Finding Solutions for Stressed Out, Exhausted Nurses, and Potentially Depressed RNs

A new survey of more than 3,300 registered nurses (RNs) shows that a majority were extremely stressed out due to lack of sleep, long hours, and numerous other workplace issues.

These high levels of stress and fatigue could lead to medical errors, and negative patient outcomes, as well as an increase in nurse burnout, further aggravating the current nursing shortage, according to the study by the Vickie Milazzo Institute, a legal nurse consulting training institute.

Among the findings, 64 percent of respondents indicated that they rarely get seven to eight hours of sleep and 33 percent said they hardly ever get that amount. Twelve-hour shifts and on-call shifts after regular shifts and overnight shifts contribute to the fatigue problem, according to the study. Fatigue and irregular sleep patterns can also lead to health problems for nurses, including increased risk of depression and anxiety disorders.

An INQRI-funded study, published in the May/June 2012 issue of the journal Clinical Nurse Specialist, looked at how depression and musculoskeletal pain among nurses impacts workplace productivity and quality of patient care. Researchers found that nurses experience depressive symptoms at a rate twice as high—18 percent—as the general public. The team found that pain and depression were significantly associated with presenteeism, which was significantly associated with patient falls, medication errors, and the perceived quality of care. Additionally, depressed workers often exhibit low mood, have difficulty concentrating, and are accident-prone.

The researchers analyzed surveys from 1,171 hospital nurses in North Carolina and found that the productivity loss due to pain and/or depression was $14,339 per nurse and $876.9 million for the state of North Carolina. If these numbers were extrapolated to the nation, the productivity loss would be $22.7 billion.

Addressing the Problems

According to the Milazzo study, other factors contributing to high levels of stress for RNs are an unhealthy work/life balance, lack of authority, recognition, and fair pay in the workplace, and lack of effective management. To address these issues, the study recommends that hospitals:

• Make work hours for RNs realistic and sane;
• Provide access to nutritious food;
• Allow experienced RNs to have the authority to do their jobs and provide RNs with management opportunities; and
• Improve management style to recognize RN’s unique contributions and provide fair pay, adequate paid time off, and a positive work environment.

As the INQRI study points out, it is also imperative to devote more attention to depression screening and early treatment for nurses. Advanced practice nurses can educate staff RNs about the high prevalence of depression in nurses, who, like the general population, may be reluctant to get screening and treatment, due to the social stigma attached to mental illness. The study identified Web-based screening as a confidential and cost-effective means of reaching the nursing population.

Other strategies for assisting nurses with depression include increasing staff nurses and managers’ awareness of and sensitivity to depression, advocating policies that support good mental health and treatment for those with problems, and promoting supportive work environments, according to the study.

The Effects of Nurse Presenteeism on Quality of Care and Patient Safety was led by INQRI grantees Susan Letvak and Christopher J. Ruhm.

The Vickie Milazzo Institute survey results are available here.

New Hospital Initiative Involves Nurses Conducting Universal Screening for Depression

Hospital patients who have undiagnosed depression often have a slower and more difficult recovery. Now, nurses at Cedars-Sinai hospital in Los Angeles, are leading efforts to screen all patients for possible depression, Nurse.com reports.

The new process is designed to help nurses detect symptoms of clinical depression characterized by a severely disheartened mood, lowered activity level, and persistent negative thoughts lasting longer than two weeks.

“We know, based on multiple medical studies over several years, that addressing depression improves all aspects of patient health,” Linda Burnes Bolton, Cedar-Sinai’s vice president for nursing, CNO, and director of nursing research, said in a news release. Burnes Bolton served as liaison to INQRI’s national advisory committee prior to joining RWJF’s Board of Trustees. “By routinely screening our patients for depression upon admission, we can ensure that they receive the appropriate treatment and protocol.”

For the new initiative, an RN will interview each patient within 24 hours of admission, asking questions about mood and energy level. If the answers indicate possible depression, the nurse will use a standard, detailed questionnaire to assess other depression symptoms, including any thoughts of suicide. If possible depression is found, Cedars-Sinai social workers and physicians will determine an appropriate intervention for the patient. For patients who are suicidal, the nursing department will notify the patient’s physician and protect the patient from self-harm.

New Coverage on INQRI Study re: Nurse Depression

INQRI grantees, Susan Letvak, Christopher Ruhm, and their team are receiving a lot of attention for a new article they published recently in Clinical Nurse Specialist which focused on depression among nurses in hospitals.

Check out their recent clips:

• 1 in 5 Nurses is Depressed - Health Leaders Media
• Why So Gloomy?  Nurses Twice as Depressed as the General Public - Nurse Zone
• Study Looks at High Rate of Depression Among Nurses - Cleveland Plain Dealer

Learn more about their INQRI study, "The Effects of Nurse Presenteeism on Quality of Care and Patient Safety."

Depression in Hospital-Employed Nurses Is Double The National Average

An INQRI supported study, published in the May/June edition of Clinical Nurse Specialist and led by INQRI grantees Susan Letvak, PhD, RN and Christopher Ruhm, PhD, has found that hospital-employed nurses demonstrated a depressive symptom rate of 18%, double that of the national average (9%). The authors of this study also expressed their concern with depression among nurses as it may result in difficult with concentration and limiting nurses ability to perform mental and interpersonal tasks to the best of their ability. Thus, depression could be linked to not only lower total work output, but negative patient outcomes.

You can access the abstract (free) and the full-text (subscription required) of this study, here.