Understaffing and burnout

Nurses Safety

Published

Hi,

I have been an LPN >8 yrs. and am currently doing pre-reqs for my RN. I am doing a paper on "burnout". I have had some frustrations of my own in the med/surg unit in the hospital I'm at. I can clearly see how understaffing and high nurse/patient ratios can contribute to burnout. I worked medsurg for the last 2 mos and the 6:1 ratio was making me HATE my job. I went back to ICU where the highest is 4:1. Anyway, I'm looking for any other situations, reasons, or ideas that anyone might feel contributes to burnout.

Thanks:smilecoffeecup:

Let me add my :twocents:

* Chronic short-staffing at all levels

* Mandatory and other forms of overtime (paid or unpaid)

* Ever-increasing acuity coupled with just-as-rapidly increasing busy-work

* Lack of leadership

* Lack of flexibility in the system from the top down

* Lack of meaningful recognition

* Management that is out of touch with what's going on on the units

* Patients and families that demand attention out of proportion to their true needs

* Violence in the workplace

I could think of many more...

One thing I haven't seen mentioned is the tendency for nurses to have the "If I don't do it, it won't get done" mentality. I hate to use the label codependant but many of the characteristics of burnout are similar to those of codependancy. When we learn to set boundaries, take care of OURSELVES, and develop a life outside of the caregiving role (along with others) burnout will be less of a problem. (IMO)

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

After 15 years as an RN I find I burn-out quicker if I am frustrated at work due to not being able to do my job properly.

The things that contribute to that include: Understaffing, ancillary staff not doing their jobs, pharmacy not suppling what I need, central supply not supplying what I need, cranky co-workers, multiple inquiry phone calls from multiple family members, the stress from dealing with nasty patients and family members slows me down too.

I love being a nurse and seem to find temporary burnout ocassionally. Things seem worse when there are outside or family issues too. If you are able to take a day or two off to resolve outside issues then work is a piece of cake.

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After 15 years as an RN I find I burn-out quicker if I am frustrated at work due to not being able to do my job properly.

The things that contribute to that include: Understaffing, ancillary staff not doing their jobs, pharmacy not suppling what I need, central supply not supplying what I need, cranky co-workers, multiple inquiry phone calls from multiple family members, the stress from dealing with nasty patients and family members slows me down too.

I love being a nurse and seem to find temporary burnout ocassionally. Things seem worse when there are outside or family issues too. If you are able to take a day or two off to resolve outside issues then work is a piece of cake.

If you were to take a poll where I work with the nursing staff, and asked the question: "What is the ONE thing that would make your job easier?" The number one answer would be: "If people just did their job."

I've seen such tremendous effort put in by others to avoid doing their job, or doing it half-a****. It's amazing the lengths I've seen some go to avoid work or do it incorrectly (so I'll have to do it). The effort and time spent doing this is far greater than it would have taken them to just do their job right in the first place.

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One day I didn't feel well. I have a part time job of 24 hours per pay period. Then there's my other part time job that can be 46 - 68 hours per pay period. Sometimes, I'll go five nights in a row or seven nights in a row. I have to very active kids I need to be involved with. There are the stressors outside of work like an ex. The stressors at work like understaffing.

So, I went to work any way thinking that I'll feel better once I start getting busy. But that evening I could only work for 10 minutes then, I had to sit down from the pain. I couldn't take it anymore so I went to the E.R. I had a kidney infection and had to go home. Five days later I still wasn't better. I had taken the antibiotics but I was dead tired. I knew I was burnt out. I couldn't recover quick enough from the kidney infection. I remember being so irritable till that point. I was yelling at everyone including my manager. I was so sick of being short staffed. I hated rushing around handing out meds for two carts for palliative patients. I hated not having the time to help dying patients families when the E.R. charge nurse wants to admit into the bed that the body hasn't even been brought to the morgue.

I still feel burnt out. Now, I've accepted Board of Director responsibilities for the native friendship center. Like I need more stress in my life. I think I'm a good example of burn out.

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Specializes in Home health; agency;ICU; med/surg.

Thanks for all the tips and stories. This has really helped me with my research paper, but even more, I understand that I am not the only one who feels like they can't cope with work sometimes and it's not because I'm any less competent than other nurses. Our jobs have become more and more difficult to accomplish and I'm hoping that during my research procs, that I may find a way to get some changes set in motion. Thanks

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Specializes in ER.

I read a nice research summary of the main contributers to nursing burnout recently. Number one of course was the higher the patient ratio, the more burnout s/sx were present.

Another reason is that what we are taught to do in school and what our nursing ethics support highly conflict with our role in the health care industry and how we are supported in our roles by the places we work.

Another huge reason - nurses do not get to be involved in decisions regarding thier own work environment and patient care. Its so nice when someone is basically telling us our input is invalid when we are the only ones that truly know what is needed on the front line. These are the main contributers.

As for JCAHO - what a useless, sorry excuse for anything to do with safe patient care. It is a money sucking scam operation that permits hospitals to provide horridly unsafe staffing and allows them to cough up excuses for everything that doesnt get done according to policy (which is usually due to understaffed conditions). I have no use for JCAHO and am glad I work nights becuase there is no way I could deal with thier brown-nosing prescence that only makes me work harder yet does nothing for my pt care and the safety of my nursing license, both of which I bust my tail for.

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Specializes in Case Management, Home Health, UM.
As for JCAHO - what a useless, sorry excuse for anything to do with safe patient care. It is a money sucking scam operation that permits hospitals to provide horridly unsafe staffing and allows them to cough up excuses for everything that doesnt get done according to policy (which is usually due to understaffed conditions). I have no use for JCAHO and am glad I work nights becuase there is no way I could deal with thier brown-nosing prescence that only makes me work harder yet does nothing for my pt care and the safety of my nursing license, both of which I bust my tail for.

:yeahthat:

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From the Journal of the American Medical Association ( attached)

Vol. 288 No. 16, October 23, 2002

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

...Conclusions* In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction...

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Specializes in psychiatric.

"Understaffing" will always be a problem because there is a big difference in how you look at staffing, and who is looking. Administration is looking at it from a monitary standpoint. They have to show a profit (even if "nonprofit") in order to pay salaries, buy new equipment, compete with others. The nurse is looking at it for job satisfaction, safety, etc. The patient/family is looking at it from a comfort viewpoint. The "productivity" experts will always say a unit is overstaffed, because that's their job. I think acuity needs to be factored in somehow, because sometimes we can work with less staff and get things done, and other times we need so many more in order to just make it to the end of the shift without an error or death.

As for burnout, the best thing I ever learned was" You have to take care of the caregiver if you are going to keep on giving care." We need to take care of ourselves" practice what we preach: RELAX, take time to do something fun. This might mean a long bath, a hot shower, a walk in the park, a golf/tennis match, reading a great book, playing with the kids, a romatic interlude, a movie, cooking, going out to eat, gettig a good nights sleep, etc. It will be different for different folks. Just unwind, leave your work problems at work and your home/personal problems at home. Take care of yourself, take care of your peers, take pride in what you do, or find something you can do that will make you a better person: get more education, take time off to regroup, become an optimist, look on the bright side, use humor to laugh. Volunteer, work with youth in the community or at church. Visit a nursing home or veterns hospital.

Good luck nurses, do what you can to prevent burnout, we need all the nurses we have and more. You chose nursing for a reason, now fulfill that purpose, make your career something you can be proud of. Take care of yourself! Take care of others!

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From the Journal of the American Medical Association ( attached)

Vol. 288 No. 16, October 23, 2002

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

...Conclusions* In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction...

It took them a year and a half of research to figure that out?

A little common sense would have saved them a lot of time.

This isn't something that hasn't been known all along. Perhaps the researchers thought "proving" it would exact change, but that is just not the way health care works. It's all about $$$.

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Staffing on pt. numbers and not acuity. Short-staffing the floor while other depts. are at the nurse's station showing family pictures and sharing community gossip while the floor is drowning. Calling for help to hear, "There's no one here.".....while the Cardizem drips (and others) need two R.N.'s for verifications, is time sensitive, and in need of one-on-one continued assessments. Having to run the block to Pharmacy and the block back to get your STAT meds for your critical patients. Finding that your supplies haven't been stocked and making the mad dash across the facility to Central Supply to get them. Mandatory meetings scheduled during work hours without staff to cover pt. care for these times....this always "dings" the Nurse's employment review. Crazy assignments that over-load one nurse and slides others. Lack of or dishonest communication. Ever-changing paperwork and constantly changing storage places. Being paged to three different pt's rooms at the same time. No breaks in a long work day. Orders not reaching the floor. Inability to get to pt. charts as they're occupied in other departments for hours. Triple documentation. Being repeatedly nominated for Nurse recognition by co-workers and patients to be sent a congratulatory letter on the nomination, but, "Sorry, not everyone is selected."

Best of all: after many consecutive days of running marathons there's not so much as a face to face smile or thank-you. But, when you arrive home in the mail there's a note from your D.O.N. thanking you for all you're doing. I may be ungrateful, however, a smile or acknowledgement during working hours and while in the thick of things would be more meaningful!

I'm developing a pretty tough hide.

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Yes there certainly is a s nursing shortage. What we see at our hospital is a greeed driven nursing shortage. Our not for profit hospital has an operating margin of over 10% (read that as profit/and the Hospital Association s own PR says a Hospital needs 5-6% to get the best bond rates and pay for capital improvements....

So we see tighter and tighter planned staffing and no one to replace sick/vacation and people who leave....

We are not "burned out" because of any personal defect--it is ok in hospital management to operate this way--burnout is part of the plan---missing meals and breaks, too many patients and fast turnover---it all makes them more money. Yes it is true that some patient populations are stressful --but we are trained to deal with them---- these thing keep happening afer we have begged for help---that is the burnout...

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