This is an implementation plan to eliminate or lessen nurse stress and burnout. The proposed solution entails stress reduction strategies. The solution is intended to overcome stress and burnout experienced by nurses. It also recognizes other key contributors who will provide the necessary approval and support to ensure effective implementation of the solution. All these stakeholders are major audience for the implementation plan and thus their influences are critical for success of the plan.
Methods of obtaining necessary approvals and securing support for proposal
Throughout the development of the stress reduction strategies, the desires to ensure integration of all stakeholders in the proposal and the need to establish a consensus and secure support have been major areas of focus.
All stakeholders have to accept, approve and support the proposal. Moreover, stakeholders’ support and approval will be crucial in budget and resource approvals.
A participatory workshop will be adopted so that all major stakeholders such as nurses, nurse managers, physicians and other support staff will generate ideas, discuss the proposed stress reduction strategies, provide feedback and contribute to the proposal. As many stakeholders get involved in the proposal development and solution evaluation, a participatory workshop is necessary to ensure that solutions receive adequate commitment from all major stakeholders.
It is expected that all contributions, opinions and feedback from stakeholders will be reviewed in another participatory workshop. This will ensure that stakeholders have an opportunity to provide their approval and support for the implementation of stress reduction strategies.
It is vital to note that participatory workshops will be preliminary stages in the overall processes of obtaining the necessary support and approvals.
Another method would involve getting the support and approval from key decision-makers after the participatory workshops. The proposal would require a critical discussion with various decision-makers so that they can give their approval and support. These stakeholders will include the following:
- Head of clinical units
- Nurse leaders
- Nurse managers
- Resource allocation and funding manager
- Facility owners
It is intended that all stakeholders will avoid unnecessary delays and reinforce the credibility of the proposed nurse stress reduction strategies. In this regard, many proposal champions will facilitate the processes across different clinical units or departments.
Thorough description of current problem, issue, or deficit requiring change
Stress and burnout are common in nursing profession (Najimi, Goudarzi, & Sharifirad, 2012). Nurse stress and burnout have affected nursing profession and patient health outcomes in different ways. Nurses exhibit tiredness, arrogant behaviors, fatigue, cases of blood pressure, anxiety, lack of collaboration, confidence, job satisfaction and low efficiency. In some cases, nurses are depressed, isolated, report late or absent.
Several factors were identified as responsible for nurse stress and burnout. The current management and job-related practices and personal characteristics among nurses are major contributing factors of nurse stress and burnout.
Poor management practices and job-related issues such as insufficient unit leadership, turnover of nurse managers, physical absence of nurse supervisors and failure to resolve identified issues have led to nurse burnout and stress. In addition, nurses are also overworked because of poor staffing (issues of nurse ratio).
Nurse and leaders’ personality characteristics are also sources of nurse stress and burnout. Anxiety traits in nurses are contributors to stress and burnout. Nurses have exhibited state anxiety when they meet demanding and threatening patients’ conditions. In addition, they also have trait anxiety, which is mainly associated with their individual personal traits. There are nurses who consider some elements of their jobs as stressful while others do not.
Interpersonal relationships among nurses, nurse managers, nurse leaders and other stakeholders also lead to nurse stress and burnout. Specifically, some elements of problematic association among nurses have been identified and therefore suspected of increasing nurse stress and burnout. There are cases of verbal abuse by nurse leaders and physicians. These conflicts have resulted into psychological issues among nurses. The relations with family members also affected nurses in their jobs.
A detailed explanation of proposed solution
Nurse stress and burnout are multifaceted challenges. Consequently, three stress reduction strategies have been proposed. These include individual-focused intervention, management and job-focused intervention, and an integrated intervention.
An individual-focused intervention strategy will include stress management programs for nurses and leaders. Stress management training will ensure that nurses have the necessary skills to management personality related stress and burnout. In addition, nurses will have abilities to cope with threatening and demanding nursing situations. The interventions will ensure that nurses and leaders are taught about adverse effects of stress and burnout. They will build skills to lessen stress, reduce anxiety and stay healthy.
Management and job-related interventions
These interventions recognize the complex health environment and its subsequent impacts on nurse stress and burnout. Management and job-related interventions will identify stressful elements of nursing such as excessive workload, abuse, conflicts and poor nurse-to-patient ratio and then strategies will be designed and adopted to lessen or eradicate these stress-contributing factors.
Management and job-related intervention will directly identify root causes of nurse stress and burnout. In addition, a more participatory management style will be adopted to enhance collaboration and teamwork. Some of the proposed interventions included the following:
- A balanced workload based on specific nurse capabilities and available resources
- Addressing nurse-to-patient ratio
- A review of job descriptions, roles and responsibilities to enhance participation and use of nurse diverse skills
- Participatory decision-making
- Enhancing communication
- Ensuring career growth opportunities and personal employee development prospects
- Encouraging social interaction and team building
- Reviewing work schedules to meet unique needs of nurses, including family life
Integrated Stress Prevention
An integrated stress prevention strategy would be adopted because of the complex nature of nurse stress and burnout. This intervention will be used because various stress and burnout contributing factors require diverse interventions. As such, a combination of an individual-focused intervention strategy and management and job-related strategy will be adopted in later stages to improve outcomes.
Rationale for selecting proposed solutions
Three stress reduction strategies have been proposed as solutions. It is widely recognized that nurse stress and burnout result from a combination on different factors, and it is difficult to recommend a single solution for such multifaceted issues (Najimi et al., 2012; Sveinsdóttir, Biering, & Ramel, 2006). From these different interventions, the following outcomes are expected:
- Nurses will have better understanding of stress and burnout at personal levels and acquire skills of self-management
- Nurse administrators also contribute to stress and burnout among nurses and thus specific interventions that focus on management practices will address nurse administrators’ practices and their stress and burnout issues
- Low nurse manager attrition and improved retention
- Interventions will go beyond descriptive to practical solutions for skill development
- Overall, improved nurse performance, job satisfaction, collaboration and patient outcomes are expected
Evidence from review of literature to support proposed solution
Current studies have shown that stress management training helps employees to cope with demanding, threatening and stressful work experiences (Deckro et al., 2000). Hence, acquiring stress management skills through education and training has been beneficial to workforce. These interventions can quickly lessen cases of stress and burnout, including anxiety. In addition, these interventions are not expensive and simple to implement (Deckro et al., 2000).
Bratt, Broome, Kelber and Lostocco (2000) established that nurse stress and burnout threatened job satisfaction and caused nurse turnover. Hence, effective nurse management and leadership are critical in ensuring retention efforts that can enhance management strategies and empower nurses to provide quality healthcare.
Moreover, these efforts can lessen stress from nurse-family relations (Bratt et al., 2000). Smith has demonstrated that transformational leadership can inspire nurses to discover meaning and purpose in their duties (Smith, 2011).
A study by Lamontagne, Keegel, Louie, Ostry and Landsbergis (2007) had established that effective formulation and implementation of integrated stress management programs had greater potential of reducing nurse stress and burnout. An integrated approach that incorporates individual-focused and management and job-related interventions has enhanced outcomes on nurse stress and burnout and organizational leadership. These interventions will target specific challenges within the hospital.
A detailed description of implementation logistics
|Communicating the issue to all stakeholders (suitable modes of communication shall be used)||All relevant stakeholders||One day|
|A participatory workshop to generate ideas, opinions and secure all stakeholders support and approvals||Nurses, nurse leaders, managers and facility owners||A two-day workshop|
|A participatory workshop to review opinions and get feedback||All stakeholders||One day workshop|
|Securing support and approval from influential nurses, unit leaders and nurses||Nurse unit leaders, managers and project champions||One week|
|Securing approval and support from key decision-makers and signatories||Project champions |
Head of clinical units
Resource allocation and funding manager
|Pre-implementation assessment of staff on stress and burnout||All stakeholders||One week activity|
|Implementation of individual-focused interventions||Nurses |
|A two-day training workshop|
|Implementation of management and job-related interventions||Nurse leaders |
|A two-day training workshop|
|Implementation of integrated Stress Prevention||All stakeholders||A two-day training workshop|
|Post implementation assessment of stress and burnout levels, leadership, patient outcomes, job satisfaction and attrition among others||Six months after implementation |
(One week activity)
|Communicating outcomes for feedback to note areas for further improvements||All stakeholders||A single day activity (various modes of communication may be used)|
Resources required for implementation (Staff, education materials, assessment tools, technology, funds, etc.)
More nurses are required to ensure favorable nurse-to-patient ratio and reduce work overload.
Staff training materials are required for training on personal stress management skills, leadership, management, culture change and interpersonal relations.
Nurses will also undergo training in technology for information management to reduce workload and enhance efficiency.
Evaluation tools will be developed to assess stress and burnout levels before and after interventions among nurses.
Technology for health information management will be implemented to ensure efficiency in nurse workload.
Funds and other resources for additional nurses, assessment tools, technologies, external adult trainers and training will be required to support the implementation of nurse stress reduction strategies.
It is expected that this implementation plan for the proposed stress reduction strategies for nurses will yield the desired outcomes.
Bratt, M., Broome, M., Kelber, S., & Lostocco, L. (2000). Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses. American Journal of Critical Care, 9(5), 307-317.
Deckro, G., Ballinger, K., Hoyt, M., Wilcher, M., Dusek, J., Myers, P.,…Benson, H. (2000). The Evaluation of a Mind/Body Intervention to Reduce Psychological Distress and Perceived Stress in College Students. Journal of American College Health, 50(6), 281-287. DOI: 10.1080/07448480209603446.
Lamontagne, D., Keegel, T., Louie, M., Ostry, A., & Landsbergis, A. (2007). A systematic review of the job-stress intervention evaluation literature, 1990-2005. International Journal of Occupational and Environmental Health, 13(3), 268-80.
Najimi, A., Goudarzi, A., & Sharifirad, G. (2012). Causes of job stress in nurses: A cross-sectional study. Iranian Journal of Nursing and Midwifery Research, 17(4), 301–305.
Smith, M. A. (2011). Are you a transformational leader? Nursing Management, 42(9), 44-50. doi: 10.1097/01.NUMA.0000403279.04379.6a.
Sveinsdóttir, H., Biering, P., & Ramel, A. (2006). Occupational stress, job satisfaction, and working environment among Icelandic nurses: A cross-sectional questionnaire survey. International Journal of Nursing Studies, 43(7), 875–889.