The American Nurses Association believes that nurses are vital to the health of the nation. Today, counting more than four million, nurses are the largest part of the US healthcare workforce. Even though no other country in the world has as many nurses as the US, there is an impending shortage. As per the US Bureau of Labor estimations, in the next few years, the demand for nurses will be growing at a 16% rate each year (Haddad, Annamaraju & Toney-Butler, 2020). To fill the gap, the US healthcare system might need eleven million nursing cadres. If the workforce is not enriched with more trained professionals, it is readily imaginable how much emotional and physical strain the increased workload will put on existing nursing staff. It comes as no surprise that nurses experience burnout, a state of complete exhaustion triggered by prolonged stress.
Nursing burnout is now considered an occupational illness and a health hazard in the United States. According to Cañadas-De la Fuente et al. (2015), burnout is an extreme response to work-related stress that encompasses three dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Emotional exhaustion occurs due to an inadequate emotional overload as a result of interactions with colleagues and patients (Cañadas-De la Fuente et al., 2015). It is not uncommon for emotionally exhausted nurses to suffer from anxiety and depression that may translate into psychosomatic symptoms, such as weakness, headaches, and insomnia. Depersonalization manifests itself through cynical attitudes toward coworkers and patients (Cañadas-De la Fuente et al., 2015). Lastly, unrewarding work experiences may result in reduced personal accomplishment because affected nurses tend to develop a negative self-concept and suffer from poor self-esteem.
Concrete numbers regarding the prevalence of nursing burnout vary. Kronos (2018) reports that as many as 85% of nurses feel fatigued on a regular basis, while 63% are on the verge of experiencing full-fledged burnout. Monsalve-Reyes et al. (2018) have found that low personal accomplishment was the most common burnout symptom, occurring in 31% of nurses and followed by emotional exhaustion (28%) and depersonalization (15-16%). Nursing specialization may be a risk factor on its own: for instance, emergency room nurses are more prone to depersonalization than their primary care colleagues that build more long-term relationships with patients (Monsalve-Reyes et al., 2018). Among other risk factors are personal (e.g. neuroticism) and organizational (poor staffing, long shifts, lack of autonomy in the workplace) (Cañadas-De la Fuente et al., 2015). Psychological reasons are out of the scope of this paper as it focuses on organizational aspects that lead to increased burnout rates.
The issue of nursing burnout cannot be dismissed because it has detrimental effects on organizational culture, patient safety, and health outcomes. Wright and Khatri (2015) discovered that toxic personal relationships were a risk factor for adverse psychological and behavioral responses. Therefore, a workplace environment that is unsafe to medical staff also puts patients at risk. A less obvious, but no less dangerous consequence is the degradation of organizational culture in which the norms of bioethics and medical deontology are no longer respected, be it due to exhaustion or a newly formed cynical attitude (Lever et al., 2019). Furthermore, as indicated by Edmonson and Zelonka(2019), one-third of nurses leave or consider leaving because of an unsafe work environment that is not conducive to good mental health. Staff turnover and attrition are undesirable outcomes given the existing shortages and the high workload.
Medical errors compromising patient safety may also be a result of nursing burnout. Hall et al. (2016) write that medical errors can be explained by the latent and active, system and individual factors. The human factor is a major contributor to medical mistakes, and today, there is a general consensus that medical precision is closely tied to mental well-being. Hall et al. (2016) argue that burnout and errors may even have a circular relationship and be part of a self-sustaining system. An exhausted nurse makes mistakes, and the heightened awareness of one’s faults only adds to reduced personal accomplishment, which is part of the burnout concept.
To date, there have been many attempts at introducing policies and initiatives that would tackle the nursing burnout issue. They can be roughly divided into two groups: addressing personal factors (low self-efficacy, neuroticism) and addressing organizational factors. The present paper proposes better staffing as a response to the silent pandemic that is nursing burnout. McHugh et al. (2017) discovered that better nursing work environments and lower patient-to-nurse ratios were reliable predictors of patients’ IHCA (in-hospital cardiac arrest) survival. Inadequate nursing work environments resulted in a 16% reduction in the survival rates. Moreover, McHugh et al. (2017) found that with each additional patient per nurse in medical-surgical units, the likelihood of survival was 5% down. The study implies that improved patient outcomes may be achieved through fostering a psychologically safe environment and keeping hospital units adequately staffed.
Today, several approaches exist toward better nursing staffing, each of which deserves consideration within this proposal. The goal of these initiatives is twofold: they aim simultaneously at existing staff retention and new talent attraction through offering advanced working conditions. Firstly, it should be acknowledged that nurses are often assigned administrative tasks that divert their attention away from their direct responsibilities. Not only is paperwork exhausting, but it also prevents them from forming stronger bonds with patients, which contributes to the burnout risk. For example, nurses may benefit from rapid response teams, which enable nurses to request a team of clinicians to take action without the hurdle of paperwork. Furthermore, a clear definition of responsibilities and mutual support, especially when patients are in crisis, may help with exhaustion.
However, transforming work processes may fall flat without making more radical changes, such as transforming the entire workplace culture. Successful approaches toward creating a better environment for retaining old and hiring new staff may include mentorship. New nurses should feel welcome and taken care of; it is important to orient them during the first few weeks and offer help. Another element of a healthy organizational culture may be exploring opportunities for all hospital staff to increase their education levels, exercise their autonomy in choosing shifts, and take up leadership roles in policy-making and regulation.
Nursing burnout is the silent pandemic in the field that leaves affected staff emotionally exhausted, depersonalized, and suffering from poor self-image. Among the risk factors are personal, such as neuroticism, and organizational – poor staffing, long shifts, and lack of autonomy in the workplace. The problem cannot be neglected because the mental well-being of hospital staff has an impact on the medical error rate and patient safety. One way to tackle the issue is through making organizational changes that aim at retaining existing nurses and hiring new ones by offering them desirable work conditions. The transformation of work processes should be accompanied by the transformation of workplace culture.
References
Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & Emilia, I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240-249.
Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic.Nursing Administration Quarterly, 43(3), 274–279. Web.
Haddad L.M., Annamaraju P., & Toney-Butler T.J. (2020). Nursing shortage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
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.
Kronos. (2018). Kronos’s survey finds that nurses love what they do though fatigue is a pervasive problem. Web.
Lever, I., Dyball, D., Greenberg, H., & Stevelink, S. (2019). Health consequences of bullying in the healthcare workplace: A systematic review. Journal of Advanced Nursing, 75(12), 3195-3209.
Monsalve-Reyes, C. S., San Luis-Costas, C., Gómez-Urquiza, J. L., Albendín-García, L., Aguayo, R., & Cañadas-De la Fuente, G. A. (2018). Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis. BMC Family Practice, 19(1), 1-7.
Wright, W., & Khatri, N. (2015). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review, 40(2), 139-147.