COLUMN-Burnout among our nurses
This past week, I had an interesting conversation with some nurses from our health care facilities across the island. They reported that they were experiencing high levels of on-the-job stress.
For instance, one nurse said that at her institution there was a burst water main that was flooding the surrounding areas of the building. Some of the water had even entered the building on occasions. And, despite several efforts to contact the authorities, given the recent outbreak of chikungunya, the leaking water still remains.
Another nurse was mainly concerned about the environmental impact of factors like dust and dirt on the health of patients and workers. In addition, she was concerned about the management structure of the organization, in terms of reporting lines of responsibility.
She further explained that even though the institution was a health care facility, it was difficult to contact housekeeping for additional assistance, if an emergency (excrement or vomit spilling onto the floor of the facility) took place after general cleaning was completed. She indicated that on many occasions the nurses themselves had to take on the added responsibility
of mopping the floor of the ward, in order to ensure that high levels of patient care was maintained.
Yet another nurse spoke of poorly designed shift hours and the impact they had on work-family life. She indicated that in several cases the rotation patterns of shift work had negatively impacted on the work attitudes of her colleagues, and had added to their job stress. This week, we look at work stress and burnout among health care individuals.
Firstly, let me state that we will all get sick at some time or the other, and will need our main health care facilities. Yet some of us act as if issues relating to health care are not our concern. Everyone has also noted that we, who formerly took pride in keeping our surroundings clean, have now begun to neglect them despite rising health issues (chikungunya, dengue and Ebola) and concerns, inter alia.
However, this is not the only pressing issue; we are also refusing to treat our employees with the respect they deserve for their dedication and hard work. Indeed, it is common to encounter organizations where systems and machinery threaten the safety and health of employees.
Secondly, we all act as if we are waiting for someone (mainly a white blond-haired individual) with a PhD to ride in on a white horse and tell us how to treat our employees. I want to suggest that we no longer have to wait for the ship to come from England; we now have access to the Internet.
For instance, the United States Occupational Safety And Health Administration (OSHA) and the World Health Organization (WHO) have websites that provide all kinds of solutions that could assist with the management of organizations. Their motto underpins the suggestion “that an organization must be responsible for seeing that the work environment is clean and free from obvious physical hazards, including trash piles, puddles of oil, water or blocked safety exits”. (Jewell, 1998, Page 328)
So, one does not have to be a rocket scientist to know that a burst pipe at a district hospital is an unhealthy environment for patients and employees alike. Moreover, it is unhealthy for nurses who are caring for patients to have to mop a floor because the help has already done so and have gone on to another area. What if infections are then transmitted to patients
from the overworked nurse?
An article by Jennings (n.d.) provided some background about stress and burnout among nurses. She observed that work stress in nursing was first documented during the 1960s. During this time, four sources of stress were identified and remain of prime importance in contemporary health care institutions.
These sources include “patient care, decision making, taking responsibility and change”. Jennings contends that the inherent role of nurses underpins stress since they are required to care for the suffering, work shift (which is often plagued with shortages of staff) and face interpersonal problems. It was also noted that with the emergence of technology, the level of work stress among nurses had increased, along with a myriad of environmental issues overlooked by management.
With regards to burnout, Jennings referenced Freudenberger (1974) who first coined the term “burnout”. The definition suggests that burnout can be described as a syndrome that is linked to emotional exhaustion. This exhaustion then negatively impacts on worker well-being and organizational performance.
One cannot help but notice that a health care facility is as good as its nursing staff. Even though, doctors are extremely important, it is the nurses that care for the patient in the end; so their contribution should not be taken for granted.
Moreover, work stress can impact on family life, and often creates a conflict between the responsibility of work and that of marriage, and often creates a situation of work and non-work stress among nurses, since the profession is predominately female.
Here in Barbados, the problem can be even more pronounced since our households are primarily matrifocal, as nurses may have the added responsibility of being the heads of households with dependents (young children and elderly parents).
It has also been well documented that nurses’ burnout can result in increased absenteeism and high levels of turnover –– both of which can negatively impact on overall health care and job satisfaction, the major causes of low motivation.
Added to that is the increasing levels of patient dissatisfaction in our care institutions. Although the research by Jennings revealed that work stress among nurses had a positive relationship with increased mortality and failure to rescue, my participants stopped short of indicating this problem. However, their major concern appeared to be the adverse effects of stress on their own well-being.
Moreover, the empirical research by Jennings suggests that the shift length was considered by nurses to be a major consideration in relation to nurse’s job satisfaction.
Finally, in relation to our island’s health care institutions, management should be cognizant of creating a healthy work environment. This can be achieved by focusing on reducing stress-inducing factors like poorly developed reporting structures.
Work-family conflict should also be a major consideration since most nurses may have the additional responsibility of caring for children and elderly parents in the home. More importantly, management should be aware that there is a direct causal relationship between work exhaustion, workplace-home and family conflict, and job satisfaction. All of these are associated with stress on the job and burnout.
(Daren Greaves is a psychology and management consultant. Email Dwensaincorporated@gmail.com)