looking for a peer review
April 16, 2021
Analyzing Nurse Burnout.
Who it effects? Reasons for it. Ways it Can Be Prevented
Nursing has dramatically changed over the last year. As a new graduate, bridging from and LPN to an RN, I wanted to know how the current situations have affected the field and people involved in it. Working through the pandemic of COVID-19 has created numerous issues that affect job performance, the health of the employees, patient satisfaction, as well as feelings of self-adequacy. Many have chosen to leave the field all together. Sadly, some have gone as far as taking their own lives. Managing the stress of heavy patient loads, unrealistic expectations by administration not being met, seeing death, and dying at a rapid rate had become too much to bear. Nurse burnout is defined by the loss of idealism, energy, and purpose. Having feelings of indifference and compromise in professional care. Dissatisfaction in one's personal performance due to the stress in the environment. Having a decreased sense of personal accomplishment leading to emotional exhaustion and depolarization from self, family, and peers. In this essay we explore analytic data to further understand the reasons for nurse burnout, who it affects, and ways to prevent it. Most do not understand the depth of the trickle effect this epidemic of burnout has had on society. Nor do the public know how hard it can be to get up every morning, put on scrubs and a smile to take on what seems as an impossible challenge.
To offer a sense of real time facts, I have created an anonymous survey that was sent out to currently employed RNs who have worked through and are still working through the pandemic. The results have been transformed into statistics, there were fill in the blank options for additional feedback. Those answers are raw, truthful, and openly give the outside world a glimpse of the heartache and struggles they have and are still facing. As well, comparing medical journals from the past to the present. Noticing that burnout has been a problem since, well, the days of Florence Nightingale. Seeing why she had such ambition to change the frame in nursing dynamics. Standards were set to uphold the way care is provided to the patient. Why has not any set standards for the way nurses are treated and cared for, been implemented? After all to care for one, you must care for yourself first.
When asked if they were happy in their current role, 65% of the surveyors (2021RNs) said they were not. That number is devastating. What is going on? Many things. Inconsistent wages showed up in almost all articles and research completed. Offering inconsistent wages (Carnevale) , not competing with wages that could be made elsewhere for less work and stress. The average wage of and RN is 68,000 a year (Carnevale). Seems high, doesn't it? That is because it is not a standard. Many RNs are making much less. Some must work extensive overtime to come close. Imagine a world where there was a minimum wage for RNs that could be voted on by nurses. One that those healthcare workers deemed fair enough to compensate for the long tiresome days, expensive uniforms, shoe replacement for when the bodily fluids become too messy to wipe off, chiropractor bill compensation from leaning over beds and moving non ambulatory bariatric patients, something that could cover the cost of living. Would that make the nurses happier to have a wage like this? Sure would help the morale. Upon answering the survey question "If there was one thing you could change about your facility to improve morale or safety, what would it be?" (2021RNs) 33% responded with answers referring to receiving higher wages, bonuses. One in particular "Giving raises instead of giving us pizza" (2021RNs) caught my attention. There currently is a movement created by nurses on social media called #THELASTPIZZAPARTY. This movement is to raise awareness of the unsafe patient ratios, wages to match the cost of living, and advocacy for safe working environments for nursing staff. Hospitals, some with up to 97% of nursing staff going on strike for two days. Side note: I would like to point out that these nurses did give their administration 10day notice of strikes for the hospital to prepare. Quite impressive the way, no hypocrisy came into play on their part. Attempting to maintain safety. By no means is this condoning strike or leaving patients at risk, the point is to show the drastic measures that have been and are continually being taken to resolve one of many problems in the field of nursing. A staggering 75% of nurses (2021RNs) reported not being supported by administration. What does this mean? Survey question #14 asks "When walking into work, do you feel confident that you will have all resources needed to provide excellent patient care?" 76% of the RNs replied no. Ultimately, it is the job of administration to ensure all equipment is in working order . Supplies for medical procedures need to be stocked and ordered regularly. Reflect on PPE shortage. In the beginning of the COVID-19 pandemic, healthcare workers were putting their own lives at risk to save others. When the CDC had numerous changes in guidelines and acceptability as to what could be substituted for face coverings, handkerchiefs were seen on the faces of professionals going into a room where a potentially deadly virus could be inhaled. Looking for data to prove the number of healthcare workers who became infected with the virus was an eye opener. Not due to the number, but the fact that only 10 out of 50 states report healthcare workers with coronavirus to the CDC (RN). Why aren't all administrations reporting? Out of the ten states reporting, California reports the highest percentage of positive cases in healthcare workers, as of April 2020 there were already 8,330 (RN). Questions and theories arise of organizations being held responsible, or liable to compensation of lost wages and medical bills come to the table. Ideas that support feelings of administration is not standing behind their employees. No data has been provided to prove such ideas. However, reports of not being able to use PTO during times of recovery of coronavirus were mentioned in the fill in the blank portion of survey (2021RNs). Again, no factual data provided to back this claim. Purpose of mention is to back the feeling of lack of support by administration. Reasons why nurses were unhappy in their current role.
Other mentions of improvement by administration include providing safe nurse to patient ratios. Unfortunately, the state of Arizona, where the majority of those interviewed, does not have laws set in place to mandate safe ratios (Zoland Law Group). Despite numerous arguments and presented data proposals proving the mortality outcomes, these laws have been rejected. Appallingly, California is the only state, out of all 50 states to have mandated ratios. Less patient to nurse ratio would offer a safer environment for both patient and nurse. Medication errors are highly probable in situations of heavy workloads combined with exhaustion. Failure to rescue rates increase along with the patient load a nurse takes on. Especially in a high acuity setting. Areas such as an emergency room where patients are checking in at a rapid rate, many with critical ailments, nurses and staff simply cannot be in all places at once. Take note to idea of heavy workload can lead to a higher risk of preventable complications. Injuries occuring during patient stay such as falls from slow reaction time due to being in another patient's room. Pressure sores arise from not being able to turn reposition and clean the patient routinely as the nurse may be faced dealing with more critical situations. Priority decisions that must be made to save lives. Unfortunately, others suffer. These unexpected injuries contribute to an increased length in stay, taking up resources that could be used on others in critical need of a hospital bed. Studies performed show data of each a Nurse with a ratio of 1:4 of surgical patients, each additional patient assigned added a probability of death increase within 30 days by 7 percent (United). As well, 7 percent were at risk for readmission for heart failure, pneumonia readmissions were at 6 percent. Out of those studied, 9percent presented higher risk of readmission for myocardial infarction. Evaluations of patient outcomes after the mandatory guidelines were set for California in 2010 were made. Comparing California mortalities to Pennsylvania and New Jersey. If these states had followed suit, they could have seen 10.6 percent less death reported in Pennsylvania and 13. 9 percent fewer deaths in New Jersey. Let that sink in for a moment.
California Nurses Association (CNA) have a proposal to mandate ratios based on acuity. They are as follows.
·ICU 1:2, Neonatal ICU 1:2,
·Emergency 1:3, ER Trauma 1:1, ICU in ER 1:2
·Operating Room 1:1, Post Anesthesia 1:2
·Step Down 1:3, Telemetry 1:3
·Med Surg 1:4
·Labor and Delivery 1:2, Antepartum 1:3, Well Baby 1:6
·Coronary Care 1:2
·Acute Respiratory Care 1:2
·Burn Unit 1:2
·Skilled Nursing Facility 1:5
·Other Nursing Facility 1:5 (United)
Asking the surveyed RNs how often they thought about leaving their current job, 19% replied always, 31% usually, 38% sometimes, 6% rarely, and another 6% answered never (2021RNs). Seeing so much death and dying. Feeling as if they cannot do enough to save everyone, when the job you have is to rescue and heal, can impose feelings of inadequacy and despair. Valid reasons for nurse burnout. 11% of nurses interviewed replied with always feeling inadequate, 6% usually, 67% sometimes, only 6% said they never feel inadequate. Emotional exhaustion weighs heavy among the currently working RNs, 33% say they always feel emotionally exhausted (2021RNs), 28% report usually, and 6% answered rarely. Sadly, 0% replied with the never option. Over half of these nurses relay crying alone as a way of dealing with the issue. 33% say they turn to their families for support, 13% said they have had to call off of their shift to recuperate from the previous shift. In turn creating a higher demand for other healthcare professional on duty, imposing the risks that have been trying to be avoided. This vicious cycle of burnout appears relentless if no changes are made.
Nurse burnout has been related to negative physical changes due to stress. Surveyed RNs were asked "Do you feel your physical health has been affected by stress in the workplace?" Out of those nurses, 94% answered yes (2021RNs). The following question was a fill in the blank format, offering a place to explain how their health had been impacted.
Some nurse responses for a clear view of what they are facing:
A."More stress, blood pressure up, always tired."
B."Weight gain, insomnia, increased anxiety, frequently feeling overwhelmed and emotional. Loss of empathy, Depression. Lack of motivation."
D."More depressed, feeling like I can't catch a break, and always worried if I am going to get yelled at, at work for not doing a good job, and worst of all, the younger generation new grads don't help out and make you feel like I am dumb."
E."I feel exhausted all the time. I have no energy and I find it difficult to care for myself."
F.Headaches, weight gain, high blood pressure, irregular bleeding, no appetite, insomnia, joint pain, neck pain, blurred vision."
H."It has improved as my stress level went down from leaving the ER."
I."Trouble sleeping, weight fluctuations, palpitations."
All responses are anonymous direct quotes from some of those surveyed (2021RNs). Nurse burnout clearly impacts the physical well being of the nurse as well as the emotional wellbeing. Research linking stress and effects on the body shows elevated stress releases hormones as those in our fight or flight system. High levels that remain for long periods of time and that are frequently released into the body can indeed contribute to increased blood pressure and heart disease. Diabetes also, due to the body reacting to stress by releasing higher levels of glucose (Mayo Clinic). Headaches are linked to anxiety, causing either overeating or undereating. Muscle tension causes restlessness in turn angry outbursts may occur. Having chest pain was shown being related to lack of motivation, drug or alcohol misuse was the note on the behavioral effect of chest pain. Fatigue changes the mood into feeling overwhelmed, with the behavioral possible consequence being tobacco use. Change in sex drive can lead to irritability, anger, and social withdrawal (Mayo Clinic). Having symptoms that create disturbances in health, caused by the environment in which you work should not be an issue as large as this is. In fact, nurses reported having the effects carry on into their home lives (2021RNs). Many state feeling, too tired to perform daily chores. Feelings of withdrawal from their families and children. Having mood swings and snapping at their children easier than they normally would. One reported not feeling like herself or a good mother until day two or three of no work (2021RNs). This is the nursing field right now. Regardless of the situations, nurses continue to get up, poor their coffee, and clock in for another shift. What can be done to provide a positive outcome?
Aside from topics previously covered such as competitive wages, availability of resources needed, more support by administration and lower nurse to patient ratios, look into selfcare. Often nurses are so busy taking care of everyone else, that the long hours only leave time for minimal sleep. Many nurses are not quite grasping the concept that it is okay to say no to your employer when asked to work above your requirements. Taking your scheduled days off to be with your friends and family, doing things you enjoy can release chemicals in your body to make you not only feel better, but sleep better. Get regular exercise or some sort of physical activity that brings you happiness. Allow yourself the feeling of accomplishment and self-worth. Meditation has been practiced for centuries to balance the mind body and spirit. Laugh. Laugh often! Maintaining a sense of humor allows you to create a positive outlook on situations rather than negative. In the workplace, be a team player. Offering oneself is the ultimate gesture that is perceived positively and quite often reciprocated. Understand your place and that of others, meaning its alright to ask for help, and accept constructive criticism. In that respect, if you see a peer struggling, lend a hand if you can, or call someone who has expertise in the situation. Give compliments when you see a job performance done well. Morale is boosted through positivity, and it all needs to start somewhere. Take your lunch break!!! Understood, this may be difficult at times with the workload. Mental clarity can only be achieved in a quiet environment. Give yourself time to reset. Even if it is only for a short period. Lastly, if nurse burnout has become far too much for you to manage, speak to your health care provider about it. Please, far too many great nurses have fallen victim to burnout. One cannot help but wonder if there were interventions made, could things have gone differently? It is okay to seek help. People ask nurses for help all day, sometime the favor just needs to be returned.
In conclusion of my research, I asked the most important question. "Are you still passionate about nursing?" All, but one nurse answered yes! Unbelievable right? The heart of nursing is very much still alive. In school our teachers told us that 50+ years ago Florence Nightingale said it would take 50 years to produce the nurse she envisioned. To the nurses who are still trying their best, holding the hands of the tired and weak, although tired and beat up herself. You are that nurse! Keep your chin up. And keep fighting for what is right.
2021RNs, Anonomous. Analyzing Nurse Burnout, Reasons for it, Who it Effects, Ways to Prevent it Desiree Shaffer. April 2020. surveymonkey
Carnevale, Anthony P. repository.library.georgtown.edu. 2015. Nursing Supply and Demand Through 2020.
Data, OCED. data.oecd.org. 2019. Nurse to 1,000 US person latest update 2019
Haddad, Lisa M., Pavan Annamaraju and Tammy J. Toney-Butler. ncbi.nlm.nih.gov. 14 December 2020. Nurse Shortage
Mayo Clinic. mayoclinic.org. n.d. Stress symptoms: Effects on your body and behavior. 1 April 2021.
Nicholas Shanosky, Daniel McDermott, and Nisha Kurani. How do the US healthcare resourses compare to other countries? 12 August 2020. Health System Tracker
RN, Amanda Bucceri Androus. registerednursing.org. 13 November 2020. How Many Nurses and Healthcare Professionals Have Coronavirus.
United, National Nurses. nationalnursesunited.org. 2021. NNU
Zoland Law Group. zolandgroup.com. 15 September 2020. Nurse-to-Patient Ratio in Arizona.