EBP: Nurse Stress/Burnout

Productivity &

safety/quality

of patient care

Nurse-patient

relationship

LITERATURE REVIEW

P - Nurses

I - Stress

C - Stressed nurses vs. well coping nurses

O - Decreased quality of care for patients

Team Ro!

VGH CP9/10 Spine/Cardiac Acute Surgery

Definitions

GOAL

Stress

• Qualitative study
• 8 articles
• limitations

Outline

An experience a person is exposed to through a stimulus or stressor.

Nurse Stress/

Burnout

Reflection

Burnout

a state of emotional, mental, and physical exhaustion

vs.

Productivity

• introduction
• reflection
• literature review
• implications for practice
• recommendations for practice
• conclusion
• questions

the ratio of output (patient care hours per patient day) to input (paid salary and benefit dollars) (NCBI, 2002).

Aware

Address

Quality of Care

Demonstration

the ability of a healthcare provider to provide services for patients that increase the likelihood of desired health outcomes (RWJF, 2012).

Anne Dawatis

Genesis Rigor

Miguel Clemente

May German

Kenny Wong

Sara Tonooka-Chong

Stefanie Paludetto

Chloris Zhang

&

Quality of Care

Hypothesis

Nurses experiencing stress provide decreased quality care for patients

Quality of Care

Stress/Burnout

is perceived from:

associated with:

• Nurses' Perspective

Topics

eg. increases in emotional exhaustion, delayed patient care

• time pressure (Teng, Hsiao, Chou, 2010)
• stressful workload
• adverse work environment

• Patient's Perspective

e.g. assurance, reliability/accountability, responsiveness, empathy, and tangibles of their nursing care

↑Increased stress/ burnout level

Increased stress/ burnout level

Themes

Keeps us healthy

mentally

IMPLICATIONS IN PRACTICE

emotionally

physically

Literature

Group

Stress Management

productivity &

stress

Daily Stresses....

School

Work/ Finances

Home

Relationships

Extracurricular

activities

that can affect us now, and will continue to have an impact in our future nursing practices as we become RNs

Student Stressors

Clinical practice

• increased absenteeism & turnover rates

(Freshwater & Cahill 2010)

• Inability to complete tasks in a timely manner

(Letvak, Ruhm & Lane 2011)

• feeling pressures of stress and need awareness of effects
• need to know job security, sick/vacation days, and adequate staffing
• need to know services and options available for us

Questions/Thoughts

GOAL!!

FINAL THOUGHTS

CONCLUSION

• Reflection of effects in practice

???

• Literature Review

RECOMMENDATIONS

1

2

productivity,

patient safety,

nurse-patient relationship

Addressing work overload

Improved

Quality

of Care

Addressing the nurses health and well-being

stress/ burnout

decreased quality of care

How will YOU improve your quality of care?

• Implications in practice

• Policy reform:
• patient-nurse ratio
• turnover & patient movement
• demographics
• Adequate staffing
• Education and resources
• Delegation

• Survey Results from RNs

Group

Literature

safety/

quality of care

• Recommendations

Billeter-Koponen, S., & Fredén, L. (2005). Long-term stress, burnout and patient–nurse relations: qualitative interview study about nurses' experiences. Scandinavian Journal of Caring Sciences, 19(1). 20–27. doi: 10.1111/j. 1471-6712.2005. 00318.

Freshwater, D., & Cahill, J. (2010). Care and compromise: developing a conceptual framework for work-related stress. Journal of Research in Nursing. 15(173). doi: 10.1177/1744987109357820

Letvak, S., Ruhm, C., & Lane, S. (2011). Impact of nurse's health on productivity quality of care. The Journal of Nursing Administration. 41(4). 162-167. doi: 10.1097/NNA.0b013e3182118516

Linzer, M., Manwell, L. B., Williams, E. S., Bobula, J. A., Brown, R. L., Varkey, A. B., Man, B., McMurray, J. E., Maguire, A., Horner-Ibler, B., & Schwartz, M. D. (2009). Working conditions in primary care: physician reactions and care quality. Annals of Internal Medicine. 151(1). 28-36.

Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2010). Nurse burnout and quality of care: Cross-national investigation in six countries. Research in Nursing & Health, 33(4), 288–298. doi: 10.1002/nur. 20383.

Teng, C., Hsiao, F. J., & Chou, T. A. (2010). Nurse perceived time pressure and patient perceived care quality. Journal of Nursing Management 18(3), 275–284. doi: 10.1111/j.1365-2834.2010.01073.x

Teng, C., Shyu, Y. L., Chiou, W., Fan, H., & Lam, S. M. (2010). Interactive effects of nurse-experienced time pressure and burnout on patient safety: A cross-sectional survey. International Journal of Nursing Studies. 47(11). 1442-1450.

Williams, A. M., (1998). The delivery of quality nursing care: a grounded theory study of the nurse's perspective. Journal and Advanced Nursing. 27(4). 808-816. doi: 10.1046/j.1365-2648.1998.00590.x

Productivity

Nurse-Patient Relationship

addressing health and well-being

addressing work overload

Nurse’s Perspective

• Supports in place and accessible
• Policy reform: # of hours for sick days evaluated
• Education through in-services

The End.

Safety/Quality of

Patient Care

• time-off and take breaks during shift
• address workload to decrease OT

• Increased absenteeism and turnover rates

• Unable to complete task in timely manner and/or inability to physically provide care

Timeframe: Ongoing

• sick days/ day-off
• monitor own health
• when to say “no” to working

• Increased risk for medication errors
• Decreased reaction time during emergencies
• Impaired decision-making process
• Selective focusing
• Self focus
• Needs focus
• Patient focus

• Communication

• Task oriented

• Less “presencing”

• Less empowered

Time frame: Ongoing

CRNBC Professional Standards for Registered Nurses and Nurse Practitioners

• standards of practice: ensure safe, quality care
• practice client centered care and safety
• aware of stressors effect on safety/patient quality of care, and how to manage it
• may be patients one day

Nurses’ perspective:

• increased med errors & impaired decision-making
• Selective focusing: Self focus, Needs focus & Patient focus

Patients’ perspective:

• Reliability/ Accountability
• Responsiveness
• Assurance

(Teng, Hsiao & Chou 2010)

Standard 1 - Responsibility and Accountability

“Is accountable and takes responsibility for own nursing actions and professional conduct”

“Take action to promote the provision of safe, appropriate and ethical card to patients”

Standard 2 - Specialized Body of Knowledge

“Use relationship and communication theory appropriately in interaction with clients, colleagues and others”

Standard 3 - Competent Application of Knowledge

“Collects information on client status from a variety of sources using assessment skills, including observation, communication, and physical assessment”

Standard 4 - Code of Ethics

“Providing safe, compassionate, competent and ethical care”

Standard 5 - Provision of Service in the Public Interest

“Reports unsafe practice or professional misconduct to appropriate person of body”

Standard 6 - Self-Regulation

“Maintain own physical, psychological, and emotional fitness to practice”

IMPLICATIONS

Standard 6: Self-Regulation

Patient’s Perspective

• Reliability/Accountability
• Responsiveness
• Assurance

"Maintains owns physical, psychological, emotional

fitness to practice."

Survey Results from the Nurses

Group

Literature

Physical/mental health

nurse/patient relationship

How does stress/burnout affect

your nursing practice?

Decision making

Communication

Timeframe:

In-service for new hire’s until policy reform info received

Education on regular basis

• client centered practice!

• develop a positive relationship with our patients

• quality and time spent on communication decreased
• Less caring and presencing
• Patients feel less empowered

(Billeter-Koponen & Freden 2005)