Part I
Nursing Burnout/Turnover in the ED
Emergency department nurses have to address life and death situations each day in their quest to provide quality patient services. They face various challenges, including high patient loads, a fast-paced environment demanding physicians, long shifts, and other physical and emotional challenges in their work setting. As a result, emergency department (ED) nurses report a high level of job burnout, which has increased in prevalence over the last few years (Brandt, 2019). While job burnout is possible in all work-related environments, it is more prevalent in jobs that require compassion and helping people, such as in healthcare. Besides, the level of burnout differs in different settings and units within the healthcare environment. Although burnout is common among all care providers, ED nurses are at a heightened risk because of the emergency life and death situations they have to deal with every day.
The National Healthcare Issue/Stressor
Burnout among ER nurses is a common problem in healthcare organizations because of the demanding nature of the department. The case study in the current analysis of the healthcare issue is the AtlantiCare, situated in Atlantic City, NJ. “Statistics at the hospital reveals that since 2016, 36 nurses have left the emergency department, with only 29 new hires. Currently, the ED is under-staffed, which has resulted in the use of agency nurses and the hiring of new graduate nurses to meet the demand.” Many nurses experiencing burnout in their workplace reveal increased intentions to leave the hospital or even quit their careers altogether. As a result, burnout is closely related to turnover intentions and completion in various EDs in hospitals, including at AtlantiCare. The challenge explains the shortage of ED nurses at the hospital.
Hospitals require the optimum number of nurses to provide care to their patients effectively. Therefore, if the hospital experiences a shortage of nurses, it is no longer effective in providing quality and safe care. The situation affects AtlantiCare currently because of the higher rate of turnover compared to the level of hiring. From the statistics, it is evident that the hospital experiences a higher turnover compared to the rate at which the hospital is attracting qualified ER nurses. The situation has a negative impact on nurses, patients, and the hospital. Nurses have to take more workload and work for long hours to meet the patients’ demand for care. As a result, caregivers suffer an even greater level of burnout, which might cause more intentions to leave. Patient care is affected negatively by the nursing shortage. Therefore, healthcare faces the issue of growing dissatisfaction and low quality outcomes.
Article Summary
Research in other healthcare settings reveals that the issue/stressor is not unique to AtlantiCare. It is a common problem experienced by all employees in emergency rooms (ER). Johnston et al. (2016) conducted a review of the literature to establish the perceptions of ED nurses about their working conditions and their views about the impact of their working environment. The reviewed literature revealed that nurses report an increased workload due to factors, such as budgetary cuts, critical staff shortages, and increasing patient numbers and acuity. The issues negatively influence the care process because they compromise the satisfaction of staff and their working conditions. Although stress and burnout are common across the healthcare organization, nurses reported that they are worse in the ER because of the high pressure and high volume workloads. The article recommends the need to implement strategies that would boost staff morale and reduce the level of stress and burnout.
Other studies have investigated the actual factors that cause burnout among nurses in the EDs. Rozo, Olson, Thu, and Stutzman (2017) studied some of the situational factors that cause burnout amongst nurses in emergency departments. The authors recognize that EDs are high-stress environments for care providers and patients. Nurses experience daily stress due to the nature of the work in the EDs and the constant contact with life-threatening situations. As a result, they suffer the risk of high levels of burnout. The issue is associated with an increased risk of other health problems, such as hypertension, depression, and anxiety. The authors further observe that the presence of medical conditions is a risk factor for further burnout, developing a cycle of stress and disease. Some of the factors associated with burnout in EDs include unpredictable work environments, overcrowding, long shifts, heavy workloads, exposure to traumatic events, violence, lack of support, and patients with acute trauma, illnesses, or injuries. The article concludes that burnout is exhibited in various ways and affects the decision of the nurse to quit the profession.
Summary of Interventions
Various interventions are suggested in research to reduce the level of stress and burnout amongst ER nurses. Johnston et al. (2016) proposed the need to improve the working conditions of nurses in EDs to reduce the level of stress and burnout. Healthcare leadership should implement evidence-based interventions to improve the morale of nurses to prevent stress and burnout. For example, nurse managers should give off days to nurses who have worked for many days and long hours to relax and return to the hospital more rejuvenated. Furthermore, leaders should include adequate support to nurses to overcome workplace challenges such as work-related stress and workplace violence.
Effective organizational management is necessary to help nurses overcome the challenges in their work. The management should implement strategies to assist nurses overcome burnout by incorporating their views of the problem and proposed interventions. Effective programs to address the problem of burnout and turnover include attracting highly skilled nurses and supporting their morale and satisfaction through clinical autonomy and teamwork (Rozo, Olson, Thu, & Stutzman, 2017). However, the proposed change will affect the organization. For example, promoting working autonomy in a high-pressure environment with huge demand for clinical skills can reduce employees’ morale. However, if the organization achieves an effective balance that stimulates and challenges nurses, it can motivate them and improve their morale and satisfaction, with a positive effect on the firm.
Conclusion
Burnout and turnover is a serious problem affecting many healthcare organizations across the United States and internationally. Nurses in the ED are among the most affected because of the demanding nature of their work. For example, they suffer from a high level of compassion fatigue that causes stress and burnout, as well as other medical problems such as depression and anxiety. The findings from the reviewed studies have revealed a high prevalence of burnout and turnover, and hence, propose effective strategies, such as managerial support and the need to attract highly qualified staff. The management should also motivate nurses to work comfortably to avoid burnout and stress that cause a turnover.
Part II
Developing Organizational Policies and Practices
The Needs Impacting the Healthcare Issue/Stressor
AtlantiCare, like many other healthcare organizations in the country and internationally, faces a serious issue of burnout and turnover among nurses in the ED. “Statistics at AtlantiCare since 2016, reveal that 36 nurses have left the emergency department, with only 29 new hires. As a result, the ED is short staffed, which has resulted in the use of agency nurses and the hiring of new graduate nurses to fill the gap and address the shortage issue.” Johnston et al. (2016) reveal that the ED is characterized by various stressful conditions, including the need to deal with life-threatening events every day. Besides, nurses are exposed to workplace violence, as well as working for long hours in a highly demanding environment. As a result, many nurses express their intentions to leave the hospital or their career altogether. Some quit the nursing career, a factor that creates the current challenge at AtlantiCare.
The Current Practice
AtlantiCare management has implemented a change in practice to overcome the high rate of burnout and turnover among ER nurses. The practice involves hiring new graduates and outside agency nurses to take the place of the ER nurses who leave because of burnout and fill the current gap in practice and care. Notably, the new graduates tend to have a longer retention rate. However, they lack the experience similar to that of seasoned nurses in the organization. Besides, agency nurses can pose a problem for the organization because they are often unfamiliar with their policy and procedures. They only work part-time in the organization, often getting only a single shift of orientation to the department. Therefore, they are not accustomed to the way work is done at the hospital and are not part of its culture. Thus, the current practice offers short-term relief from the current challenge, but the organization needs a more effective solution.
A Critique of the Current Policy
The policy has some ethical implications in solving the current issue and in organizational practice in general. However, the policy helps in closing the gap left by experienced nurses who leave the hospital because of burnout. It is ethical to ensure that the patients are protected from inadequate care because of such a gap. On the other hand, the level of care and quality is compromised because the newly graduated nurses lack similar experience as seasoned nurses, while agency nurses do not have an adequate understanding of the hospital policies and procedures since they are not part of the organization. The process might compromise the quality of care and safety of patients (Bae, Mark, & Fried, 2010). Therefore, the organization should consider a more ethical policy, such as supporting the seasoned ER nurses to remain in the hospital and provide quality care to patients.
Policy Recommendation
Instead of allowing seasoned nurses to leave and replacing them with newly graduated and agency nurses, hospital management should implement programs to support the current experiences nurses to ensure retention. The hospital should change the management practice to include the creation of a positive working environment for seasoned ER nurses (Rozo, Olson, Thu, and Stutzman, 2017). For example, the resources being used to hire the new graduates and agency nurses could be used to motivate the current nurses and add a few more qualified staff to reduce the workload. In essence, the hospital should channel resources to enhance morale and the working environment to retain qualified nurses.
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