Burnout Prevention Program for Nurses Essay Example
The nursing profession is one of the most demanding in terms of responsibilities to be performed and the working environment. The high pressure in the nursing profession makes nurses vulnerable to burnout, which affects their ability to deliver quality services to patients. Accordingly, burnout among nurses is possible when they start experiencing an increased prevalence of depression and anxiety. Their levels of commitment to their respective duties and responsibilities decline with the increasing levels of burnout. Burnout among nurses increases the annual turnover rates, as many nurses opt out of the practice to relax. Such situation is worrying and needs urgent intervention through proper coping strategies that would help them handle the numerous stresses they experience in their respective areas of work. One of the most notable examples of programs that have been successful in preventing burnout among nurses was the Resilience Training Program for Intensive Care Unit.
According to Mealer, et al. (2014), the American Association of Critical-Care Nurses (AACN) was in charge of the program and it was based on the cognitive behavioral therapy sessions, regular exercises over a 12-year period, expressive writing and mindfulness-based stress-reduction techniques. The strategies played an instrumental role in giving participants the opportunity to express themselves, hence releasing their stresses and other concerns in the best possible way. They were taught to be stronger and resilient in the stressful field. Therefore, it is vital for hospitals to understand the different challenges that nurses face in their work environments, as it would offer the opportunity to assist them in coping with burnout. Burnout prevention programs are only successful in instances where the needs of nurses are keenly evaluated and addressed in the most significant manner. The training program suggested in current essay would be crucial in addressing diverse challenges, including family problems, work structure, remuneration, interaction with patients and workplace relationships among nurses and their bosses.
Current essay explicates the concept of burnout among nurses and suggests an effective program for burnout prevention for nurses.
What is Burnout?
Burnout refers to the long-term exhaustion and diminished interest in work among professionals in different field. Ceslowitz (1988) opines that burnout is always common among highly pressured professionals, such as those in the field of nursing. Specifically, burnout is a condition that emanates from the chronic occupational stresses, such as work overload and pressures relating to the completion of different jobs at the workplace. However, further evidence reveals that the etiology of burnout is multifaceted in nature as dispositional factors also tend to play a role in its occurrence. Lambie (2006) informs that burnout is widespread among professionals, but it is not recognized as a distinct disorder in the DSM-5 due to its closeness to other depressive disorders. In the ICD-10, burnout could be found under problems related to life management difficulties. Overall, a burnout could be defined as the unending feeling and exhaustion among professions in their respective areas of work.
The Interpersonal Impact of Burnout
When the concept of burnout was first described in the 1970s, it was originally linked to interpersonal stressors on the job. Falck and Kilcoyne (1984) inform that the concept of burnout was originally observed in the context of human services, such as healthcare, hence easily revealing its interpersonal impacts. In line with such understanding, the first significant interpersonal impact of burnout is the syndrome of emotional exhaustion. It emanates from a person’s emotional demands in the course of interacting with others at the workplace. Moreover, there is a high possibility that nurses will develop a reduced emotional attachment to other people at work due to the exhaustion caused by the workplace stressors. The individual feels exhausted in terms of responding to emotional demands in respect to others in the workplace.
The second vital interpersonal impact of burnout is depersonalization. Ericson-Lidman and Strandberg (2007) are of the view that it is the cynical and negative response to patients and losing interest with oneself. For instance, nurses would lose interest in offering the required care to patients. Moreover, they tend to feel that patients are a bother to them and offer services that do not meet the required criteria due to burnout.
The last crucial interpersonal impact of burnout is reduced personal accomplishment. It is believed that due to it a worker cannot work in the most effective manner with the clients. In the hospital setting, nurses tend to feel that they cannot work effectively with patients due to the frustrations they experience in the workplace.
Symptoms of Burnout
According to Brake, Gorter, Hoogstraten, and Eijkman (2001), burnout exhibits numerous symptoms that are easily noticeable from the behavior of workers.
- The first symptom is the unique feeling of tiredness. It is when a worker experiences tiredness coupled with aches and pains in different parts of the body.
- The second symptom of burnout is the loss of interest to work. Most people find their work a fun experience. However, they reach the level, at which they perceive their work a burden rather than a fun experience.
- The third notable symptom of burnout is the feeling of loneliness emanating from the decision to isolate oneself from others in the workplace. Such detachment tends to lead to depression among workers.
- Balk, Chung, Beigi, and Brooks (2009) assert that the fourth symptom of burnout is emotional exhaustion. The emotions of individuals tend to be blunted, and they may negatively react to co-workers. They lose that passion of working effectively with other employees and fail to realize the goals of the hospital in terms of service delivery.
- The last significant symptom of burnout is anxiety and continuous instances of worry among individuals. The workers tend to be anxious about everything occurring in the workplace. Some of them become frustrated with their own job performance and all other activities taking place within the work environment.
Stages of Burnout
Burnout develops in 12 diverse phases/stages among individuals. Wang, Liu, and Wang (2015) affirm that before explaining each of the stages, it is crucial to point out that burnout is not categorized as a distinct disorder in the DSM-5 because it is problematically closer to depressive disorders. Therefore, such stages are perceived the onset of depressive disorder from the perspective of DSM-5. The relevant stages theorized by Herbert Freudenberger and Gail North are summarized below.
- Stage 1: The compulsion to prove oneself. According to Falck and Kilcoyne (1984), it refers to the excessive ambition adopted by employees. The pressure to prove oneself at the workplace leads to compulsion. They want to be above everyone in terms of performance in their areas of work.
- Stage 2: Working harder. It emanates from the desire to prove oneself at the workplace. The employee develops higher expectations and sets higher targets compared to everyone. With the desire to prove themselves, they engage in any work at the workplace.
- Stage 3: Neglecting their needs. Such individuals place all their focus on work, while forgetting their personal needs. For instance, a worker might forget to eat, spend time with the family or friends. They perceive such activities unnecessary and prioritize work at any given time.
- Stage 4: Displacement of conflicts. Kushnir and Milbauer (1993) agree that at current stage the individuals convince themselves in the fact that what they are doing is not right. However, the individuals fail to recognize the cause of the problem leading to an individual crisis. Physical symptoms begin appearing at current stage among most individuals.
- Stage 5: Revision of values. In line with current stage, the individual prefers isolating himself/herself from others. Schaufeli, Leiter, and Maslach (2009) hold the view that individuals avoid conflicts and find themselves in a state of self-denial about their basic needs with the changing perceptions. They develop a new value systems focusing on job performance and become emotionally blunt.
- Stage 6: Denial of emerging problems. Current stage is characterized by intolerance as individuals are not social. Social relationships are extremely unbearable for them due to their intolerance. At this stage, outsiders are always able to identify aggression and aspects of sarcasm among such individuals. They blame their problems on the way they have changed rather than on their work and other organizational pressures.
- Stage 7: Withdrawal. It is when the social contacts reduce to the lowest level almost leading to isolation. Individuals tend to minimize their stresses using alcohol and cigarettes.
- Stage 8: Obvious behavioral changes. Ericson-Lidman and Strandberg (2007) reiterate that changes in the behavior of the person become so apparent that friends, co-workers and family members cannot overlook them. They begin fearing and shying away from other people due to the rapid changes in behavior and aggressive tendencies.
- Stage 9: Depersonalization. Individuals tend to lose contact with themselves, as they perceive themselves worthless. They also forget their own personal needs and they view their lives from a narrow perspective. They mostly focus on the present, forgetting the future.
- Stage 10: Inner emptiness. Individuals feel extremely empty on their inside and resort to the activities such as sex, overeating, alcohol and other drugs to overcome their stresses. Their engagement in such activities is always exaggerated.
- Stage 11: Depression. Smith (1999) informs that depression develops with time, as the individuals become hopeless, exhausted and develop the belief that they do not have a future. They see no meaning in their own lives as a result of the lost hope.
- Stage 12: Burnout syndrome. The emotions and physical status of such individuals collapses to the lowest level. At this stage, there is always a need for urgent medical attention for individuals. Suicidal ideation might occur in some instances caused by extreme depression. However, only a few people commit suicide.
What is Not Burnout?
In numerous instances, burnout has always been confused with stress. Specifically, individuals tend to confuse the symptoms of stress with burnout without understanding that they are two distinct disorders. However, stress is different from burnout because it is usually characterized by over-engagement, while burnout is associated with disengagement. A person would not be termed to be experiencing a burnout when he/she over-engages in a particular activity. Additionally, Schaufeli, Leiter, and Maslach (2009) point out that instances of emotional overreaction are not reflections of burnout, but stress. Goetz, et al. (2013) hold the opinion that burnout develops as a result of emotional bluntness among individuals, as they forget their own needs, family and friends. More so, stress might lead to premature death among individuals, while a burnout only makes individuals feel worthless in their lives. It does not necessarily have to lead to suicidal ideations. Therefore, incidences of suicidal ideations may not necessarily reflect the presence of a burnout among individuals. Again, burnouts mostly tend to occur from the job, hence differing from stress, which might occur from any other causes. A burnout is not a feeling that arises from any other life event, but pressures in the work environment.
Analysis of the Real Situation and Background
MacKusick and Minick (2010) indicate that The American Association of Colleges of Nursing (AACN) indicates that the shortage of registered nurses in the country exceeds 500,000 registered nurses by 2025. It occurs due to the fear of starting the practice influenced by the associated workplace pressures. MacKusick and Minick (2010) emphasize that the study by AACN also indicated that an estimated 30%-50% of registered nurses leave their practices three years after starting their work. The longer working hours have contributed to burnout among such nurses, as they have to be involved in the routine of taking care of patients on a daily basis. Kalliath and Morris (2002) state that the increasing burnout levels lead to patient dissatisfaction with negative outcomes, which occur in the healthcare environment. Nobody wants nurses to leav the practice due to the increasing burnout levels. Again, everyone wants to experience a situation where patients are satisfied with the services delivered to them by nurses.
Such situation needs to improve to promote the ability of nurses to cope with such challenging environment. Therefore, the burnout prevention program was designed that would enhance the ability of nurses to cope with the pressures in their workplace. The program is specifically dedicated to decrease the pressures that nurses are exposed to and help them cope with their work. For instance, it focuses on encouraging hospitals to reduce the working hours for nurses, hence allowing them maximum time to rest. Even with the shortage of registered nurses, it is possible to deliver shifts that accommodate rest for nurses. The review of the work structure to manageable levels would play an instrumental role in leading to reduced burnout levels.
One significant element that makes such burnout prevention program important is that it would involve the identification of a need assessment for nurses before tackling their issues in respect to factors contributing to their burnout. Balk, Chung, Beigi, and Brooks (2009) agree that the identification of needs is crucial because it leads to a more focused approach in the execution of the prevention program. In tandem with the program, the need was expressed to prevent burnout levels among nurses. Therefore, it has been planned to conduct surveys or questionnaires with nurses to identify their needs prior to helping them cope with workplace pressures. As Wang, Liu, and Wang (2015) explain, everyone with a burnout level higher than 4 on both the frequency and the intensity scale of the Maslach Burnout Inventory would need to be involved in such burnout prevention program. It is important as these are moderate levels of burnout as experienced by each person. It is noticeable, hence leading to the loss of interest in work and undesirable patient outcomes. Such burnout prevention program would start with involvement of individuals at the moderate to the high levels of burnout to facilitate future coping among them. Such strategy is developed accordance with the research conducted from the daily lives of nurses in the hospital setting.
Program Aims and Goals
The program will have both general and specific goals to guide its purpose in helping nurses prevent incidences of burnout by dealing with different matters they face.
- The first general goal is to train nurses on the best techniques to prevent burnout, while facing different issues at their workplaces;
- The second general goal of the program would be increase awareness, hence helping nurses identify symptoms easily as they face diverse challenges in their work environments.
- To promote the understanding of common signs of burnout among nurses;
- To improve resilience among nurses through in-depth training on relevant coping strategies relating to different challenges in the workplace;
- To ensure that nurses know the antecedents of burnout, hence enabling them deal with it effectively as they start experiencing it;
- To help nurses learn how to manage time to avoid finding themselves in working situations that expose them to burnouts. Appropriate time-management skills eliminate overworking;
- To decrease their burnout levels measured on the Maslach Burnout Index;
- To help nurses understand themselves in terms of their strengths and limitations;
- To help nurses learn how to manage their private and job life to avoid overindulgence in one area, while foregoing the other one;
- To enable nurses to learn how to reveal themselves. It relates to adopting the best strategies to communicate feelings and thoughts to other people, and being able to say “no” in some cases.
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Target Population and Location
The participants in the program will be nurses from a hospital in the United States. The reason for it is that the nursing profession is one of the occupations that are exposed to numerous pressures, which lead to burnout. Smith (1999) asserts that while working in the hospital environment, nurses face different events, such as suffering cancer patients, dying patients and long working hours. Others have personal financial and family problems that expose them to burnouts, hence the need for the effective coping strategies. As noted earlier, the program would consider nurses who exhibit a burnout level higher than 4 on the Maslach Burnout Index, as they are at a high risk in terms of the burnout level. Such prevention program would only accommodate 15 nurses. Such number is perceived ideal because it is easier to work more efficiently with this number of people compared to working with a large number, for example 30 participants. Moreover, the number is ideal because it enhances personal contact with all participants, hence giving them the opportunity to benefit from the prevention program. The most significant thing to indicate here is that everyone will participate voluntarily without being coerced.
The inclusion criteria is as follows:
- A person must be a nurse;
- A person must be participating in the delivery of healthcare services at a hospital;
- Should be working in shifts;
- Must be in a high responsibility area;
- Must have a social attitude as they help others all the time;
- Must be experiencing difficult working conditions, such as experiencing death, dealing with cancer patients and other suffering patients all the time;
- Has to be friendly and needs to have a large base of social contacts;
- Could be either male or female;
- Nurses with family and money problems would also be accommodated in such burnout prevention program.
- Exhibiting zero levels of burnout;
- Low responsibility area.
The burnout prevention program will take place in a hospital in City X. Most of the sessions will take place outside the hospital setting to give the nurses a new experience that would help them relax and learn effectively. Skovholt, Grier, and Hanson (2001) are of the view that learning outside the hospital environment would be the most ideal way of helping them understand the best strategies of preventing burnout, while offering their services to patients in their respective high responsibility areas. Again, they would be able to express themselves better in any other environment away from the hospital. In addition, it may lead to the success of the intervention program in terms of enabling them prevent incidences of burnout, as they work in the future.
The prevention program is scheduled to take 12 weeks (3months) to accomplish its mission of helping nurses prevent burnout in the future. Participants would engage in similar activities with three sessions every week. There will also be an open forum session where participants have the opportunity to express themselves and receive instant feedback from facilitators. Balk, Chung, Beigi, and Brooks (2009) opine that such approach to learning would be significant in achieving the desired outcomes among the nurses. As a result, it will help improve their resilience and coping strategies in their challenging work environments.