The prevalence of stress and burnout among nurses is a common phenomenon. It is caused by a demanding and stressing work environment. The high cases of burnout in nursing are a threat to the health care system and the well-being of the patients. Many studies reveal that there is a high rate of burnout among nurses, and particularly in those serving in hospitals; Europe, Asia, and North America report a high incidence of burnout. A study done in Finland with a sample of 723 nurses, nearly half of the nurses indicated that they experienced burnout, frustration, and job dissatisfaction. Elderly, secondary level nurses and those working in psychiatric departments experienced the highest level of burnout (Jeremy et al., 2015).
A survey conducted by Zahiri et al. (2014) on a sample of 61 revealed that 24.5% of the sampled nurses experienced burnout and that only 8.19% of the participants had worked for 15 years or more which means that most nurses opt for early retirement when they can no longer handle stress at work. The levels of emotional fatigue were at 45.9%, depersonalization 40.9%, and personal inefficacy at 70.4% for nurses in this study.
There exist a link between a shortage of nurses and job dissatisfaction, burnout, and stress. In a systematic review, the findings disclosed a positive bidirectional association between the shortage of nurses and burnout among nurses working in accident and emergency section. There are two types of burnouts, the nurses who are absent from work and those that are at work but not efficiently providing quality care. The degree of the stress, job dissatisfaction, and burnout encountered by the oncology registered nurses and their view of recruiting inadequacy varied based on their work settings and demography. Nurses who hold high positions in the sector and those who worked inpatient environment and non-Magnet hospitals were more probable to attribute insufficiency of staffs as one of the key contributing aspects of their stress, burnout, and job dissatisfaction. In essence, the burnout caused many accidents and emergency nurses to quit (Fiona et al., 2016).
According to Jeremy et al. (2015), the leading cause of burn out is the conditions in the work environment, where personal risk factors vary depending on individual vulnerability where the personal risk factors include personality traits and demographic variables. The work environment that causes burnout includes; work overload, poor interpersonal relationships with other nurses, insufficient reward, unfair treatment of nurses, conflict in value and job description, and inefficiency in job performance. Personal risk factors resulting in burnout include; family status, age, education background, gender, race, and personal traits. The workload is the primary cause of burnout caused by inadequate staffing in medical care organizations a study of 665 hospitals indicated that 20% had a patient-to-nurse ratio of seven or more, while 25% had a ratio of four or less. High patients nurse ratio consumes nurses time for innovation, research, and interact with the patients. The research shows that the patient-to-nurse ratio in England high; hence nurses work for many hours causing fatigue and stress.
Low salary and poor management demotivate nurses and reduce performance and quality of patient care. These factors lead to high turnover, and most nurses intend to change career. Salary is a drive to motivation leading to performance. Poor management is a factor that causes nurse burnouts. Management plays an essential role in the control of health care institutions. It provides enough resources for the nurses to deliver quality care an innovation (Zvauya et al., 2017)
According to Leiter and Maslach (2009), poor communication and collaboration increases chances of nurse burnout. If the nurses do not collaborate with others, it becomes hard for them to deliver quality care. Communication is also a factor that leads to chances of burnout. The nurses and management should take communication as a crucial factor that contributes to the running of a hospital. Without proper communication, the management cannot give clear instructions to nurses. Most nurses do not get opportunities to advance their studies due to work related commitment caused by low nurse-patient-ratio. Inability to acquire higher credentials hinders career progression.
According to Hayley et al. (2015), nurse burnout contributes to infections in hospitals. Studying nurse staffing, burnout, and healthcare-associated infection, the researcher, found that there was a statistically significant difference between urinary tract infection and patient to nurse ratio (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model for regulating patient severity and hospital and nurse features, only nurse burnout remained statistically significant to urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01). Arguably, hospitals, whereby burnout was decreased by 0.3, had a total of 6,239 fewer infections in a year. Consequently, the survey offered a plausible illumination for the link between nurse staffing and health care linked infection.
Burnout has personal, professional, and organizational consequences to the nurses (Net CE, 2018). Some of the personal consequences burnout have on nurses are poor physical and mental health as a result of stressors, low job control, work overload, minimal teamwork among nurses and other health assistants, high job demands, and job dissatisfaction. Other severe cases resulted in high rates of musculoskeletal injuries and musculoskeletal disorders were among the nurses with job dissatisfaction, poor work scheduling, poor interpersonal relationships, and decision making.
The professional and organizational consequences caused by burnout are cases of decreased productivity during their shifts, absenteeism and in extreme situations; some leave their jobs which is a result of decreased confidence, morale and motivation. Such situations create an unsympathetic attitude, causing careless decision making, lack of innovation and fresh ideas since they do the bare minimum. Consequently, it lowers the nurse-patient ratio and raises the job turnover among nurses resulting due to job dissatisfaction, and burnout. Burnout also leads to nursing errors resulting in poor patient care where in extreme situations, patients are administered the wrong medication, or given at the wrong time. Mortality levels increase where burnout is high since, with the low nurse-patient ratio, one nurse has more than six patients. In a study done in England by Net CE, (2018), if one nurse had to attend to one or two patients, nurses would have saved an estimate of 25 lives per 1,000 hospitalized patients and 15 lives per 1,000 surgical patients.
The consequences of burnout among nurses are alarming. Leiter and Maslach, (2009) report that there are three dimensions of burnout. These are emotional suffering, depersonalization, and efficacy. When nurses encounter at least one of the aspects, then the overall job productivity reduces. The condition has resulted in daring consequences in welfare, the safety of patients, quality of life, and quality of care offered. Moreover, according to (Klein et al., 2018), burnout causes depression among nurses leading to high job turnover. A survey that involved 68, 000 registered nurses in 2007 registered inpatient nurses, nearly 43% of the nurses had a great extent of emotional suffering. The study documented that 37%, of nursing home nurses, 35% of hospital nurses, and 22% of nurses working in other environments encountered high levels of emotional suffering.
Burnout lowers the levels of patient satisfaction in the hospital. According to Dall’ Ora et al., (2015), the patients nursed in units with sufficient employees, proper management of nursing care, and functional relationship between the nurses and physicians were more than twice likely to record high contentment with care. Also, nurses in such environment showed significantly lower exhaustion and burnout. In essence, the higher the levels of job burnout, the lower the patient satisfaction.
Burnout influences the level of job turnover among nurses. Leiter and Maslach, (2009), studied 667 Canadian nurses to understand the relationship between burnout and nurses turnover. The result showed that the working environment and social-economic factors played a significant role in job turnover. The turnover trend is a threat to both the welfare of patients and nurses. It is evident that high turnover would lower nurse-patient ratio further worsening the already bad situation. It is essential to understand the relationship between stress, job satisfaction, and burnout. Khamisa et al., (2017) conducted a study with a sample of 895. The study showed that stress is a better predictor of burnout and general health than the level of job satisfaction. The study recommended urgent measures to address personal and occupational stress in the workplace.
According to Nantsupawat et al., (2016), the emotional state of nurses is significant in determining the quality of care provided to patients. The study disclosed that 32% of nurses documented immense emotional suffering, 35% low personal attainment and 18% high depersonalization. Nonetheless, 16% of the nurses considered the quality of care on the departments as poor or fair, 14% documented infections, 11% reported medication errors, and 5% reported patient letdowns. The study linked the three subscales of the MBI to rising reporting of poor or fair quality of care, medication mistakes, infections, and a decline in patients visit. Each unit of augmenting emotional exhaustion score linked with 2.63 times increase in documenting the poor or fair quality of care, a 30% increase in patient falls, a 32% rise in infection, and 47% rise in medication errors. The finding of the study is that nurse burnout linked to the increased odds of documenting negative patient results. In essence, enforcing interventions to decrease burnout among nurses is essential in enhancing patient care.
Based on available literature, the work environment is a significant factor that causes burnout and stress; modifying it has the potential to reduce burnout. Some of the ways of managing burnout is improving personal lifestyle, professional lifestyle, and organizational levels. Personal lifestyle includes; obtaining adequate sleep, proper nutrition, regular physical activities and meditation, self-reflection, identifying and maintaining priorities, recognizing own limitation, and seeking emotional assistance when necessary. Professional lifestyle includes; varying work routine, setting achievable goals, interpersonal support from other nurses, and practical communication skills. Organizational level includes; creating a good work environment, providing access to training where necessary, maintaining strong leadership roles, and participation in decision making that concern providing quality patient care. It is important to note that, it is cheaper and easier to prevent burnout that resolving it once it has occurred, thus, essential to prevent accumulation of stress.
Referring to Fryer et al., (2016), assessing the confidence of nurses and other health practitioners have and its effect on the provision of quality care. The patient’s perception showed that the level of confidence among nurses influenced the quality of services provided. Poor hospital work environment and lack of teamwork and social support affect the confidence, morale, and motivation of nurses.
Burnout affects both the emotional, social, and physical state of the nurse, as well as the provision of quality care to the patients and patient safety. Organizations and institutions should focus on creating a good work environment for nurses so that they can feel included among their colleagues and their supervisors. Such measures ensure that nursing patterns organized for effective delivery of patient care.