What is nurse burnout? Imagine you’re a nurse working in a mid-sized hospital in an area of the country that’s struggling with the COVID-19 pandemic. You’ve been checking on patients, setting up IV lines, monitoring ventilators, and filling in charts for the last 12 hours. Your feet hurt, you have a headache, and you’re hungry.
Now imagine that just as you can finally end your shift, you get word that another nurse has gotten sick and won’t be able to come in to relieve you. Because you know that your patients need you, you’re left with no choice but to keep working. Never mind that you’ve barely seen your family in the last week and are running on a few hours of sleep.
This scenario is a prime example of what causes nurse burnout—but it also shows just how the effects of burnout affect both staff and patient safety. As more healthcare organizations realize the adverse effects of burnout, they have started to take greater care with nurses’ schedules. Still, more improvements in workforce management must be made in healthcare organizations around the country for real progress to occur.
What is nurse burnout?
Even without a pandemic, nurse burnout is an issue of genuine concern that must be addressed at the top levels of administration. Nurse burnout happens when staff experience very long hours with high levels of stress, of course. But burnout and job dissatisfaction can occur even without marathon shifts and constant pressure. When nurses are not adequately supported, their physical, mental, and emotional wellbeing are likely to suffer greatly.
Many nurses realize that they should cut back on hours or find ways to alleviate stress, but find that it just isn’t possible. While they continue their work to the best of their ability, patient safety can be compromised in the process.
Predictors of nurse burnout
A recent study of over 3,000 nurses by the Joint Commission cited common signs that nurses are feeling burned out, among them:
- Constant exhaustion
- Chronic frustration
- Heightened anxiety
- Feeling unaccomplished
- Negative reactions to change
- Seeming disengaged
These symptoms result from various factors, many of which nurses have little or no control over. Predictors that nurses will experience burnout, and which managers should monitor, are:
- Staffing issues that lead to working shifts longer than 12 hours
- Not being given enough autonomy
- Not being included in major decision-making processes
- Concerns about safety and security for themselves and their patients
Understandably, nurse burnout and patient safety go hand-in-hand since a tired, frustrated nurse may not be able to devote the appropriate time and attention to their patients to ensure full and proper care.
What is patient safety?
The concept of patient safety takes different forms for different applications. When it comes to nursing care, the National Patient Safety Goals outlined by the Joint Commission focus on the following:
- Identifying patients/residents correctly
- Using medicines safely
- Preventing infection
- Preventing patients/residents from falling
- Preventing bed sores
While this list may seem simple enough, it can become overwhelming when patients are constantly rotating through a ward or a multitude of patients need of care at a moment’s notice. The ways in which nurses approach each safety goal can vary, too, based on whether they work in a hospital or clinic, as compared to a long-term care (LTC) facility.
Nurses and patient safety in hospitals
Anyone who has visited or stayed in a hospital can attest that it can be a chaotic place. Patients arrive for wide-ranging reasons, from needing an outpatient procedure or surgery to requiring critical care after an accident. Tracking the comings and goings of patients and attending to their varying needs moment by moment is a challenge, and it's the primary responsibility of nurses.
At large, busy hospitals and healthcare systems, a single nurse may be responsible for up to eight patients at a time. Providing each patient with the correct medication, monitoring their vitals, and keeping them safe and comfortable can be stressful and confusing.
The patients that a hospital nurse cares for can completely change from one day to the next, depending on which ward they are working in. Just as a nurse becomes familiar with a patient’s name, needs, and risks, they may never see them again, and instead get assigned to a new section to start over with a brand new set of patients.
Nurses must continuously document and record everything they do with each patient to ensure their safety. Advancements in technology have created electronic systems that are much more efficient and reliable. However, nurses are rarely given a chance to provide input or feedback into what works well with the system and what could be improved or changed. And learning how to use a hospital’s electronic record-keeping system takes time, something nurses do not have in ample supply. Instead, they are expected to figure things out on the floor, which can add to their frustration and feelings of underappreciation.
This constant juggling of patients and their records can be mentally, emotionally, and physically exhausting for nurses. Even under the best of circumstances, the demands that are constantly placed onto hospital nurses are overwhelming. This creates an environment in which patient safety isn’t prioritized as highly as it should be.
Nurses and patient safety in LTC facilities
Nurses who work in LTC facilities, such as nursing homes, skilled nursing facilities, and hospice centers, face a whole different set of patient safety concerns. While there is some obvious overlap with hospital care, such as preventing infection and using medicines safely, LTC nurses have other factors to consider when it comes to the needs of their patients.
In most cases, patients/residents in these facilities are elderly and may be receiving palliative care. These patients often have much more complicated medical histories and require a more significant amount of medication. All of this means that nurses have that much more responsibility to precisely monitor patients at all times.
Additionally, nurses who work in LTC facilities must keep a close eye on the position of immobile patients in bed to prevent bedsores. This physically taxing responsibility can take a toll on a nurse’s muscles and joints over time. Another safety concern for LTC nurses are patient falls. While there is always the possibility that a patient at any facility could fall, the risk is amplified in LTC. Patients may not be physically stable enough to get to the bathroom, which can lead to the need for constant assistance from a nurse.
Not only are nurses constantly worrying about patient safety in LTC facilities, but they also have to confront the emotional reality that many of the patients they work with will not be with them for much longer. Nurses often create strong bonds with their elderly or high-needs patients, so it may impact them greatly when they lose those patients.
The effects of burnout on nurses and patients
It’s clear that the demands and responsibilities of nursing, regardless of the facility type, are already incredibly high. And as nurses try to focus on patient safety, nurse burnout can create an environment that makes this task seem impossible.
When a nurse is experiencing burnout, the effects will often negatively impact the nurse and affect their patients’ safety. In a recent American Organization for Nursing Leadership (AONL) survey on the impact of COVID-19 on nursing leadership, administered in February 2021, nurse leaders reported two major challenges they face due to the pandemic. Of all 2,471 respondents:
- 67% said mental health and wellbeing of staff was a major challenge
- 65% said surge staffing, training, and reallocation was a major challenge
The following are common effects of nurse burnout on nurses themselves and on patient safety.
Nurses who feel overworked and underappreciated may struggle to show empathy to patients. Just as they feel unimportant or undervalued, nurses may inadvertently pass on those feelings to patients. In extreme cases, patients can seem more like numbers than real people.
A lack of empathy by managers can also create risks to patient safety because it removes the human element from interactions. A nurse who has to rush to get his or her work done may not take the time to fully listen to the needs of the patient, which can in turn impact the care provided. The recent AONL study on the impact of COVID-19 found that approximately 50% of nurses and ARPNs reported that being overworked is a key factor impacting mental health and resilience, and nearly 35% of nurses report that understaffing is a key factor.
Like issues with empathy, nurses often struggle to positively engage with their patients when they are experiencing burnout. If a nurse is expected to keep track of multiple patients with multiple conditions, their time will be limited with each patient, and they will feel the pressure of needing to get the next item on their list under control.
When patients don’t feel like their nurse is engaging with them, they may be less likely to ask for help. The patient may have noticed how busy or exhausted the nurse is, which may lead them to avoid mentioning their heightened pain levels or their need to use the restroom. This can result in adverse health consequences and put the patient’s safety at higher risk than it should have been.
If a nurse is pressed for time or has too many things on their mind, they may forget to ask specific questions or double-check essential information. Because care is often passed from one nurse to the next in a care handoff, a failure to do these basic safety checks can impact the continuity of care that a patient receives.
Nursing is inherently a very emotional job that involves a high level of human interaction. Even when nurses are overworked and under-appreciated, they still want to provide their patients with the best care possible and do everything in their power to help their patients feel comfortable. The AONL reports that emotional health is a concern for nurse leaders, with 16% recently surveyed stating that they “are not or not at all emotionally healthy.”
Many nurses form bonds with their patients and spend much of their emotional energy on those in their care. If a patient is suffering or passes away, it is very personal for nurses. Having to continuously go through the grieving process is incredibly emotionally taxing for nurses.
In a recent study in Australia, over one-third of nurses were found to have depression, anxiety, and stress symptoms. This state of poor mental health would affect any individual’s job performance, regardless of their line of work. For nurses in particular, it can make it difficult to focus on caring for others properly.
Patients that are being treated by nurses who are facing poor mental health may be at higher risk of safety issues and a lower level of care. The depressive state of their nurse could also negatively affect a patient’s ability to recover faster or to feel positive about their situation.
For most people, the average workday consists of eight hours on a predictable schedule that usually includes a nice midday break. For nurses, it’s not uncommon to work 12-hour shifts by default, with breaks being dependent on patient needs. Nursing is also an around-the-clock profession, so many individuals work odd hours and night shifts.
Not surprisingly, in hospitals in which nurses regularly work more than 13 hours, patients are known to be less likely to recommend that facility to others. Also, when rating hospitals with longer shifts for nurses, patients tend to give lower HCAHPS ratings overall. This information indicates that patients are aware that they’ve received lower-quality care, even if they don’t know the root cause of the issue.
When you add up the effects of nurse burnout, it’s no wonder that many nurses end up leaving their jobs or leaving the profession entirely. The AONL recently found that 18% of nurses surveyed said they intend to leave their current position in the next six months, and 21% are undecided about the future. Further, 4% of nurses surveyed said they intend to leave the nursing profession in the next six months, and 11% are undecided.
One of the most influential factors for nursing staff turnover is shift length. Studies show that when nurses work shifts over 12 hours on a regular basis, they will burn out faster, which leads many nurses to throw in the towel.
These staffing issues frequently cause shortages in nursing departments, which inevitably affects patient safety. If a unit is designed to operate with four nurses and only three are present, patient care will be limited.
Avoid putting patients and your healthcare organization at risk
Thankfully, although nurse burnout is a very real issue in medical care, healthcare organizations can implement strategies to avoid pushing nurses to burnout and resignation. Healthcare organizations can implement some strategies on their own, while others require the collaboration of the nurses.
Just as nurses use software and technology to streamline record-keeping and patient-tracking, hospitals can apply technological tools to assist with workforce management issues like:
- Time and attendance
- Staffing and scheduling
- Patient classification
- Human resources and payroll
- Outcomes analytics
Gathering and analyzing data can help a facility to become more efficient while ensuring that staff members like nurses don’t end up with excessive overtime or inflexible schedules.
Beyond helping to create reasonable scheduling expectations for staff members, the software programs save hospitals money. When hospitals aren’t left paying for overtime hours or negative outcomes from poor patient care, they're less likely to have to deal with lawsuits or other financial burdens.
Nurses should be able to expect to have a reasonable work-life balance. Hospitals need to lead the way in ensuring that this is possible for their staff members. By committing to limiting shifts to 12 hours, hospitals can help to create a work-life balance for employees. This balance will ultimately make staff members happier, more dependable, and more likely to stay on the job long-term.
Nurses who feel appreciated and acknowledged will have greater emotional reserve to dip into. This, in turn, leads to increased dedication to patients, fewer patient safety issues, and patients who feel well cared for.
When employers foster work-life balance, they also help nurses do one thing they often put on the back-burner: take care of themselves.
A balanced schedule allows nurses the time they need for self-care, which is critical for preventing burnout. Self-care can take shape in a number of ways, including getting enough quality sleep, connecting with loved ones, exercising, or spending time on a hobby. No matter how it takes shape, self-care provides fulfillment, can improve mental health and physical health, and can help nurses balance the daily stress that comes with the job.
Healthcare organizations should provide nurses with the psychological support they need when they need it. If a nurse is experiencing burnout, they should feel supported when asking for assistance from a professional that knows how to provide meaningful help.
When employers can provide nurses with the time and space necessary to mitigate the stress of the job throughout their shifts, it can help with burnout rates. Providing training for stress management can reinforce an organization’s commitment to the health and wellbeing of their nursing staff. Helping nursing staff learn different stress management techniques like mindful meditation, deep breathing, or simple stretching to release tension can provide nurses with exercises they can do in between serving patients or while filling out paperwork.
In the end, a nurse who can get the positive care they need will inevitably pass that same kind of intentional and effective support to their patients.
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