2. What is Nurse
Burnout?
Definition
▪ Phenomenon in which the
cumulative effects of a stressful work
environment gradually overwhelm
the defenses of the staff members,
forcing them to withdraw
psychologically
(Sahraian, A., Fazelzadeh, A., Mehdizadeh, A., & Toobaee, S. ,2008)
*RealWorld Problem
3. Objectives
▪ The learner will be able to define nurse burnout and acknowledge that it is a real world problem.
▪ The learner will discover the ethics and values at risk during nurse burnout.
▪ The learner will know the symptoms of nurse burnout.
▪ The learner will understand the contributing factors to burnout.
▪ The learner will know the interventions available to prevent or cure nurse burnout.
4. Testimonials of Nurses
▪ Discovery of the issue
▪ Comments Overheard
▪ At the beginning of a shift, a nurse stated: “Is
work over yet?”
▪ A comment made during shift change report
“Here we go again”
▪ Agreement to the issue
▪ Testimonials
▪ “You have more critical patients and less time
so you become stressed faster”
(Heather, Personal communication, March 2015)
▪ “You’re still expected to do everything safely
despite heavy patient loads”
(Heather, Personal communication, March 2015)
*RealWorld Problem
5. Description of the Problem
(Wang, S., Liu, Y., & Wang, L. ,2015)
*Real World Problem
▪ Nurse burnout can happen at any time, to any
one
▪ The problem occurs in all different aspects of
nursing, from pediatric nursing to geriatric
nursing; from surgical nursing to rehab nursing.
▪ Importance
▪ Learn how to recognize the signs
▪ Support your colleagues
8. WhatCausesNurseBurnout?
▪ Heavy workloads
▪ Long shifts
▪ Too much overtime
▪ Relationship conflict with other
staff
▪ Lack of managerial support
▪ High emotional needs of
patients and families
▪ Lack of reward
(Chipas & McKenna, 2011)
(Hughes & Jennings, 2008)
*Demonstrates a depth of understanding
9. Signs and Symptoms
▪Emotional exhaustion
▪Depersonalization
▪Decreased Perception of
Personal Accomplishment
(Sahraian, Fazelzadeh, Mehdizadeh, & Toobaee, 2008)
(Hughes & Jennings, 2008)
(Stewart & Terry, 2014)
10. INTERVENTIONS:
▪Empowerment and
Social Support
▪Regular rounding
by managerial staff
(Hughes & Jennings, 2008
So what do I do if I’m experiencing burnout…?
Nurses need to work together to create an environment that
promotes security, mutual respect, and positive feelings.
15. Bridging Liberal Arts and Nursing
▪Rachel: Sociology 101
▪Tanesha: Psychology 230
▪Katelyn: Family History 370
*Bridging Liberal Arts and Nursing and Multi-Disciplinary Features
16. AreYou At Risk?
▪ You may be more prone to burnout
if:
▪ You lack a reasonable balance
between work and your personal
life
▪ You try to be every thing to every
one
(Chipas & McKenna, 2011)
17. False Belief: All
Pressure/Stress is Bad
forYou
• Stress is beneficial to
performance
• Improves performance
during challenges by
providing motivation
HOWEVER:
• When the pressure/stress
becomes excessive, it loses
its beneficial effects and
becomes harmful.
18. YOU MAKE A DIFFERENCE EVERY DAY
An old man walked up a shore littered with thousands of starfish, beached and dying
after a storm. A young man was picking them up and flinging them back into the
ocean. “Why do you bother?” the old man scoffed. “You’re not saving enough to
make a difference.”The young man picked up another starfish and sent it spinning
back to the water.
“I made a difference to that one.”
19. References:
Altun, I. (2002). Burnout and nurses' personal and professional values. Nursing Ethics, 9(3), 269-278. doi:10.1191/0969733002ne509oa
Bae, S., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes:
Systematic literature review. Nursing Outlook, 62(2), 138-156. doi:10.1016/j.outlook.2013.10.009
Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. American Association of Nurse Anesthetists, 79(2).
Galbraith, N. D., & Brown, K. E. (2011). Assessing intervention effectiveness for reducing stress in student nurses: quantitative
systematic review. Journal Of Advanced Nursing, 67(4), 709-721. doi:10.1111/j.1365-2648.2010.05549.x1.
Hughes, R. G., & Jennings, B. M. (2008). Work stress and burnout among nurses: role of the work environment and working conditions.
NSW Health.(2006). Stress management for nurses.
Moustaka, Ã., & Constantinidis, T. C. (2010). Sources and effects of work-related stress in nursing. Health Science Journal, 4(4), 210-216.
Sahraian, A., Fazelzadeh, A., Mehdizadeh, A., &Toobaee, S. (2008). Burnout in hospital nurses: A comparison of internal, surgery,
psychiatry and burns wards. International Nursing Review, 55(1), 62-67.
Stewart, W., &Terry, L. (2014). Reducing burnout in nurses and care workers in secure settings. Nursing Standard, 28(34), 37-45.
doi:10.7748/ns2014.04.28.34.37.e8111
Wang, S., Liu,Y., & Wang, L. (2015). Nurse burnout: Personal and environmental factors as predictors. International Journal Of Nursing
Practice, 21(1), 78-86.
Notas del editor
Title slide: Everyone introduce selves. Our acute care clinical took place at Sacred Heart Hospital and our clinical instructor was Rorey Pritchard.
The topic we chose to research is Nurse Burnout.
Nurse burnout is a big issue right now. Galbraith & Brown report job dissatisfaction in nurses was four times higher than that of the average worker in the United States.
Throughout this presentation we will be further describing this problem, discussing interventions, and exploring our acute care capstone project experience
T = Definition: When searching the literature for nurse burnout, there were multiple definitions available. However, we found the most simplistic and direct definition as noted above. Nurse burnout is a “phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of the staff members, forcing them to withdraw psychologically”.
T =
Objectives: (Read through the objectives) We developed the following objectives relating to our project:
The learner will be able to define nurse burnout and acknowledge that it is a real world problem.
The learner will discover the ethics and values at risk during nurse burnout.
The learner will know the symptoms of nurse burnout.
The learner will understand the contributing factors to burnout.
The learner will know the interventions available to prevent or cure nurse burnout.
T = Testimonials of Nurses:
Discovery:
While working on each of our floors, we evaluated multiple nurses making comments before we had chosen our topic. These comments led us to believe that stress and burnout was an issue within our units. These comments included statements such as “Is work over yet?” and “Here we go again”.
After our discovery that nurse burnout was a real world issue both within literature and at Sacred Heart Hospital, we decided on that as a topic. We spoke with various nurses on our clinical floors to evaluate their opinions and need for burnout being further addressed. One nurse in particular had a couple of important comments. These included statements such as “You have more critical patients and less time so you become stressed faster” and “You’re still expected to do everything safely despite heavy patient loads”.
All these statements combined show the need for nurse burnout interventions and the prevalence of this real world problem.
T = Description of the Problem: We found that nurse burnout can happen at any time, to anyone, and it can occur in numerous departments and specialties within nursing.
This topic is so important because if nurse burnout is not further addressed it can have negative consequences. Furthermore, it is vital that nurses can learn to recognize the signs of nurse burnout and have and know preventative measures as well as interventions to target burnout symptoms. Burnout interventions and prevention methods will be further examined later within the presentation.
T
Finished product Presented: This here is a picture of our finished project. It was formatted as a poster because we found that nurses seemed most likely to view educational materials when they were posted in easily accessible areas and simplified. Posters meet this criteria while also providing a physical document for nurses to utilize in their practice. Also, nurses have very busy schedules and having a document with multiple pages would have been too excessive and less effective. Within this product we addressed the explanation of nurse burnout, symptoms, contributing factors, and interventions. We also included a quote that we found to be very eye-opening on the issue. The quote, taken from the book Critical Care by author Theresa Brown, states, “You can feel like you love a lot of things about your job but you can still be getting burned out about the job…giving more support, that’s a culture change that needs to happen”. We took this to heart realizing that stress is a typical concern for nurses. It does not make you a bad nurse or inadequate. Nurse burnout is not solely a personal issue. It is a system and cultural issue that needs to be addressed at those levels.
T
Ethical Dilemma discussion:
-emotional exhaustion: can lead to emotional unavailability. Causes a strain in nurse/patient relationships. Calls into question the nurse’s reliability to perform patient cares.
-Depersonalization: evidenced by altered behaviors: dangerous to the patient. Nurse’s can develop insensitive attitudes which would pose the question whether they are competent to provide important cares. Can cause low self esteem. Low self-esteem can lead to decreased level of confidence which always effects a nurse’s practice. The biggest problem related to depersonalization is loss of satisfaction. When a nurse loses satisfaction with her job, her values begin to change and lose their importance in her practice.
Values:
-Honesty: We believe honesty becomes a value in question because a nurse who is insensitive toward her patients is less likely to be honest with them. Being honest with patients is a cornerstone to nursing practice. In turn, this will cause the patient to lose trust in the nurse.
Trust: When trust is called into question, it not only reflects badly on the nurse, but also on the organization in general.
Safety: When un-managed, nurse burnout can and will impair the safety of the nurse and the patient.
K
What causes nurse burnout?:
Some causes of nurse burnout include but are not limited to, heavy workloads, long shifts, too much overtime, relationship conflict with other staff, lack of managerial support, high emotional needs of patients and families, and lack of reward. An article by Bae & Fabry found that absenteeism increased when nurses worked more mandatory overtime” (p. 149). They also explored the issue of long work hours stating, “working 12- hour shifts negatively affects nurses’ health and patient outcomes. Some of these adverse outcomes associated with too much overtime include needlesticks, sleep disturbances, and injuries. Literature by Altun also expresses that nurses should not experience burnout because it destroys creativity, decreases productivity, lowers the quality of job performance, and increases opportunities for mistakes or acts of poor judgment. Communication can also play a large role in nurse burnout as it may lead to relationship conflicts with other staff. Binkert explains that much of the conflict between nurses often occurs as a result of nurses having multiples roles, functions, and ethical obligations to both their patients and their healthcare facility and team. This can sometimes be attributed to high emotional needs of patients and their families and may elicit a “lack of reward” feeling in nurses.
K
Signs and symptoms:
Signs and symptoms of nurse burnout include: emotional exhaustion, depersonalization, and decreased perceptions of personal accomplishments. In a study performed in the United States, 49% of nurses in middle-management and higher reported high levels of emotional exhaustion”. Emotional exhaustion can build up overtime and be continually hazardous for a nurse and their patients. Depersonalization is evidenced by altered behaviors, insensitive attitudes, low self esteem, and loss of satisfaction. Lastly nurses who tend to evoke feelings of low self esteem or decreased perceptions of their own personal accomplishments can be discouraged in their work and furthermore have difficulties with performing effectively within their job.
K
Interventions:
Recognizing the causes and effects of nurse burnout we evaluated interventions and preventative mechanisms for managing burnout. First off, nurses and supervisors need to realize the importance of having a support system. Nurses need to work together to create an environment that promotes security, mutual respect, and positive feelings. Also, we found that regular rounding by the managerial staff leads to early recognition of moral distress faced by the floor nurses. It is suggested that charge nurses and/or a counselor be available on the floor to check in with nurses throughout the day and provide early interventions and other resources if needed (source 2 from poster).
Interventions continued:
As noted before, shift length and weekly work hours can have many negative outcomes on nurses performance and their health. It is advised by Bae & Fabry that nurses monitor work hours and overtime in order to prevent any negative consequences and incidences of nurse burnout. This may include limiting 12-hour shifts and overtime.
K
Interventions continued:
Breathing techniques such as slow breathing and muscle relaxation techniques such as progressive muscle relaxation can both be effective therapies at managing stress.
Slow breathing can be especially effective in that you can practice it anywhere and it only takes a minute or two. Let’s practice…
Stop what you’re doing
Breathe in through your nose and out through your mouth
Intermittently tell yourself relax in between breathes
Repeat several times until you feel relaxed and back in control
(Repeat 2 times)
K
Interventions continued: Cognitive Based Interventions
Cognitive Based interventions, also often referred to as CBIs are designed to better your emotional self management allowing you to change the things you can and accept the things you cannot. CBIs help nurses examine their emotions, behavior, and perception of events to influence better outcomes. As illustrated above cognitive theory addresses a stimulus or situation and then orchestrates a detailed mindfulness intervention to elicit a behavioral change response. CBIs can be utilized through counseling services and appropriately trained hospital staff.
R-
After conducting our thorough research on nurse burnout and discovering the need for burnout relief, we felt we wanted to do something about it. We set up a meeting with the directors of nursing for our clinical units to present to them our findings. They were very appreciative that we took the time to do so. After our presentation, the director and charge nurse explained their interest in our topic and the relevant need for more information about it. Before our presentation, we decided to create something we called the “interventions box”, as shown in the picture on the left. In this box, we included many different items that would help to prevent or relieve nurse burnout. We filled the box with objects that we felt created fun and lightheartedness. These objects included a stress ball, fun glasses, a clown nose, games, a box of tea, chocolates, and inspirational poems. The director and charge nurse expressed their excitement about this box, and promised to show it at their next unit meeting and place it in the break room to allow easy access for the unit’s staff. They also agreed to hanging up the poster we designed periodically through staff-only designated areas. Completing this meeting with the director and charge nurse gave us a heightened sense of accomplishment. The reassurance we received from them on the decision to research nurse burnout along with their enthusiasm about our “interventions box” added to this feeling.
R = Sociology: Sociology 101 was a class I took during Freshman year of college. According to dictionary.com, sociology is defined as “the science of the fundamental laws of social relations”. This definition encompasses all social relationships. Social relationships are imperative to nursing practice. Nurses are consistently maintaining a variety of relationships at any one given time. These relationships often include, but are not limited to, nurse-patient relationships, nurse-nurse relationships, nurse-manager relationships, and personal relationships outside of the workplace. Stewart and Terry adds to the significance of this issue by stating “When nurses … start to develop burnout, … the quality of their therapeutic relationships with patients… are affected”. Once relationships with patients become affected negatively, nurses have lost a huge important part of their practice.
T = Psychology: Stress affects on the psyche.
K = Family History: Gender roles and balance between personal and work life.
R
Are You At Risk?:
Are you at risk for burnout? Throughout our research there were a couple of solid factors we discovered that can put you at risk for developing burnout. We discovered that you may be more prone to burnout if: You lack a reasonable balance between work and your personal life, and/or you try to be every thing to every one. Nurses are notorious for being very compassionate people. While this is a wonderful personality trait to possess, it is important for nurses to remember to take care of themselves as well. Going along with this, maintaining a balance between work and personal life is important to maintaining a healthy lifestyle.
(Chippas & McKenna)
R
Now that we’ve just spent an entire presentation talking about the negative effects of too much stress, we want to re-iterate that NOT ALL STRESS AND PRESSURE IS BAD FOR YOU. Stress is actually beneficial to performance. In healthy amounts, stress improves a person’s performance during challenging situations by providing motivation for completing the challenge successfully. The presence of stress in a person’s life can help lead to much of that person’s success.
So, why is it that stress can cause burnout then? Stress is only healthy for a person in small amounts. When stress is excessive, it loses its beneficial effects and becomes harmful. Too much stress leads to burnout, as well as many other mental and physical issues.
R
You make a difference everyday:
If we could choose one thing for every one of you to take home from our presentation, it would be that YOU MAKE A DIFFERENCE EVERY DAY. One of our clinical instructor assistants gave us a poem on the last day of clinical that really inspired us to incorporate it in our project. This poem, called the Starfish poem, is great to think about in all aspects of our lives. *Read poem*
CONCLUSION:
Nurse burnout is indeed a huge issue in today’s nursing workforce. However, through proper knowledge of the topic, we can prevent nurse burnout and recognize it early enough to positively intervene.
