Nurse burnout is a rising epidemic within the healthcare industry. Discover how nurse burnout affects patient care and the steps our healthcare system should take to combat this important issue.
Samantha is an ICU nurse at a large metropolitan hospital. She’s been a nurse for only 3 years, and moved quickly to the ICU setting because of her love of high acuity. It’s her fourth 12-hour shift this week since nursing callouts and a nursing shortage has continued since the onset of COVID. Her nurse manager called her early this morning to see if she would pick up extra today. Thankfully, the COVID census has dropped dramatically over the past few weeks, but hospital volumes have returned to pre-COVID levels.
Today, she is not only in charge of her patients’ well-being but also expected to be the EKG tech, nurses’ aide, and secretary due to a couple of callouts. On top of that, she’s taking a stretch assignment with three patients instead of her usual two.
She has been running from room to room trying to keep up with everyone’s care for over two hours and finally has gotten a chance to sit down to record everything into the EHR she had completed earlier in the day. She spends the next half hour trying to piece together the hours prior and she is becoming even more overwhelmed. Having to act as an EKG tech on one patient in the first hour prevented her from giving her other patients their medicines on time. She handled 2 patients crashing and she took 3 physician consultant calls.
Was it the pulmonologist or the endocrinologist that called back for room 18? Or was it the cardiologist for room 20? She just can’t remember. Was it Dr. Brown or Dr. Browning she spoke to? As she continues to rack her brain for the answers, a patient’s family sounds the nurse’s call button for assistance. She has to leave her desk again for more patient care, feeling even more defeated than before she sat down.
“How long can this go on?” she thinks to herself. Maybe I should take that position in the outpatient surgery center that her friend told her about. Can she get back to loving her job, or is she on her way to burnout?
What is Nurse Burnout?
Nurse burnout is a psychological syndrome comprising emotional exhaustion, a tendency to depersonalize client encounters, and a reduced sense of personal accomplishment. Burnout is especially more prominent in affecting the job performance of professionals that work with other people in challenging situations such as nurses in hospitals and other medical settings. [1] External factors such as long shift hours, high patient workload, large amounts of administrative burden, and intrapersonal relationships can make a large impact on the level of burnout that a nurse may experience.
The Link Between Poor EHR Usability and Burnout
A recent 2021 study showed that nurses who worked in hospitals with poorer EHR usability had significantly higher odds of burnout, job dissatisfaction and intention to leave. The study also showed that surgical patients treated in hospitals with poorer EHR usability had significantly higher odds of inpatient mortality and 30-day readmission. [1]
High Nurse Demand Leads to Overwhelm
Another contributing factor to burnout is the growing demand for nurses. The U.S. Bureau of Labor Statistics projects that employment for registered nurses will grow by 12% between 2018- 2028.[2] Although this is a good thing for future nurses looking for a job, the pace of the increase has led to “growing pains” such as overwhelmed nurses, unstaffed hospitals and other healthcare centers, and nurse burnout.[3] It is noted now that as many as 70% of long-term care facilities are dangerously understaffed. [4] Data reported to the U.S. Department of Health and Human Services shows 11.8% of hospitals were experiencing a critical staffing shortage on April 10, 2021 alone and 13.9% of the hospitals expected a critical staffing shortage within a week. [2] Being understaffed has a serious snowball effect on the work environment such as affecting morale which in turn makes for an overall worsening patient care epidemic.
The Effect on Patient Care
The scenario above also exemplified how nurse burnout affects patient care — to be exact, burnout is significantly associated with worsening patient care. Examples of worsening patient care can be vast. One study showed there is a significant association between nurse burnout and UTIs and surgical site infections.[5] Another study showed that nurses who work 12-hour shifts show nearly 3 times higher risk of medical errors.[6] According to the CFNU as well, for every additional patient added to an average nurse’s workload, the rate of patient mortality increases by 7%![7] To make matters worse, another study showed that out of 587 hospitals that were reviewed, almost 2 out of every 5 nurses were burned out. The same study also found that every 10% increase in the hospital-level proportion of burned-out nurses was significantly associated with 12-20% increased odds in nurse-reported frequent adverse events including medication errors (16%), pressure ulcers after admission (19%), and hospital-associated central line infections (19%).[8]
Steps to Change How Nurse Burnout Affects Patient Care
System-Level Solutions
These are modifiable features within a nurse’s practice environment that are associated with nurse burnout, which are also all 5 subscales of the PES-NWI, the gold standard of assessing the state of nurse practice environments are[9]:
1. Nurse Manager Ability: Nurse leaders need to be supportive of the nurses and use mistakes as learning opportunities. A nurse leader also needs to remember the importance of praise and recognition for a job well done.
2. Leadership and Support of Nurses: Leaders need to give guidance and support to their nurses. Implementing support groups and classes within the organization can help to reduce burnout.
3. Staffing and Resource Adequacy: Reducing the 12- hour shifts to 6, 8 or 9 can help nurses to stay focused and engaged while working. Removing “mandatory overtime” and reducing the nurse-to-patient ratio as well can help reduce the stress of nurses.
4. Nursing Foundations for Quality of Care: Implementing active in-service/ continuing education programs for nurses and active quality assurance/improvement can help to give high quality of care to the patients.
5. Nurse Participation in Hospital Affairs: It is vital for hospital leaders to collaborate with their nurses and other healthcare professionals to address burnout. Giving nurses the ability to serve on hospital committees and offering career development/ clinical ladder opportunities will help to bring morale to the organization.
6. Collegial Nurse-Physician Relations: There needs to be constant teamwork and collaboration between nurses and physicians so they can give the highest quality patient care possible.
It is important for hospital leaders to access nurse burnout on the organizational level. Hospital leaders must invest in resources to implement targeted interventions with a specified time frame and then be able to re-evaluate the extent of burnout levels with changes in existing measures that already exist such as cost, performance, and safety outcomes. Looking at the reasons that cause burnout among nurses such as long hours and the added administrative tasks and investing in pilot programs such as reducing shift hours to 8 hours or implementing a scribe program for nurses for a specified time frame will help to see what is truly a necessity and not just what was once thought to be a luxury.
Individual Preventive Measures
1. Take Breaks from Work: Ensuring nurses take their vacation days is important to relax and regroup especially in hospital settings.
2. Learn Coping Methods: One major way to help with stressors in life and work is by learning to utilize coping skills. A few examples of coping methods, while working, are deep breathing, counting from 10 to 1, and stretching.
3. Self-Care: Self-care routines are important to regroup and stay focused in life. Self-care routine examples can be as simple as taking time for yourself and doing the things you like to do such as bike riding, gardening, reading a book, taking a bath, exercising, visiting with friends and family, or as silly as watching cute animal videos on Youtube. Another example of self-care is to ensure you have enough sleep each day. Utilizing tools like the bedtime mode on your phone will help you to be notified when you should head to bed and silence your phone while “sleeping” so you can have the most restful night possible.
It will take a collective approach to combat nurse burnout. Healthcare leaders, physicians, allied health professionals, and nurses must all work together to promote a robust healthcare system for the patients and for themselves.
Written by: Nicole Bramblett, MHA
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908908/
[2] https://www.usa.edu/blog/nurse-burnout/#_ftn1
[3] https://www.usa.edu/blog/nurse-burnout/
[5] https://www.ajicjournal.org/article/S0196-6553%2812%2900709-2/abstract
[6] https://www.netce.com/coursecontent.php?courseid=2153&works=true#bibl.workscited.99
[7] https://www.mywellbeingindex.org/blog/how-nurse-burnout-affects-patient-care
[8] https://repository.upenn.edu/cgi/viewcontent.cgi?article=5366&context=edissertations