1 Practice Problem Intervention Public health is an important factor that influences productivity, economic progress, and sustainability. Leaders collaborate with healthcare professionals at the local, state, and national levels to ensure appropriate mechanisms are implemented to support public health (Burke & Pignata, 2020). These mechanisms include mass vaccination against certain diseases, community education, provision of medications, and delivery of quality healthcare services. Policymakers are also actively involved in public health initiatives. These professionals actively participate in creating policies to address the health needs of the people and prevent members of the community from being exposed to potentially harmful practices. Although there are strategic measures to promote public health, people continue to suffer from preventable and treatable diseases, besides being exposed to numerous health challenges. Healthcare professionals also continue to experience problems at all levels of practice.
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2 The government has established numerous initiatives, including Healthy People 2020, to build a healthier nation. The Healthy People 2020 guides healthcare professionals and policymakers on the issues to address to reduce the burden of diseases in the community and improve care providers' productivity. The Healthy People 2020 is a significant public health initiative to improve the environment and people’s health. The Healthy People 2020 identifies health improvement priorities at all levels of service and recommends suitable interventions. Another role of Healthy People 2020 is to increase public awareness and understanding of the disease, disability, determinants of health, and opportunities for progress. The healthy people 2020 objectives are crucial in the treatment, management, and prevention of disorders such as childhood obesity affecting many people. In the healthcare industry, HealthyPeople 2020 goals and objectives are used to avert practice problems that affect care quality and patient safety. Nurse leaders and other health professionals utilize the HP2020 initiative to identify, investigate and propose a prevention strategy for various practice problems. Some of the practice problems that can be addressed using the HP2020 initiatives are nursing shortage, mandatory overtime, workplace safety, workplace violence, and nurse burnout (HeathyPeople.gov, 2020b). Summary of the practice problem The practice problem addressed in this paper is nurse burnout. This phenomenon is typified by a decrease in nurses’ energy to participate in care delivery and other health-related tasks such as patient education, self-care, and policy development (Wei, King, Jiang, Sewell & Lake, 2020). While the nursing profession provides a wide range of practice options, flexibility, and settings, the risk of burnout is high due to mental and physical exhaustion, long shifts, challenging patients, workload, lack of control, and conflict and bullying (Waddill-Goad, 2016).
3 Burnout affects not only individual nurses but also the hospital, families and patients served by these nurses. Kelly, Gee and Butler (2020) made it clear that more than half of the nursing workforce is experiencing burnout. The presence of many burned-out nurses implies that the industry comprises dissatisfied professionals with a high risk of poor personal consequences, high risk to patients (Bakhamis, et al, 2019) Nurse burnout is classified through three major symptoms: reduced personal accomplishment, exhaustion, and depersonalization (Kelly, Gee & Butler, 2020). Burnout manifests in decreased motivation, emotional exhaustion, frustration, depression, anger and physical fatigue. Burnout affects the nursing practice since it lowers the performance level and organizational commitment of nurses. Studies have documented the potential causes and impacts of burnout on nursing practice and patient care. Kelly, Gee and Butler (2020), for instance, noted that burnout harms the quality of life of nurses and disrupts their involvement in patient care activities. Importantly, studies have revealed that burnout is a significant contributor to the increased nurses’ desire to leave the profession (Kelly, Gee & Butler, 2020). Nurses who experience disappointment and a feeling of low personal accomplishment eventually leave the profession. Stress also affects the decision-making capability of the nurses. The risk of making inappropriate decisions is higher among stressed-out nurses (Waddill-Goad, 2019). Burnout also contributes to nurses’ disengagement from the patients. Burned-out nurses find it hard to deliver their best care to the patients even in situations where chances of recovery are minimal (Kelly, Gee & Butler, 2020). Waddill-Goad (2019) noted that the burned-out nurse might also express poor communication and incivility toward colleagues. The interaction between the nurse and the patients with their family members is also affected leading to lower patient satisfaction scores.
4 Waddill-Goad, S. (2016) noted that care quality and patient safety are compromised when stress and fatigue take over the nurse’s ability to prioritize self-care and recovery time. Overcoming burnout requires a critical investigation of the causes, tools and boundaries to combat fatigue. Nurses also need to identify the factors that augment the risk of burnout. Social Determinant Risk Factors Although numerous changes and interventions have been implemented to improve the nursing environment, nursing practice is not yet stress-free. Nurses work in a dynamic environment that predisposes them to the risk of stress. Every situation that typifies the nursing professional can lead to compassion fatigue if the necessary caution is not taken. The social factors contributing to nursing burnout include a lack of support, staff shortage, increased responsibilities, high frequency of nurses, and physical abuse (Burke & Pignata, 2020). Nurses working in an insufficient work environment that lacks collaboration practices and a good teamwork culture are likely to experience fatigue, burnout and emotional suffering. Collaboration is essential in nursing since it keeps nurses alert that averting the risk of medical errors and poor patient outcomes (Cooper & Quick, 2017). However, nurses become physically fatigued if they work in an environment where collaboration is not practiced. Support from nurse leaders and hospital management is also crucial for enhanced nursing practice. Support includes providing the necessary resources, proper scheduling, counseling services, and a suitable reward system, among others (Wang, Liu & Wang, 2015). The chances of nurses getting overwhelmed are high if nurses are not accorded the right support. Nurses also acknowledge that physical and emotional abuse at the workplace increases the risk of burnout. Emotional abuse occurs when nurses are excluded from major decisionmaking practices besides being denied a chance to contribute to policy-making (Burke &
5 Pignata, 2020). Leaders may also blame nurses for catastrophic events that occur at the workplace, further increasing their psychological and emotional turmoil (Burke & Pignata, 2020). Abuse causes nurses’ disengagement from the profession and subsequently increases the desire to leave the profession. Prevention Strategies Although nurse burnout is a widespread problem, nurse leaders can utilize numerous strategies to prevent and curb this problem before it imparts a devastating blow to patient care quality and safety. The active participation of all stakeholders is necessary for burnout prevention interventions to achieve the anticipated outcomes. Prevention strategies can be categorized into primary and secondary strategies. Primary prevention refers to the tactics employed to prevent burnout before it occurs. Secondary strategies, on the other hand, refer to strategies implemented once nurses have experienced burnout. These strategies are aimed at reducing the impact of nursing burnout on nursing practice, patient safety, and care quality. Primary prevention involves the development of policies that can effectively avert the risk of burnout. For instance, a policy banning all forms of abuse at the workplace can help establish a suitable work environment. Nurse leaders can also implement policies supporting safe and healthy practices (Vokhlacheva, Shakori & Farzanehkari, 2018). To ensure the needs and interests of nurses are taken care of, these professionals need to be involved in policy-making processes. Another practical approach to the prevention of burnout is education and awareness. Education improves the nurses’ knowledge of the tactics to employ when faced with practice challenges. Nurse leaders can distribute brochures and other learning materials to ensure other nurses familiarize themselves with burnout prevention tactics that have worked elsewhere.
6 The hospital also needs to implement an employee support program for stress assessment, stress management, and counseling (de Oliveira, de Alcantara, Gadelha & do Nascimento, 2019). In this program, nurses are provided with a base on which to share their nursing experiences with their colleagues. Sharing allows nurses to express their feelings thus reducing the emotional burden related to poor working environments. In secondary prevention, nurses are encouraged to engage in activities that improve work experience and prevent the recurrence of burnout. Leaders also implement interventions to return nurses to their original physical and mental health (Vokhlacheva, Shakori & Farzanehkari, 2018). Some of the secondary activities to prevent burnout include physical exercises, counseling programs, the delegation of tasks, and social support. Evidence shows that a physical exercise program, where nurses are encouraged to participate at least 30 minutes per day, can relieve fatigue and stress related to nursing practice (de Oliveira, de Alcantara, Gadelha & do Nascimento, 2019). Physical activities also improve the nurses’ health besides relieving stress. Related HealthyPeople 2020 goal The HealthyPeople 2020 goal that correlates with the selected practice problem is Occupational Safety and Health. The OSHA's primary goal is to promote the health and safety of workers by implementing measures to arrest potential risks and intervene before an organizational issue escalates to critical stages. In nursing practice, work-related issues are the primary contributors to nurse burnout. Therefore, the promotion of safety through workplace reorganization and establishing a positive workplace culture can eradicate burnout. Major work changes in healthcare organizations also cause nurse burnout. These changes include increased working hours, poor shift scheduling, compressed workweeks, reduced job security, nursing shortage, and limited resources. No healthcare organization has managed to
7 balance these factors to establish a competitive workplace environment. Consequently, nurses experience workplace challenges that they have little control over. Workplace settings vary from one organization to another. Factors such as location, design, size, gender and age of employees, education, training, and workplace culture greatly influence workplace settings. When implementing nurse burnout prevention strategies, leaders must put all these factors into consideration. In most organizations, nurses work for long hours and serve a large number of patients. Without addressing these challenges, hospitals cannot achieve the employee safety and health proposed by HealthyPeople.gov. According to HealthyPeople.gov (2020a), organizational leaders should collaborate with other stakeholders to establish an environment that reduces the risk of injuries, promotes the health and wellbeing of employees, and eradicates workplace issues to improve productivity. HealthyPeople 2020 proposes an increase in the number of employees with access to workplace stress reduction programs. Nurse leaders can translate this initiative into nursing practice to increase the number of nurses with access to burnout and stress prevention programs. Evidence-based Intervention Implementing a shift and practical working hour program is an evidence-based intervention that can eliminate nurse burnout. This intervention aligns with the HealthyPeople 2020 goals on occupational health and safety. Sivesind (2020) noted that the association between work schedules, health, and safety is intricate. This relationship is influenced by various factors including shift length, speed of rotation, rest breaks, shift time, duties per shift, and the work environment.
8 Researchers theorize that long working hours reduce the time available for relaxation, sleep, recreational activities, socialization, and self-care. Nurses working for long hours experience sleep deprivation and incomplete recovery from work. Family and social contacts for these professionals are also reduced (Shakori, Vokhlacheva & Farzanehkari, 2018). A shift and work hour program ensures that duties are equally distributed among available nurses. This program recommends that nurses should work for less than twelve hours per day to improve their productivity. The program also sets the time for recreational activities such as sports that are important for the socialization and physical health of nurses. A systematic review of literature by Banakhar (2017) revealed that shift length plays a vital role in the productivity of nurses. Study findings revealed that nurses working in 12-hour shifts reported higher stress levels than those working in 8-hour shifts. 12-hour shifts were also linked to chronic fatigue, emotional exhaustion, and cognitive anxiety among nurses. In another study, McDonald (2019) compared the impact of 12 – and 8- hour shifts on nurses’ productivity. The researchers reported that nurses working 8-hours were more productive and relaxed than those working for twelve hours or more. The researchers also reported that nursing working shorter shift lengths were more satisfied with their job and never experienced burnout and fatigue. These findings are relevant since they encourage organizational leaders to implement measures supporting the reduction of working hours. For instance, hiring more nurses can reduce the number of working hours for individual nurses. SMART Objective to address the HP2020 goal The SMART objective that can facilitate the achievement of the HP2020 goal on preventing nurse burnout is establishing a support program. Wei et al. (2020) noted that nurses’ stress could escalate if suitable support is not available. A support program provides nurses an
9 opportunity to express their feelings concerning day-to-day activities besides pointing out issues that affect their productivity (de-Oliveira, et al., 2019) Specific: The organization needs to implement a support program to ensure that nurses are accorded the necessary support to overcome challenging practice issues. Measurable: The support program comprises counseling sessions to enable nurses to develop coping skills. Nurses should attend at least one counseling session per month. Proper counseling helps nurses to develop the skills necessary to take full control of the practice. Achievable: The establishment of a support program is an achievable initiative that does not require many resources. Realistic: The proposed intervention is realistic. The hospital needs to allocate sufficient resources to establish proper support systems. The hospital, however, needs to hire a counselor to facilitate the counseling sessions. Time: The support program can be established within two months. Conclusion Nurse burnout is a significant practice problem since it affects nurse productivity, the outcome of patient care, and patient safety. It also lowers nurses’ performance level, quality of life and organizational commitment. The dynamic nature of nursing practice exposes nurses to numerous challenging issues. These challenges increase physical fatigue and the risk of
10 developing mental health problems such as depression. The factors that contribute to nurse burnout include nurse shortage, physical and emotional abuse of nurses, inappropriate shifts and working hours, a lack of support from organizational leaders, and an insufficient working environment. The failure to address the causes of nurse burnout increases nurses’ desire to quit their profession. Notably, most of the burnout prevention interventions are supported by HealthyPeople, which proposes occupational safety and health of all employees. This objective emphasizes the need to establish a workplace culture and reorganize workplace design to improve safety. A support program can be implemented at the hospital level to prevent burnout. The support system creates a base on which nurses can identify challenging practice issues and communicate them to their leaders. Nurses are also able to express their feelings concerning specific programs and hospital policies. A support system helps reduce stress, improve emotional wellbeing, and eradicate physical health problems.
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