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.