Nursing Burnout and Patient SafetyJessica Kenger
The purpose of this paper is to address the problem of burnout in nursing. Nursing necessitates direct interaction with patients, and a personal commitment to the work required. It is common for nurses to work with all aspects of care including patient emotions of pain, anger, fear, and frustration. Dealing with this type of situation daily can lead to increased levels of stress and for this reason, burnout remains an issue for healthcare worldwide. It affects nurses’ health and safety, turnover rates, job satisfaction and performance, and can pose a significant threat to patient safety (Henry, 2014, p. 211). The quality of care received can be greatly affected by nurses experiencing burnout, and with approximately ten percent of inpatient admissions affected by clinical error, improving safety remains a priority (Rios-Risquez ; Garcia-Izquierdo, 2016, p. 61).
Problem in Nursing
Many circumstances can lead to stress among nurses. “Interpersonal conflict with physicians or coworkers, lack of resources, lack of social support, excessive work burdens, witnessing death and the suffering of patients” can all cause undue stress (Rios-Risquez ; Garcia-Izquierdo, 2016, p. 61). Experiencing stress like this repeatedly can cause the nurse to change their response to the stress in order to adapt, which is the cause of burnout. Burnout can be described as a “prolonged response to physical or emotional stressors” and can result in feelings of self-doubt, anxiety, bitterness, and ineffectiveness (Henry, 2014, p. 211).
Three main characteristics of burnout are emotional exhaustion, depersonalization, and lack of personal effectiveness. Emotional exhaustion is due to a reduction of one’s own emotional resources and can manifest as depression, anxiety, and irritability (Rios-Risquez & Garcia-Izquierdo, 2016, p. 61). Depersonalization refers to the development of negative attitudes and insensitivity toward patients and coworkers; and lack of personal effectiveness is the perception of not accomplishing tasks, feelings of failure, and low self-esteem (Rios-Risquez & Garcia-Izquierdo, 2016, p. 61). Burnout has been associated with “decreased personal productivity, impaired concentration, inability to pay attention to detail, absenteeism, decreased morale, high turnover, diminished work engagement, and medical errors” (Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016, p. 4).
Previous work has found a “high prevalence of burnout among nurses globally” (Nantsupawat, Nantsupawat, Kunaviktikul, Turale, & Pughosyan, 2016, p.83). Research on burnout and nurse work environment has provided a vast amount of information about “occupational stress and well-being and insight in the psychosocial work environment of nurses” (Van Bogaert et al., 2017, p. 2). Themes used when conducting burnout research fit the “six areas of work life”; these include workload, control, value congruence, fairness, community, and reward (Van Bogaert et al., 2017, p. 2).
Several studies have also shown a correlation between burnout and patient outcomes. They have been able to identify and link “aspects of a balanced, healthy, and supportive psychosocial work environment with quality and patient safety indicators such as patient satisfaction, mortality, co-morbidity, and adverse events” (Van Bogaert et al., 2017, p. 2).
Statistics on the Problem
Symptoms of mental health problems, such as depression, have long been known to be elevated in healthcare workers and recent reports suggest that burnout rates are increasing (Rios-Risquez, & Garcia-Izquierdo, 2016, p. 61). Trauma, emergency, and critical care nurses have been identified as at “high risk for development of burnout due to prolonged exposure (volume and acuity), caregiver empathy, unresolved trauma in personal lives, and cases involving suffering children” (Berg et al., 2016, p. 3). It was reported that 35.9% of trauma nurses surveyed have scores consistent with burnout; while a third of more than 2,000 nurses surveyed had severe symptoms of burnout (Berg et al., 2016, p. 4).
An additional study showed that out of 2,084 nurses surveyed approximately 32% had high emotional exhaustion, 18% had high depersonalization, and 35% had low personal accomplishment (Nantsupawat et al., 2016, p. 86). The last focus group scored a combination of low compassion satisfaction and high burnout by 33.3% of those surveyed; and another 25% scored moderate burnout (Rios-Risquez, & Garcia-Izquierdo, 2016, p. 5). Within this group, there were also 42% that were at risk of burnout; and 25% who felt “distressed, overwhelmed, or useless in job” (Rios-Risquez, & Garcia-Izquierdo, 2016, p. 5).
Findings show that burnout does remain a major problem in the healthcare setting. These feelings can affect nurses by decreasing their effectiveness and performance, due to their physical and mental health being greatly affected. Burnout has increased, in part, because of “technology, insurance changes and demands, and the vast amount of new education needed to understand current and expanding treatment and disease knowledge” (Henry, 2014, p. 214). This further shows that in order to improve patient safety, burnout must be decreased.
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