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This paper discusses the significant impacts of role strain and burnout in nursing on patient quality of care and their legal and ethical implications. It will also discuss two issues that may lead to burnout, along with a possible solution for each issue. Additionally, this paper will address a personal nursing strain and how it was overcome.
Burnout occurs due to extreme and prolonged stress at work. It is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment (Nantsupawat, A., Nantsupawat, R., Kunaviktikul, Turale, & Poghosyan, 2016). Less than desirable working conditions, low staffing, and disquieting events can increase the occurrence of nurse burnout. The quality of patient care is negatively affected in proportion to the nurses’ stress levels. When a nurse’s role strain becomes prolonged or overwhelming, the patients suffer the consequences. This can manifest as an increase in medication errors, patient falls, and higher rates of hospital-acquired infections. These issues are directly related to nursing care and reflect on the quality of care. Many times, medication errors can be prevented by efficient nursing care.
How it works
In nursing practice and quality improvement, ethical issues such as moral distress and confidentiality issues, in tandem with staffing shortages, continue to afflict the nursing workplace. Ongoing unresolved ethical dilemmas cause an increase in moral distress, leading to negative quality-of-patient outcomes (Arries, 2014). There is a direct link between hostility and the staff turnover rate (Matt, 2012).
Nurses who experience burnout may develop physical and psychological symptoms such as cardiac rhythm irregularities, stomach upset, headaches, hypertension, unplanned weight loss or gain, anxiety, and even suicidal or homicidal ideation. This results in an unsafe environment for patients, staff absenteeism, and low patient satisfaction scores. Legal implications for employers include potential lawsuits from patients who received subpar nursing care or suffered a medical error, or from staff who were exposed to extreme stress, bullying, or developed post-traumatic stress disorder (McNamara, 2012).
One way nurses can reduce role stress is by improving their coping strategies. They could discuss taxing situations with peers or a professional counselor, rather than resorting to smoking or increasing alcohol consumption. Many hospital nurses work longer shifts to have days off during the week. It’s important to use these full days off to reestablish a work-life balance rather than picking up extra shifts (Wilkinson, 2014).
Nurse burnout is a slow, ongoing process. It is multifactorial and complex. Many of these factors are out of the individual nurse’s control. One issue that leads to burnout is insufficient training and resources, especially in trying circumstances. Due to this, colleagues remain unable to assist because of their own inexperience and increased workload. Employers need to be innovative with their staffing and workload. How a nurse chooses to deal with burnout, and their resiliency, will ultimately determine if they conquer tense work environments (Brown, Whichello, & Price, 2018). Another issue contributing to nurse burnout is conflict among staff, resulting from many on the team also experiencing high levels of stress and burnout. The complicated work setting limits the time allotted for social interaction or interpersonal relationship building. Nurses must develop these relationships to gain support and avoid burnout (Brown, Whichello, & Price, 2018).
This might be achieved through social events and team building. Training in areas like communication and conflict resolution may also prove beneficial.
Nurses with high resiliency were found to be more hopeful, optimistic, and flexible. They possessed analytical skills which were applied in difficult situations. These skills could be acquired either through experience or explicit training. Workshops can be very helpful in improving resiliency, reducing stress, and increasing skills required to combat challenging circumstances. Such workshops may include mindfulness-based interventions and writing exercises.
My experience with role strain began insidically in late 2008. I was newly hired to work as a contracted registered nurse at a military hospital emergency department. I could not have been more excited when I received the news of my first contracted nurse hiring. I had been very hopeful to attain this high-paying, highly desirable employment. I was still adjusting to a single-income household and had two teenagers at home. The contracting company provided very little information regarding the job, only the location, shift, and that the contract would be ongoing. On my first shift, I was assigned a kind, yet serious preceptor who told me contractors were afforded only three orientation shifts since we made “a ton of money” and were already experienced emergency department RNs. Those three shifts were a blur.
There were two electronic documentation systems to learn, policies, protocols, military jargon, emergency department flow, equipment, and so much more. I was also informed that I would start on the night shift since they had the greatest need, but that all nurses had to follow the military schedule which rotated 12-hour days and 12-hour nights every eight weeks. As a contractor, nurses tended to be assigned the higher acuity patients. The situation initially caused role strain due to the unfamiliarity of that particular environment and electronic charting systems. Later, role strain worsened due to the constant rotating of shifts from days to nights every eight weeks. I overcame this event in several ways. I developed interpersonal relationships with several staff members. We would support each other in and out of work. We also had a one-hour lunch break and would leave the facility to enjoy an uninterrupted break.
I spoke with staff who had been there awhile regarding processes and they helped to familiarize me with situations before they happened. Many of our staff were active duty military. During downtime, I would ask them to review military jargon with me. This was very helpful as all of our patients were military and would sometimes speak this way. This also facilitated building relationships at work. Ultimately, I left this employment after almost three years due to the constant rotating shifts. Physically, it became too much and I was experiencing an intermittent cardiac arrhythmia, gastric upset, and sleep disturbance.
Nursing role strain and burnout have many causes and manifestations. Organizations must discover and implement ways to prevent and decrease this stress. The implications are far-reaching, with negative patient outcomes, high nurse turnover, and low patient satisfaction scores. Nurses must also be aware of what role strain looks like and be proactive in reducing its prevalence and effects, as this strain may not only affect their work lives but their personal lives as well.
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