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Nurse Managers and Their Role in Burnout

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Sean Herrin

on 19 April 2013

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Transcript of Nurse Managers and Their Role in Burnout

What is Burnout? Mentorship Programs Regulate Work Hours Transformational Leadership Spence Laschinger, et al. (2009) Empowerment Conclusion Critical Thinking Recognize signs and symptoms of burnout Lee & Akhtar, (2011) Social Support Theory
Peterson & Bredow, (2012) Get on the same page Gormley (2011) Burtson and Stichler (2010) suggest that. “Mentorship programmes should incorporate methods of decreasing compassion fatigue in the hope of preventing burnout among newly hired nurses.” “Health care facilities can avoid preventable patient mortality and low nurse retention rates by investing in RN staffing.” Kanste (2008) also addresses leadership styles of nurse managers and found that transformational leadership is an evidence based leadership style that works exceptionally well in nurse settings. Zori, Nosek & Musil (2010) The ability of the nurse manager to promote a healthy, supportive work environment is also key to preventing burnout.

The Social Support Theory addresses structure and interaction in relationships. Nurse Managers and Their Role in Nurse Burnout Sean M. Herrin
Piedmont College “Nurses burn out when they mourn the loss of the reasons for which they viewed nursing as a viable profession” (Williams, 2012). P – Nursing managers and their staff nurses who face emotional exhaustion and burnout

I – Educating the nurse manager in order to help protect the staff from burnout

C – Nurse managers without managerial education in supporting employee morale and utilizing the Systems Support Theory

O – Nurse managers acquire managerial education in protecting staff nurse PICO Statement Social Support Theory

This theory addresses structure and interaction in relationships. I will use this theory and focus the interventional levels.

- Individual: How an individual perceives support provided by others (staff nurse)

- Dyadic: Strengthen support from a key member (nurse manager)

- Systems: Promoting policy and structural changes to increase social support in environments and/or remove barriers to social support Nursing Theory Maslach (1981) states burnout has three components, “emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment”. Burnout - exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.

http://www.merriam-webster.com/dictionary/burnout Literature Search Databases: CINHAL, EBSCOHost

Keywords: burnout, nurse manager, nurse burnout, leadership, preventing burnout, nurse turnover, work environment, job dissatisfaction Level 1 Level 2 Level 3 Hertel (2009) discusses three levels of burnout: Burnout At level one, the signs and symptoms
of burnout are relatively mild, short in duration, and tend to occur on an infrequent basis. If this stage is not recognized and steps taken to avoid progression, the nurse can advance to level two, where the symptoms become more prevalent, tend to last longer, and are more difficult to overcome. Symptoms become more prevalent, tend to last longer, and are more difficult to overcome. Level 2 is where minor stress becomes distress. By the time physical or psychological illness has presented itself, the
nurse has progressed to level three. Here, the symptoms have become chronic and affect the well-being of the individual. Signs and Symptoms At this level, the nurse is likely to experience
mental fatigue, feelings of being unappreciated, and physical symptoms such as headaches, backaches, and an upset stomach. - Signs and symptoms are more pervasive and have the potential to become chronic.

- Tendency to lose sense of idealism

- Disillusionment with work and the profession seems to surface on a more regular basis.

- Loss of interest in nursing and a sense of stagnation for periods of a month or longer.

- Patients become viewed impersonally Signs and Symptoms Signs and Symptoms - No longer able to attune to patients needs and feels irritation instead.

- Can no longer judge their own work.

- Effects are felt outside of work

- Inability to feel refreshed by personal life. Why is this important to the Nurse Manager? - Patient Care

- Cost Christina Maslack Cimiott, Aiken, Sloane, & Wu (2012) Correlation between burnout and occurrences of urinary tract infections and surgical site infections - Significant association between patient-to-nurse ratio and urinary tract infection and surgical site infection - Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections - Annual cost saving of up to $68 million Halbesleben, Wakefield, Wakefield & Cooper (2008) "In situations where the demands of the job are so great as to cause burnout, it may leave little opportunity for health care workers to monitor their environment so that they might notice medical errors occurring”. Hertel (2009) Causes - High number of distressed patients

- Demanding patients with sense of entitlement

- Large patient load

- Paperwork impeding patient care

- Guilt about personal needs

- Inability to change

- Lack of criteria for for measuring personal accomplishments Aiken, Sloane, Clarke, Poghosyan, Cho, You, Finlayson & Kanai-Pak (2011) Focused on the work environment as the biggest factor - Staffing-resource adequacy
- Nurse manager ability and leadership
- Nurse-physician relations
- Nurse participation in hospital affairs
- Nurse perception on quality of care. WHAT THEY FOUND:

- "a pronounced and remarkably consistent effect of the work environment” on all of the measured nurse and patient outcomes in every country involved in the study, “ - Employment in a hospital with a better work environment was associated with decreases in the odds of reporting high burnout across the nine countries. - Employment in a hospital with a better work environment as opposed to a poor one was also associated with significant decreases in the odds of reporting job dissatisfaction in eight of the nine countries. Spence Laschinger, Leiter, Day & Gilin (2009) Examined the impact of empowerment, supervisor and co-worker incivility, and burnout on three outcomes:

- Job satisfaction - Organizational committment - Intentions to leave WHAT THEY FOUND:

- Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment

- Emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions” Garrett (2008) “The evidence indicates that inadequate nurse staffing leads to adverse patient outcomes and increased nurse burnout. Hospital administrators should invest in adequate nurse staffing to improve patient safety and increase nurse retention” and that “fatigue is a contributing factor for nurse absenteeism, burnout, and job dissatisfaction” INTERVENTIONS The most significant discrepancies in perceptions of the work environment between nurse managers and staff nurses were : - Unit decision making - Participative governance - Nursing manager - Job enjoyment One Questions: Do the perceptions and priorities I hold match that of the staffs perceptions and priorities? “It is important for managers to understand how staff nurses perceive the work environment as these perceptions may affect nurses’ intentions to leave the organization”. “As a mediator, emotional exhaustion plays a key role in the onset of burnout.” The first dimension is the individual and how they perceive support provided by others. Not all people need the same kind of support. The second is dyadic; the strengthening of support from a key member, specifically the manger. The third and final dimension addressed by the Social Support Theory is systems. The systems aspect can be met by promoting policy and structural changes to increase social support in environments and/or remove barriers to social support. Several studies have shown that sufficient social support from the supervisor protects nurses from burnout. Kanste (2008) claims the work environments with the lowest levels of nurse burnout have good support and feedback, job clarity, and autonomy with managers who possess a social leadership style that addresses well-being and job satisfaction. The systems aspect can be met by promoting policy and structural changes to increase social support in environments and/or remove barriers to social support. "Transformational leadership and the quality of clinical supervision have shown to be related to low emotional exhaustion and depersonalization among staff." Four organizational empowerment structures: - Access to information - Access to support - Access to necessary resources - Opportunities to learn and grow “Numerous studies have established links between structural empowerment and important organizational attitudes and behaviors, including job satisfaction, commitment, productivity, and burnout”. Garrett (2008) Although the number of staff available to the unit is largely out of the hands of the nurse manager, Garrett (2008) encourages them to: - Respect nurses breaks (days off, vacations, lunch). - Respect the nurses ability to leave at the end of their shift. - Respect their right to refuse to overtime without retribution. Overtime? No thanks. This is my day off. Another interesting finding was a study in which the authors looked at the relationship between the nurse manager’s critical thinking skills and the staff perceptions of the work environment. The researchers measured critical thinking skills using the California Critical Thinking Disposition Inventory in 12 nurse managers. The staff nurses perception of practice environment was measured using the Practice Environment Scale. They found that there was a positive correlation between the two. “Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs’ perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs." “The fact that burnout is so pervasive is not a surprise, but the far-reaching ramifications should be enough to startle nurses, supervisors, and facility administrators into action”. Hertel (2009)
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