Nurse burnout: staffing isn’t the only problem

In a recent NBC News report on the association between burned out nurses and patient infections, the reporter discusses a new research study that examines the relationship between a nurse’s workload and hospital acquired infections. Doesn’t this just make sense?  The more things a nurse has to do leads to less time with each patient, and that leads to taking short cuts and increasing mistakes as the nurse works faster and harder to get all of the work done. This would not be unique to nursing; it would be true of any person who is working in an environment without what they need to optimize their productivity and effectiveness.  However, when we’re talking about nurses and patients, there are lives at stake in the process.

The problem of nurse workload, burnout, and patient safety has been studied for over 10 years.  We know that having the right amount of staff matters, but that is not the only thing that contributes to the burnout of nurses. Burnout happens when nurses are working in situations that are in conflict with their beliefs and values. Burnout is impacted by the quality of nursing leadership on a unit, by the way physicians and nurses work together, and by whether or not a nurse feels they can do what is needed for patients. It is not just staffing that impacts burnout. Many nurses work long hours or work during high periods of stress similar to what occurs during a natural disaster – but that alone doesn’t burn out a nurse.

In the past, patients stayed in the hospital much longer and there was a balance of new, very sick patients with those who were more stable. But now, patients do not stay overnight unless they need 24 hour surveillance by a nurse and almost all of those patients are new and very sick. Additionally, hospitals are facing new rules for reimbursement that link patient outcomes to payment for care. So it is more important than ever to acknowledge the value nursing brings to health care systems and to find a way to optimize the care they bring to patients.

Fortunately, much of what is needed to reduce burnout and improve patient outcomes doesn’t cost more money – it just means nurse leaders need to be well educated, physicians and nurses need to respect each other and collaborate, and hospitals need to be designed in a way that supports the nurse’s ability to care for patients.  Keeping patients in hospitals safe is less about a miracle formula for staffing and more about people working together effectively to keep the patient at the center of care.

Elaine S. Scott, PhD, RN, NE-BC
Associate Professor
Director, East Carolina Center for Nursing Leadership