotional support platform that improves staff retention will decrease burnout and, therefore, lead to positive patient outcomes.
The research used a 12-page cross-sectional survey and questionnaire (Kilroy et al., 2021). The study is solely limited to the population of Canadian nurses; hence, it is clearly non-generalizable. The sample size is sufficient and yielded positive results. Meta-analytic research shows that burnout is closely linked to psychological empowerment; thus, it demonstrates that colleague support lowers turnover rates.
Lee et al.’s Article
The culture of a nursing unit is affected by numerous factors, such as leadership styles; depending on the style, nurses might experience increased stress. Lee et al. (2019) conducted a quantitative, non-experimental study to examine how leadership and the work environment affected nursing burnout and the intent to leave. A total of 946 frontline nurses at three hospitals in Taiwan were surveyed regarding their perceptions of leadership, work environment, and burnout. Improving the work environment through communication and self-care, and implementing mindfulness and resilience training, were found to reduce burnout.
The results were obtained from a cross-sectional study using four instruments, including the Maslach Burnout Inventory. All nurses were under the same management period, and the survey lasted only two weeks, limiting its scope. This article is low-quality and a level 3 study. While the study represents junior and senior nurses, it lacked representation of male nurses, with only 37 of the 946 nurses being male. A study by the National Academies of Sciences et al. (2022) states that the absence of proper representation renders results non-generalizable and can also undermine trust. The survey results might change due to differences in burnout and the support male nurses need.
Montgomery et al.’s Article
The article under review examines the relationship between nursing burnout syndrome and patient safety. Montgomery et al. (2022) conducted a quantitative, non-experimental study to investigate this issue. In particular, 928 nurses from acute care hospitals in Alabama were asked to complete a cross-sectional electronic survey. The authors did not introduce any intervention but relied on multilevel mixed-effects models to analyze the mutual relationships among burnout, the work environment, and patient safety outcomes.
Statistical analysis of participants’ responses indicates that healthcare organizations need to reduce burnout and improve working conditions to enhance site safety. According to the article’s evaluation, its key strengths include the large sample size and the authors’ use of an established approach to diagnose nursing burnout syndrome (Copenhagen Burnout Inventory) (Montgomery et al., 2022). However, because all data were self-reported by nurses, bias or inaccuracy may have occurred due to social desirability or memory recall problems (Superchi et al., 2019). The presented evidence is of low quality and represents level three because it is not a randomized controlled trial.
Wu et al.’s Article
It is important to note that Workplace Social Support (WSS) can mitigate nurse burnout. The study’s objective was to determine the prevalence of burnout among Taiwanese nurses. Data was collected through a questionnaire, and the research was non-experimental. Five hundred nurses at a medical center in Taiwan were recruited to answer a survey. The nurses had to volunteer, had been employed for at least three months, and could not hold any supervisory or management positions (Wu et al., 2023).
The research highlights the mitigating impact of workplace social support on nurse burnout. Key findings indicate that the nurses who responded to the survey are experiencing burnout (Wu et al., 2023). Still, management intervention reduces perceived stress, thereby decreasing burnout. Nurse burnout was calculated by utilizing the Copenhagen Burnout Inventory (CBI). A small research sample limits this research.
The research is rated level three and is of low quality due to such a small sample size. Although the research sample is small, the results apply to nurses as a whole. The questionnaire is for a target population with context-specific questions that can be applied to similar clinical settings (Dang et al., 2022).
This quantitative study involving 500 nurses in Taiwan identifies key factors influencing nurse burnout and the role of Workplace Social Support. However, limitations include a relatively small, context-specific sample and a non-experimental design. Given these constraints, the study offers level three, low-quality evidence, underscoring the need for cautious interpretation when generalizing its findings to broader nursing populations.
Yujeong et al.’s Article
Yujeong et al. (2019) discuss the interconnections between three core factors: turnout among clinical nursing professionals, quality of life, and burnout and bullying. The evidence was collected through a survey; the research was quantitative and non-experimental. Five hundred nurses from a medical center finished and submitted a survey, and the organization is located in southern Taiwan’s Kaohsiung City (Yujeong et al., 2019).
The study found that nursing leadership interventions must focus on the organizational level to create a safe, healthy work environment. Nurses who experience burnout also experience compassion fatigue, leading to decreased concern for patients. Burnout was assessed by utilizing the Maslach Burnout Inventory (MBI) (Yujeong et al., 2019). The latter essentially measures three subdomains of burnout: emotional exhaustion, depersonalization, and decreased personal accomplishment.
The study was limited by convenience sampling, which does not fully represent the nursing community in Seoul (Yujeong et al., 2019). The evidence collected from this study is level 3 and of low quality. Research conducted through surveys or questionnaires often has small sample sizes. However, the survey response rate was sufficiently high to yield findings generalizable to the target population, making the evidence helpful (Dang et al., 2022).
Conclusion
In sum, research consistently highlights that high levels of burnout among nurses in various healthcare settings not only increase their intent to leave but also adversely affect patient care and healthcare worker well-being. A recurring theme in the literature, as seen in studies by Anderson et al. (2023), Marcelo et al. (2020), and Smith et al. (2021), is that nurse burnout significantly correlates with increased patient length of stay. Furthermore, Montgomery et al. (2022) emphasize the critical impact of low burnout levels and improved work environments in enhancing patient safety and care quality. The convergence of these findings underscores the need to address burnout through enhanced work conditions, authentic leadership, and emotional support. By focusing on these interventions, healthcare leaders and policymakers can formulate strategies that not only reduce nurse stress but also improve overall patient outcomes and healthcare efficiency.
References
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