Clinical nurses’ experiencing occupational burnout within the health care setting

This article was contributed by Ms. Niyaza Abdul Rahman to the ADK Hospital Newsletter “TeamTalk” Issue 2o, November 2011. With her permission I share this article on my blog.

This is a systemic review based on selected ten research papers out of 100 papers for which the aim was to find out answer for the question of :

How do clinical nurses perceive their experiences in living with burnout within the clinical area setting?

This review was my dissertation for the course which I would like to share the result of it with you all, since it is very much related to our working field and might benefit our nurses in the long run.

The term “Burnout” which appeared around (1975) in scientific literature, is referred as a low job satisfaction in many cases (Lauderdale,1982,p35). There is no specific definition for burnout in terms of medical condition, but it is well recognised and defined as a psychological condition. As a matter of fact burnout is said to be the final stage of stress when everything else fails (IMCARES), 2008

Nurses assisting in surgery

Comparatively health care professionals are at higher risk of getting burnout than any other profession, because of the nature of their work (Erikson & Grove 2008) and as well as the life and death decisions they take (Potter 2005). The main reason why nurses move out of the industry is because they experience stress,sadness, powerlessness, exhaustion, and frustration as their daily routine (Erikson & Grove 2008). From a health care commission report on Maidstone and Tunbridge wells NHS (National Health Service) revealed that staff shortage, ill health and heavy work load are contributory factors for failure of effective dealing with the patients. In addition staffs are also unaware of their own wellbeing for the safety of the patients (Bence 2008, p28). This shows that there is a link between nurses’ burnout and patient satisfaction.

A Nursing Times survey, conducted on 2000 nurses revealed that seven out of ten suffered from work related stress, where sick leaves were increased  by 30 or more sick days for the previous years as a result of job threats, increased workload and staff shortage (Jones 2007).

Burnout in nursing effects not only the organisation but also to the patients as well as the nurses’ well being. As a result of burnout, nurses’ job turnover has been increasing day by day

All these things  consequently leads to a low morale, high absenteeism, high job turn over and other personnel conflicts and thereby  reducing the job satisfaction causing low performance in work ( Carson & Fagin 1996, Cited in Fothergill & Hannigan 2000).

The emerged themes from all ten papers were, Unsupportive management,  Physiological and psychological aspects of burnout, Inadequate availability of resources,  Experience of work place alienation,  Excessive and heavy work load, Strategies for coping mechanism

For the theme of unsupportive management a vast negative perceptions were given by nurses. This theme was supported by nurses’ perceptions and experiences of negativism towards their work, lack of recognition, encouragement, support, poor supervision, high expectation from nursing management and unsupportive administrations.

All we want from management is some recognition for our hard work. Just a ‘Thank you, you’re doing a good job!’ will go a long way to motivate us. – Smit (2005, p26, col 2, lines 27 -29)

Physiological and psychological aspects of burnout were apparent from 9 out of 10 papers. Most frequently expressed psychological consequences from all of the papers were frustration, hopelessness, powerlessness, helplessness and emotional exhaustion.

But I still think in a way, I’ve complained several times but it’s not taken seriously. It’s swept under the rug. So then it really feels, what you say, it’s not worth much. In the long run I don’t think this is good for people. You need to feel involved and that you can change things. – Olofsson and Bengstsson and Brink (2003, p355 col 2 lines 16-21)

For the theme of inadequate availability of resources, mainly highlighted within the studies were, inadequacy of staff, time, high responsibilities with limited resources, skilled staff and basic resources for preventive measures.

Experience of work alienation was highlighted as unfamiliar work environment and equipments, inexperience and incompetency in work and lack of knowledge.

Difficulty in handling the advance equipments and operating the new machines were time consuming for them as they do not have the proper guidance and exposure to it.

Most leading issue from all ten papers were experiencing excessive and heavy workload.

This was highlighted in papers as multitasks with frequent interruptions within a limited time or performing multiple interventions at a limited time which further causes staff fatigue and exhaustion.

You never get any peace; never get done with anything, always interrupted by ringing telephones. During all this an assistant nurse comes and some patient is ill and you have to run. Then run from that to talk on the phone with a relative who’s calling and worried. Then rounds have to be done. These constant interruptions. While I’m supposed to do these things I want to get out and see the patients, what am I sitting here and documenting? How is the patient? How is he or she really feeling? – Olofsson and Bengstsson and Brink (2003, p354 col 2,  lines 39-52)

As for the final theme, strategies for coping mechanism, they have provided perceptions and experiences of how they relived and coped with the stressors faced within the care setting. Apparent strategies were; attempting to reduce stress by remaining calm and quite during the stressful situations, relieving by individual interests, using support and assistance from peers and family members, communicating with co workers, getting involved in something else ignoring the situation and reflecting back the situation and communicating with a colleague.

Findings suggest that nurses’ working under heavy workload pressure experiencing high level of burnout affecting them mentally and physically, which is a serious issue to consider. Consequently this leads them to move out of the industry or with a low performance in their work. Thus health care managements should be more cautious about staff satisfaction and their wellbeing in order to restrain nurses. Additionally it is vital for the supervisors and nurse managers to conduct supervisory sessions and meetings to consider nurses’ problem and to assess their workload. Within the light of this review nurses’ should be able to identify and recognise their stressors early in order to prevent them from burnout or post traumatic stress. Moreover nurses should focus on their own health and well being, caring for themselves which would consequently decrease the level of burnout and promote a quality care.

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