Nursing is hard work that takes its toll. Burnout among nurses is pervasive and can impact patients. Certainly, feeling stressed and exhausted can make it hard for all of us to concentrate and function. However, when nurses who care for patients in the hospital struggle with the effects of burnout, the impact can be devastating. How widespread an issue is nurse burnout? How does nurse burnout affect patients? What can you do?
Nurses play a crucial role for hospitalized patients.
Yes, doctors are the heads of the medical team, calling the shots (no pun intended!). But doctors don’t spend much time with any individual patient. Even with critically ill patients.
However, nurses provide 24/7 care, and our lives are in their hands.
Moreover, nurses play a key role in a hospital’s patient safety efforts. Nurses monitor patients for deterioration and detect errors and near misses. They also understand care processes and perform countless tasks to ensure patients get high-quality care.
Lastly, nurses provide much-needed, and much-appreciated, emotional support for patients and families.
It’s obvious that nurses are an essential part of healthcare, particularly in hospitals. But it’s not always easy to be a nurse. Importantly, a 2017 Kronos survey of nurses, 98% of respondents described their work as physically and mentally demanding.
Our reliance on nurses should make us all concerned on how much nurse burnout can affect patients.
What exactly is nurse burnout?
Nurse burnout, a widespread phenomenon that causes mental, physical, and emotional exhaustion, is caused by many factors, including:
- High stress work environment, including:
- The pressure of quick decision-making.
- Excessive workloads.
- Caring for patients experiencing considerable physical and emotional pain, some of whom die under their care.
- Unrealistic expectations.
- Long work hours, often 12+ hours in a shift.
- Inability to take any breaks during shifts, including not breaking for meals.
- Lack of sleep, including difficulty getting enough sleep between shifts.
- Verbal and physical abuse, and bullying, from coworkers and patients.
- Lack of workplace support.
- Understaffing which increases workload and stress.
- Difficult work-life balance.
How common is nurse stress and burnout?
Even before COVID-19, nurses faced considerable stress (see stats below). However, COVID-19 has led to staffing shortages, intense workloads, emotional stress, and other stressors.
For instance, in a 2021 survey of 200+ nurses by Hospital IQ, 90% of respondents stated they are considering leaving the nursing profession in the next year. Furthermore, 71% of RNs with 15+ years of experience are thinking about leaving as soon as possible or within the next few months.
Additionally, a 2021 survey of nurses by Cross Country Healthcare found that 37% of nurses report feeling burned out, stressed and/or overworked. Moreover, 66% expressed some level of interest in leaving the profession, with 29% stating their desire to switch careers is dramatically higher now as compared to pre-pandemic.
Similarly, a 2021 survey by McKinsey & Company found that 22% of nurses may leave their current position providing direct patient care within the next year. This represents a 60% increase in the number planning to leave compared with the 2020 survey results.
Additionally, a 2021 survey of nurses by Medscape found:
- 25+% said the pandemic decreased their satisfaction with being a nurse.
- 20+% reported feeling “very burned out” or “burned out”.
- 40+% reported experiencing verbal abuse, with patients as the most cited source of the abuse.
Even before COVID-19, nurses felt stressed.
Before COVID, Medscape’s 2019 survey on job satisfaction among nurses found that almost all nurses were glad they became a nurse, but 15% – 21% said they would pursue a different career if they had the chance (results varied by nursing specialty).
And, in a 2016 survey by RNnetwork, 50% of nurses said they have considered leaving nursing, with “feeling overworked” as the most common reason given.
Similarly, in a 2018 survey by Kronos, 63% of nurses said their work has caused burnout.
On top of this, many nurses face nurse bullying, a common occurrence which impacts nurses and patients. For more information on nurse bullying, ready my blog post: Does Nurse Bullying Impact Patients?
How does nurse burnout affect patients?
Burnout leads to staffing shortages.
Over the years, even before COVID-19, the workload for hospital nurses increased due to a number of factors, including shorter hospital stays, patients requiring an increasing intensity of care, and a nurse shortage.
The high workloads lead to burnout and job dissatisfaction, which cause nurses to leave hospital jobs, further contributing to a nursing shortage. It’s a vicious cycle, made worse as COVID-19 led many nurses to leave their jobs due to burnout and/or more lucrative out-of-state temporary nursing assignments.
Unfortunately, the nursing shortages are expected to get worse in the coming years, and continue to at least 2030. Factors that contribute (for now and in the future) to the nursing shortage include:
- Nursing school enrollment isn’t growing fast enough to meet the projected demand, in part due to a shortage of nursing school faculty.
- A significant portion of nurses are nearing retirement age.
- As the US population ages, more nurses will be needed to care for seniors.
- Many nurses are leaving the profession due to stress and poor job satisfaction.
The impact of nurse shortages on patients.
Certainly, as nurse burnout contributes to nurses leaving their jobs, we will all feel the effect. The impact of a nursing shortage could likely range from frustrating waits for nursing help to serious, potentially life-threatening, delays in response to bedside alarms.
Importantly, abundant research shows the importance of adequate RN staffing for achieving good patient outcomes, safety, and job satisfaction.
For instance, one study found that for each additional patient assigned to a given nurse, the patient has a 7% increase in the chance of dying within 30 days of his/her hospital admission, and a 7% increase of death from a treatable complication.
Another study found the odds of a patient dying within 30 days of hospital discharge increased by 16% for each additional patient in the average nurse’s workload.
And researchers found that when critically ill patients are in units with high workload/staffing ratios, there is a substantial reduction in the odds of survival.
Nurse fatigue can harm patients.
The schedules and demands of nursing to fatigue that can interfere with the quality of care nurses provide. Importantly, fatigue can cause slower reaction times, increased errors and decreased cognitive ability. Additionally, fatigue can impair judgement, decision-making ability, and concentration.
Respondents in a 2017 nurse survey by Kronos reported negative consequences of their own exhaustion, including:
- 37% worried about making a mistake.
- 11% say they’ve made a mistake at work because of exhaustion.
- 44% worried their patient care will suffer because of exhaustion.
- 83% have helped another nurse who felt too tired to work.
Nurse burnout affects the quality of care.
Researchers investigated the association between nurse burnout and nurse-rated quality of care and found an association between higher levels of nurse burnout and lower ratings for quality of care. This degradation of care was seen across all types of facilities and settings.
Nurse burnout impacts patient satisfaction.
Researchers examined the impact of the nurse work environment and nurse burnout on patients’ satisfaction with their nursing care.
Unsurprisingly, patients were twice as likely to report high satisfaction with their care when they were in units where the nurses:
- Reported significantly lower burnout.
- Felt the unit had:
- Adequate staff.
- Good administrative support.
- Good relations between doctors and nurses.
What can you do about nurse burnout?
Recognizing the stress and fatigue most nurses cope with is a good place to start. Be kind to nurses. Don’t be a bully.
Of course, you need, and deserve, high quality care. So, if you or a loved one are in the hospital and have a problem with the care you receive from a nurse, share your concerns with the charge (head) nurse.
Additionally, realize nurses might not be able to provide the level of care and attention they would like to provide. There are many tasks that family members and other caregivers can do to counteract the to counteract the fact that nurse burnout can affect patients. For instance, you can alert staff to missed bedside alarms, and provide comfort care, such as adjusting pillows.
And don’t worry about overstepping your boundaries. Nurses and patients benefit when families stay involved in the process.
When possible, a family member should stay with the patient in the hospital – many hospitals provide cots for this purpose. When this arrangement is not possible, some patients and families hire outside help.
In fact, there has been an increase in the number of patients who bring their own caregivers to the hospital with them. Clearly this is beyond the financial means of many patients, but it is a good alternative for those who can afford it and who don’t have family who can stay by their side.
For specific recommendations on how families and other caregivers can help mitigate the impact of nurse stress and fatigue, read my blog posts:
- Hospital Patients: Your Relationship with Your Nurse Can Impact Your Health.
- Medication Errors in Hospitals – How Can You Protect Yourself?
- How Common are Patient Identification Errors?
NOTE: I updated this post on 3-7-22.