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Grand Rounds: Nursing Burnout

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Jenny Baker

on 13 November 2014

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Transcript of Grand Rounds: Nursing Burnout

Nursing Burnout
PICO Question
Literature Review
Level of Evidence
Defining Burnout:
A syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment

Contributing factors to nurse burnout:
High patient-to-nurse ratios
Extended work shifts
Lateral violence

Reasons to eliminate burnout:
Increased job satisfaction and decreased turnover
Improved patient outcomes and satisfaction
Improved physical and mental health for nurses

PICO Question
In hospital nurses, do nurses who work in environments where there is decreased staff, workplace bullying, and extended hours experience more nurse burnout and decreased quality of patient care, as opposed to nurses who work in opposite environments?
Literature Review
Patient-to-Nurse Ratio
Each additional patient per nurse is associated with a 23% increase in job burnout and a 15% increase in job dissatisfaction

Heavy workload is considered one of the biggest stressors for ICU nurses
Not enough time to finish tasks or provide emotional support to patients

Nurses involved in lower patient-to-nurse ratios have shown a reduction in:
Medical errors
Readmission rates
Job dissatisfaction
Decreased hospital costs
Extended Hours
Patient-to-Nurse Ratio
Nurses caring for <5 patients have the potential to:
Improve quality of care to patients
Enhance patient experience during stay

Mandatory nurse-patient ratios guarantee adequate staffing, thus:
Decrease workload and stress
Improve patient outcomes
Improve job satisfaction

Extended Hours
Nurses working rotating shift schedules have a lower incidence of burnout when compared to those working fixed shift schedules -
Lower rates of emotional exhaustion
Lower rates of depersonalization
Higher rates of personal accomplishment

Studies use large sample sizes

Majority of studies provide qualitative and quantitative data

This is a well researched issue and is a common issue among hospitals

Many of the studies are within a single region

Some frameworks do not take into account individual attributes (coping mechanisms and emotional support) of study participants

Many of the studies use self reporting measures, such as surveys

Program Goals
To properly identify factors that contribute to nurse burnout

To implement new practices in order to decrease nurse burnout

To increase staff satisfaction and reduce staff turnover

To increase patient satisfaction and quality of care

Levels of Evidence
Level A articles- 1
Level C articles- 4
Level D articles- 2
Form interprofessional teams to promote professional engagement and recognition
Establish a lower patient-to-nurse ratio
Mandatory laws and staffing committees
Restrict the number of consecutive hours nurses can work by accrediting bodies, such as the Joint Commission
Recognition of staff
Personalized feedback
Employee recognition system
Open communication amongst staff and management
Use teachable moments forms
Workplace Violence Programs
Burnout -
50% of ICU physicians and 33% of critical care nurses suffer from severe burnout syndrome

Patient-to-Nurse Ratios -
More than 75% of RNs believe short staffing impairs of the quality of work life and the level of patient care

Mortality rates were 6% higher on units that were consistently understaffed
One study indicated that 61% of RNs had reported experiencing at least 2 instances of bullying in the last 12 months
Of those nurses, the average level of burnout was over 50%

(American Association of Colleges of Nursing, 2014; Hughes & Jennings, 2008)
(American Association of Colleges of Nursing, 2014)
(Allen & Holland, 2014)
(Aiken, Sloane, & Sochalski, 2012)
(Sullivan, 2012)
(Aiken, Clarke, & Sloane, 2002)
(Aiken et al, 2002; Carayon & Gurses, 2004; Shahriari, Shamali, & Yazdannik, 2014; Cho et al, 2009; Tervington, 2011; Allen & Holland, 2014)
Aiken, L. H., Sloane, D. M. & Stimpfel, A. W. (2012). The longer the shifts for hospital nurses, the higher the
levels of burnout and patient dissatisfaction. Health Affairs, 2501-2509.

Aiken L.H., Clarke SP, Sloane D.M., Sochalski J, Silber JH. (2012) Hospital nurse staffing and patient mortality,
nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987.

Allen, B. C., & Holland, P. P. (2014). The effect of bullying on burnout in nurses: The moderating role of
psychological detachment. Journal Of Advanced Nursing, doi:10.1111/jan.12489

American Association of Colleges of Nursing. (2014). Nursing shortage fact sheet. Retrieved from http://

Carayon, P. & Gurses, A (2004). A human factors engineering conceptual framework of nursing workload and
patient safety in intensive care units. Intensive and Critical Care Nursing. 21(5), 284-301

Cho, S.H., June, K.J., Kim, Y.M., Cho, Y.A., Yoo, C.S., Yun, S.C., & Sung, Y.H. (2009). Nurse staffing, quality of
nursing care and nurse job outcomes in intensive care units. Journal of Clinical Nursing, 18, 1729-1737. doi: 10.1111/j.1365-2702.2008.02721.x

Chlan, L.L. (2013). Burnout Syndrome Among Critical Care Professionals: A Cause for Alarm. Critical Care
Alert(21)9, 65-72. Retrieved from http://www.ahcmedia.com/public/samples/CRC-Sample.pdf

Hughes, R. G., & Jennings, B. M. (2008). Work stress and burnout among nurses: Role of the work environment
and working conditions. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2668/

Laschinger, H., Grau, A. L., Finegan, J., & Wilk, P. (2010). New graduate nurses' experiences of bullying and
burnout in hospital settings. Journal Of Advanced Nursing, 66(12), 2732-2742. doi:10.1111/j.1365-2648.2010.05420.x

Shahriari, M., Shamali, M., & Yazdannik, A. (2014). The relationship between fixed and rotating shifts with job
burnout in nurses working in critical care areas. Iranian Journal of Nursing and Midwifery Research, 19(4), 360-365

Sullivan, E.J. (2012). Effective leadership and managemetin nursing (8th ed). Upper Saddle River, NJ: Prentice-

Tevington, P. (2011). Professional issues: Mandatory nurse-patient ratios. MEDSURG Nursing, 20(5), 265-268.
(Cho et al., 2009; Aiken et al 2002; Tevington 2011)
In hospitals in which a higher proportion of nurses work >13-hour shifts, higher percentages of patients reported that they would not recommend the hospital to friends and family and gave the hospital lower overall ratings

Patients in the hospitals with more nurses working long shifts reported that nurses:
Sometimes or never communicated well
Pain was sometimes or never well controlled and they
Sometimes or never received help as soon as they wanted
Bullying is associated with:
Higher levels of staff turnover
Decreased morale
Loss of productivity
Poor working relationships

Bullying causes psychological and physical damage
Impaired sleep
Diminished social skills
(Allen & Holland, 2014)
(Shahriari, Shamali, & Yazdannik 2014)
Nurses who work 12-13hr shifts are more likely to leave the job
44% of nurses who work 12-13hr shifts experience burnout compared to only 20% in nurses who work 8-9hr shifts
(Aiken, Sloane, Stimpfel, 2012)
(Aiken, Sloane, Stimpfel, 2012)
(Chlan, 2013)
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