Running head: NURSE BURNOUT 1

Nurse Burnout
Sydonie Stock
Ferris State University

NURSE BURNOUT 2
Nurse Burnout
Burnout is a continuing problem for the nursing profession. This miniature literature
review will look at the affect differing shift lengths have on nurses burnout rates. The burnout
could be something that affects the nurses care for patients at work, or it could affect the nurses
home life, or both.
PICO Question
The PICO question being examined is: Is there a correlation between hospital nurse
burnout and shift length, comparing 8 and 12 hour shifts. The Population is nurses working
either 12 or 8 hour shifts in a hospital. The Intervention is working 8 hour shifts. The
Comparison is working 12 hour shifts. The Outcome is a lower burnout rate.
Research Findings
Burnout is a problem because it leads to quittingjob dissatisfaction, lack of marital
and familial harmony, decrease in self-esteem (Demir, Ulusoy, & Ulusoy, 2003, p. 808) among
many others. Not only does burnout affect the nurses quality of life, it also affects the care given
(Demir, Ulusoy, & Ulusoy, 2003, p. 808). Demir, Ulusoy, & Ulusoy (2003) found several
definitions of burnout, including one by Maslach (1981): a physical, emotional and
intellectual exhaustion syndrome manifested by adverse attitude to professional life and other
people with the development of a negative self-esteem in the individual experiencing chronic
fatigue, and feelings of helplessness and hopelessness (p. 807).
Through their research, Hoffman & Scott (2003) examined the stress level and career
satisfaction of RNs working in hospitals in Michigan (p. 337). Initially, their survey results
showed that working 12 hour shifts led to significantly higher levels of stress (Hoffman &
Scott, 2003, p. 339) compared to RNs working 8 hour shifts. They then factored in the differing
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ages and experience levels of the two groups of nurses and found similar levels of stress
(Hoffman & Scott, 2003, p. 339). When asked about career satisfaction, there were no significant
differences between the two shift length groups (Hoffman & Scott, 2003, p. 340). RNs
determined career satisfaction by pay, autonomy, and professional status (Hoffman & Scott,
2003, p. 339).
They also presented the fact that new nurses are often hired into a 12 hour shift position.
This lack of experience added to the tiredness that comes with working 12 hours enhances the
stress experienced by new nurses and limits the abilityto respond, cope, and adapt to stressful
situations (Hoffman & Scott, 2003, p. 341) when compared to the more experienced nurses
working 8 hour shifts. Demir, Ulusoy, & Ulusoy (2003) also found in their research that new
nurses have a higher burnout rate than more the more experienced because they are not as
capable of handling the stress that goes along with the job (p. 821).
The surveys and interviews conducted by Demir, Ulusoy, & Ulusoy (2003) identified
areas of the nurses lives where stress levels increased. Participating nurses stated they were
adversely influenced by the scarcity of attendants (p. 811) and by the lack of equipment (p
812). The shortage of assistance and equipment increases the nurses emotional exhaustion
(EE) and depersonalization (DP) (pp. 808, 811-812). Not only does the work environment
affect nurse stress levels, but also the home environment as well (pp. 812-818).
Along with working and living conditions, the duties of a nurse takes its toll. Yoder
(2008) paraphrased Figley in 2002, saying, Compassion fatigue is an emotional effect of being
indirectly traumatized by helping those who experience primary traumatic stress (p. 191). Yoder
(2008) found that compassion fatigue is related to burnout, but are not the same thing (p. 191).
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Yoder (2008) found that the degree to which the nurse is empowered by the care she
gives, has a negative correlation to compassion fatigue and burnout (p. 195). However, she found
that nurses working 8 hour shifts had significantly higher (Yoder, 2008, p. 193) compassion
fatigue than those working 12 hour shifts.
Recommendations
Even though RNs make up the largest group of hospital healthcare employees, they are
an easy target for cutbacks, layoffs, and restructuring (Hoffman & Scott, 2003, p 341).
Hoffman & Scott (2003) suggest that these changes can have a devastating effect on staff
morale and may perceive the restructuring of nursing positions as devaluation of their
professional role, status, and worth (p. 341), thus decreasing job satisfaction. If hospital policies
are implemented to protect the nursing job, there could be a positive effect on job satisfaction.
Demir, Ulusoy & Ulusoy (2003) predicted that one dollar spent for stress management
will bring five dollars back (p. 808). If hospitals implemented stress relieving programs for their
employees, they would save money from nurse burnout and turnover. Because both Demir,
Ulusoy & Ulusoy (2003) and Hoffman & Scott (2003) found that new nurses were less equipped
to handle the stress, there should be focused stress relieving methods for this demographic to
prevent rapid burnout (p. 821) (p. 341). This information was not originally part of the PICO
question, but was found in the course of the research.
If these changes are made, the quality of nursing care will improve because the nurses
stress level will not lead to compassion fatigue. The hospital expenses will decrease because the
nursing staff turnover will decrease with increased job satisfaction. The nurses quality of life
will improve with decreased stress.
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When making policy changes in a hospital, more evidence is needed than three research
articles. These three articles each have a low level of evidence (Melnyk & Fineout-Overholt,
2011, p. 82), being descriptive and mixed methods studies. More research of higher levels of
evidence would have to be conducted since these articles have conflicting findings. The relevant
research must be disseminated to those in a position to make policy changes. This is done by
communicating the findings, usually through conferences or presentations (Nieswiadomy, 2012,
p. 262), and collaborating together to find the best way to implement the changes.
Before any changes are made, it has to be proven to positively impact the nursing
profession. The change must be relevant to those being affected, and the facility or department
must have the resources available to implement the change. If there is not enough money to
make the changes, it will not matter the level of evidence proving the benefits of the change.
Conclusion
Hoffman & Scott (2003) urge Nursing Executives to realize any change in the practice
environment can cause negative stress and lead to burnout, job turnover, and dissatisfaction
among nurses (p. 341). However, there is not enough evidence within these three articles to
definitively say whether 8 hour shift work has less burnout than 12 hour shift. In order to relieve
stress and decrease burnout, it is recommended that hospitals implement a stress relief program
for all nursing staff, focusing on the newly graduated nurses. This will decrease staff turnover,
increase nurses quality of life, and increase patient care.
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References
Demir, A., Ulusoy, M., & Ulusoy, M. (2003). Investigation of factors influencing burnout levels
in the professional and private lives of nurses. International Journal of Nursing Studies,
40(8), 807-827.
Hoffman, A., & Scott, L. (2003). Role stress and career satisfaction among registered nurses by
work shift patterns. Journal of Nursing Administration, 33(6), 337-342.
Nieswiadomy, R. (2012). Foundations of nursing research (6
th
ed.). Upper Saddle River, NJ:
Pearson Education, Inc.
Yoder, E. (2010). Compassion fatigue in nurses. Applied Nursing Research, 23(4), 191-197.
doi:10.1016/j.apnr.2008.09.003.
Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare:
A guide to best practice. Philadelphia: Lippincott, Williams & Wilkins