Researching a Nursing Burnout

Subject: Nursing
Pages: 8
Words: 2093
Reading time:
7 min
Study level: College

Abstract

Nurses work as lifelines, caretakers, and educators of the patients. The working condition in the nursing profession leads to a majority of nurses experiencing physical, emotional and mental fatigue, otherwise referred to as burnout. Burnout leads to a high rate of employee turnover in the nursing industry. Nursing burnout is a challenge that affects a majority of the hospitals in the United States. Most nurses opt to retire at an early age due to exhaustion. Medical facilities are unable to retain experienced nurses, and this affects service delivery. Some causes of burnout include poor working conditions, failure to provide social support and poor work schedule. This paper will review three articles that discuss the causes of nursing burnout. The paper will evaluate the credibility of each item with respect to methods, data collection, limitations, conclusion, design, and recommendations.

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Introduction

Burnout is a term used to refer to employees’ response to the unceasing pressure that is prevalent in professions that involve frequent direct contact with people. Burnout is a “condition that is characterized by depersonalization, emotional exhaustion and decreased personal achievement” (Lang, Pfister, & Siemens, 2010, p. 436). A majority of the studies associate burnout with working conditions. The studies maintain that cases of burnout are common in careers that are quite demanding. Employees require balancing their career with social life, in which failure to do so may result in exhaustion. There are no studies that focus on the relationship between burnout and social support. The rate of employee turnover in the nursing field is high. Every year, hospitals lose at least 42% of the nurses due to burnout. Increased turnover has prompted the need to understand the causes of exhaustion among the nurses. This paper was compiled using literature from both PROQUEST and MEDLINE databases. For PROQUEST, the researcher used the terms burnout, working conditions, and nursing. The search terms for MEDLINE included burnout, work schedule, and nursing. Scholarly materials were chosen based on their significance for the intended study. The researcher used only peer-reviewed articles. The hypothesis for the study was, working conditions and work schedules contribute significantly to nursing burnout and employee turnover. The article will seek to determine the correlation between the working condition and nursing burnout.

Article 1 (Trinkoff et al., 2011)

Research Question, Population and Study Design

A majority of studies show that lower nurse staffing level affects service delivery. For instance, lower nurse staffing level leads to an increase in inpatient mortality. The study by Trinkoff et al. (2011) sought to find out if, in healthcare facilities where nurses report unfavorable work schedules, there would be a high rate of patient death and control for recruitment. The study involved a total of 633 nurses who worked in acute nonfederal hospitals. The nurses were recruited based on the period that they had worked in the hospital. One had to have worked for at least one year.

The study used cross-sectional analysis that integrated records from nurses and the facilities where they worked. The benefit of cross-sectional analysis is that it is cheap and can help to examine huge data. On the other hand, the cross-sectional analysis may not be used to analyze a distinct question. The researchers used a total of 71 hospitals to compile the report. The researchers used Standard Shiftwork Index to derive the work schedule data. The study used multiple variables. They included the hours worked per day, shift rotation, the number of hours worked per week, and weekends worked per month among others. The work schedule was the independent variable while patient death was the dependent variable. The investigators obtained the staffing data from the American Hospital Association Annual Survey of Hospitals. The data included the number of licensed practical nurses and full and part-time registered nurses. Inpatient Quality Indicators (IQIs) Windows version 3.2 was used to compute mortality. The researchers used binomial logistic models to determine the correlation between nurses’ work schedules and patient death.

Limitation, Results, and Recommendations

Limitations: The study was subject to many restrictions. First, the participants were more experienced than the general hospital nurses. The research focused on teaching hospitals only. Hence, it was hard to generalize the results of the study. Second, some work schedule elements did not corroborate a relationship with mortality. Third, the data on scheduling was obtained from self-report. Consequently, it was prone to numerous biases. The researchers gathered data at a time when, “there was no indication that the information would be related to patient outcomes” (Trinkoff et al., 2011, p. 5). As a result, it restricted possible penchant to overemphasize schedule challenges. The study relied on secondary data only. Hence, it was hard for the researchers to incorporate variables that were absent in the collection of primary data. Besides, the researchers had no power over the measures used in the study.

Results: The results concluded that long work schedules contributed significantly to burnout when hospital features and staffing levels were put into control. Death cases were prevalent in hospitals where nurses worked for long hours. Patients were likely to die if attended by nurses who were sick. Besides, the weekly burden contributed to a high number of deaths of patients suffering from acute myocardial infarction.

Recommendations: The study recommended the introduction of an alternative work schedule to guarantee that nurses have adequate sleep. Also, the study suggested that nurses should leave the job on time and work for five days per week. It also suggested that nurses be accorded breaks and allowed to take purposefully placed siestas. Hospitals should use fatigue risk-management software to enhance work schedules for nurses.

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Article 2 (Lang, Pfister, and Siemens, 2010)

Research Question, Population and Study Design

The study aimed at determining the disparities in the degree of burnout among “Army and civilian nursing personnel assigned to a large U.S. Army teaching hospital” (Lang et al., 2010, p. 435). The army and civilian nurses acted as the independent variables while emotional exhaustion was the dependent variable. A total of 364 Army and civilian nursing personnel participated in the research. The participants comprised registered nurses, certified nursing assistants, licensed practical nurses, and Army medics. Besides, they had to have been in the nursing field for six months. The researchers had to seek authorization from the institutional review board before conducting the research. They had to brief the nursing leadership on their intentions. The researchers ran a power test to come up with a suitable sample of qualified participants. The members were requested to fill out the Maslach Burnout Inventory (MBI). The study used MBI due to its strong psychometric properties. The “Cronbach’s alpha for all the four subscales was above 0.6” (Lang et al., 2010, p. 439). The data was analyzed using ordinal logistic regression and the independent t-test. The researcher used ordinal logistic regression to examine the assumption that there is a correlation between burnout and work-related demands. For a group of nurses to be considered somewhat burned out, the emotional exhaustion mean had to lie between 19 and 26. On the other hand, the average score for depersonalization had to lie between six and nine. The average rating for decreased personal achievement had to fall between 34 and 39. Numerical investigations were done using Statistical Packages for Social Sciences (SPSS) 16.0.

Limitation, Results, and Recommendations

Limitations: The researcher did not discuss any possible limitations of the study. However, the researcher hinted that the model used to analyze decreased personal achievement did not satisfy the test assumptions. Thus, the researcher did not interpret the findings as a way to avoid potential biases.

Results: The results concluded that both civilian and Army nursing personnel suffered from a moderate degree of burnout. Nevertheless, the civilian nursing staff showed arithmetically lower levels of depersonalization and emotional exhaustion. The results showed that nursing personnel who did not serve a lot of military patients suffered from lower levels of depersonalization and emotional exhaustion. Such personnel also worked for less than 8 hours a day. The results indicated that older nurses did not exhibit signs of burnout. The researchers used the independent t-test to account for the disparities between the civilian and the military nurses.

Recommendations: The study recommended that further research be carried out in the Army hospitals to understand the causes of burnout among the nurses. It also suggested that the hospital leaders evaluate the demands placed on nurses as well as the working environment to come up with appropriate policies. The study proposed that the hospitals establish 12-hour shifts to capitalize on the work environment for both the civilian and military nursing personnel who do not go to work in war-torn countries. It also proposed the development of a plan that considered the long-term effects of these policies.

Article 3 (Laschinger, Leiter, Day, and Gilin, 2009)

Research Question, Population and Study Design

The research question was to examine the effects of workplace incivility and empowering work conditions on nurses’ experiences of burnout. The study was exploratory research. The study could not commence before ethical approval. The study involved a total of 1106 workers from five different organizations. The majority of the participants were female (95%). The nature of their employment varied, including casual, full-time, temporary, and part-time. The researchers used questionnaires to conduct the study. The study used a customized Dillman Total Design Methodology to boost the return rates. Also, the study used the Conditions for Work Effectiveness Questionnaire (CWEQ-II) to measure structural empowerment. The CWEQ-II comprised four subscales. Each subscale contained “three items, rated on a 5-point scale, which were summed and averaged” (Laschinger, Leiter, Day, & Gilin, 2009, p. 305). The workplace incivility was measured using the incivility scale. Besides, the researchers used the “Cynicism and Emotional Exhaustion subscales of MBI to measure burnout” (Laschinger et al., 2009, p. 305). The study used a 7-point Likert scale to rate job satisfaction. The size ranged from very discontented to very contented. The researchers guaranteed the reliability and validity of the study through “second-order confirmatory factor analysis” (Laschinger et al., 2009, p. 305).

Limitation, Results, and Recommendations

Limitations: One of the limitations of the study was that the cross-sectional nature of the original research disqualified high claims of causal effects. The researchers should have used a bigger and more inclusive sample to authenticate the model. The study relied on secondary data. Therefore, it was hard to factor in future changes.

Results: The results concluded that workplace incivility, empowerment, and burnout had significant effects on organizational loyalty, job satisfaction, and turnover objectives. Cynicism, supervisor incivility, and empowerment significantly contributed to corporate commitment and job satisfaction. On the other hand, “cynicism, emotional exhaustion, and supervisor incivility contributed to turnover intentions” (Laschinger et al., 2009, p. 307).

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Recommendations: The research underscored the importance of coming up with and implementing anti-bullying policies to reduce cases of employee turnover. The study also recommended that health care managers should take full responsibility for developing and implementing anti-bullying policies. The study proposed a longitudinal study to accommodate the changes that may occur over an extended length of time.

Conclusion

Working conditions and work schedules contribute to nursing burnout and employee turnover. The reviewed literature showed a significant correlation between working conditions and nursing burnout. For instance, a majority of the nurses who cared for injured soldiers showed signs of emotional exhaustion. Serving injured soldiers, especially those with traumatic brain injury and amputation was quite demanding. Consequently, it led to burnout. The literature also showed that nurses that worked in stressful environments were likely to experience burnout. Apart from working conditions, poor patient outcomes and lack of social support resulted in exhaustion. Nurses felt motivated when they realized that their patients were doing well. Besides, providing social support to nurses acted as an impulsion and boosted their morale. Employee empowerment may go a long way towards curbing nursing burnout. The literature showed that supervisor incivility contributed to burnout. Work schedules should be structured in a manner that nurses get adequate time to sleep. Depriving nurses of their sleep can lead to burnout and increased turnover. The nurse managers should ensure that nurses take enough rest before they report to work.

References

Lang, G., Pfister, E., & Siemens, M. (2010). Nursing burnout: Cross-sectional study at a large army hospital. Military Medicine, 175(6), 435-441.

Laschinger, H., Leiter, M., Day, A., & Gilin, D. (2009). Workplace empowerment, incivility, and burnout: Impact on staff nurse recruitment and retention outcomes. Journal of Nursing Management, 17(1), 302-311.

Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y. & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1), 1-8.