REALITY SHOCK, BURNOUT, SHORTAGE OF STAFF

REALITY SHOCK

Transitions in Nursing What are transitions? Passages/changes from one situation, condition or state to another over time A lot of transitions occur at same time Types Developmental Situational Health-Illness Organizational

Transitions in Nursing (cont’d) What are important factors influencing transitions? Understand from person’s perspective Positive Negative Neutral Transition desired? Expectations realistic?

What Is Reality Shock? Reaction experienced when entering work force after years of preparation Recent graduates are expected to be competent, capable nurses—without the experience Increased acuity, combined with the nursing shortage, may leave you feeling depressed, insecure, and powerless

What Are the Phases of Reality Shock? Honeymoon phase—no one watching over your shoulder (exciting phase) Shock and rejection phase—when the bad days outnumber the good ones Recovery phase—humor, decrease in tension Work toward effecting a better solution through conflict resolution

Role Transformation When does the role transition to graduate nurse begin? Moving into novice role when you took your first nursing course! At advance beginner at graduation

Role Transformation (cont’d) How can I prepare myself for this transition process? During last semester No “mama management” Realistic patient-care assignments/shifts Perform instead of observing Truth about real work setting Look for problem-solving opportunities/practice critical thinking Request constructive feedback Request clinical experience in area of interest

Role Transformation (cont’d) How can I prepare myself for a transition? Think positively Be flexible Get organized Stay healthy Find a mentor Find other new grads Have some fun! Know what to expect

IDENTIFICATION AND PREVENTION OF NURSE BURNOUT

Do you suffer from? Chronic fatigue Anger, self-criticism, cynicism, negativity and irritability A sense of being under siege Frequent headaches Gastrointestinal disturbances Weight loss or gain Sleeplessness Depression Shortness of breath Suspiciousness Feelings of helplessness An increased degree of risk taking

You could be suffering from burnout Burnout is described as “a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that occurs among individuals who work with other people” (Bakker, 2000, p. 885).

Causes of Stress: The following stressors can lead to burnout: The current nursing shortage Students can feel the stress from floor nurses. Work overload This can affect the floor nurse and the student nurse. Nursing school is difficult and a lot is expected from the students. These are a few of the causes of stress in the nursing profession that can have an impact on the undergraduate student.  

Facts about burnout: Nurse burnout has been reported to be as high as 40% (Aiken, 2002, p. 1987). Burnout is the single biggest factor driving nurses out of the industry (Erickson, 2007, Retrieved February 14, 2009). 1 in 5 nurses report that they intend to leave their current jobs within a year (Aiken, 2007, p. 1987).  

Dealing with stressful situations Remember the Four A’s: Change the situation. Change your reaction. *Avoid the stressor. *Adapt to the stressor. *Alter the stressor. *Accept the stressor. Stress Management Strategies: *Take a deep breath. *Clear your mind of all thoughts. *Take hardships in stride. *Resolve conflict positively. *Use humor to deal with challenges. (Make sure the situation is appropriate).

Red flag feelings and behaviors that require immediate attention! Inability to sleep. Feeling down, hopeless, or helpless most of the time. Concentration problems that are interfering with your work or home life. Using smoking, overeating, drugs, or alcohol to cope with difficult emotions. Negative or self-destructive thoughts or fears that you can’t control. Thoughts of death or suicide. (Smith, M., 2008b, Retrieved July 9, 2009).

If you find stress in your life: If you find that you are experiencing any of the indications of stress or burnout, there are things that you can do in order to bring some calm back into your life.   The Three R Approach: Recognize Reverse Resilience

The Three R Approach: RECOGNIZE: Sometimes it is easy to become so involved in our work that we fail to see what is happening in our own lives. Take the time and review the signs of burnout. REVERSE: It is important to remember that you didn’t get to this point overnight. However, it is possible to undo the damage by managing stress and seeking support. RESILIENCE: Learn how to deal with stress in a positive manner. This includes physically and mentally. (Smith, M., 2008a, Retrieved February 26, 2009).

SHORTAGE OF STAFF (PRACTICE & EDUCATION)

Definition of nurse staffing Number of nurses or nursing hrs/ the number of patients or patient days Skill mix of nurses Little scientific evidence of exact nurse-to-patient-ratios needed Staffing adequacy is related to workload

Definition of workload The amount and intensity of work a nurse encounters in a given period of time. Affected by all of the following: # of patients patient acuity patient throughput unit design technologies resources amount of administrative tasks skills and education of nurses

Pathways of inadequate staffing Inadequate staffing/heavy workload create a difficult work environment: Time constraints Inadequate knowledge or experience Inadequate supervision of support staff Inadequate communication Generally chaotic or stressful environment

Difficult work environment A difficult work environment can lead to poor performance Inadequate monitoring Missed care Wrong care

Other factors influencing performance Degree of control over nursing practice Nurse managers Nurse-physicians relationships Skills, competencies, and reactions of the individual nurses Culture

Faculty Shortage/ Causes Causes of the faculty shortage include: an aging nurse faculty workforce— large numbers of faculty retirements are anticipated in the near future— and a limited pool of potential nurse educators. Barriers to recruiting qualified new faculty include: limited availability of master’s and doctoral programs with a focus on nursing education; under-representation of minority groups (including men) on faculty; inadequate faculty compensation school budgetary limitations); To elaborate on only one aspect of the problem, the average salary for a practicing nurse with an advanced degree is $80,000, but a nursing faculty member makes about $50,000. workplace issues such as workload, scheduling,student attitudes and abilities, and generational and cultural issues.

THE CURRENT CRISIS Computer and technology boom leads to better jobs Baby-boomers are retiring before being replaced Not enough nursing faculty in nursing school programs, therefore, limiting available seats per semester Limited clinical sites Creating a backlog of qualified applicants who wait over a year to begin nursing school resulting in many potential nursing students to pursue a different career.

WHAT NURSES ARE SAYING American Nurses Association (April 2001). Retrieved July 4, 2007 from http://www.op.nysed.gov/nurseshortage.htm

Impact on patients: selected studies 2002-2003 Higher numbers of RNs/adjusted patient days r/t lower rates of pneumonia (Kovner et al., 2002) Higher ICU RN/patient ratios r/t fewer patient complications (Dang et al., 2002) An increase in RN HPPD or proportion r/t a decrease in the odds of pneumonia (Cho et al., 2003)

Impact on patients: selected studies 2002-2003 Higher levels of licensed nurses (LNs) r/t fewer: Atelectases Pressure sores Falls UTIs (Unruh, 2003) Higher proportion of LNs r/t fewer Pneumonia

Impact on patients: summary Most studies find at least one positive relationship between staffing and patient outcomes. Counting the number of statistically significant relationships, the following are related to nurse staffing: Falls FTR Mortality Pneumonia

Impact on nurses: emotional Emotional exhaustion and/or job dissatisfaction are r/t: insufficient nurse staffing high work or job demands/pressure high patient acuity lack of time to do the job too many things happening at once exhaustion at the end of a shift a sense of poor quality fear of making or actually making a mistake

Impact on nurses: emotional Burnout and job dissatisfaction reported by surveyed nurses (linked to archival staffing data) r/t lower staffed hospitals (Aiken, et al., 2002)

Impact on nurses: physical Higher probability of a needle-stick injury r/t understaffing high workloads (Clark, et al. 2002a,b)

Impact on nurses: physical Physical work demands are r/t neck injuries shoulder injuries back injuries (Trinkoff, et al., 2003) Imbalance between effort & reward is r/t poor self-rated health (Weyers, et al.,2006) Work pressure is r/t the health status of nurses (Landeweerd & Boumans,1994)

Impact on nurses: retention Reasons for nurse dissatisfaction psychological stress stressful work (Gardulf, et al., 2005) Reasons for intending to quit higher work tempo work-related exhaustion lower quality of care

Impact on nurses: retention Why nurses left their last job: poor staffing poor work environment work stress (Strachota, et al., 2003)

Impact on finances: costs Older studies of the impact of RN skill mix on personnel & operating costs have mixed results. A newer study of both personnel and operating costs finds that: Greater RN skill mix is cost-neutral for both types of costs Greater use of temp RNs leads to higher operating costs (Bloom, Alexander, & Nuchols, 1997)

Make other improvements in nursing work environment Scheduling/work hours Leadership and management Organizational culture Professional Practice Staff development & educational support Interdisciplinary collaboration Workspace and work process redesign Nursing process Nurse Competence

THE FUTURE The image of nursing is changing from a negative to a positive and respectful profession As nurses increase in numbers so will job and patient satisfaction