Abstract
This work presents research on the connection between stress and burnout syndrome among nurses and patient safety. It provides a review of the relevant literature and an analysis of key findings. In many cases, this syndrome resulted in a decrease in the level of healthcare. However, the practical implementation of management and leadership strategies improved the situation.
Stress and Burnout
Stress and burnout syndrome is caused by constant emotional and physical weariness. This condition affects the professional accomplishments of individuals. Healthcare specialists suffering this syndrome lose the ability to efficiently perform their functions and cooperate with colleagues. The stress and burnout syndrome among professionals in medical settings has recently become a focal point of attention due to a large number of medical errors and negative patient safety outcomes. The average number of nurses suffering from burnout ranges from 10% to 70% (Lyndon, 2015). Therefore, this is a large-scale problem, and it needs to be addressed. The main goals of this paper are to analyze the effect of burnout and nursing stress on medication errors and patient safety and discuss possible ways to improve this situation.
PICO question
To address this problem, it is necessary to formulate a PICO question. PICO stands for problem, intervention, comparison, and outcomes. The main reason for burnout among medical staff is the irrational distribution of duties. Hence, the following research question was formulated to guide this project: Can the application of management and leadership techniques eliminate negative patient safety outcomes caused by the stress and burnout syndrome among nurses?
Literature Review
In the first article, the authors conclude that “poor staff management” leads to insufficient medical care (Khamisa, Oldenburg, Peltzer, & Ilic, 2015). It diminishes the personnel’s morals and causes job dissatisfaction. In the next article, the authors state that nurses “who had higher satisfaction levels experienced less stress and lower levels of burnout” (Hayes, Douglas, & Bonner, 2015). Most of them had extensive working experience. In another article, the authors conclude that managers should pay more attention to job control, social support, and a reward system (Adriaenssens, De Gucht, & Maes, 2015). These aspects improved professional accomplishments among nurses. The authors of the next work conclude that the main reasons for burnout are “job strain, overcommitment, and low social support” (Chou, Li, & Hu, 2014).
The authors also highlighted the highest level of stress in nurses compared to other medical staff. In the next study, the authors suggest that the development of management should enhance collegial support and positive affirmation (Drury, Craigie, Francis, Aoun, & Hegney, 2014). These factors contribute to the reduction of anxiety in registered nurses. The authors of the next article emphasize the importance of leadership techniques aimed at increasing job satisfaction through providing a positive working environment to eliminate the impact of stress on nurses’ health (Khamisa, Peltzer, Ilic, & Oldenburg, 2016). The implementation of this strategy improved patient safety outcomes. The authors of the next work show that guided interventions had positive long-term effects on personnel burnout (Westermann, Kozak, Harling, & Nienhaus, 2014).
This tactic helped to reduce the number of medical errors. In the next article, the authors state that web-based training programs provide an opportunity to address nursing-related nervousness (Hersch et al., 2016). The improvement of the quality of healthcare proved the effectiveness of this method. The authors of another article highlight the importance of social support outside of work (Woodhead, Northrop, & Edelstein, 2016). It resulted in declining stress levels among registered nurses. In the next article, the authors underlined the necessity of stimulating and supporting nursing unit managers (Van Bogaert, Adriaenssens, Dilles, Martens, Van Rompaey, & Timmermans, 2014). This strategy allowed delivering the safest patient care. In the next work, the authors suggest the application of person-focused strategies to help nurses manage stress at the individual level (Roberts & Grubb, 2014).
They also say about the importance of organization-focused strategies that create a positive working environment. Another article describes a new stress management program involving the use of mobile phones (Villani et al., 2013). It showed positive short-term effects for oncology nurses. In the next article, the authors reveal the results of a new strategy aimed to reduce the level of depression among nurses (Watanabe et al., 2015). It is based on the use of omega-3 fatty acids. Another article describes the cognitive intervention stress management program (Mok, Chau, Chan, & Ip, 2014).
The results show the significant improvement of the emotional conditions of nurses. The next article demonstrates the results of another tactic aimed to create a healthy working environment via a 2-phase program that enhances nurses’ resilience (Rushton, Batcheller, Schroeder, & Donohue, 2015). The program improves the quality of healthcare in high-intensity settings. The authors of the next article support engagement in health promotional strategies (Neville, & Cole, 2013). Such an approach improves nurses’ abilities to resist compassion fatigue. The authors of another work confirm “the importance of optimism and proactive coping in the prevention of symptoms of burnout” (Chang & Chan, 2015). Stress management interventions promote emotional health among medical staff.
The authors of another article conclude that acceptance and commitment training prevents stress and burnout during nursing activities (Frögéli, Djordjevic, Rudman, Livheim, & Gustavsson, 2016). Due to this program, the level of mindful awareness was increased as well. The next article describes the mindfulness-based stress-reduction management (Smith, 2014). This approach cultivates the ability to deal with stress and consequently leads to a higher quality of medical services. The authors of another article show the difference between a stress level depending on the ethnic origin of nurses (Admi & Eilon-Moshe, 2016). Thai nurses show the highest stress level. On the other hand, Israeli nurses have the lowest stress level. The next study, “examines the extent of stress and burnout experienced by nurses during hospital restructuring” (Greenglass, & Burke, 2016). The results show the direct connection between the emotional conditions of nurses and patient safety.
Method and Analysis
In order to answer the PICO question, qualitative research was conducted. Studying articles from medical peer-reviewed journals reveals a certain trend regarding the connection between management strategies and a stress level among healthcare staff. Applying an observation method helps to collect data about a burnout syndrome phenomenon. The methods of intervention in this problem include different management and leadership techniques. The comparison of the results of the mentioned above studies illustrates that the most effective strategies like job control, social support outside of work, increasing job satisfaction, guidance, and web-based training programs improve the quality of healthcare. Research proved the strength of this type of intervention as aspects that have the most impact on the emotional condition of medical staff like job satisfaction, work engagement, and emotional exhaustion improved in approximately 20% of participants due to the new management strategies (Adriaenssens et al., 2015). Also, the fact that poor healthcare is caused by the low level of job satisfaction was highlighted in the articles by different authors. Therefore, the connection between management and leadership policies and the quality of medical services is proved.
Clinical Case
This clinical case describes a student of an internal medicine residency program. She is perceived as a talented resident, and the administration gives her many responsibilities. As a result, she feels much pressure and suffers from fatigue and burnout. This student does not have enough energy to complete her duties. She works at night in an intensive care unit. Hence, she suffers from sleep deprivation, as well. She was diagnosed with clinical depression several years ago, and current symptoms seem to be similar. Nobody can substitute her at work. She prefers not to tell anybody about her problems as people might consider her as a weak person.
In this case, the situation is absolutely similar to the situations described in the mentioned above articles. The student cannot handle her responsibilities due to the heavy workload and the lack of experience. Hence, certain changes in clinical management can resolve this problem. First, it is necessary to designed mentor programs for junior medical personnel. Second, a flexible schedule can free up more time for personal needs. Finally, additional medical education programs to promote wellness will contribute to the improvement of the general health of such students.
Discussion and Findings
Stress and burnout syndrome cause numerous medical errors and aggravate the quality of healthcare. It ruins a stimulating working environment and worsens individual behaviors. However, there are proven methodologies addressing this issue. Management and leadership techniques are widely used and provide favorable outcomes. Hence, it is necessary to implement some of such approaches. First, an administration should provide clear expectations for all medical staff and get its confirmation. Second, nurses should be provided with all the necessary equipment and resources. Third, personnel has to undergo training programs to maintain competency. Finally, a convenient working schedule is a crucial aspect of the personnel’s well-being.
Conclusion
However, these measures might not always eliminate stress and burnout completely because there are certain factors that are hard to deal with, like relationships among personnel or ethnic origin. Therefore, further research in this field is of high priority. As many researchers stated, nurses are the busiest medical personnel in clinics. Nursing is one of the most stressful occupations in medical settings. Their duties include looking after patients and their behavior, collaborating with other medical specialists to design treatment plans, performing treatments and medications, and many other functions. Hence, research for strategies aimed to reduce stress and burnout should include specific approaches regarding nurses’ needs, like establishing separate nursing divisions that have fewer responsibilities and more narrow specialization.
References
Admi, H., & Eilon-Moshe, Y. (2016). Do hospital shift charge nurses from different cultures experience similar stress? An international cross sectional study. International Journal of Nursing Studies, 63, 48-57.
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Causes and consequences of occupational stress in emergency nurses, a longitudinal study. Journal of Nursing Management, 23(3), 346-358.
Barkley, E.F., Cross, K.P., & Major, C.H. (2005). Collaborative learning techniques. San Francisco: Jossey-Bass.
Chang, Y., & Chan, H. J. (2015). Optimism and proactive coping in relation to burnout among nurses. Journal of Nursing Management, 23(3), 401-408.
Chou, L. P., Li, C. Y., & Hu, S. C. (2014). Job stress and burnout in hospital employees: Comparisons of different medical professions in a regional hospital in Taiwan. BMJ Open, 4(2), 1-8.
Drury, V., Craigie, M., Francis, K., Aoun, S., & Hegney, D. G. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: Phase 2 results. Journal of Nursing Management, 22(4), 519-531.
Frögéli, E., Djordjevic, A., Rudman, A., Livheim, F., & Gustavsson, P. (2016). A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses. Anxiety, Stress, & Coping, 29(2), 202-218.
Greenglass, E. R., & Burke, R. J. (2016). Stress and the effects of hospital restructuring in nurses. Canadian Journal of Nursing Research Archive, 33(2), 93-108.
Hayes, B., Douglas, C., & Bonner, A. (2015). Work environment, job satisfaction, stress and burnout among haemodialysis nurses. Journal of Nursing Management, 23(5), 588-598.
Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research, 32, 18-25.
Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International Journal of Environmental Research and Public Health, 12(1), 652-666.
Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B. (2016). Work related stress, burnout, job satisfaction and general health of nurses: A follow‐up study. International Journal of Nursing Practice, 22(6), 538-545.
Lyndon, A. (2015). Burnout Among Health Professionals and Its Effect on Patient Safety. Web.
Mok, A. L. F., Chau, J. P. C., Chan, D. W. K., & Ip, W. Y. (2014). The effectiveness of cognitive behavioral interventions in reducing stress among nurses working in hospitals: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(7), 12-23.
Neville, K., & Cole, D. A. (2013). The relationships among health promotion behaviors, compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a community medical center. Journal of Nursing Administration, 43(6), 348-354.
Roberts, R. K., & Grubb, P. L. (2014). The consequences of nursing stress and need for integrated solutions. Rehabilitation Nursing, 39(2), 62-69.
Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420.
Smith, S. A. (2014). Mindfulness‐based stress reduction: An intervention to enhance the effectiveness of nurses’ coping with work‐related stress. International Journal of Nursing Knowledge, 25(2), 119-130.
Van Bogaert, P., Adriaenssens, J., Dilles, T., Martens, D., Van Rompaey, B., & Timmermans, O. (2014). Impact of role‐, job‐and organizational characteristics on Nursing Unit Managers’ work related stress and well‐being. Journal of Advanced Nursing, 70(11), 2622-2633.
Villani, D., Grassi, A., Cognetta, C., Toniolo, D., Cipresso, P., & Riva, G. (2013). Self-help stress management training through mobile phones: An experience with oncology nurses. Psychological Services, 10(3), 315.
Watanabe, N., Furukawa, T. A., Horikoshi, M., Katsuki, F., Narisawa, T., Kumachi, M.,… & Matsuoka, Y. (2015). A mindfulness-based stress management program and treatment with omega-3 fatty acids to maintain a healthy mental state in hospital nurses (Happy Nurse Project): Study protocol for a randomized controlled trial. Trials, 16(1), 36.
Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review. International Journal of Nursing Studies, 51(1), 63-71.
Woodhead, E. L., Northrop, L., & Edelstein, B. (2016). Stress, social support, and burnout among long-term care nursing staff. Journal of Applied Gerontology, 35(1), 84-105.