Shiftwork and its effects on burnout

[zurita.a12]

Article Review: Nursing Burn-Out: Cross-Sectional Study at a Large Army Hospital

The article focused on using the Maslach Burnout Inventory to assess burnout amongst the samples of nurses. The researchers identified that nurses working in the army were experiencing higher levels of stress but found there was a lack of research in that setting.

Their approach was to find full-time nurses that had completed their onboarding and training period and issued a paper and pencil survey. They recruited nurses by approaching nurse leaders and creating informational sessions.

In total 22 questions were asked ranging from; direct measures of emotional exhaustion, depersonalization, and reduced personal accomplishment. The goal was to break them up into low, medium and high levels of burnout categories.

Overall the results had a total sample size of 364. This allowed for a sample size that was large enough to have statistical significance in its results with a G power of .8, relatively high.

Comparing the two groups there was an equal number of civilian and army nurses that participated. However, the civilian nurses were on average older than army nurses and also worked less 12-hour shifts than the army nurses. There was a significantly lower number of nurses that had their masters, the majority had a bachelors or less than a bachelors. As some might expect the largest percentage of nurses worked in 12-hour shifts overall. Surprisingly there was a total of 13% that worked a second job in addition to their nurse position.

Overall the results showed that both showed levels of burnout.

Nurses who had worked fewer hours and who didn't tend to military patients had less reported levels of burnout. A few of the takeaways from the article relate to how traditional jobs are maintained. They offer the idea of changing the 12-hour shift and rotating shifts. They associate these 12 hours to a staffing issue which may or may not be so.

There is something to consider when asking what can be done to alleviate the stresses that affect nurses outside of the direct work-related variables. The job itself is stressful enough that it is up to the organization to ensure that the environment is set up to provide optimal environments. In addition, the idea of working 12 hours allowing for more than two days off might be an alluring part of being a nurse.

This article leads to other ideas in terms of assessing what nurses encounter. There are obvious sleep issues that have been studied; night shift, in general, can affect circadian rhythms and you can see that the general consensus is to support nurses by suggesting ideas such as hearing plugs, covering eyes during sleep, going home with sunglasses so that the sun has such a huge impact on the body, and sleeping in the right dark environments.

There are other parts to consider such as the social aspect, that night shift and 12-hour shift is very similar to other jobs such as overnight and restaurant positions where the support of family and friends are hindered. Having friends or acquaintances get together on weekends which is the ideal time to meet when working traditional hours leaves non-traditional working employees out of the loop.

Finally, there needs to be a way to accept all those variables and measure it instead of providing proof or ideas that go against the way of things when realistically speaking it might not lead to a change. Essentially, accepting: higher levels of stress, less sleep, less social support, higher burnout, and then measuring how all that is dealt with by the thousands of nurses experiencing that day to day. Once you have those measures you might have a better idea of how to address the situation instead of providing frustrating statistics or facts that only lead to an article or idea posted online instead of application in the work setting.

[CraigB-RN, MSN, RN]

The whole topic is old news. I remember participating in a survey 15 yeras ago about 12 & 8 hour night shifts and how it affected my performance, life, enjoyment of my profession. Ear plugs, black out currents, white noise machines were all suggested as solutions to not sleeping.

What's news about it is that nothing has ever been done to mitigate the effects of working nights. That's not completly true. We got rid of the rotating night shifts. The 2 days, 2 evening and 2 nights, 2 off schedule that I worked my first years on a fairly busy USAF Med Surge floor.

[zurita.a12]

Interesting! I mean the article was published in 2010 so it is relatively new. I do agree that those types of schedules are far fewer however, at least in civilian (never been in the military) hospitals, they still continue night shifts with scheduling being sporadic. Yes night shift is consistent and it doesn't require evening or day shifts but having a 3 on, one day off, 3 on is occurring regularly. One might stay that is not the norm, however, when you add the factors that night nurse staffing is significantly lower than morning nurse staffing in many hospitals as well as other departments where you rely on them to assist in completing your tasks, in addition to morning meetings that require night shifters to stay etc etc etc, you can imagine that the issue is still very real.

[Ruby Vee, BSN]

2010 is still an older study -- it was probably designed and started a decade ago in order to be ready for a 2010 publication date. While nursing, the hours, shift rotation, etc. probably have not changed that much in ten years, the staffing levels have changed, "customer service" has gone crazy and the nurses themselves are from a slightly different generation. In addition, the burnout rates suffered by Army nurses may not be related to caring for Army personnel but instead be related to the very different working environment in Army hospitals.

I don't claim to have any knowledge of working in an Army hospital or caring for Army patients. My (admittedly indirect) experience stems from four years of marriage to an Air Force Nurse in the mid 1980s. His working environment was very different from my working environment in the civilian hospital ten miles down the road. For one thing, we had more support. At night, his MOD (Medical Officer of the Day) might be a dermatologist or a psychiatrist when the retired Master Chief came into the ER with crushing substernal chest pain. On more than one occaision, my husband and some of the other the night nurses at the Base hospital would call me at work in the CCU to describe what they were seeing and ask me what to do because the MD on call had no idea. Even something simple like oxygen might be something that the dermatologist on call wouldn't think of. It generated numerous transfers from the base hospital to our CCU, but I also know that it caused an awful lot of stress for the Air Force nurses on shift. I can only assume that the ED, Med/Surg and OB nurses at the base hospital encountered similar knowledge deficits and lack of support. The research may have been done in a larger or more equipped hospital, but then again, maybe not.

The Air Force is a definite hierarchy. As experienced CCU nurses, my friend and I expected a certain amount of respect from the ICU nurses at the Base Hospital when we got together for nachos and beer and to share our "worst patient ever" or "dumbest order yet" stories -- but that wasn't forthcoming. The Base nurses treated us as though we didn't know anything much because we weren't officers. Even my friend's husband, a cardiologist, wasn't viewed in the informal, social setting as knowing anything much. From what I witnessed on the few occaisions when I visited my husband at work, and from what he described in comparison to our University Hospital experience prior to his commissioning, that translated into less collaboration between disciplines than we were used to in the civilian hospital.

Twenty years is a long time, and things may be very different in military nursing these days. But I would at least consider that the work environment in military nursing may be very different from the work environment in civilian nursing for reasons other than caring for military versus non-military patient populations.

And then again, I'll say that the military patients I've cared for in various CCUs and CVICUs across the country are generally much better behaved that the civilian patients in the same units.