Work Stress and Burnout Among Nurses


The work environment and working conditions are important factors that have an impact on staff performance. Negative work environment and unfavorable working conditions can lead to work-related stress and even burnout. These outcomes are not desirable in all spheres of activity and even dangerous in nursing because of nurse job satisfaction influences not only nursing staff but the quality of patient care. In conditions of increased interest in the issue of continuing quality improvement (CQI), the role of the work environment and working conditions as factors influencing work stress and burnout among nursing staff increases. The current paper reviews the concept of CQI, the role of nurses in the process of CQI, and the relations between CQI, work stress, and burnout.

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Continuous Quality Improvement and Nursing Contributions

CQI in healthcare follows a major goal related to the reduction of errors and the improvement of patient outcomes. Frequently, CQI is achieved through the implementation of quality programs in healthcare facilities (Costa, Greco, Bohomol, Arreguy-Sena, & Andrade, 2014). Nurses as active participants of the care process can contribute to CQI as well. For example, they can evaluate programs for CQI from nursing professionals. The research by Costa et al. (2014) analyses opinions expressed by professional nurses about the CQI program at a university hospital. The research revealed the fact that although many respondents did not provide personal opinions about the program, the majority of the participants mentioned a positive impact of the CQI program on their working conditions. Also, some respondents feel positive about the program but do not want to join it.

Kakyo and Xiao (2017) present experiences of nurse managers about CQI. The researchers focus on CQI in poorly-provided healthcare facilities where these interventions are particularly important. The research revealed the following themes which can serve as ways for nurse managers to contribute to CQI. First of all, nurse managers can participate in diverse CQI activities and “prioritize quality improvement activities in a local context” which is essential for resource-poor health care facilities where the research was conducted (Kakyo & Xiao, 2017, p. 2). Secondly, nurse managers can monitor the quality improvement activities and control the achievement of goals. Also, they can apply in-service education to empower CQI. Finally, nurse leaders can provide information about the resources necessary for CQI in conditions of their healthcare facilities.

One more aspect of quality improvement is its positive influence on patient outcomes. Thus, the study by Weston and Roberts (2013) proves that initiatives aimed at quality and performance improvement positively influence not only nursing work but patient outcomes as well. Some of the results include the reduction of hospital-acquired conditions, implementation of mobile technologies in the process of care, and broader access of nursing staff to information resources which stimulates evidence-based practice (Weston & Roberts, 2013).

Relations of Continuous Quality Improvement, Work Stress, and Burnout

Burnout is a frequent consequence of work stress in nursing which negatively influences job satisfaction. Myhren, Ekeberg, and Stockland (2013) investigate job satisfaction and burnout among intensive care unit nurses and physicians and conclude that burnout rates result from “low job satisfaction and a high degree of job stress” (p. 6). Since nurse burnout can negatively influence the quality of care, there is a need for interventions aimed at work stress and burnout reduction.

CQI has the potential to influence job-related stress and burnout among nurses through the improvement of work environment and working conditions and an increase in job satisfaction. One of the aspects of employee satisfaction and a factor that positively influences the level of stress is the promotion of employee health. The research by von Thiele Schwarz, Augustsson, Hasson, and Stenfors-Hayes (2015) studies the problem of health protection, health promotion, and continuous improvement integration. The findings of the research reveal the positive impact of the mentioned integration on employees’ workability and productivity.

White, Wells, and Butterworth (2014) discover the influence of a large-scale quality improvement program on work engagement. This national cross-sectional survey proves that the Productive Ward program positively influences the work engagement of nurses. Moreover, it stimulates the engagement of nurses into clinical teams thus contributing to further quality improvement. Also, such interventions follow one of the essentials of a Master’s education in nursing which is quality improvement and safety.

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One of the tools to support CQI is nurse education which is grounded on the most important theories and concepts. One of these theories, which applies to both inpatient care and improvement of the working environment, is Watson’s Human Caring Theory (Clark, 2016). The theory is based on the principles of transpersonal psychology. The theory presupposes the creation of an environment for healing that will be favorable both for a patient and for a nurse.


To conclude, it should be mentioned that the issue of continuous quality improvement is one of those, which are actively implemented in contemporary health care. CQI programs and interventions have strong potential. First of all, quality improvement contributes to better patient outcomes and an increase in patient safety. Secondly, CQI provides healthcare facilities with tools that can be used to improve the quality of care in every setting after a careful analysis of resources that are necessary for the improvements. What is more, CQI has a strong positive influence on nursing staff contributing to the decrease of work stress and reduction of burnout that are achieved due to the improvement of the work environment and working conditions. Consequently, the use of CQI can be recommended to all healthcare facilities.


Clark, C. (2016). Watson’s Human Caring Theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(4), 21. Web.

Costa, F., Greco, R., Bohomol, E., Arreguy-Sena, C., & Andrade, V. (2014). The nursing staff opinion about the continuous quality improvement program of a university hospital. Einstein (São Paulo), 12(2), 211-216. Web.

Kakyo, T., & Xiao, L. (2017). Nurse managers’ experiences in continuous quality improvement in resource-poor healthcare settings. Nursing & Health Sciences, 19(2), 244-249. Web.

Myhren, H., Ekeberg, O., & Stockland, O. (2013). Job satisfaction and burnout among intensive care unit nurses and physicians. Critical Care Research and Practice, 2013: 786176. Web.

von Thiele Schwarz, U., Augustsson, H., Hasson, H., & Stenfors-Hayes, T. (2015). Promoting employee health by integrating health protection, health promotion, and continuous improvement. Journal of Occupational and Environmental Medicine, 57(2), 217-225. Web.

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Weston, M., & Roberts, D.W. (2013). The influence of quality improvement efforts on patient outcomes and nursing work: A perspective from chief nursing officers at three large health systems. The Online Journal of Issues in Nursing, 18(3). Web.

White, M., Wells, J., & Butterworth, T. (2014). The impact of a large-scale quality improvement programme on work engagement: Preliminary results from a national cross-sectional-survey of the ‘Productive Ward’. International Journal of Nursing Studies, 51(12), 1634-1643. Web.

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