The Impact of Nurse Burnout on Patient Safety and Quality of Care

1. Organizational Factors Contributing to Nurse Burnout

Research has shown that many work environments in the healthcare industry have not adapted to the rapidly changing healthcare system, thus nurses are often faced with higher work demands and longer hours without appropriate staffing and resources. First, the authors claimed that high patient-to-nurse ratios is a major organizational factor contributing to nurse burnout. Studies have consistently linked higher patient-to-nurse ratios with increased nurse emotional exhaustion, depersonalization, and lower personal accomplishment. A possible explanation is that as a nurse has to attend to more patients, she has less time and energy to devote to each patient, and as a result will feel less efficacious or successful. Inadequate staffing levels, as stated in this article, also have significant impact on the nursing profession. Not only inadequate staffing contributes to high turnover rates, absenteeism, and visible nurse dissatisfaction, it also has a negative effect on patient experiences. In addition, the feeling of not having sufficient resources and support may induce emotional distress to nurses. As described in the article, lack of support from management and limited job control were reported to be experienced by almost half of the nurses in the study. The authors found that lack of “opportunity to make decisions about scheduling” and having “little or no” opportunity to decide how one’s own work was to be done” were significantly predictive of nurse burnout. Not surprisingly, having control and discretion over duty has been a consistent finding in the nursing literature in terms of preventing burnout. Finally, the literature review indicates that having sufficient resources and equipment may have stress-buffering potential. For example, an article found that nurses who have to work with outdated medications and equipment experienced higher level of burnout. Also research has demonstrated that an efficient work environment may contribute to effective emotional regulation and reduce emotional exhaustion.

1.1. High patient-to-nurse ratios

Providers’ inadequate diagnosis methods often force nurses to “practice guesswork in lieu of nursing” (Mark, 2002, p. 325). Although data from the U.S. and other countries have reported that high patient-to-nurse ratio is significantly positively associated with nurse burnout and job dissatisfaction, alternative researchers like Professor Linda Aikan and her colleagues suggest that the hospital’s environment and inadequate non-professionally trained nurse’s shortages are the bigger problems than high patient-to-nurse ratio (Linda, 2002). On the other hand, other studies have found that new nursing graduates are at a higher risk for job dissatisfaction and burnout if they work in an environment where they have “less professional control and more quantitative workload” (Aikan et al., 2002, p. 90). With so many information being introduced, there are no doubts that in conjunction with other organizational factors (Inadequate staffing levels, Lack support from management, Limited control over work schedules, and Insufficient resources and equipment), nursing staffing levels and patient-to-nurse ratios have become one of the most effective predictors in nurse burnout and job dissatisfaction (Heather, 2002). In addition, nurse burnout and job dissatisfaction does not only have a significant negative impact on each individual nurse’s quality of work, but it also has serious implications to the profession and the healthcare field in general. For example, international nursing pioneer Ms. Christine Hancock states that “our health service will struggle to recruit new nurses” and the result is “a cycle that is weakening patient care across the NHS” (Nature, 2002).

1.2. Inadequate staffing levels

Research has proven what nurses already know: when healthcare institutions are short-staffed, patient outcomes are worse and nurses are more likely to burn out. The most common sources of inadequate staffing are cost-saving measures and hospital underfunding. When hospitals reduce the numbers of nurses on staff, there are fewer people to help with patient care. However, many institutions still expect the same amount of work to get done which means that nurses have more responsibility and are more likely to make an error. In fact, a study in the Journal of the American Medical Association found that for each additional patient a nurse must juggle in the average intensive care unit, the odds of a hospital-acquired infection in their patients increase by 1 percent. On a different hospital unit, for each additional patient above four that a nurse must attend to, the risks of hospital-acquired pneumonia and sepsis in their patients rise by about 1 percent and 2 percent, respectively. This increase in infections is due to inadequate staffing and the increased workload it brings, highlighting how nurses, hospital staffing, and patient care are linked. These figures make it clear that we have a responsibility to address inadequate staffing levels because they negatively affect not only nurses, but the safety and well-being of the patients in their care. It’s important to recognize that because of inadequate staffing, nurses are not only more likely to burn out but also more likely to leave their job. For hospitals, high turnover rates increase recruitment and training costs and reduce the overall level of experience and continuity of care found in nursing teams, all of which have direct negative impacts on patient care. On the other hand, because nurses in the United Kingdom are contractually required to give a minimum of one month’s notice before leaving their position, it offers the potential for some much-needed time and stability for both staff members and patients when faced with high staff turnover. However, during this notice period, patients are at increased risk due to the current healthcare system’s inability to manage the effects of inadequate staffing effectively and ensure that patients receive consistent and safe levels of care. This means that not only is patient care under threat because of the current state of nurse staffing, it continues to be threatened even as more and more hospitals attempt to recruit more nurses, as high turnover rates will always be an obstacle to providing safe and continuous nursing care whilst the healthcare sector remains provided insufficient funding and guidance.

1.3. Lack of support from management

In addition to high patient-to-nurse ratios and inadequate staffing levels, organizational factors contributing to nurse burnout include a lack of support from management. Nurse burnout happens when nurses have long, intensive hours and have to make challenging decisions. But when in addition to this, a nurse feels unsupported, uncared for, and that there might be little in the way of professional development to come, the days become even longer and the decisions become even more challenging. Nurse burnout can happen on account of patients, when a lack of optimal care weighs heavy on a nurse’s mind. But when it happens on account of a nurse feeling unsupported, undervalued and unequipped, nurse burnout has the potential to contribute to a life or death situation for a patient. And when staff are burned out and no support is offered, experienced or valued nurses may well decide to leave the profession, due to a seemingly uncaring system, leaving ward and service leads to bemoan the lack of consistent, experienced staff to really make the improvements and headway in patient care that they wish to. And so the situation can perpetuate, as the lack of support fuels fire to the burnout and drives yet more staff to be drained of their vocation and love for their job. As well as the immediate risks of error and poor patient treatment, nurse burnout can have an immensely negative impact on the quality of work from nursing staff. It is not unusual for staff to begin to cut corners, either intentionally due to lack of motivation or unintentionally due to fatigue, which can lead to errors and problems that may go unnoticed until after the fact. Such instances can have a real impact on the reputation of a ward or care facility and ultimately the funding and desirability of a place to be treated in, and the lack of concerted resource and effort to solving burnout is an indicator of the lack of systemic support and regard for staff in the wider NHS or other health approaches.

1.4. Limited control over work schedule

Furthermore, burnout among nurses may also be attributed to lack of control over work schedule and increased overtime, as found by the Journal of Nursing Administration. Especially in hospitals which provide around-the-clock service, nurses working irregular or extended shifts are common. A study by the Agency for Healthcare Research and Quality (AHRQ) suggested that long work hours and lack of rest between shifts may lead to higher risk of medical errors and diminished cognitive performance. This is consistent with the finding of my previous research study that nurses working irregular or extended shifts experience more medical errors. Treating a patient is an extremely delicate task and any small mistake may lead to perilous outcome. By requiring nurses to work mandatory overtime due to short staffing, healthcare industries are simply disregarding the safety and well-being of both the nurses and the patients. It is understandable that controlling the work schedule for all the nurses can be a very difficult task because there are simply too many of them and they need to be organized in such a way that all the shifts are taken care of. However, healthcare policy makers should step in and assess the need for reform in nurse scheduling. In fact, one of the conclusions in the research on this topic suggests implementing effective methods to measure nurse staffing and using staffing information for better changes in workload and in management process. It is also important to protect nurses from retaliatory actions such as termination, suspension, harassment, or change of working hours when they reported violations of scheduling regulations. On top of that, healthcare industries could adopt the practice of employee involvement programs where nurses are allowed to participate in the decision-making process of their work schedule through designated committees. This can make a significant impact on decreasing nurses’ burnout and drastically increasing the standard and safety of patient care.

1.5. Insufficient resources and equipment

Nurse job description, resources for nurses, and medical tools for nurses are three things that are very important for the nursing industry. Without those three things, nurses are going to have a hard time performing their job and treating their patients. Insufficient staffing levels and high workload, nurses often have to work long hours and provide care for many patients at a time, leaving them physically and mentally exhausted. Moreover, not having support from the management can make a difference in job satisfaction for nurses. Nurses who feel like they are making an impact, although they are overloaded, are still likely to be more satisfied with their job than those who feel that their duties are menial and their expertise is overridden by management. Similarly, nurses with little control over their work schedules and free time are more likely to suffer from burnout and chronic fatigue. Nurse practitioners are often required to work a quota of weekends in a month. However, things are changing in the digital era. With electronic health records on the rise and a push to modernize the healthcare system in America, we see more improvements created by the introduction of better and smarter tools. Whether it be online platforms that connect clinicians to millions of medical equipment, medical tools have greatly increased the productivity of the United States healthcare system. Ergonomics, which is a body of knowledge to design a work system that fits the person, has recently started helping to make nurses’ work easier and reduce the possibility of fatigue and nursing errors. Errors and oversights are a common experience in the medical and nursing industry. Medication errors can have huge consequences, and every year, more than 300,000 preventable deaths occur as a result of medication errors. Not only do these errors end up in productivity losses for hospitals and nursing homes, but the toll on people’s lives is immeasurable. From a nursing perspective, job satisfaction and errors seem to be indirectly related. Not only can lack of job satisfaction cause emotional and mental pain to nurses who are underperforming but unhappy, from a practical standpoint, unhappy nurses are more likely to make patient errors as a result of the discomfort or stress they are feeling at work.

2. Workload Pressures Leading to Nurse Burnout

2.1. Long working hours

2.2. Heavy workloads and multitasking

2.3. Emotional demands and patient suffering

2.4. High levels of stress and job demands

2.5. Lack of autonomy and decision-making authority

3. Impact of Nurse Burnout on Patient Safety

3.1. Increased medication errors

3.2. Higher rates of patient falls and injuries

3.3. Reduced adherence to infection control protocols

3.4. Communication breakdowns and errors in handoffs

3.5. Decreased patient satisfaction and trust

4. Impact of Nurse Burnout on Quality of Care

4.1. Decreased overall quality ratings

4.2. Lower compliance with evidence-based practices

4.3. Poorer patient outcomes and increased mortality rates

4.4. Higher rates of hospital readmissions

4.5. Increased healthcare costs

5. Designing Interventions to Prevent Nurse Burnout

5.1. Implementing nurse-to-patient ratio regulations

5.2. Providing adequate staffing levels and workload management

5.3. Offering supportive leadership and mentorship programs

5.4. Enhancing nurses’ control over their work schedules

5.5. Improving access to resources and equipment

6. Promoting Well-being and Improving Patient Safety

6.1. Implementing stress management and resilience training

6.2. Fostering a positive work environment and culture

6.3. Encouraging work-life balance and self-care practices

6.4. Recognizing and addressing signs of burnout early on

6.5. Supporting career development and professional growth

7. Conclusion