Management and Working Conditions: A Cause for Burnout

The term “burnout,” a metaphorical reference to the extinguishment of some symbolic flame representative of one’s desire or passion, was originally coined in 1974 by psychologist Herbert J. Freudenberger. His idea conceptualized the formation of “exhaustion, cynicism, and inefficacy” amongst workers within the workplace (Monetero-Marin & Garcia-Campayo, 2010, p. 302). In the field of nursing, the passion and dedication of one entering into the field must be, presumably, high in recognition of the time and energy exerted through years of nursing school to achieve their certification. Their exuberance and anticipation to begin their lucrative career engender a blinding lust similar to that one possesses at the start of a sexual relationship which inhibits their ability to see negativity within the workplace. Unfortunately, as in any loving relationship, in time, once the eyes readjust and feet settle back on the ground, the fervor fades and reality is unveiled. It is at this time when the effects of the shortage of nursing staff on nurse workloads become evident to those directly and adversely affected, thus enacting the regression of esteem, both individually and collectively, in the workplace which leads to burnout. Through necessity, there must be change to aid this ailing profession from the woes of the drudge of the endless shift.

The detrimental impact of burnout in the nursing profession has largely been blamed on the widening ratio between nurses and patients; however, in delving the implications of the nurse to patient ratio, it becomes pivotal to develop the foundational, or rather, the motivating causes to which this predicament can be accredited. It is not outlandish to state this is a corollary of the remarkably low number of nurses available. Keenan and Kennedy (2003) have listed what is to be considered five causes of this low availability of nurses: “increased demand as a result of population aging;” “other career options;” “responses to health care cost pressure;” “wages;” “workload and work environment (p. 7).”Littlejohn, Campbell, Collins-McNeil, and Khayile attest to the scarcity of qualified applicants either willing or capable of fill available positions which, they claim, results in the importation of qualified nurses from foreign countries to fill those vacancies in the United States (2012, p. 23). This is merely a temporary appendage to the wound that ails the nursing profession. The determent of individuals from the option of nursing as a career is due to detestable working conditions (Littlejohn et al., 2012, p. 23). Mending the issue through importing willing, qualified nurses into the United States does not begin to alleviate the issue of detachment, depersonalization, isolation, and separation felt by veteran nurses suffering from occupational burnout resultant of excessively demanding working conditions.

There seems to be a direct negative correlation between the limited resources (i.e., working staff) within the workplace (which adversely affects the nurse to patient ratio), occupational dissatisfaction amongst nurses, and overall stress in the workplace. Aiken, Clarke, Sloane, Sochalski, and Silber asserted in their findings “an increase of 1 patient per nurse to a hospital’s staffing level increased burnout and job dissatisfaction … by 23% and 15%” (2002, p. 1990). These findings indicate an inversely-proportional correlation between the increase of patients and job satisfaction. Not only are workers inhibited by overwhelming workloads but the patients. When nurses become inundated by an insurmountable quantity of duties, their attention to detail, a critical aspect of the nursing profession, suffers. The question herein lies in whether or not this issue is unavoidable due to lack of job opportunities, the lack of qualified applicants or some other extrinsic factors, or if there are viable methods capable of rejuvenating occupational satisfaction within the field of nursing.

Many, if not most of the issues and concerns encompassing the field of nursing and its high rate of burnout among nurses can be attributed to managerial processes of planning and assessment, organization and the development of strategies, the implementation of such strategies, and evaluation and feedback. If the lack of qualified nurses is, in fact, a verified fact, this is most likely due to the determent of a number of prospective applicants in regard to extreme working conditions. Hence, a simple readjustment of these conditions may, in fact, reverse this trend by promoting the field as one which gleams of opportunity for advancement and elicits worthiness which has seemingly been lost in this now ill-perceived occupation.

Managerial planning and assessment are vital to the efficacy of nurses and the overall well-being of patients. Simply put, planning institutes organizational direction. Generally speaking, planning is generally confused with organization as it is perceived as the delegation of duties within the workplace, but, in planning, management must be, more than anything else, conscientious of the humanly limits of their workforce. One of the primary issues pertaining to the nursing shortage is extreme working conditions (Littlejohn et al., 2012, p. 24). Excruciatingly long 12-hour work shifts have been attributed as a leading factor in nurses’ tiredness resultant of sleep deprivation (Gold et al., 1992, p. 1013). Gold et al. continue by claiming this sleep deprivation and “misalignment of circadian phase as experienced during rotating shifts are each associated with frequent lapses of attention and increased reaction time” which inevitably increases the risk of error within the workplace (1992, p. 1013). In health care, an error can be detrimental to the patient, the nurse, and the nurse’s colleagues. A simple shift from the 12-hour working schedule to a more humanly manageable 8-hour shift would drastically decrease reactionary time among nurses as well as reduce lapses of attention.

The organization and development of strategies within the workplace, an important aspect of managerial duties, may also contribute to an increase in worker satisfaction. In the nursing profession, it becomes evident, if not already presumed, the job is anything but predictable. This unpredictability makes it difficult for managers to delegate duties to their staff which often results in an overlap of duties (Keenan & Kennedy, 2003, p. 3). As in any profession, when duties become overlapped, that is, when two individuals happen to partake in the same action, completely unaware of the others’ doing so, this produces a sense of meaninglessness of the various duties (supposedly) assigned to each individual. Overlap tends to be a product of unpredictability. Though difficult to construct, let alone implement, there must be an effort to, both, construct and implement a more structured organizational approach through the development of strategies that account for the variability of unpredictability. In delegating duties to the nurses, managers may designate a number of nurses at any given time into somewhat of a ‘rover’ duty which will alleviate the strenuousness of unpredictability at times when every nurse has been assigned to specific duties.

There must be an implementation of a feedback system as a managerial strategy to achieve success within the workplace. Buchannan and Bucher have studied such a system in home healthcare settings with proven results of self-monitoring and self-correction (1989, p. 550). The implementation of such a system in a hospital setting may produce similar results. A quality assurance feedback system may be instilled on every level: patient-to-nurse, nurse-to-manager, nurse-to-nurse, as well as manager-to-nurse. One may contest this system as too constricting in that nurses may feel constantly watched, or essentially aware of eyes everywhere. Though, this system more of a means of suggestion and in no way should be a viable means toward reprimand. This system can be used for general inquiries, as well as personal observations of self or others, both positive and negative. As in any organizational structure, the workers view their jobs differently than managers. With such a system in place, nurses will be able to voice their opinions of their working conditions in a way that is anonymous, allowing management to consider the outside opinions of those non-management individuals. These suggestions will also remain cyclical in that everyone (patients, nurses, and managers) will be inclined to use such a system.

The scarcity of qualified nurses within the United States has proven to be merely a consequence of a deeper issue. Many prospective nurses are deterred from the field by these high working conditions whereas those nurses who continue their pursuit of this career often are inhibited by the strenuousness of the profession which is attributed to their high likelihood of burnout as well as compassion fatigue. The system has attempted to amend the shortage of nurses by importing qualified foreigners, though this is equitable to placing an appendage on an ailing internal wound. It has been perceived the underlying issue plaguing the nursing profession is the excruciatingly long 12-hour workdays which have been noted as the cause of erroneous nurses, dreary from sleep deprivation. There are, however, viable solutions to this problem. A simple shift on the organizational layout of the nursing profession, such as shortening the length of the workday, the restructuring of the organizational layout and delegation of duties within the workplace, and the implementation of a simple quality assurance feedback system may produce a drastic increase in job satisfaction amongst workers which can potentially lead to an influx in qualified nurses entering the field in the near future. The perception of satisfaction may radiate and re-illuminate this profession as one which promotes the humanly needs of the worker and seeks to satisfy worker needs. The renewed job satisfaction of the worker will transcend throughout the workplace in that patients, nurses and management will feel a renewed sense of satisfaction.

References

Aiken, L. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288(16), 1987-1993.

Aitamaa, E., Leino-Kilpi, H., Puukka, P., & Suhonen, R. (2010). Ethical problems in nursing management: The role of codes of ethics. Nursing Ethics, 17(4), 469-482.

Brannon, D., & Bucher, J. (1989). Quality assurance feedback as a nursing management strategy. Hospital Health Services Administration, 34(4), 547-558.

Gold, D. R., Rogacz, S., Bock, N., Tosteson, T. D., Baum, T. M., Speizer, F. E., & Czeisler, C. A. (1992). Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. American Journal of Public Health, 82(7), 1011-1014.

Keenan, P., & Kennedy, J. F. (2003). The nursing workforce shortage: Causes, consequences, proposed solutions. The Commonwealth Fund, 3, 1-8.

Littlejohn, L., Campbell, J., Collins-McNiel, J., & Khayile, T. (2012). Nursing shortage: A comparative analysis. International Journal of Nursing, 1(1), 22-27.

Montero-Marin, J., & Garcia-Campayo, J. (2010). A newer and broader definition of burnout: Validation of the "Burnout Clinical Subtype Questionnaire (BCSQ-36)". BMC Public Health, 10(1), 302.