'Nursing Burnout in the Healthcare System.'

Nurses are a crucial arm the healthcare system at all levels of the society. They administer medications for treatment of health complications, handle medical emergencies such as strokes and heart attacks, assist physicians in medical procedures and also evaluate and record the symptoms of patients. Nurses are also involved in education patients as well as the general public about various health conditions. They are therefore vital in the coordination and provision of patient care in the society. However as they go about doing their job, nurses are exposed to various psychological and social risk factors that can result in work stress and burn out that is caused by physical exhaustion, psychological exhaustion and emotional exhaustion. This compromises the quality of service provided by the nurses as it negatively impacts their well-being and may result to incidences of medical mistakes in patient care. Nurses are responsible for providing high quality care for all the patients they take care of. There are various ethical rules and guiding principles that dictate their decision making process and work performance to guarantee that they provide quality healthcare services. Despite this, there has been increased incidences of nursing burn out all over the world that are raising a cause of concern amongst many researchers. Berry and Curry (2012) opine that the due to the present-day stultifying work assignments that nurses have, along with the absence of guidance on how those assignments are determined, as well as the absence of independent decision making with respect to patient care, the nurses are going burnout at unprecedented levels. The authors further suggest that as a result of the burnout, the nurses hardly have the ability to provide the care that is much needed by their patients and therefore fail to fulfill the professional obligations, as well as the ethical and legal obligations they owe their patients and the patients' families. There is therefore a need to carry out investigations to determine the root causes of nursing burnout and ascertain the effects that it has on patient healthcare.

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According to Maslach and Leiter (2005) Burnout Syndrome or Burnout is a prolonged reaction to stress factors that physical or emotional which leads one to feel exhausted, become overwhelmed, have self-doubt, develop anxiety as well as feel bitter, cynicism, and inefficient. It is majorly occurs amongst caregiving professions where it is requisite of professionals to closely work with people in where great levels of emotions are involved (Spooner-Lane & Patton, n.d). The professionals acquire negative attitudes and emotions toward the people that they work with and as well as their professional role (Maslach &Jackson, 1989). It is therefore a response to chronic work stress. The effects of nursing professional burnout consists of reduced productiveness , absenteeism, deficiency of motivation, musculoskeletal complications, increased endangerment of cardiovascular diseases, and psychological fatigue (Y. Chang & J. Chan, 2013;Suner-Soler et.al, 2012; S.Wang, Liu & L.Wang,.2015). In the past few years, there have been growing concerns of Burnout in the nursing profession. The issue around Burnout syndrome keeps on evolving with the constant changes in medical practices in the healthcare system. As a result, the causes and effects of nursing burnout are still being explored. Due to the ever-changing environment in the healthcare system, there is need to explore the issues contributing to Nursing Burnout and the effects it has on the provision of quality healthcare.

Staffing is a major contributor to nursing Burnout in the healthcare system. Increase in nurses staffing in hospitals has been associated with a reduction in mortality rates (Harless & Mark, 2010).According to the 2010 Workforce Profile of Registered Nurses in Canada (2012), the number of registered nurses (RNs) in Canada, including nurses practitioners in the year 2010 was 287,344 yet only 93.4 percent of these were employed in nursing while a percentage of the rest were either employed outside of nursing or were not employed. The author further argues that the ratio of employed RNs to the population of Canada in 2010 was 1 registered nurse for every 127 people. This coupled by the fact that nurses are on call twenty four hours a day, seven days a week goes to show that nurses are arguably overworked. Nurses provide a number of services on a normal day such as administration medications for treatment of health complications, handling medical emergencies such as strokes and heart attacks, assisting physicians in medical procedures and also evaluating and correctly recording the symptoms of patients. At any time of the day, their work may increase due to occurrence of unexpected events such as floods and earthquakes. Overstretching of nurses sometimes makes them skip lunches and breaks and leaves them feeling exhausted both physically and emotionally when the day comes to an end (Maslach & Leiter, 2005).The care of all these cases left to one person a whole day and through the night would definitely lead to fatigue immense stress from the pressure to complete the task. Work related pressures which lead to an increment in the load of effort needed to perform work are a major cause of fatigue (Cordes et al 1997). Altun (2002) suggested that Burnout is the end result of unmanaged work stress. According to Aiken, Clarke, Sloane, Sochalski and Hiber (2002), every additional patient that is given to an overloaded nurse causes an increment of 23 percent in the probability of the nursing professionals suffering from burnout and a 15 percent increment in the chance of discontentment with their job.

Since the Burnout Syndrome is characterized by feelings of emotional exhaustion, feelings of inefficiency of work and keeping a distance from patients, it is quite possible that more often than not, Burnout leads to a reduction of the quality of care that nurses give. Poghosyan, Clerke and Aieken (2010) argued that high levels of nurses' burnout were directly linked to a reduction of the quality of care they gave. Burnout not only contributes to a reduction in the quality of healthcare services provided by the nurses but it also puts the health of the nursing professionals at great risk. Nurses experiencing burnout don't realize that their own health is at risk and as a result, the quality of services they provide goes low. Maslach and Jackson (1989) opine that Burnout can be detrimental to the people suffering from it and those they interact with, like the patients under nursing care since people enduring burnout don't see a way out of their situation. The components of the burden of work in the nursing profession contributes to burnout which leaves them susceptible to negative health outcomes and eventually affects their performance and their quality of care they provide ( Aiken, Clerke and Sloan, 2002; Gunnarsdottir, Clerke, Refferty & Nutbean, 2009). Since nurses spend most of their time taking care of their patients and their families, they are quite vulnerable to several physical, emotional and mental risk factors as that can lead to burnout therefore directly affecting the quality of care they deliver. Research has seen Burnout be conceived as a mental syndrome that is consist of emotional exhaustion, a propensity to objectify the clients that one comes up, and a reduction in the sense of personal accomplishment (Maslach, 1982). Burnout therefore has a negative influence on job performance and contributes to the action of nurses undermining the due care professional attention they are supposed to give to their client as is ethically required of them. According to the Aiken, Clerke, Sloane, Sochaslaki and Hiber (2012), the rate of mortality of patients increased by 7 percent for each surgically treated patient that was added to and average nursing workload.

However, there is a school of thought that argues that there are several other factors that leads to a reduction in quality of healthcare that nurses provide to their patients and therefore nurses must uphold the ethical standards that are required of them under the law. The ethical standards of nurses are informed by seven relatable primary values in Part I of the Canadian Nurses Association (CNA) Code of Ethics for registered nurses which constitute principles of ethics that date back as far as 1780 B.C.( Keatings& Smith 2012). These values include provision of competent, compassionate, safe and ethical care in the healthcare system, promotion health and well-being of people, promotion and respect of the making of informed decisions, preserving dignity, and maintaining the privacy and confidentiality of their patients, promoting justice and being accountable (Code of Ethics for Registered Nurses, 2017). According to Keatings and Smith (2012), a national code of ethics for RNs provides them with a culturally adapted set of regulations since such is an essential basis for providing guidance to nursing professionals. Despite the argument that nurses who experience burnout may be unable or unwilling to provide quality healthcare to patients and their families due to emotional and psychological distress, working in an environment where the quality of healthcare provisions low, for example due to lack of important medical facilities may as be the cause of emotional distress and disengagement. Some researches indicate that burnout only mediates the connection between staffing of nurses and the described quality care of nurses (Bogaert, Meulemans, Clerke, Vermeyan & Heyning, 2009). Burnout and the perception of poor quality care by the nurses may be due to the subjective negative assessment or discontentment with their working environment.

All in all, the issues discussed in this essay clearly show that staffing is a major contributor to nursing Burnout which consequently compromises the quality of work provided by the nursing professionals. Burnout is common in the nursing profession since it is mainly found in caregiving professions where it is requisite of the professionals to closely work with people in where great levels of emotions are involved. The issue of nursing burnout has therefore attracted great a number of researchers who dive deep into the factors surrounding it. However, since it is a continuous problem that is bound to change with the fast changing global and national environments, and given the increase in number of incidences of burnouts in healthcare nursing, continuous research need to be carried out to determine emerging issues surrounding this subject in order to implement appropriate proactive measures.References

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