Psychosocial Hazards in the Health Care Workplace Leading to Nurse Burnout and a Retention Problem

Psychosocial hazards in the health care workplace leading to nurse burnout and a retention problem

Erik Dahlgren

Webster University

Abstract

Psychosocial hazards are encountered frequently by the nursing workforce. These hazards have been well defined as well as their impact on a nurses’ mental health. This study aims to explain the link between the psychosocial hazards experience in the nurse workplace leading to burnout and a nurses’ decision to leave the profession. The method used in this paper was an analysis of literature on three groups of psychosocial hazards: fatigue from workload and work schedule, compassion fatigue and moral distress, and finally, verbal and physical abuse. I explored the role each group played in nurses reaching the point of burnout leading to the conclusion that it indeed does play a role in the decision of many nurses to leave the profession.

Psychosocial hazards in the health care workplace leading to nurse burnout and a retention problem

Introduction.

Nurses represent one of the largest professional groups in the global health care industry. According to the U.S. Bureau of Labor Statistics Employment Projections program, there will be a 16% increase in employment of registered nurses between 2014 and 2024 representing 439,300 additional nurse positions ("Bureau of Labor Statistics," 2016-2017). That study finds many factors contributing to this increase such as an aging population, increased access to health insurance due to health care reforms which drive people to access health services previously unavailable to them, and an increased focus on outpatient and home care facilities in lieu of hospitals for patient care ("Bureau of Labor Statistics," 2016-2017). While these projections seem a boon to a health care system concerned with the increasingly aging population, a recent study predicts that a shortage in registered nurses in the United States will occur through 2030 (Juraschek, Zhang, Ranhanathan, & Lin, 2012). Contributing to this trend are nurses going part time, taking a break from the profession, or leaving the profession all together. This only serves to increase the strain on hospitals already short staffed. In a study of newly licensed nurses, "41.5% reported that if they were free to go into any job, they would want another job, and 24% indicated that they planned to leave their first job within two years of taking it; 37% of the sample intended to search for a new position in one year” (Kovner, Fairchild, Poornima, Kim, & Djukic, 2007, p. 68). What could be causing this increasing trend of nurse professional turnover? In light of that question, much research has been performed on the topic of psychosocial hazards in the health care workplace and their detrimental role in nurses’ mental health. This paper will explore that research and investigate these psychosocial hazards to determine if they are having an impact on a nurses’ decision to take a break from or leave the profession of nursing.

Psychosocial Hazards

Psychosocial hazards are defined as “aspects of the design and management of work, and it’s social and organisational contexts that have the potential for causing psychological or physical harm” (Jain & Leka, 2010, p. 4). The way these hazards have a negative effect on nurses is by causing increased work-related stress (Jain & Leka, 2010). The constant fast pace and increasing patient population, coupled with a continued nursing shortage, can often lead to nurse burnout. Burnout is defined as “a state of physical, emotional and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding” (Schaufeli & Greenglass, 2001, p. 501). Ask any nurse about the emotional demands of their profession, and you will surely find that their job entails some of the most emotionally demanding work of any industry. In a survey of literature on the concept of burnout, Demir, Ulusoy, & Ulusoy (2003) found that “severe burnout gives rise to problems such as quitting one’s job, job dissatisfaction, lack of marital and familial harmony, decrease in self-esteem, difficulty in concentrating, social isolation, fatigue, loss of libido, headache, cold, gastrointestinal problems, sleep disorders, and alcohol and drug abuse" (p. 808). While any of these symptoms on their own may not be enough to drive a nurse to give up the career they worked hard to achieve, the cumulative effect of them may, as well as be a great danger to patient care. While not at all an exhaustive list of psychosocial hazards that can lead to burnout, the following hazards are of particular concern to nurses: Fatigue from workload and work schedule, compassion fatigue and moral distress, and finally, verbal and physical abuse.

Fatigue from workload and work schedule

Two factors in a nurses’ workplace that may lead to excessive fatigue are workload and work schedule. The nursing shortage is making short staffing of nurses something that is hard to avoid. Over time this can lead to burnout and feed into a vicious cycle as nurses leave and make the situation that much worse for those that remain. Even pay increases are sometimes unable to alleviate the repercussions of nurse short staffing as feelings of guilt over the inability to keep up with basic patient care drives nurse’s away (Herbst, 2007). This shows how difficult the effects of short staffing are to combat. In a study on hospital short staffing and nurse burnout, it was found that “forty percent of hospital nurses have burnout levels that exceed the norms for health care workers” (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p. 1987). Aiken et al. (2002) also found that “job dissatisfaction among hospital nurses is 4 times greater than the average for US workers, and that 1 in 5 hospital nurses report that they intend to leave their current jobs within a year” (p. 1987). The study did not further delineate whether the 1 in 5 hospital nurses were choosing to change hospitals only, or choosing to leave the profession all together. Using nurse surveys and hospital data, Aiken et al. (2002) also found that nurses with high nurse-to-patient ratios “are more twice as likely to experience job-related burnout and twice as likely to be dissatisfied with their jobs compared with nurses in the hospitals with the lowest ratios” (p. 1992). In addition to the increased workload stemming from the short staffing of nurses, a nurses’ work schedule also has a great impact on increased fatigue leading to burnout. Many studies have been performed on the relationship between burnout and the most common extended nurse schedules of 12 hours a day, 3 days a week; and 12 hours or more on Saturday and Sunday (Stimpfel, Sloane, & Aiken, 2012). 12 hour shifts for nurses are becoming much more commonplace. From a manager’s perspective, efficiency is improved by “reducing the number of nurse shifts a day, therefore resulting in fewer handovers between shifts, less interruptions to clinical care provision and increased productivity due to a reduction in the overlap between two shifts” (Dall'Ora, Griffiths, Ball, Simon, & Aiken, 2015). For nurses, longer shifts give greater flexibility in scheduling to include a shorter work week, typically 3 days a week or weekend shifts, thus increasing down time and creating a more attractive commuting schedule. Dall'Ora et al. (2015) surveyed 30 hospitals in 12 European countries to gauge the impact of these extended shifts. In their research, “specialized nursing units (eg, intensive care, long-term care) were excluded because of their potential difference in staffing and shift patterns” (Dall'Ora et al., 2015, p. 2). Instead, at a minimum, they focused on two non-specialized medical nursing units per hospital to obtain a more consistent sampling. The Maslach Burnout Inventory (MBI) was used to gauge the level of burnout for each nurse. Worldwide, the MBI is the most utilized measurement for work-related burnout. Their scores indicated that “shifts of 12h or more for hospital nurses are associated with more reports of burnout, job dissatisfaction, dissatisfaction with work schedule flexibility and intention to leave” (Dall'Ora et al., 2015, p. 5). The data showed the odds nurse dissatisfaction increased 40% for those who worked shifts 12 hours or more. A similar non-specialized nurse demographic survey was used by Stimpfel et al. (2012) to measure the correlation of nurse work schedule and burnout in hospital across multiple states in America. Their results were strikingly similar as they found that “the odds of burnout and job dissatisfaction were up to two and a half times higher for nurses who worked longer shifts than for nurses who worked shifts of 8-9 hours” (Stimpfel et al., 2012, p. 2504). These results are concerning given the trend toward extended shifts for the sake of increased flexibility, efficiency, and cost savings. It is possible that the preference for flexibility and short work weeks led the nurses to accept the fatigue that extended shifts may cause. “Nurses may be choosing to sacrifice work satisfaction for benefits in other spheres of life. However, this type of choice is likely to compromise nurses’ recovery sleep, physical and psychological well-being” (Dall'Ora et al., 2015, p. 6). Over time, this fatigue will add up and likely lead to burnout and desire to leave the environment