Tuesday, August 14, 2012

The Consequences of Nurse Burnout

So, my friends, the votes are in and the verdict is clear. Nurse burnout has real consequences and a ripple effect that is far-reaching and pervasive. Now that we clearly know that the impact is real, just what will we do about it?

According to a study by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, there is a causal link between nurse burnout and an increase in nosocomial infection rates. And although this relationship has not been proved beyond the shadow of a doubt, we can surmise that these findings hold enough water to prompt some needed changes in the industry.

Infections 'r' Us

In their research study--entitled Nurse Staffing, Burnout, and Healthcare-Associated Infection--published in The American Journal of Infection Control (edition 40, pages 486-490), the authors report that more than 1.7 million patients hospitalized in American facilities each year develop infections while undergoing treatment for other conditions. Using impressive data from a highly scientific and controlled study, the authors conclude that poor nurse staffing practices--including high nurse-patient ratios--directly impact the incidence of various forms of hospital-acquired infections, including urinary tract infections.

Within the conclusions of the study, the authors clearly convey their findings that increasing a nurse's patient workload by one patient can significantly increase the risk of post-surgical infections and UTIs, with small increases of 10% in nurse burnout causing very statistically significant increases in infection rates.

The research authors conclude thus:
In this study, we provide a plausible explanation for the association between nurse staffing and health careeassociated infections. Based on our finding that the staffing-infection relationship is mediated by job-related burnout, practitioners should work to implement organizational changes known to build job engagement, such as educational interventions, performance feedback, and social support, as strategies to reduce nurse burnout and thereby help control infections in acute care facilities.

Health care aassociated infections are associated with morbidity, mortality, and enormous costs to health care facilities, and insurance providers nationwide are denying payment for costs associated
with these infections. Health care facilities can improve nurse staffing and other elements of the care environment and alleviate job-related burnout in nurses at a much lower cost than those associated with health careeassociated infections. By reducing nurse burnout, we can improve the well being of nurses while improving the quality of patient care. 
What Else Can Change the Calculation?

I agree wholeheartedly that staffing issues are a prime factor when it comes to nurses making errors of exhaustion and overwork. I also agree that understaffing can certainly lead to burnout, which, in turn, leads to increased errors and lapses in care.

The authors of the study recommended "organizational changes known to build job engagement, such as educational interventions, performance feedback, and social support as strategies to reduce nurse burnout". 

I readily agree with these recommendations, and I add that there are simple--and complex--issues at play that, if addressed, can help to assuage the widespread scourge of burnout.

Staffing: This is where the researchers placed their bets, and based on their data it seems a likely culprit that can be addressed head on. With appropriate nurse-patient ratios and adequate coverage for shifts, nurses can have more time with patients and avoid the errors that undoubtedly come from having to be in too many places at once. Mandatory overtime and other questionable staffing practices also undermine our ability to provide proper care, especially when nurses are forced to work extra hours beyond their perceived ability to do so safely.

Bullying and lateral violence: There is a great deal of talk these days about bullying, intimidation and lateral violence among nurses, and many organizations are striving to make a dent in this horrendous problem that drives many nurses to leave the profession altogether. While overwork and high nurse-patient ratios may increase stress which leads to the nefarious practices of bullying and intimidation, there are likely other causes that must be addressed and remedied on every level: interpersonal, inter- and intra-departmental, organizational, and beyond.

The small things: Many nurses complain of small "injustices" at work that, cumulatively over time, add to stress and the development of symptoms of burnout. Nurses that I speak with in my coaching practice describe workplaces where taking the time to drink, eat, use the bathroom or rest during a shift are looked upon as ways in which nurses decrease productivity and waste important time for patient care and other tasks. 

Self-care: It is the rare healthcare facility that provides services or space for nurses and other employees to practice any form of significant self-care. Although the Hospital of the University of Pennsylvania boasts a "Nurse Rejuvenation Center" where nurses can meditate, do yoga, listen to relaxing music, or otherwise de-stress from work, apparently very few other hospitals are following suit and heeding the writing on the wall.

A culture of sacrifice: It's my belief that nursing has been falsely founded on the ill-conceived and Victorian-era notion that nurses are virginal, angelic deliverers of mercy who live to serve others, with little thought for themselves. With a collective historical memory of us nurses being the unprofessional, unscientific and inadequately trained handmaidens to the all-powerful physician, a subterranean self-esteem deficit may cause nurses--collectively speaking--to quietly submit to grueling hours, high nurse-patient ratios and other insults as simply "par for the course" for the lowly nurse. (Meanwhile, we bash and torture one another in order to vent our frustrations and feelings of inadequacy. See "Bullying and Lateral Violence" above.)

There's always more: This list could go on and on, but you get the picture. There are multiple factors at play here, and we cannot fix the problem with one simple fix. It is, undoubtedly, multifactorial.

Where to Now? 

Obviously, the hard work is ahead, and it is only a matter of time before the studies, reports and recommendations continue to multiply. We bloggers, writers, researchers and nursing pundits can continue to pontificate and publish our findings and opinions, but there comes a time when the rubber must hit the proverbial road, and I believe that that time has come.

Who will make the first move? Who will attempt to break the cycle and move us forward? Only time will tell, and I believe that we're capable of great things.

Our desire to prevent burnout, improve patient outcomes and satisfaction, and improve the quality of healthcare in this country while decreasing costs is laudable and right-minded. Now we simply must find the solutions, implement them, and evaluate their efficacy as we continue to tweak the fixes.

It's for all of us. Patient and nurse alike. And we all have a vested interest in the outcome.
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