Advanced Practice and Nurse Burnout

[samiiow]

Hello everyone

This is written by a friend from China, I tried to answer her questions, but Im not an advanced practice nurse, so I don't really know what's happening in their world. I post this here to hear from you experience. I will post my answer to the first question below, just sharing my thoughts. But I have the same concerns as my friend. The more technical our job is, the less caring we might be.

I am a final year bachelor of nursing student in China. I have been doing some research for my essay. And here I have encountered many questions on nurse staffing, burnout, and expanded scope of practice.

In China, it is seldome that nurse hold advanced degrees. We may have clinical nurse specialist (a position given to senior staff, but they are not called CNS, but rather just senior) , but we don't have nurse practitioners for sure. Much of our knowledge come from experience, rather than evidence based practice. Although my bachelor programme teaches EBP, yet it is not central to our education, nor my culture embrace this kind of practice. We value experience more than everything.

Comparatively speaking, there is a simultaneous emphasis on EBP and patient-centred care in western education. First I don't understand how EBP fit into patient centred care? In china we generalise our care regardless.

Second, nurse burnout seems like a universal issue in terms of staffing. Chinese nurses confront this problem more extreme than you I think, we typically look after 20 to 30 patients per shift. We have continue professional education, but it is very rare for us to progress our education to masters level. It is already busy enough to cover our basic tasks, such as giving meds, vital signs, hygiene etc. Not to mention to expand scope of practice. So my question is, does CNP or NP take the same workload as staff nurse? How do they manage that? Do they experience the same burnout before they are advanced?

My teacher is a CNS from England. I often ask her what CNS does in hospital. I don't know if this is her or it's a CNS problem. It seems to me her work is very advanced and technical. like interpretation of ECG etc. And she often loath Chinese nurses on our poor interpersonal skills. She is right, we don't talk to our patient much, because we are too busy and patient's family sometimes are horrible. You may not know, Some paediatric nurses get slap on the face from family, if they can't succeed venipuncture for the first time. So my question here, i guess is similar to my first question, does advanced practice only advance technical aspect of nursing? If yes, is that still care? my teacher often lecture us on how care is, well i don't know, caring? not just repair and maintain. But her CNS job sounds like lots of repair and maintain.

[samiiow]

My response to her first question. It is indeed true that EBP is based on population research and patient-centred care (PCC) is, well, bespoke. How to adjust between EBP and PCC is depends on how you use your judgement and reasoning.

So far, our body is the same. So research on bodily function and related care should be universal.

Secondly, critic your evidence. Generally I wouldn't worry too much about peer-reviewed journals, no matter it is qualitative and quantitive. I just assume if there is problem with their findings in terms of methods/methodology. They would pick it up before printing. So the problem here is how to translate their findings to practice. Many nurse scholars have dedicated their career on clinical reasoning or decision-making modelling. In Australia, we recently pushing clinical reasoning cycle (developed by Levett-Jones) as a, um..., thinking process that translate evidence into practice. I know in United State, you have Diagnosis Classification and Intervention Classification as reference. I don't think these classifications will help much my Chinese friend. But some thinking process certainly will help us universally i guess.

Care is much more than just repair or maintain. I think how you care your patient depends on how you look at human being. If you think human is just a bunch of cells, then certainly repairs and maintain is care. Many nurses take holistic approach when thinking about human. Nowadays, I look at my patient through their stories. Many evidence support early ambulation. But I would force my 20 years old dancer to get out back the next day, compare to my 75 yo man after a stroke. I would give the old man more leeways in terms of rest and exercise. But my 20 years old dancer has to go through the prescribed rehab as it is, even the surgery just happened yesterday.

In terms of interpersonal skills, I don't think even my Australian education teach that much. I did study some non-communication skills in first year, but that then soon-to-be-forgotten. Look back, much of my education is in fact technical. I learned my interpersonal skills through work. And i think master degree focus much more than just techniques, but I don't think they cover interpersonal skills, Im in my graduate certificate programme. and it is so technical cover to cover. Master degrees have more component in research, leadership and EBP. And Im deeply concerned that as more advanced I am, the more technical my job will be. Maybe one day I will be like 'too posh to wash'.

Speaking from experience, many CNS in my workplace relegate basic nursing care to nurse assistant, but teach their bachelor student how important showering patient is. You can do skin assessment, talk to your patient, bonding etc. Maybe one day I will be just as hypocritical as every CNS. Joking.