Obstacles Nurses Face and How to Beat Them

[Spring Arbor University]

You must care for your patients, but you must also care for yourself. Call it survival - it's a prescription to avoid becoming a burned-out nurse. Here are some of the obstacles nurses face and how you can beat them.

One of the main obstacles and burnout risks nurses face is high patient-nurse ratios. The relationship between high patient ratios and nurse burnout is well-documented. For every additional patient a nurse cares for on a regular basis, the risk of burnout increases by 23 percent, and risk of job dissatisfaction increases by 15 percent. Additionally, increased patient ratios are associated with higher mortality and failure-to-rescue rates.

Nurses also face significant physical hazards, which include physical injuries. A nurse may spend more than twelve hours per shift on their feet, and nurses are often responsible for transferring or lifting patients, some of whom may weigh several times their body weight. The American Journal of Critical Care reports that 38 percent of nursing staff has experienced a back injury or has chronic back pain. In addition to back injuries, nurses are also exposed to bodily fluids, hazardous materials and the occasional violent patient.

Nurses may find it difficult to maintain a healthy work-life balance. It's common for many to work three 12-hour shifts per week. While that leaves four days off, nurses oftentimes find that they are exhausted on their precious days off, and some of their days off may be occupied by mandatory on-call time. Occasionally, nurses work overtime.

Other factors that may affect nurses' happiness on the job include feeling unable to freely express opinions and suggest changes without retaliation, having scheduling issues, feeling unable to provide individualized care and having inadequate resources, including help, equipment and supplies.

Recognizing the obstacles that are hindering happiness and on-the-job satisfaction is important. However, conquering them and becoming part of the solution is even better. Employee engagement has been shown to be a good predictor of nurses' job satisfaction and desire to stay in their workplace. Raising the bar with an egalitarian team approach is one solution. Empowerment and recognition of all team members is critical to effective teamwork and has been proven to be associated with increased motivation. Consider joining a council that your unit or hospital may have in place. Influencing changes that you would like to see yourself is great for easing burnout and feeling more involved in the happenings in your hospital.

As important as it is to nail your own job interview, it's equally important to interview potential employers if you're switching jobs, or even units. Another key to preventing burnout before it happens is thoroughly investigating the benefits that different employers offer. Make sure that you are being taken care of and will have the resources you need, especially when it comes to staffing and patient ratios, paid time off, and health benefits.

A few benefits to look for when investigating different employers include:

Tuition assistance, should you choose to pursue your BSN or MSN

• Self-schedule, or flexible scheduling for nurses
• Paid holidays, including your birthday
• More than three weeks paid time off
• Full health, vision and dental benefits
• Work/Life center that offers counseling and support
• Carpool assistance program
• Free or subsidized training for career growth
• Child care assistance

It's also critical to consider the patient ratios. If the position isn't in a state with mandatory patient-nurse ratios, are the patient ratios acceptable? Are patient care assistants (PCAs) or techs provided to assist with patient care? PCAs are an invaluable part of the patient care team, and patient ratios for assistive personnel should also be considered. Does each PCA have a manageable patient load? While the unit may have assistants to help with patient care, ultimately the nurse is responsible for patient care. If patient-to-PCA ratio is unmanageable for them, as the nurse you will need to provide the care that they were unable to provide. Another important issue to consider is that different facilities grant PCAs different abilities and responsibilities.

In many instances it's possible to shadow a nurse. Job shadows are especially insightful as they allow you to see the workflow on the unit, see teamwork in action and observe the attitudes of potential fellow employees. It's also a great opportunity to ask about taking breaks. While some states have laws that mandate breaks for employees, others do not. Be sure to ask how break coverage works, and if the employees are ever unable to take breaks.

Nursing is a physically, mentally and emotionally demanding job, and those who do it well deserve recognition. Be sure to check out the recognition programs that an employer has in place. It's important that an institution respects and values the compassion and high-quality care that nurses provide. Do units celebrate an employee of the month? Does the hospital participate in the Daisy award program? Not only does recognition feel good, it also helps elevate your feelings toward your work. In hospitals with meaningful nurse recognition programs, nurses report lower levels of burnout and job dissatisfaction. Recognition has also been shown to increase compassion satisfaction in nurses.

There are also some more concrete issues about a hospital or facility to consider. Is it a teaching hospital? Will you be working with a medically-diverse treatment team? It can be frustrating when it's difficult to reach certain types of specialists.

As the medical and nursing fields are advancing at a rapid pace, facilities should devote plenty of resources and attention to continually improving the standards of care as the evidence base increases. Is there an evidence-based practice committee in the hospital, or on the unit that you're interested in?

In order to protect nurses from the some of the physical job hazards, some facilities have created a no-lift work environment. In no-lift environments, equipment, such as patient lifts and slide sheets, are provided, as is staff education on their use. Patient lift teams may also be in place. When checking out a new facility, be sure to see what other precautions they have in place to protect staff. Is there a "Code Violet" program in place to help de-escalate situations and protect staff from violence? Is occupational health on-site? The facility should also provide regular education on the hazardous materials used on each unit and how to handle them.

Finally, be sure to make sure that your work-life balance is adequate. If 12-hour shifts are unmanageable for you, it might be worth looking into a position that has 10- or 8-hour shifts. Know what a facility's policies are regarding taking paid-time off and sick days. Also ask about the weekend rotation and if you will be required to take on-call time.

As a nurse, you must be aware of the obstacles that stand in your way and know how to conquer them. Being a nurse is a difficult yet rewarding profession. There's no doubt that many are called to serve humanity through their compassion and healing touch. However, the healers must also be cared for, and be sure that they are caring for themselves.

We hope you enjoyed this article. Spring Arbor University provides online education opportunities for nurses who want to do more with your drive to make a difference. Gain career growth in primary or preventative care on your own schedule while you continue to work. Lead change, advance health, and go forward as you educate patients and families on their continued care. Contact us to find out more about our MSN-NP, MSN-NE, MSN/MBA, RN-MSN-NP, RN-BSN and other online nursing programs. Learn more here.

Sources:

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987

Brown, D. (2003). Nurses and preventable back injuries. Am J Crit Care, 12-5, 400-401.