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Nurses are the central workforces of any hospital, providing quality care to patients and spending more time with them than doctors. The main concern of such intense nursing schedules, filled with patient interviewing, various procedures, and the emotional comforting of families, is burnout (DallOra et al., 2020). The latter is defined as a psychological syndrome that appears in response to prolonged workplace stress (Soósová, 2021). It results in such adverse consequences as anxiety, depression, absenteeism, reduction in performance, job turnover, and increased error rate among nursing staff (Soósová, 2021). Since patient safety is the major indicator of the quality of care, it is crucial to improve working conditions for nurses to diminish the number of medical errors due to nurse burnout and stress.
Since burnout directly affects patient care, attempts have been made to measure this parameter to understand factors contributing to the rise and drop of stress among nurses. Many tools and methods were developed to quantitate burnout rates among nursing staff. For example, the Maslach Burnout Inventory assesses such dimensions as emotional exhaustion (EE), low personal accomplishment (PA), and depersonalization (DP) (Kakemam et al., 2021). The study involving 1004 nurses showed that 56% of the participants experienced a high degree of burnout due to PA, 48% because of EE, and 26% had EE (Kakemam et al., 2021, p. 1976). Another tool is Copenhagen Burnout Inventory, which evaluates work-related (WB), client-related (CB), and personal (PB) issues that cause burnout (Montgomery et al., 2021). The study among 59,000 nurses in Alabama showed that the average PB score was 56, CB was 39, and WB was 54 (Montgomery et al., 2021, p. 312). These two research pieces showed that nursing staff is mostly stressed due to personal and workplace problems.
Burnout among nurses is a significant burden on the six dimensions of healthcare quality. Specifically, it affects safety, effectiveness, patient-centeredness, timely care, efficiency, and equitability ( Six domains of health care quality, 2018). The most substantial impact of burnout is that it puts patient safety at risk and reduces the efficiency and effectiveness of care (Quigley et al., 2022). Furthermore, if nurses are stressed and exhausted, they are not able to deliver timely, equitable, and patient-oriented care since many of them develop cynicism about their duties (DallOra et al., 2020). Therefore, hospitals that strive to raise the quality of care should consider the needs and emotional well-being of the nursing staff.
The primary agency that regulates the quality of care and the issue of burnout among clinicians is the Joint Commission (TJC). Since TJC aims to make patient care safe and efficient, it has developed strategies to combat burnout among nurses. It can be achieved through improving mastery and competency among nurses through additional training, giving more autonomy to nursing staff, and emphasizing meaning and purpose (Hilton, 2019). Additionally, nurse leaders should help their colleagues develop emotional resilience through self-example and motivation (Hilton, 2019). TJC is an essential mediator and regulator of workplace-related issues in hospitals that affect patient care.
TJC annually releases guidelines for doctors and nurses to upgrade the quality of care in healthcare organizations. For example, in 2022, the agency released National Patient Safety Goals (NPSG) to reduce the incidence of adverse medical events due to incorrectly administered medications or wrong procedures (TJC, 2022). NPSG suggests that before any operation, the doctors and nurses should pause and ensure that this surgery is indicated for this specific patient, marking ones body site that requires the procedure (TJC, 2022). To improve health care quality, it is essential for clinicians to report all adverse events, indicating possible causes, not to punish the participants but to find breaches in various levels of safety.
The quality improvement initiative aims to make patient care safer and more efficient by reducing burnout among nursing staff. Since the statistical data from previous studies showed that nurses are primarily stressed by work and personal issues, it is essential to address these two domains (Kakemam et al., 2021; Montgomery et al., 2021). Firstly, nursing leaders should maintain a positive environment in their departments to reduce work-related stress. Secondly, all hospitals should hire more psychologists to help employees to cope with problems with family, friends, and colleagues. When nurses have this level of support, they will be less burned out, which should reduce the rate of adverse events related to medical errors.
In summary, burnout among nurses is a significant public health problem because it not only affects clinicians mental well-being but also harms patient outcomes. Indeed, when the nursing staff is chronically stressed from work and personal problems, they become cynical about their work, their efficiency drops, and nurses make more errors, potentially harmful to hospitalized individuals. Thus, the Joint Commission developed strategies to reduce the number of medical mistakes and diminish hospital burnout rates. It recommends adding safety levels when administering medication or procedures to prevent adverse events. Moreover, TJC suggested giving nurses more autonomy, support, and motivation to make them feel less stressed.
References
DallOra, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18(1), 1-17. Web.
Hilton, L. (2019). Joint Commission tackles nurse burnout with solid solutions. Nurse.com. Web.
Kakemam, E., Chegini, Z., Rouhi, A., Ahmadi, F., & Majidi, S. (2021). Burnout and its relationship to selfreported quality of patient care and adverse events during COVID19: A crosssectional online survey among nurses. Journal of Nursing Management, 29(7), 1974-1982. Web.
Montgomery, A. P., Azuero, A., & Patrician, P. A. (2021). Psychometric properties of Copenhagen Burnout Inventory among nurses. Research in Nursing & Health, 44(2), 308-318. Web.
Quigley, D., Slaughter, M., Qureshi, N., Gidengil, C., & Hays, R. D. (2022). Associations of pediatric nurse burnout with involvement in quality improvement. SSRN, 1-25. Web.
Six domains of health care quality. (2018). Agency for Healthcare Research and Quality. Web.
Soósová, M. S. (2021). Association between nurses burnout, hospital patient safety climate, and quality of nursing care. Central European Journal of Nursing and Midwifery, 12, 245-256. Web.
The Joint Commission. (2022). Hospital national patient safety goals. Web.
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