Theory Guiding Practice: Nurse Burnout and Job Dissatisfaction Presented by: Katrina General, RN, BSN

Scope Background  Burnout is described as “a state of fatigue and frustration among human service professionals” (Kanai-Pak, Aiken, Sloane & Poghosyan, 2008).  There is a high incidence of burnout among nurses.  Burnout can be caused by several factors, including: poor working environments, inadequate staffing, lack of support, little to no control over work schedule, and a disruption of work-life balance.

Scope History  Nurses may account for the most dissatisfied professionals in the United States (U.S.) workforce.  They were 4 times more likely to be dissatisfied with their job as opposed to the average U.S. worker.  The national turnover rate for hospital nurses increased from 12% in 1996 to 26.2% in 2000 (Larrabee et al., 2003). (Halm et al., 2005)

Nursing Practice Problem Nurse burnout and job dissatisfaction contributes to poor nurse retention and decreased quality of patient care.

Significance  In a study by McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken (2008), survey data from 95,499 nurses revealed that 24% of hospital nurses were dissatisfied with their jobs.  Poor nurse retention leads to inadequate staffing which is directly linked to nurse burnout and job dissatisfaction.  Each additional patient added to the average work load of a nurse was associated with a 23% increase in the odds of high nurse burnout and a 15% increase in the likelihood of job dissatisfaction (Kanai-Pak, Aiken, Sloane & Poghosyan, 2008).

Significance (cont.’d)  In a study of hospitals with low nurse-to-patient ratios, there were higher in-hospital deaths related to complications (Halm et al., 2005).  According to Aiken, Clarke, Sloane, Sochalski & Silber (2002), the odds of patient mortality increase 7% for every additional patient added to the average nurse’s workload.  Inadequate staffing and nurse burnout have also been linked to preventable errors.

Role of Nurse Leader  Implement interventions which will reduce and prevent burnout  Foster a supportive work environment which protects against burnout and job dissatisfaction

Discussion of Solution Application of a theory to address problem Maslach’s Multidimensional Theory of Burnout  Purpose: To provide a more precise definition of burnout, clear description of the sources of the problem, as well as offer proposed solutions.  Three core concepts of burnout:  emotional exhaustion  depersonalization  reduced personal accomplishment (Maslach, 1998)

Multidimensional Theory of Burnout The multidimensional theory of burnout proposes that the greater the mismatch between the person and the job, the greater the chances are that burnout will occur.  Six mismatches which have a distinct relationship with burnout  Work overload  Lack of control  Insufficient reward  Breakdown of community  Absence of fairness  Value conflict (Maslach, 1998)

Rationale for Use Allows organizations to design effective interventional strategies using the terms of the three dimensions which will ensure that the phenomenon of burnout is being addressed, with relevant criteria for determining effectiveness (Maslach, 1998).

Implementation Educational Interventions  Teambuilding, stress inoculation therapy, relaxation, mediation, time management, rational emotive therapy, and training in interpersonal and social skills. Managerial Interventions  Address the six areas of work life and correct the mismatches.  Day-to-day interactions through personal dialogue; in-house newsletters or chat groups; staff surveys; and value clarification and planning sessions.

Evaluation Assess level of burnout on an ongoing basis  Goal  Decreased levels of burnout  Increased levels of job satisfaction  Evaluation Tool  Maslach Burnout Inventory (MBI)  A tool that assesses all three dimensions of burnout.  Most widely used tool to assess the presence and severity of burnout (Kleijweg, Verbraak & Van Dijk, 2013).

References  Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse  staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16),  Halm, M., Peterson, M., Kandels, M., Sabo, J., Blalock, M., Braden, R., &... Topham, D. (2005). Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 19(5),  Kanai-Pak, M., Aiken, L., Sloane, D., & Poghosyan, L. (2008). Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals. Journal of Clinical Nursing, 17(24), doi: /j x  Kleijweg, J. M., Verbraak, M. M., & Van Dijk, M. K. (2013). The clinical utility of the Maslach Burnout Inventory in a clinical population. Psychological Assessment, 25(2), doi: /a  Larrabee, J., Janney, M., Ostrow, C., Withrow, M., Hobbs, G. J., & Burant, C. (2003). Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration, 33(5),  Maslach C. (1998). A multidimensional theory of burnout. In C. L Cooper, Theories of Organizational Stress (pp. 68–85). Oxford, NY: Oxford University Press  McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs (Project Hope), 30(2), doi: /hlthaff