Jeannie P. Cimiotti, DNSc, RN
Author – Jeannie P. Cimiotti, DNSc, RN
Executive Director, NJ Collaborating Center for Nursing;
Associate Professor, Rutgers University College of Nursing
Job-related burnout has been well-documented among individuals who provide care to others. The etiology of burnout points to chronic stress that results not only from the close interaction with people, but with the organizational climate in which people work. One organizational area that has been extensively identified as a contributing factor to this complex syndrome is workload.
Historically, nurses provide care under less than desirable circumstances. Often overworked and under appreciated, nurses are the only professionals who are in constant contact with patients, and they deal with life and death issues on a daily basis. It’s not surprising then that our survey of nurses in Pennsylvania showed that more than a third reported high levels of emotional exhaustion, a key component of burnout syndrome. We must ask ourselves, what happens when nurses suffer from high emotional exhaustion? It’s simple – they begin to feel like they lack control. Then, they psychologically and cognitively detach from the care environment. The result is less than optimal nursing care.
Nurse workload has been linked to patient infections, yet, the mechanism has not been clear. We know that good organizational climate can lead to fewer adverse patient outcomes, despite less than optimal nurse staffing. We also know that improved workload and good organizational climate can reduce job-related burnout.
We now have promising evidence that links nurse burnout to catheter-associated urinary tract (CAUTI) and surgical site infections (SSI). In our study of Pennsylvania hospitals published in the American Journal of Infection Control (AJIC), we found that increasing a nurse’s workload by one patient was associated with increases in both CAUTI and SSI. Each 10 percent increase in a hospital’s high-burnout nurses corresponded with nearly one additional CAUTI and two additional SSIs per 1,000 patients annually. We suggest that if nurse burnout rates could be reduced to 10 percent from an average of 30 percent, Pennsylvania hospitals could prevent roughly 4,160 infections annually with an associated savings of $41 million.
Reducing burnout rates of nurses is a win-win. By reducing nurse workload we can protect our nurses from burnout and we may be protecting patients from infections.
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August 15, 2012 at 12:34 am ET - Margaret Mungai
Nurse patient ratios are high in our public hospitals where unlike privately owned hospitals controlling the number of patients (workload) is beyond the hospitals management.This scientific evidence is timely and should be considered very seriously by governments to prevent HAIs, reduce public hospitals congestion, improve nurses health and reduce health care expenditure.The percentage of nurses in any health facility should not be less than 40% unlike most facilities that have up to 80% of non nursing staff resulting to increased nursing workload.
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August 8, 2012 at 1:58 pm ET - rocky
I don’t understand how “pooling nursing resources county wide” from various hosptials would reduce cost or improve outcomes. Really tired of nursing professionals being treated like units that can just be shuffled into open spots according to the latest whim in the name of efficient care. Nurses become experts in thier area practice similar to other professionals and facilities need to do what it takes to attract them for good outcomes. It’s not rocket science people; burn out is huge factor in attrition from the profession. And is apparent is how to remedy this. Quit cutting corners is providing good nursing care.
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August 7, 2012 at 3:24 pm ET - Erin Tolbert
It’s good to have some more concrete data on the effects of nurse burnout. Maybe this can be used to show hospitals that patient: nurse ratios need to be kept low and that the quality of work environment directly impacts patient care.
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August 6, 2012 at 9:18 am ET - Linda Douglas
Is there a widely accepted definition of burnout? i.e. Are there recognized criteria for diagnosis of burnout?
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August 2, 2012 at 6:46 pm ET - Michael E. Bailey
As hospitals, long-term nursing facilities, and other medical facilities look for ways to cut costs, the first place they look at is nurses. It cost less to hire LVNs than RNS, and less still to layoff LVNs and RNs and add patient load onto the staff that remains. And so Health care related illnesses increase. Maybe a greater emphasis on home health care and on Community First Health care–bringing the health care to where the patient is in the least restrictive setting would be helpful. So might setting up nursing boards at the county level that would allow all hospitals in the county to pool their nursing resources to provide better service at lower cost. Another thing would be increasing health IT so that automation could do more of the administrative functions and nurses could focus on the aspects of direct patient care.
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August 2, 2012 at 12:42 am ET - Anwar
Moreover , we all confirm that workload do contribute to harmfull efect on patient safety, Nosocomial Infections are still heading in an increase manner if polices & Procedures are broken. Nurses play an essential role if they adhere to infection control policy and procedures, and workload make a huge obstacle in achieving that.
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August 1, 2012 at 5:02 pm ET - Dorothy Gall
I do agree with this article. I can easily see the reasons for a connection between nurse workload and increased infections. I find that when the nurse is overwhelmed she will be much less likely to push for a catheter to be discontinued especially on an incontinent patient or one who is difficult to toilet. They are also more likely to delay removing a catheter when the order is received. I believe catheter care suffers also. Dressing changes may be rushed or missed on surgical sites as well. I believe the overall feelings of the patient influence their immune system and their nutritional intake and this affects healing. When the nurse can practice with caring and compassion the patient feels better. It just makes sense.
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August 1, 2012 at 3:43 pm ET - Patsy
It is ironic that you have identified this with a negative outcome. I find that if there are no documented outcomes including sometimes death, then nurses are not considered to be burnt out. It seem as if administrations and governments are actually waiting for these untoward events to occur before employing more nurses and ensuring that nurses are remunerated adequately
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August 1, 2012 at 12:32 pm ET - Jane Cooperman
This is really a win-win-win. Not only does it prevent burnout of the individual nurses, and protect patients from infections, but in a larger picture it protects our workforce – and as baby boomers age out of nursing this is important!
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