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Nurse Burnout

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Jenelle Elm

on 28 February 2011

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Transcript of Nurse Burnout

At the end of this class the learner will:
1. Assess personal risk for burnout.
2. Distinguish among the fours stages of burnout.
3. Value the importance of preventing burnout.
4. Predict burnout given a situation.
5. Recommend a strategy for dealing with burnout given a situation.
6. Examine the implications of nurse burnout

Nursing Patients Healthcare The Recession
Nurses postponed retirement
Part-time nurses are now working full-time to make ends meet
Hospitals have instituted hiring freezes to help keep costs down
Nurses with experience hired before new grads (costs less) Implications What is Burnout? Learning Objectives

Usually a reaction to an immediate or specific traumatic situation. Nurse still cares about her work/patients. A form of PTSD.

Precipitated by isolated or situational instances

Related to factors in personal life or biochemical imbalances Burnout vs
other clinical entities When "results, rewards, recognition, and relief are not forthcoming the groundwork is being laid for burnout." (Gorkin, 2008). Causes &
Risk Factors Work Environment Demographics

Younger age (more idealistic, susceptible to the "eat their young" phenomenon)

Early in career (first 1-5 years)

Lack of life partner or children

Higher level of education (higher expectations) Personality Traits

Low self-esteem or confidence
No recognition of personal limits
Need for approval
Need for autonomy
Unrealistic expectations
Personality D Symptoms Exhaustion,
Lack of energy
Musculoskeletal symptoms
Respiratory illness
Gastrointestinal disorders
Cardiovascular conditions
Skin problems
Inability to concentrate
Lack of motivation
Low morale
Addictive behavior (Alexander, 2009) Nurse is emotionally detached and withdraws from patients, coworkers, and the organization.
Numb and cynical.
Sick calls and periods of absenteeism increase.
Nurse contemplates leaving profession.

"I'm damned if I do...damned if I don't " Stages
of Burnout (Edelwich & Brosky, 1980) Wait......it does not have to be that way!!! Instead of perceiving certain events as threatening or difficult, they should be seen as challenges and opportunities for growth.

Proper sleep
Good nutrition
Identify and maintain priorities
Plan vacations
Hobbies/Other interests
Maintain Sense of humor
Recognize limitations
Seek emotional support from family
Maintain network of friends
Engage in spirituality
Professional therapy Set realistic goals

Impersonalize negative interactions/situations

Take breaks (even short ones)

Ask for help

Become an advocate

Build work relationships

Grieve well

Enhance communication skills Stress Management
to Prevent Burnout (Alexander, 2009) Personal Professional How often do you:

1. find yourself with insufficient time to do things you really enjoy?
2. wish you had more support/assistance?
3. lack sufficient time to complete your work most effectively?
4. have difficulty falling asleep because you have too much on your mind?
5. feel people simply expect too much of you?
6. feel overwhelmed?
7. find yourself becoming forgetful or indecisive because you have too much on your mind?
8. feel powerless to improve work conditions?
9. feel you have too much responsibility for one person?
10. feel exhausted at the end of the day?


almost always- 4 often- 3 sometimes- 2 almost never- 1 Danny is a 24-year-old RN, who has been working on a very busy medical/surgical floor for 1 year now. His friends would describe him as a perfectionist and very compassionate. His colleagues see him as efficient, reliable, and precise in his care. It is a Friday morning and the floor is full, as usual. Two coworkers call out sick again. The charge nurse changes the assignment and Danny's patient load increases from 5 to 8. This has been a growing trend over the past 5 months that he starts his shift with 7 or 8 patients. After report he realizes that he has the highest acuity of patients in comparison to the other nurses' assignments. He feels overwhelmed by the amount of work he has to do but tells himself he can handle it so he does not ask for help. He is beginning to get a headache over the daunting workload ahead of him and skips a break because he feels too busy to eat.

His day is very demanding at the end of his shift he feels exhausted and frustrated. He has worked 12 hours and has not taken a break. He finally sits down for the first time to give report and noticed he forgot to check a blood sugar. The other nurse is annoyed at his oversight, and this makes Danny feel like a bad nurse. On his way out the door, he hears the charge nurse say to another nurse "we already have two call outs for tomorrow, it's going to be another glorious day on the east wing." Danny's stomach starts to burn.

1. Is Danny at risk for burnout?
2. Why is he at risk?
3. What are three recommendations (include personal and professional) that you make for him to manage/prevent burnout? Psychological Assess your stress Hardiness (Maslach, 2003) Case Studies Mike is 29 years old and has been a nurse for 3 years and works on a surgical step-down unit. He prides himself on being a good nurse and feels he does quality work. Over the course of the 3 years he has worked there, budget cuts have deteriorated the resources he was used to having when he started. The 16-bed unit now has only 2 functioning thermometers, the linen cart always seems empty, and the doppler to check pulses is missing. Mike is frustrated that he cannot do his job properly and has become increasing more irritable at work and often snaps at his coworkers. He comes home and complains to his family that he does not feel he is doing a good job anymore or making a difference.

One year later, Mike is still at the same job and has no desire to take care of patients anymore. He is in Mrs. White's room to draw her blood and tries to open the bedside cart and finds it is broken and does not open. He goes to another room, gets supplies, and comes back to draw Mrs. White's blood. He does not make eye contact with Mrs. White and while she is trying to make conversation with him, he says "I can't concentrate, do you mind not talking right now?"

1. Is Mike at risk for burn out?
2. Why or why not?
3. What are three recommendations (include personal and professional) that you make for him to manage/prevent burnout? Maryann is 23 years old and has been a nurse for 1 year. She has been working on a pediatric orthopedic floor since she gradated school and loves working with children. Her friends describe her as energetic, dedicated, and eager to please people. She wants her other, more experienced coworkers to like her, so she tends to do favors for them even when they are not busy. She values their opinion of her and wants them to think she is a good nurse. A few of her co-workers take advantage of Maryann and when she asks if they need help, they ask her to do tasks they do not feel like doing. Maryann started to realize a few months that she has been doing patient care for other nurses while she finds them talking on their phones or sitting down checking their Facebook.

A few months later, Maryann started to get headaches at work and had difficulty sleeping. She was constantly worried she was not as smart or as good as the other nurses. She would come to work tired and found it difficult to keep up with her patients needs. Her manager approached her the other day about doing a project for the leadership committee because another nurse went out on maternity leave. Maryann does not want to disappoint her manager, so she agrees even though she does not have any energy when she goes home. Maryann's headache has been getting worse and she started having two or three glasses of wine at night to help her sleep.

1. Is Maryann at risk for burn out?
2. Why or why not?
3. What are three recommendations (include personal and professional) that you make for her to manage/prevent burnout? Nancy is 27 years old and is a new graduate with a BSN. She was recently hired to work on a medical/surgical unit. She always knew she would end up in a helping profession. Nursing seemed like the perfect choice because it combined her natural curiosity about health and science with the hands on, human interaction of bedside care. She also knew that nursing offers a great deal of flexibility within the profession, like changing specialties, shifts, and work settings.

Five years later, she is still on the same medical/surgical unit. It frustrates her that she is responsible for so much more than her nursing responsibilities. She is constantly paging and chasing down doctors for orders that were not placed correctly and for things that they missed during their rounds. She also finds it annoying that even though she knows what her patient needs, she still has to wait for a physician’s order. This is because administrators made it a policy that RN's can only take physician verbal orders in an emergency. She also did not expect to do the jobs of housekeeping, maintenance, social work, dietary, and physical therapy. She thought she would have enough time to give thorough and complete care for all of her patients. But, the pressure of discharging patients and admitting new ones prevents her from doing so.

Nancy usually ends up staying late after work to complete her charting, which sometimes takes over an hour. She is exhausted on her days off and has stopped going to the gym because she is too tired. She feels like she cannot be successful in this profession and is thinking about changing careers.

1. Is Nancy at risk for burn out?
2. Why or why not?
3. What are three recommendations (include personal and professional) that you make for her to manage/prevent burnout? Baccalaureate-prepared RNs have a higher risk of burnout than those with associate degrees. Nurses with higher levels of licensure and education degrees usually have high expectations for work satisfaction. Burnout usually occurs in the first 1 to 5 years, which causes young, burned out nurses to leave the profession. Research shows 20% of registered nurses will experience burnout in their career and consequently leave the profession. A survey of 120,000 nurses who left the profession found that 45% left from stress and burnout Research conducted by individual organizations found that turnover rates for new graduate nurses is between 22% and 60%. Burnout has been linked to low nurse retention, high turnover, low patient satisfaction, and reduced patient safety. When nurses perceive that their work institution supports professional practice, they are more likely to be engaged in their work, which has been shown to create safe and high-quality patient care. Patients rated their quality of care the lowest on units where nurses felt exhausted or frequently expressed a desire to quit. Nurses with higher levels of burnout rated their quality of patient care as poor. There is a direct relationship between adequate nursing staff and lower patient mortality levels, lower failure to rescue rates, and shorter length of stay. Adequate nurse staffing levels were significantly related to lower patient fall rates, better pain control, decreased medication errors, and fewer nosocomial infections. The cost of hiring and orienting a newly licensed registered nurse is estimated to be between $42,000 and $64,000. The cost of burnout among staff includes increased employee absenteeism, turnover, decreased performance, and difficulty in recruiting and retaining staff. Despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to be anywhere from 300,000 to 800,000 RN's by 2020. The average annual turnover rates for RNs employed by hospitals is 14%. The average cost of replacing an RN ranges from $22,000 to $64,000. This cost includes nurse recruitment, agency/traveling nurses to fill vacancies, mandatory/excessive overtime, and reduced productivity. A study found that 13% of newly licensed RNs had changed primary jobs after one year, and 37% reported that they felt ready to change jobs. A state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations. (Pines & Arnson, 1988) Progressive loss of idealism, energy, and purpose as a result of the condition of their work (Edelwich, 1980). Described by some nurses as "not having the energy to do the things you know you can and not enjoying the work you used to love to do" (Selder & Paulstian, 1989). Burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment (Maslach, 1982). Physical New nurse is full of energy, idealistic, works super hard, and the job promises to be everything.

"I'm going to improve the lives of so many people and I am excited to be a member of this great organization." Nurse realizes the discrepancies between expectations and reality.
Idealistic goals are reduced to simply completing tasks.
The nurse starts to cut corners so tasks done on time.

"I can't get Mr. Smith out of bed today and I am not staying late. He can dangle on the side for a few minutes instead." Nurse feels disappointed with the job. Feelings of powerlessness and hopelessness develop.
Professional goals are no longer important.
External factors play a negative role.
Physical, mental, and emotional symptoms become present.

"My back is killing me, maybe if this place would hire more nurses I would not have to break my back all the time." Apathy Enthusiasm Stagnation Frustration Jenelle D. Elm How do some nurses remain compassionate and enthusiastic ? Hardiness
key! You can't always influence what happens to you but you can influence your choices, actions, & reactions. Kobasa, 1988 Commitment means having a purpose to life and involvement in family, work, community, social, friends, religious faith, ourselves, which give us meaning to our lives. The key is balance. Studies have shown that how much control we perceive we have over any stressor will influence how difficult the stressor will be for us to cope with.

Internal Locus of Control

External Locus of Control Commitment Control Challenge When the going gets tough,
the tough plan a vacation Last part...
time to relax! Stress Compassion
fatigue Depression Result of prolonged stress Develops over a longer period of time. Nurse becomes uncaring and distant. Related to specific factors in the work setting Burnout Burnout Burnout 25 to 40 points indicates a high risk for burnout. Work overload: Limited staff, time, equipment, and other resources
Lack of control: Lack of autonomy, powerless to make changes, unable to influence decisions that affect nursing. Insufficient reward: Absence of acknowledgment, appreciation, or lack of opportunities to advance Absence of community: Lack of peer cohesion, difficulties with nurse-physician interactions, and inadequate administrative support
Lack of fairness :
Inequality in workload, salary, or professional respect Lack of respect:
Poor nursing image,
media stereotypes,
not being treated as professionals by others Out of 10,000 nurses, 54% said they were burned out. A look at burnout Prevention &
Management (Health Resources and Human Services, 2006). (Aiken et al, 2002) (Hall, 2004) (Whitman et al, 2002) (Orsini, 2005 & Mills & Mullins, 2008) (Halbesleben et al, 2008) (Wharton, 2004) (Najjar et al, 2009) (Lang et al, 2004) (Vahey, 2002) (Poghosyen, 2010) (Agency for Healthcare Research and Quality, 2007) (Halbesleben et al, 2008) (PricewaterhouseCoopers, 2007) (Vahey, 2004). (Buerhaus et al, 2009) (Jones, 2005) (Kovner, 2007) (ONA, 2008) How could this
possibly cause
burnout? Conflicting values:
When job responsibilities
conflict with personal beliefs
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