Capstone Nursing Project

Running head: NURSE BURNOUT LITERATURE REVIEW Nurse Burnout Literature Review 1 NURSE BURNOUT LITERATURE REVIEW 2 Nurse Burnout Literature Review The review of literature will help to see how the PICOT question has been researched by other authors and the evidence that is available regarding the question. The PICOT question is: In patients who are hospitalized/SNF’s(P), how does reducing the number of hours nurses work per week(I) compared to an increase in overtime(C) affect nurses satisfaction towards their job and patients satisfaction with the nursing staff(O) during their stay(T). As such, the literature review aims to find out how the authors have researched the topic of nurses burnout and its effect on the job satisfaction as well as service rendered to patients. Research Questions Various articles tackling the issue of burnouts among nurses tackle different research questions. For instance, Dall’Oral et al. (2015) research the association between working long hours and burnouts and job dissatisfaction. Similarly, Stimpfell et al. (2012) compare long hours with burnouts, job dissatisfaction, and intention to leave jobs by the nurses. A different question researched in connection with the PICOT is the connection of nurse environments with the nursing outcomes due to burnout (Valley, et al., 2010). Stimpfel & Aiken (2014) research the connection between shift length, scheduling characteristics, and safety and quality. Of the four sets of authors two research identical questions regarding the connection of burnouts with job satisfaction while the other two research connected questions on scheduling and safety due to burnout. Further, Wisetborisut et al. (2014) simply research the relationship between shiftwork and burnout. The risks that long hours of work, poor sleep, and shift work cause to employees and patients are researched by Caruso (2013). This research is similar to Stimpfel and Aiken’s NURSE BURNOUT LITERATURE REVIEW 3 concerning the safety of workers as well as patients. Lockley et al. (2007) study the effects of long work hours for nurses on their safety and the errors that they make. The other research was by Canadas De la Fuente et al. (2014), and it assessed the prevalence of burnout. Most of the research questions seek to find the job satisfaction and safety related to burnouts. Also, the issue of prevalence of burnouts is viewed in the research articles. Sample Populations The authors use different sample populations, which make their studies varied and thus covering wide populations. Canadas De la Fuente et al. (2014), for instance, carry out their research in public health centers in Andalusia, Spain. Lockley et al. (2007) carry out their research across different hospitals in the U.S. Caruso (2013) carries out his study in the Midwest while Wisetborisut et al. (2014) undertake their research at Chiang Mai University Hospital, Thailand. Another area where the sample population is taken from is 577 acute care hospitals in four U.S states by Stimpfel & Aiken (2014). Valey et al. (2010) researched 20 urban hospitals across the U.S. The authors engage in different geological areas thus increasing the validity of their findings. Stimpfel et al. (2012) carried their quantitative research in four states, the same area that they further carried out a qualitative research. Finally, Dall’Oral et al. (2015) carried out their research in 12 general Med-Surg European hospitals. The sample populations taken by each of the researchers show diversity and the coverage of a wide area of study. For instance, among the eight sets of researchers, only one set carries out their research in a single location. The diverse set of the sample populations allows the researchers to explore the different populations. The most diverse population sample is the 577 acute care hospitals where Stimpfel and Aiken NURSE BURNOUT LITERATURE REVIEW 4 carry out their research.

Therefore, the PICOT research spread out in the U.S and parts of Europe and Asia presents compelling results. Limitations The research carried out by the different researchers provides a good basis for the PICOT study. However, there are various limitations to the studies that they carry out in the different areas. The first limitation observed is with Wisetborisut et al. (2014) whereby the research was carried out in only one hospital. The researchers carried out an online questionnaire research with employees from only one hospital thus reducing the validity of the results. The other limitation observed in the literature review is the use of cross-sectional study in the research (Caruso, 2013; Lockley et al., 2007). Although the cross-sectional research may have produced results from the population, the research is limited to the feelings of the sample population at that moment.

Therefore, it fails to validate the results over different atmospheres and time differences. Conclusion and Recommendations The analysis of the eight research articles allows the development of insight in the issue of nurse burnout and how it affects dissatisfaction as well as the risks that it presents. As such, it supports the PICOT study regarding the effects of long hours on the nursing burnout and the risks that they experience in the case of the burnout. Further research can be conducted on how to manage the shift work to ensure that nurses finish their work within a ‘safe’ period where they will not experience burnouts as they lead to increased risks and lower job satisfaction levels. NURSE BURNOUT LITERATURE REVIEW 5 The articles recommend that nursing working hours should be shortened to at most 12 hours per 24 hour day and 60 hours per week. Also, they come up with the recommendation that nursing environment be improved to limit the effects of burnout and increase the nurses’ efficiency in the working place. The training of managers is also necessary to avoid the work shifts that cause burnouts. The government should also be involved in setting a shift-hour limit. These articles form a proper basis for examining the PICOT question in focus. Further study in the appropriate means of reducing the shift hours and increasing safety can be done to assist in eliminating the burnouts. NURSE BURNOUT LITERATURE REVIEW 6 References Cañadas-De la Fuente, A. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240 – 249. DOI:http://dx.doi.org/10.1016/j.ijnurstu.2014.07.001 Caruso, C. (2013). Negative Impacts of Shiftwork and Long Work Hours. Rehabilitation Nursing; 39(1): 16–25. doi:10.1002/rnj.107 Dall’Ora, C., Grifitths, P., Ball, J., Simon, M. & Aiken, L. (2015). Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open 2015; 5: e008331. doi:10.1136/bmjopen2015-008331 Lockley, S., Barger, L. & Ayas, N. (2007). Effects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance. The Joint Commission Journal on Quality and Patient Safety, 33(11), 7-18. Stimpfel1, W., Sloane, W., and Aiken, L. (2012). The Longer the Shifts or Hospital Nurses, the Higher the Levels of Burnout and Patient Dissatisfaction. Health Affairs, 31(11), 25012509. doi:10.1377/hlthaff.2011.1377 Stimpfel, W. & Aiken, L. (2014). Hospital Staff Nurses’ Shift Length Associated with Safety and Quality of Care. Journal of Nursing Care Quality, 28(2): 122–129.

doi:10.1097/NCQ.0b013e3182725f09 Vahey, D., Aiken, L., Sloane, D., Clarke, S., & Vargas, D. (2004). Nurse Burnout and Patient Satisfaction. Medical Care, 42(2), II57–II66. doi:10.1097/01.mlr.0000109126.50398.5a NURSE BURNOUT LITERATURE REVIEW Wisetborisut, C., Angkurawaranon, W., Jiraporncharoen, R., & Wiwatanadate, A. (2014). Shift Work and Burnout Among Health Care Workers. Occupational Medicine, https://academic.oup.com/occmed/article/64/4/279/1464114/Shift-work- and-burnoutamong-health-care- workers 7 Running head: NURING BURNOUT Nursing Burnout Relates to Long Shift Hours 1 NURING BURNOUT 2 Nursing Burnout Relates to Long Shift Hours Nursing burnout has long been a problem in the healthcare industry. Nurses are the frontline of healthcare and have numerous numbers of tasks to be done and at the same time has increased liabilities. Many studies have been completed to try to determine what exactly causes nurses to become “burnt-out” and the problems that arise from it. Burnout, as defined by Maslach and Jackson is, “a syndrome characterized by emotional exhaustion, depersonalizations and a perceived lack of personal accomplishment” (Maslach and Jackson 2014).

As more and more nurses suffer from burnout, nurse and also patient satisfaction is going down. There are a lot of factors that contributed to nursing burnout, from inadequate staffing, working long hours, high demands from the job and verbal abuse that they get from the patients and maybe even other staff members.

Nurses are humans too, they can only handle so much, however hospitals and other healthcare settings have been utilizing nurses as much as they can for their profit. Due to working too many hours in a given week, there has been increase in nurses calling in sick, patient satisfaction ratings and quality of care has been going downhill, and nurse’s job dissatisfaction has been increasing (Dall’Ora, 2015). There has been an increase in medical errors and also less and less patient interaction has become a problem (Baker, 2011). This capstone project is aimed to find some causes and to formulate a recommendation to decrease nursing burnout in the hospitals, skilled nursing facilities and other health care facilities. This project is also aimed to determine a way to increase patient and nurse satisfaction by decreasing nursing burnout. NURING BURNOUT 3 Nurses experiencing burnout may have impaired attention, memory and critical thinking skills that is important to give a safe and effective patient care. “The cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene and lapses in other infection control procedures among registered nurses” (Cimmiotti et al, 2012). Diminished vigilance, cognitive function and increased safety lapses increases the risk for errors for nurses. They can develop negative attitudes towards patients and decrease interest in career improvement and personal development. It also brings poor decision making and poor interaction and communication with patients (Zimmerman, 2017). Studies show that nurses who work 12 hours shift is more likely to experience nursing burnout than those who work 8 hours shift (Stimple, 2013). There are some health care facilities that have been giving out bonus, incentives and spacing out nursing staff’s off days in order to give nurses the ample time to rest and recuperate after a long shift.

There are other health care facilities that have been hiring more nursing staff and as needed nurses to help alleviate the burnout and lack of staffing that may be present. The recommendation of hours of work per week a nurse should work should not exceed more than 54 hours and the patient to nurse ratio should not exceed 10 patients to one nurse. The Accreditation Council for Graduate Medical Education (ACGME) implemented rules limiting the work hours for all (physician) residents, stating that residents cannot work more than 80 hours per week or 24 hours in a row. This rule was set in place after a patient died due to a medication errors made by a physician working a 36-hour long shift (U.S. Department of Health NURING BURNOUT 4 and Human Services, 2016). This is something that should be implemented in health care field for all health care providers, including nursing staff. “Although some states have laws against mandatory overtime, voluntary overtime has no limits and nurses have reported feeling coerced into working late or taking extra shifts” (Stimpfel, Sloane, and Aiken 2012). This is a major contributor to the nursing burnout problem. To decrease this problem in health care, nursing staff should be allowed to work only a maximum 54 hours per week. NURING BURNOUT 5 References Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care–associated infection. American Journal of Infection Control,40(6), 486-490. doi:10.1016/j.ajic.2012.02.029 Barker, L.M. & Nussbaum M.A. (2011). Fatigue, performance, and the work environment of Registered nurses. Journal of Advanced Nursing, 76(6), 1370-1382. Capstone Nursing Project Doi:10.1111/j.13652648.2010.05597.x Burnout Among Health Professionals and Its Effect on Patient Saftey. (2016, February). Retrieved from http://psnet.ahrq.gov/perspectives/perpective/190/burnout-amounghealth-professionals-and-its-effect-on-patient-saftey Dall’Ora, Chiara, Peter Griffiths, Jane Ball, Michael Simon, and Linda H. Aikens. “Association of 12 h shifts and nurses job satisfaction, burnout and intention to leave: finding from cross-sectional study of 12 European countries.: BMJ Open. September 01, 2015. Received from http://bmjopen.bmj.con/content/5/9/e008331.info. Maslach, C., & Jackson, S. (1981). The Measurement of Experienced Burnout. Journal of Occupational Behaviour, 2(2), 99-113. Retrieved from http://www.jstor.org.libproxy.nau.edu/stable/3000281 Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs,31(11), 2501-2509. doi:10.1377/hlthaff.2011.1377 NURING BURNOUT 6 U.S. Department of Health and Human Services. (2016, July). Physician Work Hours and Patient Safety. Retrieved February 22, 2017, from https://psnet.ahrq.gov/primers/primer/19 Zimmerman, B. (2017, May 05). Capstone Nursing Project

Survey:70% of nurses report burnout in current position. Retrieved from http://www.beckershospitalreview.com/human-capital-and-risk/survey70-of-nurses-report-burnout-in-current-position.html Nursing Burnout Nursing Burnout Related to Long Shift Hours Nursing Burnout Nursing Burnout Related to Long Shift Hours Nursing burnout is a term that is difficult to explain or diagnosed due to the many, different changing factors involved in the word itself. There is no standard guideline or screening that can be used to determine whether an individual is experiencing burnout. The term was coined by a psychologist, Herbert Freudenberger, who stated that it was a condition that is most often experienced by public servants (Freudenberger, 2013). Nursing burnout does not only affect the nurse but also the patients they are sworn to care for. This condition affects the whole health care system due to the fact that nurses are an integral part of care from time of admission to time of discharge. Public servants, like nurses, experience this condition because they are constantly under pressure to perform during high levels of stress and to exhibit high level of ideals expected from them by the community. In patients who are hospitalized/SNF’s(P), how does reducing the number of hours nurses work per week(I) compared to an increase in overtime(C) affect nurses satisfaction towards their job and patients satisfaction with the nursing staff(O) during their stay(T). Nursing burnout occurs due to the amount of hours and workload that a nurse is put under without having the adequate time to recover. Capstone Nursing Project

Nurses often have to work in these conditions because of the high nurse to patient ratio given to them by the facility they work for. Facilities often do not have adequate staffing that causes nurses to work longer than their shift entails or sign up for a shift they are suppose to be off. Mandatory overtime is also an issue that is a current practice in some states. In Arizona, 15% of nurses working in hospital settings are required to work mandatory overtime (Mandatory Overtime, 2012). This can lead to nursing burnout and will have different products. Nursing burnout will lead to nurses calling off during Nursing Burnout shifts, high turnover rates, higher nurse to patient ratios for other nurses, and/or substance abuse. The patients are affected as well if they are under the care of a nurse experiencing exhaustion. The patients are more at risk for not receiving the adequate care they need and and an increased risk of medication/care error when the critical thinking of the nurse is impaired. This can affect the nurse physically and mentally. A nurse working more hours than recommended can neglect nutrition due to the fact that by taking a break, it can put them behind during their shift, therefore, risking not finishing their assignment by the time they need to punch out of their shift. A nurse can also neglect exercise because by the the end of their shift they are exhausted and sleep is what their body needs. Mental exhaustion also occurs and this can alter their critical thinking and response during certain events. A mentally exhausted nurse can make medication errors or poor judgment that can put the lives of their patients in jeopardy. Some mentally exhausted nurses can also turn to substance to help cope with the high levels of stress the are experiencing. Capstone Nursing Project

Substances affect the critical thinking of nurses and therefore more susceptible in making an error while providing care. There are many proposed solutions to combat nursing burnout. The main suggestions include shortening shifts, decreasing nurse to patient ratio, increasing staff pool, and having a set amount of hours a nurse can work during the week. Shortening the shift can allow the nurse to be more efficient throughout the day, reducing near misses or errors during the care they provide to the patient. Decreasing nurse to patient ratio is also helpful as this can decrease the emotional stress the nurse experiences during the shift. Being part of the life of the patient can lead to mental exhaustion as the nurses are also undergoing the troubles the patient is going through. Facilities also need to provide debriefing for nurses to evaluate what happened during events. This allows the nurse to verbally relay how they are feeling and what they need after going Nursing Burnout through such an event. Increasing the size of the staff pool can also help as a nurse would not be required to taken on unnecessary overtime because there are designated nurses who can pick up the workload. There are agencies advocating for nurses to help prevent nursing burnout. One of the organizations is the American Nurses Association (ANA). Capstone Nursing Project

ANA is advocating for adequate nurse staffing (Nurse Staffing, 2015). They want to ensure that a nurse receives the proper support they require for the facilities they work for. Another organization advocating for nurses is the National Nurses United. This organization is demanding facilities to give nurses guaranteed ratios. This will ensure that the nurse can provide the right amount of attention per patient. This will help ensure the nurse does not try to rush or take shortcuts as this can affect the level of care provided to patients (Issues, 2017). Nursing burnout is an unknown term to the public but it is very well known in the nursing community. It is difficult to determine what nursing burnout is as every nurse has different capacities and coping mechanisms. A nurse needs to be able to admit to themselves that they are experiencing physical and emotional distress. A nurse needs to also be able to tell employers that they require adequate time of rest and relaxation to fully work in a proficient way. Ample time for rest, exercise, and proper nutrition is something every nurse requires to be able to provide the highest level of care their patient deserves. Nursing Burnout References Freudenb