This article first appeared November 28, 2017 on HealthLeaders Media.
Jennifer Thew, RN
Stress manifests among nurses in various forms and can affect patient outcomes. Fortunately, leaders can implement solutions to help reduce this pervasive problem.
Being a nurse can be fulfilling and rewarding. We get the privilege of helping new lives enter the world, comforting those who are exiting this world, and everything in between. Yet nursing is also taxing and draining at times. Off-shifts (nights and weekends), hectic workloads, violence from patients and families, and incivility among staff members can all cause physical and emotional wear and tear among nurses.
Unfortunately, issues like depression, burnout, and fatigue are extremely prevalent among nurses. As my fellow editor Alexandra Wilson Pecci writes in a recent article, one 2016 study found that nurses experience depression at twice the rate of those in other professions.
This is not just bad for nurses but bad for patients as well. Another study Pecci highlights found a link between nurses reporting poor health, particularly depression, and higher rates of reported medical errors.
That’s a serious issue and one that certainly needs to be addressed.
Some recent HealthLeaders articles offer solutions to address stress among RNs.
There’s a common belief that burnout is a personal failing and that resolving dimensions of burnout—emotional exhaustion, cynicism, inefficacy—are that individual’s responsibility. Eat a salad, go for a walk, take a yoga class and you’ll be fine. Rather, burnout is a sign something is amiss within an organization, and healthcare leaders need to uncover both the prevalence of burnout at their organizations as well as its root causes.
“There needs be a framework to understand where the pain points are, and then how an organization can do something about that,” says Karen Weiner, MD, MMM, CPE, chief medical officer and CEO at Oregon Medical Group, a physician-owned, primary care–based multispecialty group of about 140 healthcare providers, with offices in the Eugene and Springfield area.
Weiner advises that leaders implement system-wide changes to address the factors contributing to burnout. After administering the Maslach Burnout Inventory at OMG, the organization made multiple changes including creating a physician-organization compact, developing new compensation practices, and redistributing workloads.
A 2015 Gallup survey found that more than half of all healthcare workers report they are thriving in none or only one element (purpose, social, financial, community, physical) on the Gallup-Healthways Well-Being Index.
To better help employees cope with the emotional demands of caring for others, some organizations are implementing programs to prevent problems like burnout, suicide, or substance abuse.
“Strategies that could support employees include reducing the stigma about mental health concerns, providing resilience training and care for the caregiver support programs, and providing health and wellness benefits, including policies that allow for time off for mental health concerns as well as for physical health concerns,” says Celeste Johnson, DNP, APRN, PMH CNS, a member of the board of directors of the American Psychiatric Nurses Association and director of nursing, psychiatric services at Parkland at Green Oaks Hospital in Dallas.
For example, the University of Missouri Health System’s ForYOU program provides support to healthcare workers experiencing symptoms of second victim syndrome.
Parkland provides universal screening for suicide risk including for those employees seen in the employee clinic.
Another source of stress among nurses is workplace violence and cyberbullying meets that definition. Thanks to technology, bullying behaviors can now occur in digital form via means such as instant messaging, email, text messaging, social networking sites, or blogs.
According to the National Council for the State Board of Nursing’s policy on social, any online comments posted about a co-worker may constitute lateral violence—even if the post is from home during non-work hours.
To confront cyberbullying, individual nurses should save evidence of bullying comments. Then, during a private conversation, present the evidence to the person who made the comments. Document the conversation and its outcome and if there is a second instance of cyberbullying, report it to the nurse manager. If the behavior continues, alert the chief nursing officer.
Nurse managers should verbalize to their staff that there is a zero-tolerance policy for bullying of any kind, including comments made online. They should also educate staff on standards and polices regarding cyberbullying and take derogatory remarks seriously.
Creating a work environment that addresses issues that contribute to nurse stress and burnout is more than something that’s just nice to do, it’s also a way to improve patient care. There are plenty of reasons to improve. Research by Linda H. Aiken, RN, PhD, FAAN, FRCN, at the University of Pennsylvania has found patients who had surgery at hospitals with better nursing environments and above-average staffing levels have better outcomes at the same or lower costs than other hospitals.
Need any more proof?