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Running head: PREVENTING NURSING BURNOUT
Preventing Nursing Burnout through Positive
Working Environments and Self-Care Activities
Taylor Glover
Minnesota State University, Mankato
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PREVENTING NURSING BURNOUT
Preventing Nursing Burnout through Positive Working Environments and Self-Care
Activities
The need for high quality nurses is in high demand due to the increasing age of the
population; however, retention of nursing staff is becoming more difficult due to increasing
burnout rates. According to Lintern (2013), the Centre for Workforce Intelligence predicted that
there would be 47,500 fewer nurses than needed by 2016. The nursing shortage is a direct
reflection of burnout experienced by nurses. Markedly, Erickson and Grove (2007) found that 43
percent of surgical nurses who reported high levels of burnout said they intended to leave their
jobs within the next twelve months. Moreover, the ANA reported that the four most frequent
causes of burnout in nurses were exhaustion and discouragement (50%), sadness by what they
couldn’t provide for their patients (44%), powerlessness to affect change necessary for safe,
quality patient care (40%), and fear for patients’ health and safety (26%) (Erickson & Grove,
2007). When the perceived stress of nurses is significantly high, stress-related health outcomes
may result and quality of patient care is negatively impacted. It is important to implement
strategies to help nurses remain engaged in their work. The purpose of this study is to show how
implementing positive work environments through developing strong relationships and
professional communication with colleagues can help facilitate a less stressful environment.
Moreover, evaluation of self-care activities is examined in helping to reduce perceived stress in
nurses and increasing quality and safety of patient care.
Methods
Unfortunately, the nursing shortage directly correlates to burnout experienced by nurses.
In order to decrease the shortage, promotion of a desirable work environment and the use selfcare activities should be implemented. To find adequate and relevant research related to this
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topical area, I searched the databases of ProQuest, EBSCO, and CINAHL. For each database, I
limited my search to peer reviewed, full text articles published in the last ten years. In ProQuest,
I used the search term of “self-care in nursing” and had 54,954 hits, and I chose two studies from
that database. In EBSCO, I used the search term of “preventing nursing burnout” and had twenty
hits and also chose two studies from that database. Lastly, in CINAHL, I used the search term
“job satisfaction in nursing” and had 1,495 hits and chose only one study from that database. To
determine if a research article was useable, I checked the credibility of the authors by looking at
their credentials in relation to the study. Also, I ensured that each of the studies were primary
sources. Four of the five studies examined workplace burnout related to job dissatisfaction and
other stressors (Alacacioglu, Yavuzsen, Dirioz, Oztop, & Yilmaz, 2009; Pino & Rossini, 2012;
Silén, Tang, Wadensten, & Ahlström, 2008; Spence Laschinger, Leiter, Day, & Gilin, 2009).
Three of the five studies assessed how to reduce stress through self-care activities and creating a
more desirable work environment (Newsome, Waldo, & Gruszka, 2012; Pino & Rossini, 2012;
Spence Laschinger, Leiter, Day, & Gilin, 2009). Overall, the studies helped identify the reasons
of burnout and how to combat it through positive working environments and self-care activities.
Analysis
Although the population, setting, and analysis of each study had some differences, there
were several similarities. All five studies consisted of predominantly female nurses or students
desiring to work in nursing with an age range of 21-63 years old (Alacacioglu et al., 2009;
Newsome et. al, 2012; Pino & Rossini, 2012; Silén, et. al, 2008; Spence Laschinger et. al, 2009).
Two of the studies had a higher number of participants ranging from 967 to 1106 total
participants (Spence Laschinger et. al, 2009; Pino & Rossini, 2012). The three remaining studies
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had fewer participants ranging from 21 to 56 total participants (Alacacioglu et al., 2009,
Newsome et. al, 2012; Silén et. al, 2008).
The setting for the researched studies generally were the same, except for one study. Of
the five studies, four of them were based out of hospitals or clinics (Alacacioglu et al., 2009;
Pino & Rossini, 2012; Silén, et. al, 2008; Spence Laschinger et. al, 2009). Of those four studies,
three of them were based out of Europe (Alacacioglu et al., 2009; Pino & Rossini, 2012; Silén et.
al, 2008) and one of them was based out of Canada (Spence Laschinger et. al, 2009). The
remaining study was based out of a university in the Southwest of the United States (Newsome,
et. al, 2012). The research articles wide range of geographic locations helped to see the causes of
nursing burnout around the world and strategies other countries are using to decrease this
burnout.
Among the five studies, most of them used similar quantitative data analysis techniques,
while one study used qualitative data analysis methods. Three of the studies used the Statistical
Package for Social Sciences and descriptive and inferential statistics (Alacacioglu et al., 2009;
Pino & Rossini, 2012; Spence Laschinger et. al, 2009). Moreover, three of the five studies used
independent t-tests and one-way ANOVA’s to analyze their data (Alacacioglu et al., 2009;
Newsome et. al, 2012; Pino & Rossini, 2012). The remaining study utilized qualitative latent
content analysis to analyze and interpret their data (Silén, et. al, 2008). The combination of
utilizing both quantitative and qualitative data facilitated a better understanding of nursing
burnout and how creating better working environments and implementing self-care activities
decreases the incidence of burnout in nursing.
Findings
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All nurses seemed to experience the effects of burnout, but found ways to combat the
stress through self-care activities and working in a positive work environment. The findings
among the three studies agreed that job dissatisfaction and distress is due to a negative work
environment and low staffing of the workplace (Alacacioglu et al., 2009; Silén et. al, 2008;
Spence Laschinger et. al, 2009). When a negative working environment exists, nurses may have
negative feelings towards their profession or place of employment causing low quality patient
care. Moreover, effects of low staffing may increase workload; therefore, the stress experienced
by nurses is also increased leading to nursing burnout. Also, one study found that female nurses
experience higher levels of stress compared to male nurses due to emotional perceptions of their
stress (Pino & Rossini, 2012). Females may have a more difficult time handling stress related to
nursing, which is an alarming finding since females saturate the nursing profession. Moreover,
two studies conflicted in their findings in the correlation of perceived stress and marital status.
According to Alacacioglu et al. (2009), their study found that younger and single nurses had
higher stress compared to older and married ones. However, Pino & Rossini (2012) found that
stressors were perceived similar between single and married nurses. Even though these findings
conflict, it is important to remember that everyone experiences stress from nursing, whether
married or single. Fortunately, there are ways to combat nursing stress and burnout. Four of the
studies discussed ways to combat workplace stressors and job dissatisfaction through
mindfulness techniques, support from colleagues, and ensuring that workplaces promote positive
working environments (Newsome et. al, 2012; Pino & Rossini, 2012; Silén et. al, 2008; Spence
Laschinger et. al, 2009). By implementing these practices into healthcare facilities, nurses
perceived stress may be reduced decreasing nursing burnout and increasing the quality of patient
care delivered.
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Discussion
The purpose of this study was to examine the causes of nursing burnout and how to
combat burnout through the use of self-care activities and the promotion of a positive working
environment. The studies researched had several strengths in the methods used for conducting
their research. In utilizing research methods, four of the five studies utilized quantitative research
methods to compare with previous studies done with similar research questions; moreover, they
all used questionnaires that participants answered on a five or six-point scale facilitating in
attractiveness and ease of participation in the study (Spence Laschinger et. al, 2009; Pino &
Rossini, 2012; Newsome et. al, 2012; Alacacioglu et al., 2009). However, one study utilized
qualitative research methods due to the limited research about distress and ethical issues in
neuroscience nursing (Silén et. al, 2008). However, their qualitative research methods proved to
yield supporting data in identifying stressors in neuroscience nursing and how to focus future
studies to help validate their findings. Whether quantitative or qualitative methods were used, all
studies produced results that directly related to their original research question demonstrating
effective and reliable research skills.
The studies demonstrated weaknesses in their population demographics and reliance on
self-reporting methods of gathering data. The population samples of all five studies had either a
small number of participants, a large number of female participants, or focused specifically on a
department of nursing making it difficult to generalize the information to nursing practice. All
five research articles consisted of primarily female participants; in fact, one study correlated their
findings based on sex and 85% of their participants were females (Pino & Rossini, 2012).
Although females saturate the nursing career, it is important that males are equally involved in
research studies because findings from studies that predominantly consist of females are difficult
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to generalize to the male population. Moreover, two of the studies focused their research on
neuroscience nursing and oncology nursing; also, they had a small number of participants (2156) making it difficult to apply their research to other departments of nursing around the world
(Silén et. al, 2008; Alacacioglu et al., 2009). Also, one study did not exclusively apply to nurses.
Instead, it applied to students desiring to work in a helping profession making it difficult to relate
the data to nurses in practice (Newsome et. al, 2012). Moreover, all five studies utilized selfreporting as the way of gathering their data. Although self-reporting is a common method of
gathering data, researchers must rely on the fact that the participants are telling the truth and
fully understanding the questions being asked. Because of this, results can be easily
misconstrued decreasing the validity of conclusions that have been made.
In order to fulfill remaining gaps to enhance nursing knowledge, additional research
should be performed utilizing more participants and more male participants to show how stress is
perceived in all departments of nursing rather than just neuroscience and oncology. Then, results
can be synthesized to show how specific departments affect stress levels of nursing.
Furthermore, self-care activities and positive working environments can be more heavily
promoted in those departments found to cause more stress for nurses.
Implications for Nursing Practice
After researching the causes of burnout in nurses, decreasing workload and promoting
positive working environments can significantly decrease turnover and burnout rates. According
to Pino and Rossini (2012), the single sources of stress in nursing are workload and turnover.
Moreover, Alacacioglu et al. (2009) found that low levels of personal accomplishment were a
common finding of nurses in practice due to a stressful work environment. Because of the
nursing shortage, many floor nurses find themselves with more patients than they can manage
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during a single shift. Unfortunately, nurses can become overworked and often quit nursing and
find a less stressful work environment, worsening the nursing shortage. Fortunately, there are
strategies that can be implemented to improve the environments of the workplace. According to
Spence Laschinger et. al (2009), the results from their study found the importance of positive
working environments in retaining nurses in the hospital setting; these environments are
maintained through treating each other respectfully, refraining from uncivil behavior, and
establishing a non-threatening relationship with the supervisor. In implementing these behaviors
in a hospital setting, valued care can be delivered by nursing staff. According to Silén et. al
(2008), high quality care is a direct result of well-qualified nurses viewing a patient in a holistic
view and collaborating with other healthcare professionals. By promoting a positive work
environment within a hospital setting, nurses will be able to respectfully and professionally
communicate with one another and their supervisor about any concerns they are having with
stress and/or workload. Then, together as a team, nurses and their supervisors can come up with
a plan to help decrease the stress and workload. As a result, nurses will have more time with their
patients allowing them to deliver quality patient care and improve the nurses overall job
satisfaction.
While creating a positive work environment is important in preventing burnout,
participation in self-care practices can also help reduce the stress that nurses experience.
According to Newsome et. al (2012), self-care is critical in sustaining effectiveness in a helping
profession; moreover, they found mindfulness to be an effective self-care activity that assists
individuals in paying attention to the present moment while not worrying about the past or the
future. Nurses may find themselves overwhelmed with the amount of care that each patient
requires and may constantly think about what they need to accomplish in a given shift.
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Unfortunately, anticipation of future actions increases stress and anxiety and may take away
from the quality of care they are giving in the current moment. However, participation in
mindfulness was shown to reduce levels of perceived stress and increase levels of selfcompassion even one month after the intervention was performed (Newsome et. al, 2012). If
hospitals provide opportunities for nurses and other healthcare professionals to participate in
mindfulness group work, the quality of care may be greatly increased while stress and anxiety
are decreased. Besides mindfulness, there are other self-care activities nurses can do to combat
stress. According to Pino and Rossini (2012), men used their non-working time to dispense their
stress by relaxing at home while women used social support as a principal source of managing
their stress. Women tend to deal with their stress more outwardly; therefore, talking to someone
about their stress experience is an excellent self-care technique to combat stress. For instance,
according to Silén et. al (2008), when nurses are faced with moral or ethical stressors, discussion
with colleagues can help clarify the perspectives of their patients; in turn, nurses can fully
understand their patients reasoning for withdrawal or continuation of care reducing the nurses
stress. Through utilizing the self-care activities of mindfulness, relaxing at home, or social
support, the stress of nursing can be more efficiently managed and reduced. In reducing stress,
nursing burnout can be prevented and quality of nursing care and overall patient and employee
satisfaction can be achieved.
After researching the prevalence of burnout in the nursing profession, I have realized the
importance of taking steps in preventing this from happening in my career as a nurse. When
working on the floor, it is important that I contribute to a positive working environment. I can do
so by not talking poorly of my colleagues, communicating in a professional and respectful
manner, and developing a positive and supportive relationship with my nursing supervisor.
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Furthermore, it is important that I participate in self-care activities. After reading about the
positive and long-term effects of mindfulness, I would like to facilitate the use of it among
nurses and other hospital staff at my future place of employment. Also, being a female, relying
on social support from others is important for relieving any sort of stress I am experiencing.
Conversely, I need to be there to support my colleagues when they are experiencing stressful
situations. By incorporating these techniques and practices into my future nursing practice, I can
combat nursing burnout and assure that I am providing quality, competent nursing care to my
patients.
Conclusion
Prevention of burnout and turnover rates can be combated through the implementation of
promoting positive working environments and self-care activities. The nursing shortage is a
prevalent issue around the world and if not addressed, quality of healthcare will be negatively
impacted. Every effort should be made to expose new and seasoned nurses to high quality
working environments and engage them in their profession. This can be done by fostering
positive working environments that empower nurses to perform according to professional
standards, which also promote positive behavior by all healthcare staff. Moreover, the use of
self-care activities, whether they be performed individually or as a group, can also help in
sustained effectiveness and persistence in the nursing field. Overall, the need for high quality
nursing care is in great demand, and implementing strategies of self-care and positive working
environments can maintain the high caliber of nursing care needed.
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References
Alacacioglu, A., Yavuzsen, T., Dirioz, M., Oztop, I., & Yilmaz, U. (2009). Burnout in
nurses and physicians working at an oncology department. Psycho-Oncology,
18(5), 543-548. doi:10.1002/pon.1432
Erickson, R. J. & Grove, W. J. C. (2007). Why emotions matter: age, agitation, and burnout
among registered nurses. The Online Journal of Issues in Nursing 13(1). doi:
10.3912/OJIN.Vol13No01PPT01
Lintern, S. (2013). NHS to face chronic nursing shortage by 2016. Retrieved from
http://www.nursingtimes.net/roles/nurse-managers/nhs-to-face-chronic-nurse-shortageby-2016/5059871.fullarticle
Newsome, S., Waldo, M., & Gruszka, C. (2012). Mindfulness group work: preventing stress
and increasing self-compassion among helping professionals in training. Journal For
Specialists In Group Work, 37(4), 297-311. doi:10.1080/01933922.2012.690832
Pino, O., & Rossini, G. (2012). Perceived organizational stressors and interpersonal relationships
as predictors of job satisfaction and well-being among hospital nurses. International
Journal of Psychology and Behavioral Sciences, 2, 196-207.
doi:10.5923/j.ijpbs.20120206.02
Silén, M., Tang, P. F., Wadensten, B., & Ahlström, G. (2008). Workplace distress and ethical
dilemmas in neuroscience nursing. Journal of Neuroscience Nursing, 40(4), 222-231.
Spence Laschinger, H., Leiter, M., Day, A., & Gilin, D. (2009). Workplace empowerment,
incivility, and burnout: impact on staff nurse recruitment and retention outcomes. Journal
Of Nursing Management, 17(3), 302-311. doi:10.1111/j.1365-2834.2009.00999.x