How to improve the well-being of nurses and the quality of patient

care.

By Hayley Ryan

Nearly seven million hospitalized patients each year acquire infections while being treated for other conditions. The culprit, according to a study published in the American Journal of Infection Control, is nurse burnout and has been linked to higher rates of hospital-acquired infections (HAIs).

Nurse burnout is that feeling of emotional exhaustion and disillusionment nurses feel about their current job that can creep up when working with heavy patient loads and under stress. These problems affect nurses both personally and professionally, and it may affect their patients as well.

A team of re searchers at the Univer s it y of Pennsylvania used a survey tool called the Maslach Burnout Inventory to analyze nurses’ job-related attitudes. It then compared a hospital’s percentage of burnout nurses to its rates of catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs).

The researchers found that every 10 percent increase in the number of high-burnout nurses correlated with one additional CAUTI and two additional SSIs per 1,000 patients annually.

At first glance, this might not seem like a big deal, but according to the Association for Professionals in Infection Control (APIC), using the per-patient average costs associated with CAUTIs ($749 to $832 each) and SSIs ($11,087 to $29,443 each), researchers estimate that if nurse burnout rates could be reduced to 10 percent from an average of 30 percent, imagine how many infections could be prevented and savings had.

Impact of Work Environment
In addition, a study by the Agency for Healthcare Research and Quality (AHRQ) offers evidence that nurse-to-patient staff ratios has been linked with patient outcomes. It seems rather clear-cut that, from time constraints alone, fewer caregivers would translate into a lower standard of care. But this study goes a step further, suggesting the issue is not simply the number of nurses on staff, but the quality of the work environment.

When nurses feel there is a lack of teamwork, or that management’s values conflict with their own – putting financial concerns ahead of patient safety, for instance – stress can build up to the point that some nurses simply detach from their work.

Because Medicare and some private insurers are no longer reimbursing for CAUTIs and SSIs, it only makes sense that hospitals would do everything possible to eliminate these adverse events. That includes not only encouraging nurses to adhere to infection control practice guidelines, but also to improve the work environment as well.

Taking a Break
One common method to reduce nurse burnout is to make sure that staff has adequate time for rest periods. This means ensuring that nurses get their days off and are not asked to work additional hours due to staff shortages or that they get the regular breaks throughout their workday.

“We plan ahead for staffing by hiring part-time and PRN (as needed) employees in order to increase staffing when volume increases,” said Mary Jane Adams, RN, MSN, senior vice president, chief nursing officer, University of Louisville Hospital, part of KentuckyOne Health. “We also have float pools that support unscheduled absences and increase in volume. When we need staff beyond this, we first ask for volunteers. Many times there is a staff member who is willing to work an extra shift. This generally results in additional pay, either overtime-pay or bonus-pay.

“Next would be to offer another day off in return for working that particular shift,” she continued. “There also may be another unit that has a low census, and we could ask a nurse from that area to help out. We look at many different alternatives before we would mandate a nurse to work outside of their assigned shift.”

Processes in Place
While University of Louisville Hospital does not have a policy regarding nurse burnout, explained Adams, they do have processes in place to address burnout. For example, nurses are involved with decisions about their professional practice.

“This is a way that they have a voice and can provide input which gives them a sense of control and engagement in their unit and the organization,” said Adams.

This is accomplished through frequent rounding by leadership, unit based practice councils, and staff meetings. Nurses also participate in hospital committees to address practice changes, evaluate new equipment, peer interviewing of new staff as well as promotions within specific areas. Some facilities even have a holistic council who address ways to support nurses to avoid burnout.

As the needs of the patients grow more complex and the pool of available nurses able to handle a multitude of patients with varying maladies shrinks, hospitals and practices need to seriously address the issue of nurse burnout. Patients depend on it.