How well do you function when you’re exhausted and overwhelmed? That’s a trick question, because no one is at their best under those conditions. We’ve all had times in our lives when exhaustion made it hard to concentrate and function. However, if you’re an exhausted and/or stressed nurse responsible for patients’ lives, the impact can be devastating. When you prepare for a hospital stay, it’s important to realize nurse stress and fatigue can impact your health. What should you do? Read on!
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. When we’re in the hospital, our lives are in their hands. Additionally, 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. Additionally, nurses provide emotional support for patients and families.
It’s obvious that hospitals cannot function without nurses. But nursing is an exhausting job, and nurse stress and fatigue is an issue that impacts both nurses and patients. And this is something we should all be concerned about.
COVID-19 takes a toll on nurses.
Unsurprisingly, COVID-19 has taken its toll on nurses, with insufficient staff levels, intense workloads, emotional stress, and other stressors.
For instance, 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.
- 60% reported the COVID-19 pandemic increased the likelihood they would leave their nursing position.
- Over half said they were seeking another career path, a non-direct care role, or planning to retire or leave the workforce entirely.
Additionally, results of a 2020 survey by Medscape on job satisfaction among nurses show that 35% of RNs (registered nurses) and 28% of NP (nurse practitioners) blame COVID-19 for a decrease in job satisfaction. In contrast, prior surveys by Medscape found that 90+% of nurses expressed satisfaction with their careers.
Furthermore, 69% of nurses reported a degree of burnout before COVID-19. In contrast, 83% of nurses expressed a degree of burnout since the pandemic began.
Even before COVID-19, nurses felt stressed.
Medscape’s 2019 survey on job satisfaction among nurses found:
- 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).
- The most common reason for liking nursing was helping people and making a difference.
- The worst parts of nursing were administration issues and workplace politics.
A similar survey by RNnetwork reveals a stark picture – 50% of the nurses said they have considered leaving nursing. The respondents’ reasons for thinking about quitting:
- Feeling overworked (27%).
- Not enjoying their job anymore (16%).
- Spending too much time on paperwork (15%).
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?
Nurses are exhausted, and patients pay the price.
The schedules and demands of the job lead to fatigue that can interfere with work quality. According to a Kronos survey on nursing fatigue, 98% of nurses describe their work as physically and mentally demanding.
The nurses reported their top causes of fatigue are:
- Excessive workloads (60%)
- Inability to take lunch and dinner breaks during shifts (42%)
- Inability to take any kind of break during shift (41%)
- Difficulty getting enough sleep between shifts (25%)
- 12-hour shifts (24%)
How does fatigue impact patient care?
Fatigue impacts the care nurses provide. No doubt about it.
How? Fatigue can cause slower reaction times, increased errors and decreased cognitive ability. Additionally, fatigue can impair judgement, decision-making ability and concentration. It’s easy to see how fatigue can negatively impact a nurse’s ability to provide high quality care.
- 37% worry about making a mistake
- 11% say they’ve made a mistake at work because of exhaustion
- 44% worry their patient care will suffer because of exhaustion
- 83% have helped another nurse who felt too tired to work
Nurses are burnt out, and it impacts patient care and outcomes.
Not only is nursing exhausting, as discussed above, but nursing is hard work that takes its toll. Burnout is pervasive. Of the respondents to the Kronos survey, 63% of nurses said their work has caused burnout. As with exhaustion, work stress can impair judgement.
Nurse burnout impacts patient infection rates.
Research found a significant association between nurse burnout and urinary tract infections and surgical site infections. Furthermore, hospitals that reduced nurse burnout by 30% had a significant reduction in infections, with an associated significant cost savings.
Burnout impacts the quality of care.
A study investigated the association between nurse burnout and nurse-rated quality of care. The results show 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. The results are not surprising.
Patients were twice as likely to report high satisfaction with their care when they were in units where nurses reported significantly lower burnout, and where nurses felt the unit had adequate staff, good administrative support, and good relations between doctors and nurses.
The situation is only getting worse.
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. And as the COVID-19 pandemic rages, nurses (and others) are leaving their jobs due to burnout and more lucrative out-of-state temporary nursing assignments.
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 of nurse stress and fatigue.
Most nurses think current working conditions in hospitals is a problem that will negatively affect staffing levels. For instance, of the respondents to the Kronos survey, 83% of nurses think hospitals are losing skilled nurses because other employers provide a better work-life balance.
The impact of patient/nurse ratios.
Determining proper staffing levels and schedules is complex, but both are key to providing high quality care. 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 that when critically ill patients are in units with high workload/staffing ratios, there is a substantial reduction in the odds of survival.
Are there laws regarding nurse staffing?
California has laws regarding nurse/patient ratios; the federal government and other states are considering legislation. Additionally, the National Academy of Medicine is recommending that 80% of all American RNs have a BSN (Bachelor of Science in nursing) by 2020. (Note, in 2010, only 50% of nurses had a BSN.)
How do hospitals determine staffing needs?
Most hospitals look at a combination of factors when determining staffing levels – patient acuity (level of care required), budget, and nurse-patient ratios. But, hospitals can struggle to determine just the right number of nurses with the right mix of experience and training for every unit.
What can you do to before a hospital stay to limit your impact of stressed and burnt out nurses?
Recognizing the stress and fatigue most nurses cope with is a good place to start. Since nurses might not be able to provide the level of care and attention they would like to provide, it’s important for the family to get involved.
And don’t worry about overstepping your boundaries. Nurses and patients benefit when families stay involved in the process.
There are many tasks that family members and other caregivers can do to counteract the impact of burnt out or exhausted nurses, including alerting staff to missed bedside alarms, and providing comfort care.
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 9-8-21.