Introduction
Most nurses face different levels of stress levels associated with the burnout they experience in the places of work. The primary cause of burnout in nurses that predisposes them to stress is workload (Gulavani & Shinde, 2014). Once nurses are faced with such stressful events, they react through the adoption of coping strategies. Some of them may decide to use stress strategies while others may leave the profession. This leads to the PICO question on whether the use of stress strategies or quitting the profession in burnout nurses is the most effective way of reducing stress levels and giving nurses a balance in their work in six months. The studies conducted by Rushdy (2016) and Gulavani and Shinde (2014) provides the answer to this question. However, this paper will discuss the burnout problem, review the articles and establish their link to the problem and the PICO question, and finally propose evidence-based practice changes.
Nurse Burnout
Nurses experience high levels of burnout in their practice settings mainly because of the nature of their involving work. Many researchers have investigated the major causes, effects, and ways of preventing or mitigating burnout in these professional care providers. According to Spooner-Lane and Patton (2007), most nurses experience burnout that is associated with nursing roles, role conflict with other professionals, role overload, and role ambiguity. In most cases, they work for many hours in work extended shifts of up to thirteen hours instead of the normal eight, which not only leads to the occurrence of physical but also emotional stress. Despite 80% of the nurses showing satisfaction with their working schedules, research studies have revealed that 13-hour work shifts have a significant adverse effect on patient care (Gulavani & Shinde, 2014). Burnout is directly associated with patient dissatisfaction with the care that nurses provide and job dissatisfaction among the nurses themselves.
The working environment is also a major role player in determining the occurrence and prevalence of burnout in nurses. Many studies that have explored stressors that result in burnout have majorly found the environment as a determinant of many nursing problems including high turnover rates and burnout. Some of the stressors include poor working relationships among healthcare professionals such as doctors and nurses (Konstantinos, 2008). Demanding communication, poor relationships with patients and their relatives, high levels of workloads, stressful emergency cases, and home and work imbalances predispose nurses to burnout. Moreover, the acute shortage of nurses due to understaffing and the lack of positive feedback or support from senior staff increase both emotional and physical burnout (Konstantinos, 2008). Therefore, nurses experience many problems in their areas of practice that increase the likelihood of developing burnout.
This problem affects not only the nurses and their healthcare institution but also the patients who receive care. Nurses who suffer from burnout are likely to express apathy and cynicism towards their patients in addition to showing reduced professional adequacy (Rushdy, 2016). Such a thing reduces healthcare quality and increases the likelihood of making errors when delivering care, something that endangers the lives of patients. Furthermore, the costs of healthcare increase because of poor quality care since patients may incur long hospital stays or even die in the course of treatment (Rushdy, 2016). The lack of motivation among nurses with burnout may further result in increased job stress and dissatisfaction, which still put patients at risk of suffering the consequences of this problem.
Institutionally, burnout affects quality care delivery, retention of staff due to high employee turnover, and employee motivation among others. Suffering from many problems that cause burnout to compel nurses and other care providers to look for better places to work in an attempt to avoid the work-related challenges (Dalmolin, Lunardi, Barlem, & Silveira, 2012). As a result, high rates of staff turnover occur among nurses. Institutions face challenges in trying to hire new professionals to cover the shortage created by the leaving nurses. Consequentially, the quality of care is compromised leading to reduce patient satisfaction that, in turn, compromises institutional reputation (Dalmolin, Lunardi, Barlem, & Silveira, 2012). Institutions that have such problems incur huge costs on human resources yet their productivity dwindles. Institutions further appear to be unable to provide for the needs of its nurses including the provision of a safe and motivating work environment.
Use of Nurse Burnout PICOT Question Frame: Quantitative Study
This qualitative descriptive study provides information on nurse burnout and role overload. Rushdy’s (2016) study is titled “Relationship among Nurses Role Overload, Burnout and Managerial Coping Strategies at Intensive Care Units.” Its aim was to examine the association between nurse burnout, role overload, and managerial coping strategies at four Intensive Care Units (ICUs) at the renowned Assiut University Hospital. The significance of this study was justified by the frequent occurrence of burnout and role overload in high-stress environments, especially in the ICUs. The subjects comprised of all nurses in general, postoperative, and casualty ICUs, and the coronary care unit. This article is connected to the PICO question because it provides information on the effectiveness of the stress strategies. Most importantly, it gives much information concerning the problem of burnout in nurses besides offering the solution.
The study found the highest levels of burnout, role overload, and managerial coping strategy scores in general, causality, and postoperative ICUs respectively (Rushdy, 2016). The effective managerial stress strategies include passive wishful thinking, resigned distancing, rational problem solving, and seeking support. It is only wishful thinking that was not utilized by nurses in role overload. The results show that it is only through the adoption of stress strategies that stress levels can reduce burnout nurses instead of quitting the profession.
Use of Nurse Burnout PICOT Question Frame: Qualitative Study
This qualitative descriptive study investigated nurses’ burnout at their places of work and the efficiency of stress strategies in reducing burnout impact. The study whose title is “Occupational stress and job satisfaction among nurses” was conducted by Gulavani and Shinde in 2014. It is closely linked to the study problem and the PICO question because it provides important information on the effectiveness of stress strategies compared to leaving the profession to mitigate stress level and give nurses work balance. Much information in the article discusses the cause of burnout and its effects on nurses. The study utilized an explorative research approach, and the sample of 100 nurses was selected through the use of a convenient sampling technique (Gulavani & Shinde, 2014). Researchers utilized relevant and reputable sources that are up to date to back up their findings, making the information from their article reliable to use in answering the PICO question.
The study had several findings including information on occupational stress, job satisfaction, demographics, and the relationship between job satisfaction and occupational stress among others. 88% of the participants were nurses, 50% had extreme occurrences of stress associated with death and dying, 49% reported having experienced stress, and 83% reported being satisfied with their job (Gulavani & Shinde, 2014, p. 737). Other causes of stress in the majority of the nurses included uncertainty by the concerning treatments, workload, conflicts with physicians, conflict with supervisors and other senior staff, and problems in dealing with patients and their families. Furthermore, peer conflicts and inadequate emotional preparation were identified as occasional factors that induce stress (Gulavani & Shinde, 2014, p. 737). The research found that these problems can be solved through stress strategies rather than leaving the profession, something that provides a conclusive answer to the PICO question.
Evidence-Based Practice Changes
Nurses experience different levels of stress due to the differences in their work settings. For instance, nurses working in the ICU experience higher stress levels than their colleagues in other departments. From Rushdy’s (2016) study, there are many effective stress strategies in burnout nurses compared to leaving the profession to reduce stress and give a balance of work. Since nurses the level of stress in ICU is higher than in other departments, nurse leaders and managers should rotate nurses from one unit to the other to buffer negative work experiences associated with their practice settings. In care facilities, training programs on stress coping strategies need to be implemented to help nurses to cope with both role overload and burnout. Rushdy (2016) recommends that managers should start to recognize passive coping in addition to changing leadership styles and reallocation workforce to mitigate burnout and role overload. Therefore, the hospital administration has a huge role to impact practice by adopting evidence-based practice to address stress in burnout nurses.
Moreover, nurse leaders should still work together with their juniors to identify and eliminate all stress causes. Some of the causes are death and dying, job pressures, conflicts with colleagues and patients, and workload (Gulavani & Shinde, 2014). There is a need to appreciate the work of nurses, increase staffing levels to curb increased workload, enhance good leadership and teamwork to reduce job conflicts, provide counseling services to staff who experience stress, and involve nurses in the making of decisions to increase job satisfaction and reduce burnout. Gulavani and Shinde (2014) further explain that supervision and workload are the leading causes of stress in nurses. Therefore special measures should be in place to reduce conflict with supervisors in the workplace. Nurses should also get training on how to solve conflicts and manage stress because such things may not be entirely avoided in work settings.
Conclusion
In burnout nurses, stress strategies are the most effective way of reducing stress levels and giving a balance in work compared with leaving the profession. Nurses in ICUs are the most vulnerable to stress. Stressed nurses offer poor quality care, which does not only result in high health costs but also endangers both the health and lives of patients. Additionally, hospitals face serious challenges because of the high turnover rates in burnout nurses, making the institution have a negative reputation and high levels of patient dissatisfaction. Some of the causes of stress include work conflicts, role overload, work overload, and poor leadership among others. Enhancing better leadership, appreciating nurses for their work, involving them in the making of decisions, and providing training opportunities on handling stress and solving conflicts are some of the effective strategies to mitigating stress.
References
Dalmolin, G. D. L., Lunardi, V. L., Barlem, E. L. D., & Silveira, R. S. D. (2012). Implications of moral distress on nurses and its similarities with Burnout. Texto & Contexto-Enfermagem, 21(1), 200-208.
Gulavani, A., & Shinde, M. (2014). Occupational stress and job satisfaction among nurses. International Journal of Science and Research (IJSR), 3(4), 733-740.
Konstantinos, N. (2008). Factors influencing stress and job satisfaction of nurses working in psychiatric units: a research review. Health Science Journal. Web.
Rushdy, M.F. (2016). Relationship among nurses role overload, burnout and managerial coping strategies at intensive care units. International Journal of Nursing Education, 8(2), 39-45.
Spooner-Lane, R., & Patton, W. (2007). Determinants of burnout among public hospital nurses. Australian Journal of Advanced Nursing, 25(1), 8-16.