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Joint Commission tackles nurse burnout with solid solutions

The Joint Commission released its Quick Safety, Issue 50: “Developing resilience to combat nurse burnout” advisory in July.

It’s a document aimed at offering you and your employers tools to help combat nurse burnout by developing resilience.

“Burnout is a major safety issue,” said Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, associate nurse executive with The Joint Commission. “Nurses who experience burnout leave an organization and perhaps even leave the nursing profession.”

Researchers have found nurse burnout — exhaustion, cynicism and inefficiency that can result from a nurse’s response to chronic emotional and interpersonal stress at work — negatively impacts not only nurses and nurse retention, but also patients.

Patient satisfaction, outcomes and safety suffer. Even mortality can increase with nurse burnout, according to reports.

There are ways to help reduce nurse burnout and its consequences by giving nurses access to leadership-supported interventions such as mindfulness and resilience training.

Not all resources and strategies come from experiences in healthcare. The advisory mentions Daniel Pink’s book “Drive.” In the book, the author addresses three factors that increase performance and satisfaction:

  1. Autonomy or being self-directed and part of decision making
  2. Mastery or competency to do the job well
  3. Purpose in meaningful work

“Healthcare can learn from other disciplines and his three concepts to improve job satisfaction ring true for nurses in the context of what most of us want in our work,” Moorehead said. “We all want to be part of something greater than ourselves. If any of these three are missing, job dissatisfaction can occur, and this can lead to burnout.”

Nurse leaders can build resilience at work

Nurse leaders, individual nurses and nurse faculty have roles in preventing burnout.

nurse burnout

Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP

Nurse leaders have the responsibility to create resilient work environments. Acknowledging burnout is a risk and it does exist is a first step, according to Moorehead.

“This Quick Safety encourages nurse leaders to evaluate burnout, its causes, take steps to improve or eliminate [those causes], measure improvement and then start again,” she said.

An important characteristic when building a resilient work environment is the ability for staff to discuss concerns and leaders to listen, learn and act.

“Staff have to be comfortable in speaking up about burnout and its causes, as well as other issues and opportunities for improvement,” Moorehead said. “Leaders have the responsibility to make improvements in work processes as identified by those who do the work and allow staff to participate in decisions affecting their work.”

Staff must watch for signs of nurse burnout

Staff have a role in this too. They need to recognize signs of burnout in themselves and others, so they can take steps to address those symptoms.

They also should take steps to take care of themselves and develop personal resilience, according to Moorehead.

Challenging patients or clinical scenarios and other stresses at work can erode resilience. Some nurses become overwhelmed by the challenges they face, while others thrive because they can adapt to changes and maintain fulfillment, according to the advisory.

Sometimes, it’s simple communication among colleagues that helps nurses thrive despite the challenges.

“One strategy that has been helpful to me through the years is to develop relationships with colleagues, mentors and coaches,” Moorehead said. “In the past, I appreciated a colleague who came to me because of his concern that I was experiencing signs of burnout — exhaustion, cynicism, inefficiency. I didn’t agree at first, but after I thought more about his comments and did my own self-reflection, he was right. I took action to improve my own resilience and was able to decrease those signs of burnout and find joy in my work again.”

Some of a nurse’s ability to avoid burnout comes naturally — and some is learned. Even nursing school faculty have a responsibility to help arm nurses with what they need to know to build resilience and prevent burnout, Moorehead said.

“Faculty should teach students to recognize the signs of burnout, be able to discuss common causes, and look for work environments that foster resilience as they are making decisions about where to start their careers,” she said.

Research can help you prevent nurse burnout

Nurses and nurse leaders can refer to the nursing literature and other leadership and management literature for resources they can use to prevent and address nurse burnout.

“The Quick Safety advisory has a robust reference list included at the end of the document that provides tools to measure burnout, for example,” Moorehead said. “A good first step is for staff nurses to evaluate themselves for signs of burnout and to do an inventory of their own sources of resilience. The same can be said for nurse leaders. Nurse leaders have another layer of responsibility and that is to begin the discussion of burnout among staff; make it OK to discuss burnout and strategize for [how] resilience can be improved within the work environment. Beginning the discussion is a good — and necessary — first step.”

According to The Joint Commission, healthcare employers can follow these safety actions to help nurses develop resilience.

  1. Provide education for nurses, preceptors and nurse leaders to identify behaviors caused by burnout and compassion fatigue.
  2. Improve clinician well-being by measuring it, developing and implementing interventions, and then re-measuring it.
  3. Offer nurses opportunities to reflect on and learn from practice and other practitioners (e.g., positive role models).
  4. Develop or use current tools for staff to use to anticipate opportunities and problems.
  5. Work with internal team to assess if the current electronic health record (EHR) system may be customized to optimally support nursing workflow.
  6. Conduct regular staff meetings with discussions on new organizational policies, processes and outcomes from higher leadership meetings. Engage nursing input in these meetings.

Take these courses related to nurse burnout:

Harmonize Diversity and Improve Health Outcomes
(1 contact hr)
Healthcare today thrives on teamwork and partnering with patients to achieve exceptional health outcomes for staff and patients alike. Positive and productive relationships depend on personal and team awareness of various personality types across the continuum of their partners and their willingness to bridge the gaps among those differences to create a harmonic work climate. Having a genuinely shared healthcare plan, driven by patient participation, team connectedness, and improved resilience, maximizes communication, morale, and collaboration, and minimizes team burnout, job dissatisfaction, and general negative health outcomes of patients and staff. This module introduces the concept of personality sensitivity and gives examples of how personality-sensitivity training can improve performance, satisfaction, and outcomes.

Managing Your Time
(1 contact hr)
Time management is a core skill of 21st century nurses. It’s the key to improving outcomes, keeping patients safe, and reducing burnout. This module identifies strategies to help nurses be more productive, more efficient, and less stressed. It explores ways to improve nurses’ ability to manage their time in their personal and work lives by exploring time-management barriers and identifying the strategies needed to overcome those barriers. The how to’s of delegation, a complex skill that’s central to time management, is included. Nurses who gain control over how they manage their time boost their performance, gain a sense of satisfaction, and reduce their daily stress.

Research Reveals the Benefits of Meditation
(1 contact hr)
Healthcare practitioners in various disciplines and their patients use meditation. Meditation training has proved an effective adjunct therapy for many conditions and can be discussed as an option among healthcare providers. Meditation and relaxation techniques are part of a program to help patients reverse heart disease, for example. Healthcare programs are incorporating meditation into many clinical practices. A healthcare provider’s relationship with patients can influence the outcome of clinical problems as well as the satisfaction of provider and patient. A healthcare provider’s physical, emotional and mental health can influence the provider-patient relationship. By reducing stress and developing concentration, meditation cannot only increase concentration but also may help prevent job burnout. The result is a better relationship with patients and perhaps a method for self-healing. This course discusses meditation and the research supporting its use when caring for patients with a variety of conditions

By | 2019-09-10T09:41:30+00:00 September 5th, 2019|Categories: Nursing careers and jobs, Nursing news|12 Comments

About the Author:

Lisette Hilton
Lisette Hilton, president of Words Come Alive, has been a freelance health reporter for more than 25 years and loves her job.

12 Comments

  1. Avatar
    Dawn Griswold September 12, 2019 at 5:41 pm - Reply

    Burn out is caused by having to shoulder too much critical thinking without the time to perform tasks that are required just for basic tasks. Too much responsibility and understaffed units. With an adequate staff a nurse can do her job with competence, pride and a caring attitude. When one is over loaded with even basic routines, family concerns and problems that need to dealt with immediately, that can not be accomplished. So the nurse ends up with an over load of anxiety and inadequacy. This leads to burn out.
    The commission recommends 6 safety steps to residency. These steps will only put on paper what should work, but will not. Just ask a nurse!!!,

    • Avatar
      Daria W. September 15, 2019 at 7:14 am - Reply

      I agree wholeheartedly Dawn. I, am one of those nurses who has left the profession due to the conditions within the hospital. It was not an easy decision to do so, as the money was decent…not really good, but decent.

      While so many write articles about nurse burnout…indicating that we nurses need to recognize burnout in our fellow nurses, manage time better, etc… how about the Joint Commission doing better research on how managers of units get bonuses for keeping staffing numbers low…for corporate to realize BIGGER $$$….

      One troubling situation is how admissions are even at times unnecessarily encouraged…for $$$.

      The straw that broke this camel’s back was when I was assigned an ICU hold patient (due to not enough ICU nurses-BEDS WERE AVAILABLE).. in the ER…which many here can relate and I have done many times before…But this time it was different in its extreme nature of unsafety to the patient, my nursing license and my conscience.

      This patient remained unnecessarily intubated though his respiratory crises had resolved… The ICU Intensivist would not extubate him in the ER.
      I insisted that we either extubate or at the very least change from Diprivan…as his BP was precariously low. No one would listen.

      I documented like crazy for legal purposes…and still had my other ER patients to care for..and was expected to be relieved for lunch by a fellow nurse…who still had her own 4 patients… Are you kidding me?! I refused to relinquish my post as I feared for the life of a man who laid there helplessly at the mercy of a dollar-driven administrator…. These are those things…which people need to realize cause burnout…

      The bottom line is… it repulsed me how patients were being treated… How a deceased patient and family can be deprived from bereavement as there were times we needed the room for another non-critical patient…just to make the numbers!

      I miss the camaraderie which the staff used to have…which is now replaced by the frustration between physicians, nurses, the lab, radiology and all other departments..which has been caused by dollar-driven #’s!

      The LARGEST WHITE ELEPHANT in the room people… is that hospital… a.k.a. Corporate America, needs to staff better! For safety of all…staff better. To reduce nurse burnout…staff better. To reduce unnecessary lawsuits and patient complaints…..staff better.

      But that would mean higher-level administrators wouldn’t get the $$$’s they strive for….hmmm. It’s all about priorities …. and they continue to ignore the biggest one’s.

      So in essence, someone’s family member

  2. Avatar
    LaTeshia September 15, 2019 at 12:51 am - Reply

    Poor patient to ratio status, forcing nurses to take on too much responsibility that is not realistic for the outcomes of good patient care. Lack of support from management/administration. Wages not competitive, no incentives for advancement! Need I say more. It can be resolved but the powers they be are inlybconcern about their bottom line!!

  3. Avatar
    mama jo September 15, 2019 at 2:41 am - Reply

    I thought this worth forwarding it can certainly become a problem. my student nursing advice was to avoid empathy , but certainly have sympathy it is possible with empathy to skew rx. a dr. friend I knew well, decided to check the blood w0rk on his daughter, and mis dignosed her problem…..leukemia . unconsciously he saw saw what he wanted to see. I ams sure that there is a middle ground, otherwise no one could be a hospice nurse. perhaps my training was too pedantic, but we were influenced to
    a great amount of sympathy, but empathy could skew our care.. .
    I am sure that by now you have worked out what you can deal with. compartmentalizing is sometimes a solution

  4. Avatar
    Karen Wagner September 15, 2019 at 8:07 am - Reply

    I believe safe staffing is the issue to burnout , there’s only do many hours in a day to get everything done. It’s also very frustrating to go your charting when the batteries on your computer or the computer shuts down because of connection . There’s always a problem with not enough supplies , always searching throughout the hospital and making calls to central supply. Nurse attendants don’t stock the rooms for basic supply needs for patients , patients always in call bell asking for a nurse when an NA can help them , Monitors are over 39 years old , missing parts , wires frayed, not enough working transport monitors , Medications are do when doctors want to round. Rooms are so tight most of them use to be single rooms , my husband skyways asking why I have all these bruises , Security is very minimal ,,anymore can walk in without giving any ID , children under 12 years if she always by pass security. Most of the time we do not get our breaks because there is so much charting to do ,just waste of precious time , now I make sure they pay me overtime for missing breaks . I personally would not recommend any nurse to do beside ,

  5. Avatar
    Julia R Harbeck September 15, 2019 at 1:44 pm - Reply

    I just retired after 40 years and I see so many problems these day which all lead to burnout. Short staffing and critical patients being first. No breaks and 12 to 16 hour shifts and mandatory overtime. Not being able to eat and drink at the work station resulting in missed meals and dehydration. Management always telling you about what went wrong but never telling you what went right. Patient safety being last on management agenda with satisfaction scores still being expected to be high. Patients being forced to wait a long time for help because there isn’t enough help. I think part of the problem is the push toward every nurse being forced to have their BSN. When I started we had orderlies, aides and LPN’s working side by side with us. We had time for walking the patients, teaching the patients, being there for the patients. When I started administration was all nurses so they related, now they have zero nursing skills, just management skills which don’t translate into good patient care. We also are forced to take on other specialty area’s jobs like doing cardiac procedures in a infusion center just because we are open every day. Training consists of watching doing and trained. Brand new nurses in ICU and ER with zero critical care experience. There are so many things wrong and no one is listening to the nurses. Most want to give the best care possible, but find they aren’t allowed to do it. The system is broke.

    • Avatar
      Amanda September 16, 2019 at 10:45 am - Reply

      This is such a well written portrayal of problems faced by nurses who want to provide the best possible level of patient cares. Thank you!

  6. Avatar
    Fed up September 15, 2019 at 5:19 pm - Reply

    Adequate is the major reason for burnout. Nurses are expected to do everything. We are expected to do everything from housekeeping to phlebotomy. I have worked places that don’t have a single cna to help take patients to the bathroom. Most places that’s all a cna does. How am I supposed to take my patient to the bathroom, feed them, do vitals, draw labs, turn them every 2 hours, pass meds, do doctors treatments, ensure testing is done, ensure the medications are correct, make sure that respiratory treatments are done and start all over on 5-6 patients. Some places are more. Add bathing, changing linens, keeping the room cleaned and who’s got time to make sure that the doctor or pharmacy didn’t mess up an order. I go to work praying that nothing bad happens. As a cna I took vitals reporting abnormal. Checked sugars. Removed ivs and Foley’s, I even bathed patients. The big difference was that I only had 14 patients. Now I see many places that have 1 cna to 25 patients, making it difficult for them to be a certified Nurses Assistant. This leaves the nose in the position of not having time to complete anything. Adequate staffing and upper management listening is what it takes to prevent burnout. Several of the 0laces I have worked the upper management only worked on the floor a few weeks before moving to management. They never actually work the floor to see what some of the problems are. I worked one place where management wouldn’t even come in to help when the floor was extremely short staffed. The i in team is inside the A. It means cover my a%%.

  7. Avatar
    Cindy Mason September 15, 2019 at 6:33 pm - Reply

    I have been in the nursing field at some capacity since I was 16 years old. I am 61 now. The patient to nurse ratios need overhauling. Having 5-7 patients 30-40 years ago is not like having 5-7 patients now. Patients are more complex. Technology is more complex. Equipment is more complex. All of these advances in medicine have kept patients alive longer than 30-40 years ago. A simple adjustment in patient ratio could cut burnout in half. Of course the hospitals do not like this because of the extra cost for extra staff.

  8. Avatar
    John Kauchick, RN, BSN September 16, 2019 at 2:52 pm - Reply

    Over the years I reported safety concerns to JC. I was once told if a hospital does not want to make patient safety a priority, “there is only so much we can do.” One problem with JC is its secrecy. They will not discuss the results of a complaint investigation. One of the things that prevents reporting is the perception that nothing happens if you report. And, of course, one is likely to be fired.

    The resiliency fad is another money maker for sale. It’s an example of people who haven’t done patient care in decades speaking for those who are in the trenches. Next, they will be saying nurses should do SEAL BUDS training to toughen us up for the daily abuses we experience. Well, you guys. I left the abuses behind after 37 years.

  9. Avatar
    Uzzal September 19, 2019 at 12:58 am - Reply

    Poor patient to ratio status, forcing nurses to take on too much responsibility that is not realistic for the outcomes of good patient care. Lack of support from management/administration. Wages not competitive, no incentives for advancement! Need I say more. It can be resolved but the powers they be are inlybconcern about their bottom line!! now I make sure they pay me overtime for missing breaks . I personally would not recommend any nurse to do beside ,

  10. Avatar
    shajib hasan September 19, 2019 at 12:59 am - Reply

    The straw that broke this camel’s back was when I was assigned an ICU hold patient (due to not enough ICU nurses-BEDS WERE AVAILABLE).. in the ER…which many here can relate and I have done many times before…But this time it was different in its extreme nature of unsafety to the patient, my nursing license and my conscience.

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