Nursing Fatigue and Burnout: Causes, Effects and Recommendations

Abstract

Nursing burnout and fatigue will affect every nurse at some point in his or her career with many contributing factors. Nurses are the front line of health care services. The effects of nursing burnout and fatigue can directly affect patient care and the nurses own health. Prevention tactics and education provided to the nursing staff is essential to physical and mental stability. The online databases involved were Pubmed Query, CINAHL Complete, and EBSCO Discovery. The literature is peer reviewed and ranked by using the evidence hierarchy. The framework used to mold the study is the IOWA model. The Maslach Burnout Inventory General Survey (MBI-GS) will be completed before the initiation of the study and then again two months after interventions took place. The study will be conducted at Children’s Hospital of New Orleans in the Pediatric Intensive Care Unit.  Interventions including counseling, educational resources, engagement in group activities, healthy nutritional options for both day shift and night shift, and unit lead relaxation techniques will be implemented to reduce nursing burnout and fatigue. Related constraints include lack of participation from staff.

Keywords:
nursing burnout, fatigue, prevention    

Problem or Knowledge Focused Triggers- Nursing Fatigue and Burnout

As nurses, we are the front line of health care services. Nursing burnout and fatigue will affect every nurse at some point in his or her career. Nurses work long hours, sacrifice time away from their families, and have an increased amount of emotional and physical stress. Nurses also have increased responsibilities without mandatory break times, increased patient acuity, and lack of ancillary staff. Following those things mentioned above lack of sleep, exercise, and the proper diet result in lack of self-care which ultimately affects patient care. Contributions to burnout include moral distress, emotional and spiritual demands creating the perception of excessive workload, and stressors associated with physical and psychological environments (Rushton et al., 2015). The pediatric intensive care unit can be very challenging, demanding, and strenuous in many ways. It can also be very rewarding as well. Many experienced and valuable nurses on my unit are leaving due to many of the factors listed above. This evident problem is concerning and needs to be addressed. 

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As a
newer nurse, learning from experienced nurses is very valuable. The fatigue and
burnout of experienced nurses is evident. Encouraging and promoting ways to
prevent burnout and fatigue from happening to bedside nurses is important. A
variety of clinical and intellectual experience in every unit is essential. On
a day to day basis nurses may be faced with stressful life or death situations
that can be emotionally and physically draining, which can lead to nursing
fatigue and burnout very fast.

The
IOWA Model was chosen as a framework for this study. The Iowa
Model is a widely used framework for the implementation of evidence‐based
practice (“Iowa Model”, 2017). This model helps to promote the use of evidence
based practice, and is a guideline to show how facilities can promote quality,
safe, and effective care using evidence based practice. There are always things
changing in nursing, new medications, practices, and policies ect. The model
helps to keep new research organized according the changes that will help to
improve care and enforce change.

Literature Review

By
using the University of Louisiana at Lafayette’s online database, all of the literature reviewed for this project is peer reviewed and
ranked by using the evidence hierarchy. The literature reviewed all show that
nursing fatigue and burnout is a growing issue in the healthcare field, but
also implements ways to help reduce the rising trend. A cross-sectional survey
and structured questionnaire completed by Bogaert, Timmermans, Weeks,
Heusden,Wouters, & Franck (2014) used to  investigate the impact that burnout has on
a  nurses environment, work ethics, and
patient care and safety. Various unit- level associations were identified
between environmental factors, work characteristics, and burnout dimensions. In
addition, there were many independent variables such as nursing management unit
level, emotional exhaustion, turnover rates, and medication errors just to name
a few. The level five-ranked study suggested that a stable work environment
improves patient safety outcomes, when unit-favorable perceptions are meet
resulting in decreased levels of nursing burnout.

The cross- sectional study
that was completed by Khasmisa, Oldenburg, Peltzer, & Ilic (2015) examined
the relationships between work related stress, burnout, job satisfaction and
the overall general health of nurses. The participants included in the study
were given five questionnaires to take Socio-Demographic Questionnaire (SDQ),
Nursing Stress Inventory (NSI), Maslach Burnout Inventory- Human Services
Survey( MBI-HSS),  Job Satisfaction
Survey(JSS) , and General Health Questionnaire (GHQ).  In result concluding that  Burnout
clearly impacts on the mental health and wellbeing of nurses, which is most
likely compromising productivity, performance and the quality of patient care (Khasmisa
et al., 2015). The study also states that stress management programs including
education training, and stress reduction strategies are linked to minimizing
burnout and increasing the overall health of nurses.

Some nurses develop resilient coping strategies and adapt to
stressful work experiences, mitigating the development of common maladaptive
psychological symptoms (Mealer et al., 2014). A randomized control trial, and
intervention study completed over a twelve-week period. Educational classes,
counseling, exposure sessions, and stress reduction exercises were all
interventions that were performed within a two-day period. In conclusion, after
implementation of the training programs there was a significant decrease in
resilience, environmental stressors, posttraumatic stress syndrome (PTSD), and
burnout syndrome.

A two phase project completed by Rushton, Batcheller,
Schroeder,& Donohue ( 2015) was  performed to increase the resilience of nurses
while improving retention and reducing turnover.   In
phase one the cross sectional survey used to determine the areas of high
stress, and in phase two by using survey tools including the Maslach Burnout
Inventory Survey, Moral Distress Scale, Perceived stress scale, Meaning scale,
and Hope scale were used to assess the nurses charteristics and determine the
factors that involve burnout. Concluding, that moral distress was predictor of
all aspects of burnout, and the relationship between burnout and resilience was
powerful. Physical and emotional well-being had a direct association with
greater resilience.

Resolution

As the
literature clearly states there are many problems that directly related to
nursing fatigue and burnout. Education and awareness were mentioned in the
literature-reviewed sources quite often. At Children Hospital of New Orleans,
educational resources can be used to bring awareness and prevent nursing
fatigue and burnout. Mandatory assignments will be created and presented into
the Children’s Hospital Intranet for all nurses with to complete with CEU
credits as a reward for completion. Counseling, educational resources, unit
lead relaxation techniques, and healthy nutritional options for all shifts. Counseling
that is available for day shift and night shift will allow nurses to express
their feelings of concern and allow for open communication. Educational
resources such as videos, and models presented in the intranet allows nurses to
implement ways to prevent nursing burnout. Unit led relaxation before and after
every shift will allow a release of endorphins and decrease stress. Lastly,
allowing for the cafeteria to be open until at least 10:30pm to allow for night
shift employees, patients, and family member to have a healthy well balanced
meal. Nurses who practiced a healthy lifestyle were
significantly more likely to provide guidance and counseling to families on
healthy behaviors and promote personal health and wellness (Hasson et al.,
2018). All of these methods will help to prevent
nursing burnout and fatigue as well as provide a stable work environment,
well-balanced personal and mental health. Nurses with spiritual and mental
well-being, hope, and resilience were protected against burnout (Rushton et
al., 2015).

Implementation Plan

All
nurses in the Pediatric Intensive Care Unit at Children’s Hospital of New
Orleans will be encouraged to complete the Maslach Burnout Inventory General
Survey (MBI-GS) initially before the start of the project. As stated by
Bianchi, (2015) The Maslach Burnout Inventory General Survey (MBI-GS) is a 16
question survey measuring exhaustion, cynicism, physical fatigue, and
professional efficacy. Flyers and email reminders will be posted and sent to
all nurses to complete the survey. Nurses will be allowed to choose any
intervention to be able to participate, but more than one is suggested. Over
the two month period nurses will be able to provide verbal feedback. Biweekly
meetings will take place at times available for both day shift and night shift
to attend, to obtain feedback from the nurses participating.

Monitor & Analyze Outcome Data

The best way to evaluate
the change that has been implemented would be to have a formal discussion with
the nurses, and have complete the MBI-GS survey again to evaluate the outcome
of the plan. Nursing fatigue and burnout affects everyone differently, so the
changes implemented may benefit one more than another. Feedback from the staff
is imperative to determine whether the implemented strategy that was beneficial
or not. Nursing Research should be conducted under real-world conditions and in
the setting where the findings are intended to be applied (Battagila et al,
2018).

By communicating effectively, change will evolve. Knowledge and evidence derived from scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care (Curtis et al, 2016). The most appropriate way to share the information with others at my facility would be to send an email to all of the nurse staff on the unit, and to create flyers to post in the break room and nurses station. This will show the outcome of the benefits that are available.

Evaluation and Dissemination of Plan

Upon completion of the
project, the results and findings should be shared with all staff members.
Dissemination of the plan can be done in many ways.   By
communicating effectively, change will evolve. Knowledge and evidence derived
from scholarly methods should drive our clinical practice, decisions and change
to improve the way we deliver care (Curtis et al, 2016). The most appropriate
way to share the information with others at my facility would be to send an
email to all of the nurse staff on the unit, and to create flyers to post in
the break room and nurses station. This will show the outcome of the benefits
that are available. EBP cannot evolve unless communication channels in the
societal system are used effectively to bring about change (Schmidt & Brown,
2015).

Summary

Nurses are the front
line in healthcare. Nursing burnout has no boundaries and can affect many
things impacting personal health and patient care in a negative way. The
physical and mental stability of nurses should be a priority to administration
as well as the nurses themselves. By working as a team to reduce nursing
fatigue and burnout, patient safety and satisfaction will increase. Providing
safe and effective care is priority. Bringing education and awareness about
nursing fatigue and burnout and implanting the ways to prevent it will allow
for a safer work environment, personal well-being, and proficient patient care
experiences.

References

• Battagila, C., & Glasgow, R.E. (2018) Pragmatic dissemination and implementation research models, methods and measures and their relevance to nursing research. Nursing Outlook. Doi: 10.1016/j.
• Bianchi, R. (2015). What is ‘severe burnout’ and can its prevalence be assessed? Intensive Care Medicine, 41 (1), 166. doi:10.1007/s00134-014-3534-y.
• Bogaert, P.V., Timmermans, O., Weeks, S.M., Heusden, D.V., Wouters, K., & Franck, E. (2014). Nursing Unit Teams Matter: Impact of Unit-Level Nurse Practice Environment, Nurse Work Characteristics, and Burnout on Nurse Reported Job Outcomes, and Quality of Care and Patient Adverse Events- A Cross-Sectional Survey. International Journal of Nursing Studies, 51(8), 1123-1134. Doi: 10.1016/j.ijnurstu. 2013.12.009.
• Curtis, K., Shaban, R. Z., & Cibsidne, J.(2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872. Doi: 10.1111/jcon.
• Hasson, R., Strak, A. H., Constantini, N., Polak, R., Verboy, G., Edelstein, N., Stein-Zamir, C.    (2018). “Practice What You Need Teach” Public Health Nurses Promoting Healthy Lifestyles: Program Evaluation. Journal of Ambulatory Care Management, 41(3), 171. Retrieved from http://ezproxy.ucs.louisiana.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct-true&AuthType=ip,cookie,uid,url&db-edo&AN=129968629&site=eds-live
• Khasmisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work Related Stress, Burnout Job Satisfaction and General Health of Nurses. International Journal of Environmental Research and Public Health, 12(1), 652-666. Doi: 10.3390/ijerph120100652
• Mealer, M., Conrad, D., Evans, J., Jooste, K., Solyntjes,J., Rothnaum, B., & Moss, M. (2014), Feasibility and Acceptability of a Resilience Traning Program for Intensive Care Unit Nurses. American Journal of Critical Care, 23 (6). Doi: 10.4037/ajcc2014747
• Rushton, C.H., Batcheller, J., Schroeder, K.,& Donohue, P. (2015). Burnout and Resilience Among Nurses Practicing in High- Intensity Settings. American Journal of Critical Care: An Official Publication, American Association of Critical- Care Nurses, 24(5), 412-420. doi: 10.4037/ajcc2015291.
•  Schmidt, N. A., & Brown, J. M. (2015). Evidence-based practice for nurses: Appraisal and application of research. Jones and Bartlett Learning.