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Problem Statement
The incidence of work-related burnout remains high in nurses when it comes to their first years of work in inpatient settings. As per Bakhamis et al. (2019), by promoting workforce attrition, the burnout syndrome further increases the workload on hospital nurses and lowers the supply of RNs relative to the country’s population. Burnout affects up to 70% of nurses; this and other job dissatisfaction factors result in 60-65% nursing staff turnout rates for hospital nurses within their first year of employment (Bakhamis et al., 2019; Boamah et al., 2017; Brown et al., 2018). In first-year RNs (the target population), the effects of burnout caused by bullying, exhaustion, and poor acceptance in the workplace are further exacerbated by humble wages, thus contributing to nursing shortages (Bakhamis et al., 2019). In phenomenological studies, first-year nurses’ workplace experiences are inseparable from difficult transitions to practice, the lack of “a beneficial transition period” provided by employers, and the feeling of disempowerment and stress, resulting in early intentions to leave (Brown et al., 2018, p. 282). This ubiquitous nature of burnout makes anti-burnout intervention selection a critical issue at the local and national levels.
The gap in practice that will be the project’s focus refers to the lack of knowledge regarding teamwork-focused interventions’ role in preventing or addressing burnout in new nurses compared to personal skill development initiatives. From preliminary literature search activities, existing research on the topic is rather fragmented and focused on testing particular interventions separately. Many interventions utilize personal skill promotion initiatives, including yoga programs, mindfulness training, cognitive coping strategy programs, mental attention training, resilience training, spiritual pain assessments, and similar approaches (De Oliveira et al., 2019; Lear & Andrewes, 2021). Some workplace programs emphasize teamwork and collaboration and find reflection in nurse supervision initiatives and teamwork courses, though teamwork-focused measures’ benefits for burnout reduction compared to personal skill improvement do not deserve much attention (De Oliveira et al., 2019). The literature review endeavors to address the gap and determine the role of teamwork promotion interventions in burnout prevention would inform the selection of optimal new nurse retention strategies for hospitals.
Practice-Focused Question(s)
The practice gap that the project will address is related to the limited understanding of teamwork promotion in reducing burnout rates in new hospital nurses and the lack of guidelines that would summarize burnout prevention knowledge and provide recommendations regarding teamwork-related interventions and skill improvement programs that support the hospital workforce retention. Specifically, the World Health Organization is concerned that companies in the healthcare industry, especially in high-stress hospital environments, are increasingly concerned with investments in treatments and medical equipment (De Oliveira et al., 2019). This runs counter to the recommendation to work on clinical environments’ quality and strategies to reduce teams’ job turnover intentions.
The selected practice question is as follows: how significant is the role of teamwork compared to personal skill development to prevent burnout in new nurses? The question’s relevance to the identified gap stems from the insufficient popularity of anti-burnout interventions that would prioritize teamwork over individual skill improvement (Hellyar et al., 2019). For example, in the literature review by De Oliveira et al. (2019), only three out of thirty reviewed trials demonstrate such interventions, whereas teamwork-strengthening interventions, including interprofessional peer-review programs for blame-free investigation of clinical errors, have been shown to decrease burnout levels effectively (Hellyar et al., 2019).
Social Change
By exploring burnout interventions in diverse populations, including new nurses, the project will promote social change emphasized in Walden University’s mission statement. Specifically, the literature review results will motivate healthcare organizations to strike the right balance between teamwork and skill promotion in burnout interventions for the staff, thus reducing a crucial barrier to success in the profession. This could increase the culture of nurse burnout prevention, resulting in fewer care mistakes and the optimization of nurse-to-patient ratios, which would eventually promote better outcomes for healthcare consumers. Individuals who might benefit from the results are HR managers and the executive leadership teams in hospitals involved in organizational efforts peculiar to nursing staff retention. Specific ways of promoting change might include distributing the outcomes of a review among local hospital managers or writing a health policy letter to promote burnout interventions that are in line with new RNs’ educational needs and evidence on effectiveness retrieved from current empirical research.
The Context for the Doctoral Project
The selected project type, the systematic review of the literature, does not require the student’s presence in specific clinical settings for successful completion. The systematic literature review process will require access to information regarding PRISMA guidelines and relevant databases, including PubMed, PsycInfo, MEDLINE, CINAHL, and so on (Pati & Lorusso, 2018). The author’s current practice setting, a critical care unit of a multispecialty inpatient healthcare facility, can further promote the research endeavors by enabling the student to get acquainted with some promising themes in nurse burnout prevention in critical and intensive care. Particularly, aside from preliminary analysis, the student will be able to identify the keywords and promising themes to be searched by transforming the observations and takeaways from intra- and interprofessional communication in the specified setting into knowledge to be applied during the systematic literature review process. New nurses are unlikely to have profound knowledge regarding burnout prevention programs and their components. Therefore, conversations with the hospital’s managerial team regarding the facility’s history of anti-burnout measures could support learning about strategies that should be reflected in keywords and inform the selection of inclusion and exclusion criteria for the literature.
Sources of Evidence
The current literature published within the last five years highlights the promise of teamwork-focused interventions in anti-burnout strategies. Evidence suggests that insufficient role clarity, which is related to teamwork, joins the ranks of significant contributors to job dissatisfaction in new nurses and is related to burnout symptoms in this staff category both cross-sectionally and longitudinally (Frögli et al., 2019). Also, evidence from cross-sectional surveys in all healthcare workers, including hospital RNs, demonstrates that a poor teamwork climate promotes disruptive behaviors that are positively correlated with staff burnout rates (Rehder et al., 2020). The findings above are reflective of hospital nurses’ perspectives on teamwork and burnout, thus highlighting the problem’s relevance to the profession.
Aside from the mentioned findings, the current literature hints at the great role of teamwork-related deficiencies in the emergence of burnout symptoms in nurses. As per research, teamwork improvement interventions are increasingly used in both new and existing hospital interprofessional teams for the promotion of healthier teamwork behaviors, but their potential for burnout prevention remains relatively unexplored (McEwan et al., 2017). According to the thematic analysis by Geuens et al. (2021), hospital RNs with diverse years of experience consider teamwork-related factors as crucial contributors to long-term burnout symptoms. The theme includes a variety of stressors, for instance, having to communicate with large groups of colleagues, including non-ambitious individuals and those who are overly assertive or too slow in their work.
Approach or Procedural Steps
The procedural steps will be informed by the multi-step protocol for systematic literature reviews. Pati and Lorusso (2018) offer a sixteen-step literature review framework that promotes procedural steps informed by the PRISMA guidelines and source classification/theme identification efforts by means of using Excel spreadsheets. Following the framework, the researcher will develop an unambiguous question regarding teamwork/individual skill development as an anti-burnout measure aimed at new nurses, come up with clear definitions for terms in the PICO question, and develop and approve the inclusion/exclusion criteria (Pati & Lorusso, 2018). After that, the researcher will conduct the initial review and the subsequent article quality checks.
The next efforts will be related to quality appraisal and review endeavors. The researcher will use the levels of evidence framework to rate the articles for inclusion, collaborate with another researcher in the field to conduct an interrater reliability assessment, and work on identifying critical themes and writing a report (Pati & Lorusso, 2018). The resources to complete the project are medical and healthcare-related databases, whereas the strategies to obtain data might include simple keyword search and Boolean search techniques (keywords and Boolean operators), depending on the searching system’s characteristics. Along with staff education initiatives, practice guidelines, and QI project evaluations, systematic reviews of the literature are among the acceptable DNP project types.
Ethical
The project will not involve interventions affecting staff members or patients in the author’s current practice setting, which minimizes the influence of ethical issues and the need for protection for human subjects. The ethical issues presenting barriers to successful completion are, however, relevant to the case. They include data assessment inaccuracies or biased attitudes to the question of interest, resulting in the review’s limited generalizability or applicability to practice. Some feasible strategies to overcome these issues include the implementation of the Cochrane risk-of-bias evaluation tool or similar tools during the quality appraisal procedure and measures to ensure interrater reliability, thus avoiding unilateralism in terms of interpreting the results (Farrah et al., 2019). Additionally, it will be crucial to demonstrate that the researcher does not have any interests apart from researching and summarizing the evidence regarding burnout prevention in nurses. Aside from that, no ethical challenges will impact project completion.
Alignment
In terms of alignment, the various aspects of the prospectus align and will support research endeavors to identify the potential gap in nurse burnout prevention practices employed in healthcare facilities, including strategies addressing burnout in recently employed critical care nurses. The sources supporting the problem of burnout in new nurses include articles by Boamah et al. (2017), Bakhamis et al. (2019), Brown et al. (2018), and other studies, whereas teamwork-related concerns are cited as a prominent factor in burnout in Frögli et al. (2019), Rehder et al. (2020), and Geuens et al. (2021). The previously formulated practice-focused question will promote the problem’s resolution by enabling the exploration of the nurse-perceived role of teamwork and individual skill development in burnout prevention. Similarly, the outlined procedural steps will promote the generalization of current evidence from diverse contexts regarding teamwork-focused interventions in strategies to prevent job-related burnout in new employees. The results of the research could motivate a positive shift in approaches to burnout prevention targeted at medical nurses, including new staff.
References
Bakhamis, L., Paul, D. P., Smith, H., & Coustasse, A. (2019). Still an epidemic: The burnout syndrome in hospital registered nurses.The Health Care Manager, 38(1), 3-10.
Boamah, S. A., Read, E. A., & Spence Laschinger, H. K. (2017). Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: A time-lagged study.Journal of Advanced Nursing, 73(5), 1182-1195.
Brown, J., Hochstetler, G. A., Rode, S. A., Abraham, S. P., & Gillum, D. R. (2018). The lived experience of first-year nurses at work.The Health Care Manager, 37(4), 281-289.
De Oliveira, S. M., De Alcantara Sousa, L. V., Gadelha, M. D. S. V., & Do Nascimento, V. B. (2019). Prevention actions of burnout syndrome in nurses: An integrating literature review.Clinical Practice and Epidemiology in Mental Health, 15, 64-73.
Farrah, K., Young, K., Tunis, M. C., & Zhao, L. (2019). Risk of bias tools in systematic reviews of health interventions: An analysis of PROSPERO-registered protocols.Systematic Reviews, 8(1), 1-9.
Frögli, E., Rudman, A., Lövgren, M., & Gustavsson, P. (2019). Problems with task mastery, social acceptance, and role clarity explain nurses’ symptoms of burnout during the first professional years: A longitudinal study. Work, 62(4), 573-584.
Geuens, N., Franck, E., Verheyen, H., De Schepper, S., Roes, L., Vandevijvere, H., Geurden, B., & Van Bogaert, P. (2021). Vulnerability and stressors for burnout within a population of hospital nurses: A qualitative descriptive study.Canadian Journal of Nursing Research, 53(1), 16-26.
Hellyar, M., Madani, C., Yeaman, S., O’Connor, K., Kerr, K. M., & Davidson, J. E. (2019). Case study investigation decreases burnout while improving interprofessional teamwork, nurse satisfaction, and patient safety. Critical Care Nursing Quarterly, 42(1), 96-105.
Lear, P., & Andrewes, T. (2021). Do mindfulness interventions reduce burnout in oncology nurses? A literature review. Cancer Nursing Practice, 20(4). Web.
McEwan, D., Ruissen, G. R., Eys, M. A., Zumbo, B. D., & Beauchamp, M. R. (2017). The effectiveness of teamwork training on teamwork behaviors and team performance: A systematic review and meta-analysis of controlled interventions.PloS One, 12(1), 1-23.
Pati, D., & Lorusso, L. N. (2018). How to write a systematic review of the literature. HERD: Health Environments Research & Design Journal, 11(1), 15-30.
Rehder, K. J., Adair, K. C., Hadley, A., McKittrick, K., Frankel, A., Leonard, M., Frankel, T.S., & Sexton, J. B. (2020). Associations between a new disruptive behaviors scale and teamwork, patient safety, work-life balance, burnout, and depression.The Joint Commission Journal on Quality and Patient Safety, 46(1), 18-26.
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