Hello, dansd-ga!
Nursing "burnout" is a very real problem. Due to the current serious
nursing shortage, methods to decrease burnout and increase nurse
retention are starting to gain momentum. The following information
should help to shed some light on these issues.
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PREVENTING OR ALLEVIATING BURNOUT
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WHAT CAN MANAGEMENT DO?
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Commit to helping
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"Management has to be committed to address and help prevent burnout.
The reduction of staff workloads, availability of 'time out' periods,
and job related training should be mandatory. Staff supporting each
other and recognizing when someone needs help is a professional must.
We have to help our fellow workers instead of pushing them over the
edge. Nurses have to stop backstabbing one another and help foster a
supportive environment especially to new staff members. Each one has
to maintain professional accountability."
"Personal hardiness is imperative for nurses. Hardiness ratings have
shown to be the lowest among the young nurses, (Bryant, 1994). To help
nurses feel hardy, the establishment should provide social support,
stress management courses and how to develop your personal
enhancement. Together, these programs help nurses deal with their
feelings and turn experiences that may be negative into positive
challenges."
Provide Stress Management and Support Systems
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"Critical incident stress management is a group of very dedicated
professionals who are specially trained in counseling. Many nurses get
worn down dealing with very emotional, devastating situations time
after time. An individual would have to be a stone not to feel for any
situation that causes stress. Critical incident stress debriefings are
designed to deal with these emotions right after they occur. The team
deals with immediate crisis intervention, (Rubin, 1990). These
sessions should be held often to provide a venting period. These are
not designed as a counselling session; if a person needs more personal
treatment, they should seek individual help."
From "Burnout: Don't Let It Happen To You," by Corinne Shore, R.N.,
E.N.C.(C), C.F.N., University of Manitoba (1999)
http://216.239.53.104/search?q=cache:QRbR12gJX6AJ:www.umanitoba.ca/faculties/medicine/units/emergency_medicine/archive/burnout/burnout.htm+preventing+nursing+burnout&hl=en&ie=UTF-8
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Management should take an active role in implementing employee
support systems and encouraging staff to use them.
"Support systems are crucial for preventing burnout (Mulligan, 1998).
This may involve simple colleague support such as spending a moment to
praise, discuss, or simply acknowledge personal needs. On a more
formal level, productive support sessions involve sharing feelings and
participation in the establishment of unit goals and objectives.
Taking action under stressful conditions (rather than remaining
passive) is a powerful coping strategy. Support systems such as
training (improving communication, learning skills for giving and
receiving support, burnout workshops and appropriate supervision) and
education (providing realistic job descriptions and stress management
skills) are methods of taking positive action."
From "Stress and Burnout: A Nursing Perspective," by Warren Edwin.
Beginning Journeys. Volume 5 (1999)
http://www.chchpoly.ac.nz/nursing/journey5/edwin.asp
Create a Sense of Workplace Empowerment
---------------------------------------
A study of 192 Canadian nurses found that a sense of psychological
empowerment is closely tied to preventing burnout. Excerpts from the
Abstract follow:
Objectives:
"Kanter’s (1993) Theory of Organizational Empowerment provides a
framework for investigating the role of empowering work conditions
among nurses. Kanter maintains that work environments which provide
access to information, resources, support, and opportunity to develop
are empowering and enable employees to accomplish their work in
meaningful ways. The main objective of this study was to test a model
derived from Kanter’s theory linking the effects of structural and
psychological empowerment at one point in time to nurses’ reports of
burnout three years later."
Conclusions:
"Nurses’ perceived access to workplace empowerment structures
resulted in increased psychological empowerment at Time 1 and these
feelings of empowerment were predictive of reported burnout levels at
Time 2. These results support the expanded theoretical model of
nursing empowerment and strengthen those of previous cross-sectional
research linking empowerment to burnout among nurses."
Implications:
"The results suggest that fostering environments that enhance
perceptions of empowerment can be an effective way of preventing
burnout among nurses."
From "Workplace Empowerment as a Predictor of Nurse Burnout in
Restructured Health Care Settings," by Heather K. Spence Laschinger,
PhD, RN, School of Nursing, University of Western Ontario. Work Place
Issues (Nov. 2003)
http://stti.confex.com/stti/bcscience/techprogram/paper_15876.htm
Employ Various Methods to Improve the Work Environment
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"Organisational improvement relates to changing the staff policies and
procedures of a health organisation to decrease the incidence of
stress and burnout. For example, reducing staff-client ratios allows
for staff to focus more on the positive aspects of their work. The
resultant satisfaction for the nurse will decrease the risk of
burnout. Health organisations need to consider the cost-benefit
equations of staff burnout regarding waitlist pressures (Mulligan,
1998). Another organisational improvement is limiting hours of
stressful work. Maslach and Pines (1988, cited in Mulligan) found
longer direct contact hours with clients increased stress and burnout.
Consideration could be given to creating part-time positions, having
shorter work shifts and the use of task rotation to provide a balanced
workload. In short, health organisations must ensure flexibility in
their work environments if staff burnout is to be reduced."
From "Stress and Burnout: A Nursing Perspective," by Warren Edwin.
Beginning Journeys. Volume 5 (1999)
http://www.chchpoly.ac.nz/nursing/journey5/edwin.asp
WHAT CAN NURSES DO?
====================
Don't Neglect Self
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"Do you remember why you became a nurse? If you think you’re too busy
to slow down to contemplate an answer, that may be all the more reason
to make the time. You could be a candidate for the nemesis of
healthcare workers challenged by an ever-changing, stress-inducing
landscape. It’s the big "B" - burnout."
"The very word conjures up such negative images and it’s time to
update the aging term, which was borrowed from the space industry.
Instead of focusing on "avoiding burnout," think of it as "learning to
stay well."
"The secret to having enough energy to keep giving compassionate care
lies in creating a positive environment within yourself through
meditation and positive thinking. The heart of the message from many
counselors of healthcare professionals: Don’t forget to take care of
yourself, physically, emotionally, and spiritually and always remember
why you became a nurse."
From "Nurse-tips." TipZine, Issue 37: Preventing Nursing Burnout.
(June 2001)
http://nurse.lifetips.com/RscNLV.asp?year=2001&month=6&day=29
Employ Self Management
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"Self-management hinges on awareness of stressors and the effects of
stress. Nurses then develop positive coping strategies for each
problem. Self-management strategies may include learning new knowledge
and skills, or setting clear, attainable goals. Nurses should remember
to support the basic habits of good health: adequate nutrition and
regular physical exercise."
From "Stress and Burnout: A Nursing Perspective," by Warren Edwin.
Beginning Journeys. Volume 5 (1999)
http://www.chchpoly.ac.nz/nursing/journey5/edwin.asp
Stay in control with humor and self-regulation
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"A sense of humour is important to develop a healthy, fostering
environment, (Wylie, 1997). Maintaining a sense of humor is important
for our own mental health. Humor is a stress relief, it alleviates
fear and anxiety in your co-workers and clients. Life is too short to
always be hard-nosed."
"Preventing burnout takes a conscious effort on the individual
recognizing the signs and getting appropriate help. Nurses are their
own worst enemy; sometimes we just have to say 'no' and do the best
job we can. We are only responsible for ourselves, we cannot carry the
weight of the world on our shoulders."
Read "Burnout: Don't Let It Happen To You," by Corinne Shore, R.N.,
E.N.C.(C), C.F.N., University of Manitoba (1999)
http://216.239.53.104/search?q=cache:QRbR12gJX6AJ:www.umanitoba.ca/faculties/medicine/units/emergency_medicine/archive/burnout/burnout.htm+preventing+nursing+burnout&hl=en&ie=UTF-8
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On a lighter and more personal note:
Read the AllNurses.com Bulletin Board thread on "Preventing Burnout."
http://allnurses.com/forums/showthread/t-35660.html
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IMPROVING NURSE RETENTION
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Increase job satisfaction and nurses will stay!
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Determinants of job satisfaction can be linked to promotional and
training opportunities, perceptions of adequate pay, the existence of
pleasant workplace relations, reasonable workload and quality of the
work environment. However, in a British research study, opportunities
for career advancement were a critical indicator of job satisfaction.
Read "Improving Nurse Retention in the British National Health
Service: The Impact of Job Satisfaction on Intentions to Quit," by
Michael A. Shields and Melanie E. Ward. Discussion Paper No. 118. IZA
(February 2000)
ftp://ftp.iza.org/dps/dp118.pdf
The following excerpt says it all:
"During the past six months, I have been listening to an outpouring of
emotion by many nurses who would strongly agree that nurse retention
should be considered a highly significant problem within hospitals and
other healthcare institutions today. In my discussions with nurses on
the internet, in-person, and via telephone, I have found that
* staffing
* work/life balance
* and the amount of work hours that is expected of nurses
is one of many of the major positions/ work-related complaints of
nurses today.
Underlying their positions for better work hours are underlying needs.
One of these needs is
* respect - respect from doctors, managers, and senior administration
for their contributions and positions.
Respect is of huge importance for nurses, and most nurses that I have
spoken with, find that there is a definitive lack of respect within
their work environment. Respect takes different forms for nurses - to
some it is higher pay, to others, it is recognition, or respecting
their need to "have more hours to themselves or their families," as
one nurse explained. To most of the nurses I have had a conversation
with, nursing is a "labor of love," because they feel they are
answering a "calling to help patients" from a higher power.
* From my perspective, when management and other teams members do not
affirm or recognize the value of nurses with respect; anger and
frustration become normative emotions within conversations."
Read "Summary of Nurse Retention Analysis and Report in The U.S.," by
Louis Carter. Best Practice Publications (2003)
http://home.nyc.rr.com/bestpractices/nurse-retention.htm
Employ "Recognition, Reward and Renewal Programs"
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High turnover in the nursing profession has been closely linked to a
lack of recognition. One very important means of increasing retention
is to adequately recognize and reward nurses for their performance.
"Recognition has long been identified as a motivator and primary job
satisfier. Lack of adequate recognition has been linked closely with
job dissatisfaction. Another important component in job satisfaction
is the receiving of rewards. Rewards may be monetary or other benefits
that may include pay, incentives, bonuses and other items
complimenting reimbursement of services. The majority of nurse burnout
literature deals with stress identification and reduction. A less
well-documented area among nurses is the implementation of renewal
activities specifically designed to refocus, refresh and re-energize
the nurse professional."
Some examples employed by North Carolina area healthcare agencies
follow:
Provide for on-site or off-site education programs
Establishment of an agency library
Provide a Birthday "day off" with pay
Design team-building retreats
Provide reward recognition
Provide faculty mentoring and scholarship awards
Provide one-day seminar and clinical experiences
Read "Improving Nurse Recognition, Reward and Renewal in North
Carolina: 1997-1998."
http://www.nursenc.org/recruitmentandretention/grantprogram/docadobe/RRR98Report.PDF
==
Read "Utilizing a Recognition Dinner to Assess Retention of Oncology
Nurses," by Maureen Mullin, RN, BSN, OCNŽ, Anne Jadwin, RN, MSN,
AOCNŽ, and Lisa Roman, RN, BSN, OCNŽ, Fox Chase Cancer Center,
Philadelphia, PA.
http://www.ons.org/xp6/ONS/Convention.xml/Abstracts.xml/03Abs/03_172.xml
Improve the Quality of Work Life!
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Research results from a study of nurses and job-related retention
variables show that:
"unit organizational culture does affect nurses' quality of work life
factors and that human relations cultural values are positively
related to organizational commitment, job involvement, empowerment,
and job satisfaction, and negatively related to intent to turnover.
These findings suggest that although increasing recruitment of nurses
and improved compensation and benefits strategies may offset hospital
nurse shortages in the short term,
* improving quality of work life may be a more practical and long-term
approach to improving hospital nurse retention."
From "Executive Summary: The Relationship Between Hospital Unit
Culture and Nurses' Quality of Work Life," by Blair D. Gifford, Ph.D.
Journal of Healthcare Management. Volume 47, Number 1
(January/February 2002)
http://www.ache.org/PUBS/jhm471.cfm
Provide a Flexible Work Week
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Retention and dissatisfaction problems led Memorial Sloan-Kettering
Cancer Center to try a novel approach to implementing a reduced work
week.
"The new care delivery model involved partnering two nurses in a
collaborative relationship with two physicians to ensure coverage and
continuity of care using a four-day workweek. The model was presented
to nursing and hospital administration to establish an implementation
plan. The pilot commenced January 2002 and ended June 2002. It
included 11 attending oncologists, 12 office practice nurses, and
three research nurses. Three data points were used to evaluate the
model pre- and post-implementation: nursing documentation, turnover
rate, and satisfaction surveys completed by physicians, nurses, and
patients. The evaluation demonstrated marked improvement in all
areas."
Read "A Novel Care Delivery Model: Utilizing a Flexible Workweek to
Improve Nurse Retention and Satisfaction," by Colleen Lyons, RN, BSN,
Memorial Sloan-Kettering Cancer Center, New York, NY.
http://www.ons.org/xp6/ONS/Convention.xml/Abstracts.xml/03Abs/03_173.xml
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Additional References:
"Burnout among Nurses in Intensive Care Units, Internal Medicine Wards
and Emergency Departments in Greek Hospitals," by E. Adeli and Priami
M. ICU's and Nursing Web Journal. Issue 11. (2002)
http://www.nursing.gr/burnout.pdf
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I hope the information I have provided has proven helpful. If you
need additional clarification, please let me know and I will be happy
to help if I can!
Sincerely,
umiat
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