MARIA PEREZ 2020-10-28 21:07:12 -------------------------------------------- All caps

Burnout in Nursing Professionals

Nursing is very complex, and it requires a strong personality to endure all work-related stress and problems. For a long time, many nurses and health workers have found themselves unable to withhold job pressure and balancing it with family and other daily activities that involve themselves in. as a result, they end up in distress and depression, making them unable to perform their duties as it is required of them. Too heavy workloads, extended shifts, and management problems are among the many reasons that make the field quite unbearable for many nurses.

According to Patrick and Lavery (2007), organizational management issues are the most significant contributor to stress-related problems among nurses. Burnout is characterized by emotional exhaustion, reduced personal accomplishments, and depression among workers. These conditions lead nurses to become less productive, resigning, or even getting depressed both at work and at home. As a result of the effects of burnout, medical facilities become understaffed and cannot handle heavy workloads.

Significance of the Practice Problem

The purpose of this study is to level and prevalence of burnout among professionals in the nursing practice. After assessing the prevalence, we will go ahead and identify the leading causes of burnout among nurses and discuss how burnout affects the nursing profession as a whole and how it affects an individual emotionally both at work and at home. At the end we will seek for ways of preventing burnout and recommend possible solutions that can be implemented by healthcare facilities to prevent their workers from suffering from burnout. When all individuals are satisfied at work and working at optimal levels without pressure and stress, productivity increase and health facilities dispense quality services to their customers.

It is important to conduct this study because of the rising cases of nurses resigning form duty in the recent years because of being overwhelmed with work. According to a recent article in The Guardian, ‘Record numbers of NHS staff quitting due to long hours’ the number of nurses leaving their jobs has tripled despite there being over 40,000 job openings that nurses are supposed to fill. The study indicates that a big percent of those that have quit did so because of spending too much time at work, poor work life and not having time for family.

With such a great number of nurses leaving their jobs and professions, there could be a looming crisis that is ahead. A good example was witnessed at the wake of Covid19 where hospitals were overwhelmed by large number of cases that required special attention. Having few nurses, it has been very difficult to manage the crisis. Therefore, this study seeks to understand why nurses are getting burned out in large numbers and suggest solutions that are going to manage the crisis.

Hopefully, we can come up with possible measures to ensure that nurses are satisfied at work and are providing good care for their patients.

PICOT Question

The compelling need to analyze the study issue and why nurses are getting burned out in large numbers will be developed using the PICOT format below. (P)the population of interest, (I)Int. ervention for the issue at hand, (C)Comparison of the issue of interest, (O)outcome of the interest, and the time (T) used to relay the outcome.

Population

The targeted population for this research is registered nurses who are working in public and private facilities across the nation.

Intervention

The desired intervention is creating awareness on the optimum workload and coming up with possible solutions to prevent nurses from being burned out or reducing the currently high rate. When such is done, the large number of nurses resigning due to a low work-life balance may be minimized.

Comparison

Several factors will be compared, among them being the performance and customer satisfaction level from overworked nurses. This will be done to assess the effect of quality output on heavy workload among nurses.

Outcome

The outcome of this study is to create a perfect work-life balance among nurses. By eliminating the contributors to burnout among nurses, nurses can get the desired job satisfaction and perform well both at work and at home.

Time frame

The time frame for this project is the three months of the fall 2020 semester.

Theoretical framework

MARIA PEREZ 2020-10-28 21:10:58 -------------------------------------------- extra space The theory of structural empowerment in organizations such as hospitals defines empowering conditions in social structures and at workplaces. These conditions are put in place to enable employees to do their work in meaningful ways and get job satisfaction. The empowering conditions are set by the management and leadership of organizations. Access to information, support, and resources in the work setting together with the ability of the leadership to mobilize workers to work in harmony and accomplish tasks successfully determines the success of the structural empowerment theory. Employees are empowered to be productive and work in meaningful ways when they have access to good working conditions. The lack of a well laid out structural empowerment program at work creates a toxic working environment for nurses.

Vallerand et al. (2010) suggests that there should be a good work life balance in order to increase productivity of workers. Obsessive passion for work creates a conflict between work and other daily activities that nurses are supposed to engage in. on the other hand, harmonious passion positively contributes to work satisfaction by balancing the two. Without such a balance, individuals are subjected to a mental and emotional staleness that leads to them getting burned out. Even though the structural setting of the organization plays the biggest role in employee welfare, it is also upon individual nurses to create their own balance. That is the reason why you may find one nurse doing well in a specific department while another is experiencing serious burnout. To find out why nurses get burned out, a correctional study will be conducted on a selected sample of registered nurses to determine the causes and effects of a poor work life balance.

Synthesis of the Literature

MARIA PEREZ 2020-10-28 20:59:35 -------------------------------------------- extra space Burning-out (burnout), according to Wang et al (2018), is the psychological, emotional, motivational, physical, and mental exhaustion experienced by a person after mentally demanding tasks for a long time. You experience burnout by feeling excessively overwhelmed, psychologically down, emotionally drained, and lack of mental motivation and energy to meet daily demands. Burnout is not necessarily a mental illness, but more of a mental health concern. Burnout in the nursing field is a prevalent issue of concern globally, usually indicated by reduced nurses' performance, poor work ethic, reduced motivation and devotion towards work and

patients' service some end up resigning causing a shortage in the industry (Haddad, Annamaraju & Toney-Butler, 2020). There is also increased emotional exhaustion, adverse feelings of remorse, and reduced efficiency, which might lead to poor nurse-patient interrelationship (Zang et al., 2018). We're addressing the prevalence of burnout among nurses in America, causes of burnout in nursing, the effects of burnout on nursing at organizational and individual levels, and propose the most appropriate remedies for curbing burnout in the nursing practice.

Prevalence of Burnout among Nurses in America

According to the CDC (2018), 38% percent of nurses in America suffer from burnout every year. A survey conducted by Kronos in 2017 on nurse’s burnout in America showed that 98% of American nurses perform mentally and physically demanding tasks, which subjects them to the risks of burnout. 85% of the nurses said their job made them extremely tired, while 63% of health centers in America reported that their nurses experienced burnout. 44% of nurses indicated that their biggest worry was patients receiving substandard services due to nurses’ fatigue. According to the Monthly Index of Medical Specialties (MIMS), 41% of nurses in America have considered changing their workplace places or quitting the industry due to burnout and mental torture.

Data from CDC shows that, in a population of 10,000 registered nurses in America, 43% experienced emotional fatigue. Out of this data, 37% were nurses working in hospital environments, those working in nursing home care facilities recording 35% and 22% among nurses working in other environments. According to (Kleinpell et al., 2020). The prevalence of depression among American nurses is higher than among other health-related workers; out of

1,171 registered inpatient nurses, 18% experienced burnout-related depression than the national prevalence of depression in America (9%). Based on gender, female nurses are at a higher risk of experiencing burnout (30-60%) prevalence. Younger nurses are more likely to experience burnout compared to old-and experienced nurses. Nurses below the age of 55years have a 200% chance of developing burnout. Nurses with children below 20 years have a 54% chance of experiencing burnout while having a marital partner, not in the nursing/healthcare industry, increases the chances of developing burnout by 23%.

Causes of Burnout among American Nurses

Fida, Laschinger and Leiter (2018) suggest that lengthy working hours are a chief contributor to nursing burnout. Working for too long is likely to cause physical and mental fatigue, which leads to burnout. In Michigan State, registered nurses working for 12 hours a day recorded more burnout complaints compared to registered nurses working for 8 hours (De Keyre, 2018). Nurses find themselves operating from the boardroom to the patient's wards, directing and administering medical care, offering medical education to patients and subordinates, attending to patient's needs, comforting patients, and attending to their personal life like families and leisure (Bakhamis et al. 2-18). Attending all these demanding activities on a daily routine, as demand can lead to fatigue. In the United States, nurses working in the acute care settings work for 12 hours shifts, with many demanding tasks leading to fatigue and burnout due to the more inpatient care services they provide (Bamonti et al., 2019), and which are the most demanded; and the longer the shifts, the higher the risk of experiencing burnout.

Teamwork stressors are a key factor causing nursing burnout in the US. According to Orkibi (2016), pressure resulting from working in groups and teams is the most significant cause of burnout among American nurses. The cultural diversity in many American workplaces leads to poor communication, racial conflicts, and interpersonal conflicts, which causes workplace stress and burnout (Jennings, 2018). Due to ethnic and racial disparities, culturally diverse nurses might feel segregated in the place of work, the increased mental stress will hinder their optimal performance (Darban et al., 2016). Besides, too much group workload, group pressure, unfavorable team-selection, and inappropriate job demands increase nurses' chances to experience burnout (Doulougeri et al., 2016). Poor team-selection for group work makes marginalized group members fell out of place and may suffer psychological stress. Continued participation in the team's affairs will consequently lead to burnout (Rozo et al., 2017).

Being too much philanthropic exposes American nurses to burnout. Nurses’ innate desire and urge to help patients at personal levels increases nurses’ chances of experiencing burnout.

Nurses tend to put patients before themselves, and may end up denying themselves rest, just to attend to patients (Dyrbye et al., 2017). Nurses' increased philanthropic measures to help patients lead to increased working hours, increased tasks- others not even assigned, increased worries, and more demand for the nurse from patients, which increases the fatigue, and thus increases burnout among nurses (Flynn & Ironside, 2018). When nurses are enthusiastic to help patients and are not motivated by money, they are likely to be more stressed and burned out due to the complex tasks they handle.

Effects of Burnout in Nursing

Nursing burnout increases nurses' errors and risks the patient's lives. Nurses can only work effectively if they have enough rest and are in better physical and mental states, free from fatigue and stress (Guo et al., 2019). With long working hours, poor working environments, randomly rotating working shifts, and job pressures reduce nurses' motivation, become sluggish and irresponsive and may develop a poor relationship with patients due to anger, making the nurse provide poor healthcare services, or error-filled operations, risking patient's life (Fortunatti & Silva, 2017). Nurses’ reduces patient’s satisfaction; Overworked and burned out nurses can complicate essential healthcare operations and may lead to negligence of vital health-based practices like cleaning surgical tools, hence infecting patients (Grace & VanHeuvelen, 2019).

Practice Recommendation

Gaining a better understanding of the practice of nursing would help nurses overcome burnout. As healthcare practitioners, nurses should identify the various ways which stimulate their bodies and balance between professional and personal life (Kleinpell et al., 2020). Besides, both physically and mentally, investing in self-wellness is vital for nurses (Khamisa et al., 2017). Nurses should know when to take a break and foster healthy relationships with patients to reduce stress and psychological torture (Nazir et al., 2018). Gaining cultural competence will help nurses survive in culturally diverse regions successfully and without experiencing adverse culture shock/stress, which influences burnout (Pastores et al., 2020). The government and MIMS should

employ enough nurses to match the nurse-patient ratio, and reduce the working hours for nurses, to reduce fatigue, and aid replenishing.

Eradicating workplace adversities and enhancing the workplace environment is essential for motivating employees and stimulating them to curb mental and physical stress. Besides, upholding mentally refreshing and inducing approaches like the holistic organizational culture will help nurses express their worries and offer an appropriate platform for nurses to elongate their demands, discuss their issues, and stipulate the most appropriate remedy for the prevalent problem of burnout. The government, the public, patients, and the health sector all have a responsibility to play in ensuring better working conditions and stress-free approaches to undertaking health-based tasks. Nurses take care of our health; we, too, should take care of their physical and mental health by ensuring better patient; nurse ratios, healthy working environments, and even working hours as well as an appropriate reward system for nurses.

Besides, regular training programs should be set aside to help nurses deal with contemporary issues affecting them, like burnout.

Project Description

The literature review will be conducted to investigate how effective can primary prevention be in delaying the onset of Burnout in Nursing and what factors influence the success or failure of these actions. In this context, I will review no fewer than 30 articles, from 2014 up to 2019 that will be the body of literature using Internet access with the following search tools: Google Scholar, CINAHL, Medline, PubMed, Cochrane database, and the Ana G Mendez Virtual Library. In some case of specific interest, other literature could be included outside of those limits. The following keywords will be used in this search: Burnout in Nursing prevalence increase, Burnout in Nursing screening, Burnout in Nursing -EPI, Burnout in Nursing primary care detection, and BIN primary care diagnosis. The literature review design will be effective because of the availability, although disperse literature of already conducted research studies on the selected topic under study. More so, the pool of online meta-databases will be essential while selecting specific articles based on the topic of study. The search will allow the determination of key variables to adequately address the research question and problem statement.

Project Evaluation Results

After the data is collected, the analysis will be done with selected information that will be included in the final report. In the analysis of data, one of the steps is to remove the errors that might have occurred during data collection. Several processes will occur during data analysis, all related with the data information available in the different literatures that has been examined. I will review both primary research evidence and systematic reviews, mainly using quantitative evidence. Given the nature of my research topic and my research question, epidemiologic studies will be welcomed in my search.

Summarized tables with all citations will be presented in Appendices A and B. Appendix A will be used for the summary of primary research evidence, and Appendix B will be used for the summary of the systematic reviews. Appendix A will include the citation, question or hypothesis, theoretical foundation, research designed and sample size, key findings, recommendations or implications, and level of evidence (I to VII), of each article. Appendix B will include also citation, question, search strategy, inclusion/exclusion criteria, data, extraction and analysis, key findings, recommendation/implications, and level of evidence ranging from Level I to Level VII.

Each article will be evaluated as relevant information, not to specifically answer my research question. An Excel database will be used to compute all information, and SPSS statistics package will be used to summarize some results.

Discussion and Implications for Nursing and Healthcare

From the study, we note that too much tasks given to the nurses without giving them time to are very tiring to a point that can get to a breaking point. When they start experiencing the physical and mental torture, they cannot provide optimum services to their patients. When a nurse is overwhelmed with work and the services they offer are below standards, the healthcare sector in general is affected. The quality of service is very important in maintaining high standards in our health facilities. Quality standards cannot be achieved with burned out nurses.

The nature of patient care from highly fatigued care givers is of very little efficiency. Individual performance definitely suffers as a result of work stress and fatigue. When individual performance id affected, general performance of a specific facility and the entire sector is affected due to the ripple effect. Burnout has also been associated with low turnover intentions, reduced organizational commitment, unproductiveness and actual turnover.

Apart from low levels of quality services offered, the other direct effect of having fatigued healthcare providers is absenteeism. Due to fatigue, it has been noted that nurses fail to show up at work at times. In a healthcare sector that is already facing a shortage, absenteeism is a very serious issue that can harm the output levels of any facility. Research also states that an emotionally and mentally unstable health provider have a lower level of care and empathy to patients. More to that, it has also been noted that health workers that are burned out project low levels of self-esteem and efficacy. By default, reduced esteem creates a significant impact to the level of client care and service delivery.

Burnout causes a ripple effect when it affects even a single individual in an organization. For example, when some workers are absent from work because of burnout, the remaining ones will have larger workloads to cover up for those that are missing. The coworkers absorb this effect and if it is not handled early enough, they may also end up getting burned out. When the is in an increased frequency of absenteeism, the administration also suffers from the burden of frequent requirements of staffing and requiting, interviewing and training of new employees.

There have also been studies that indicate that there can be burnout contagion in organizations. This happens through conscious or subconscious influence through exposure to colleagues suffering from burnout syndrome.

Plans for Dissemination

This project will be presented at Ana G Mendez University as a requirement for partial fulfillment of the Master’s program. It will be accomplished by presenting a PowerPoint presentation to my colleagues and the professor. In addition, this project will include a poster illustrating the important findings to be displayed in the showroom at Ana G Mendez, South Florida Campus. The results will be disseminated on the university’s website. Additional dissemination will be carried out through presentations at seminars such as teacher education and science education conferences, regionally and nationally, as well as through articles published in peer-reviewed journals. A hard copy will also be held in the university library to be reviewed by alumni and facilitators interested in the subject. The principal investigator and his mentor will

have access to the information obtained. The information obtained from the literature review will

be kept for a period of 5 years, locked in the principal investigator’s home office. After 5 years,

any information will be destroyed by a paper shredder and discarded by the principal investigator.

Summary and Conclusion

The purpose of this paper was to examine the causes, impact and solutions to burnout among nurses. It has been noted that healthcare workers are working in the most difficult environments characterized by regulatory, vocational, and relational job demands. At most times, the demands at work are too much on the workers and it goes beyond their control.

According to our findings, the environment in the health sector is extremely stressful and inherently tiresome and often leads to burnout. High levels of burnout have not only been seen among nurses but also doctors, therapists, and a variety of other care givers in the healthcare industry.

This study has revealed that most of the nurses in America re-experiencing burnout at work. There is a general feeling of both physical and mental fatigue among healthcare providers. It has also been noted that female nurses have a higher rate of burnout and emotional fatigue. Younger nurses have also been seen to be more fatigued than their older counterparts. The reason for this disparity can be explained in two dimensions. One, is that unlike the new entrants, older professionals have been thought the ups and downs of the industry and have somehow managed to get used to the tough working conditions. Another possible

explanation that arose it that the younger nurses in training and those that have just started working tend to be given more tasks than their older experienced counterparts.

It is therefore important that every organization identifies risk factors that may expose their employees to burnout and coming up with appropriate behavioral and organizational systems using the theory of structural empowerment to ensure that job satisfaction is achieved. Some of the suggested methods that can be employed to curb this situation include; resilience training, physical activity incentive, staggering shifts, motivation form the organization, giving nurses breaks and holidays, and proper staffing. At individual level, nurses can participate in activities they enjoy over the weekends, spend time with family, travel often, pay attention to what they feel, and take short breaks during work hours. This way, we can have a healthy industry that will provide quality healthcare to those who need it.

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Appendix A

Summary of Primary Research Evidence

Citation	Question or Hypothesis	Theoretical Foundation	Research Design (include tools) and Sample Size	Key Findings	Recommendations/ Implications	Level of Evidence

Legend:

Level I: systematic reviews or meta-analysis

Level II: well-designed Randomized Controlled Trial (RCT)

Level III: well-designed controlled trials without randomization, quasi-experimental

Level IV: well-designed case-control and cohort studies

Level V: systematic reviews of descriptive and qualitative studies

Level VI: single descriptive or qualitative study

Level VII: opinion of authorities and/or reports of expert committees

Appendix B

Summary of Systematic Reviews (SR)

Citation	Question	Search Strategy	Inclusion/ Exclusion Criteria	Data Extraction and Analysis	Key Findings	Recommendation/ Implications	Level of Evidence

Legend:

Level I: systematic reviews or meta-analysis

Level II: well-designed Randomized Controlled Trial (RCT)

Level III: well-designed controlled trials without randomization, quasi-experimental

Level IV: well-designed case-control and cohort studies

Level V: systematic reviews of descriptive and qualitative studies

Level VI: single descriptive or qualitative study

Level VII: opinion of authorities and/or reports of expert committee