In America, according to the DPE 2012 fact sheet, there are an estimated 500,000 RNs in the U.S who are not practicing their profession, citing difficult working conditions of limited staffing and long shifts. The care restructuring of the health care industry in the 1990s, which was aped and the re-aped by the Blair and Cameron governments in the UK, meant hospitals reduced staffing levels to lower costs.
Nurses now care for more patients during a shift, which has led to a number of problems for both nurses and patients. Overworking results in injury. In America, 39% percent of RN injuries resulting in missing work were attributed to overexertion, with many hospitals routinely requiring nurses to work unplanned or mandatory overtime and to “float” to departments outside their expertise. Over 60% percent of RNs report being forced to work voluntary overtime, which leads to Nurses’ cardiovascular health suffering from working long shifts and overtime. In a 2010 study, researchers showed a clear link between frequent overtime work and incidents of heart disease, with workers reporting three to four hours of overtime work per day being 1 to 6 times more likely to have cardiovascular health disorders.
Many RNs also complain that current workloads cause burnout. Nurses as a profession are overworked, stressed and more prone to illness than other types of workers, according to an article in the Spring 2011 issue of “Minority Nurse.”
Nurses are more likely to stay in nursing if they feel they have autonomy, recognition, a reasonable workload and good peer relationships, according to the “Minority Nurse” article. But during a nursing shortage, all of these qualities can be problematic. When there are too few nurses for the amount of work, people are often tired and can become irritable with one another. Nursing is a team effort. When the team begins to fragment, individuals often burn out from overwork and lack of support.
Nursing is emotionally demanding work and is often physically demanding as well. However, nurses under age 30 are significantly more likely to burn out than their older counterparts and leave nursing, according to a January 2008 article in the “Online Journal of Issues in Nursing.” The authors found nurses in the study felt exhausted, discouraged, saddened, powerless and frightened on a daily basis, and were susceptible to emotional exhaustion. The authors reported that younger nurses who were burned out were less likely to use coping strategies to manage burnout than older nurses.
An article in nationalnursesunited.org quoted Lisa Ermak (HollandSentinel.com January 26, 2014), ‘Nursing shortages increase the potential for burnout, and nurses who burn out tend to leave the profession, creating a vicious cycle.
According to a 2013 survey by the Michigan Center for Nursing, 42 percent of all active RNs say they plan to practice nursing for only one to 10 more years. “More nurses are retiring earlier, and that’s a real concern for all of us in the public. We want those experienced nurses to stay on and provide quality, safe care.” As hospitals try to cut costs, that tactic backfires and becomes a patient safety issue’.
The article compares nursing to post-traumatic stress disorder, in which a blunted response to emotional events becomes normal, and claims ‘burnout has probably worsened, as the workload of the average nurse is greater today than it was 10 or 15 years ago because of more technology, documentation, electronic medical records and added nursing responsibilities’.
‘In order to reduce burnout, the Michigan Nurses Association is hoping for the passage of a state law that would require hospitals to provide minimum nurse staffing at all times. State Rep. Jon Switalski and state Sen. Rebekah Warren have introduced two bills to address that concern. Currently, both are waiting to be taken up by legislative committees. If passed, Kettinger said, the bills would keep nurses from working 15- to 18-hour shifts and reaching the point of exhaustion and eventual burnout’.
What I suggest is an excellent point – the fluctuation of staffing levels – was made in nursinglicensure.org, 2013:
‘There is something to be said for what your daily expectations at work entail. If continuously adjusted, or changed, as in the case with many nurses, the individual is left in a quandary unknowing of their tomorrows. This is a parallel of the nurse to patient ratio, always changing. Routine is fundamental in achieving a stress-free, happy atmosphere. Nurses, today, are not experiencing this, consequently triggering an unhealthy and unsafe work environment. The well-being of the nurse is on the decline as a result of unrealistic demands being thrust upon them. Nurses nationwide are rallying to implement the fixed nurse to patient ratio law. This has currently only been legislated in one state in our country, California. California has seen a drastic decay of “burnout”, and hospital and clinic nurse retention is on the increase. Nurses love what they do, but “burnout” is inevitable if the factors leading up to it, are not attended to’.
I have called for an end to the unending ‘paperisation’ of nursing over the last 20 years, freeing nurses to do more bedside nursing; have regularly demanded that nursing must be organised on an 8, 8, and 10 hour shift pattern, with double shifts not being allowed; that nurses should not be allowed to work outside of their area of competence; and that agency involvement in nursing be abolished, compelling hospitals and care homes to recruit ‘bank’ staff.
Financial and legal interests rule nursing, not nurses.
I have also called for ‘residency’ programs for newly qualified nurses, as operated in the University of Iowa Hospitals and Clinics. These short courses are run by the hospitals, and impart to the ‘new’ nurse a sense of the physical and emotional stress of nursing, and leadership and communication skills, prior to any job offer. Thet can be likened to a pre-shock course. Ann Williamson, the Chief Nursing Officer at the University of Iowa Hospitals and Clinics said: “We saw the value in helping new graduates get a good start in their first year of employment.” She follows up with “It is a significant investment on the part of the hospital, but we wanted to give us both the best chance at success.”
As stated in nursinglicensure.org (2013), ‘Recent graduates are on the hunt for these residency programs nationwide, to jumpstart and advance their future career capabilities and opportunities. It has become evident that entering a residency program offers the advancement of experiencing the demands that will be expected of them prior to starting their first nursing job.
During the attendance, or upon graduation of residency programs, nurses often question “Am I guaranteed a job?, or “Do I have a choice in where I can work?”, or “Can I choose my own rotation and area of focus? All of these are good and legitimate questions, however the answers will only be relevant to the particular person asking. A preceptor is assigned during the residency program, and this person’s involvement is to provide clinical guidance, support, feedback, and assessment throughout the term of the residency. The preceptor, in conjunction with the shift supervisors, will tackle these questions based on their overall evaluation of the individual. Numerous tips and pieces of advice will be offered to the resident nurse upon graduation. The most pivotal being that the nurse must remain confident, focused, and happy. After all, they have graduated from the residency program, which was their first step in becoming successful. It will be impressed upon the nurse to continue in the same area in which they have spent their residency. Most importantly, the preceptor will bolster the nurse’s confidence in assuring them that they have been given all of the necessary tools, and ingredients to be a successful nurse. The communication skills, knowledge, and mental capacities necessary to perform the job of a nurse have been acquired through the residency program’.
I believe that 3 month post-graduation programs should be added to a shortened version (3 months) of the pre-graduation, ‘hands on’ program being trialled in the UK, with ‘residency’ graduates being guaranteed a permanent, full time job.
Staffing levels of nurses and nursing assistants (in both hospitals and care homes) has been an issue that UK unions have not campaigned for as vigorously as their American counterparts.
To be too vigorous is to threaten (their seat at their lord’s table).
Failure to address the issue of nurse burnout merely dumps a vast number of nurses into the ‘500,000 RNs in the U.S who are not practicing their profession’ heap.
But, perhaps this is the plan. Only so many sheep can graze in a field: if you don’t kill some of them, how can new arrivals eat the same grass?
As light bulb manufacturers, the nurse lecturing industry mostly produces dispensable products that burnout.
lenin nightingale 2015