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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 1 2 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 3 PREVENTING NURSING BURNOUT 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 4 PREVENTING NURSING BURNOUT 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 PREVENTING NURSING BURNOUT 5 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. 6 PREVENTING NURSING BURNOUT 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 PREVENTING NURSING BURNOUT 7 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 PREVENTING NURSING BURNOUT 8 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. PREVENTING NURSING BURNOUT 9 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. 10 PREVENTING NURSING BURNOUT 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. 11 PREVENTING NURSING BURNOUT 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