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.

Study of Nurses Shows Benefit of Mindfulness-Based Stress Reduction

The results of a research project that included a group of nurses suggests that implementing a Mindfulness-Based Stress Reduction (MBSR) program could help reduce employee stress and burnout, Medical Xpress reports.

MBSR was first developed in 1979 to teach patients with chronic medical conditions how to lead fuller and healthier lives, according to the researchers. Mindfulness is defined in the research as “a self-directed practice for relaxing the body and calming the mind through focusing on present-moment awareness.”

The MBSR study, led by Dawn Bazarko, senior vice president of the Center for Nursing Advancement at UnitedHealth Group, included 41 female nurses who participated in an eight week scheduled course of guided instruction in mindfulness meditation practices, facilitated group discussion, stretching and yoga, work and home assignments, and individually tailored instruction and support, according to Medical Xpress. 

Researchers surveyed the nurses’ overall health and well-being at three intervals: prior to beginning the program, immediately following the program, and four months after the program was complete. They found statistical improvement in overall health and wellness of the nurses at each of these markers.

While the study was conducted with nurses, it was intended to show that MBSR is a universal practice and can be utilized by a variety of clinical and non-clinical professions. The findings were published in the Journal of Workplace Behavioral Health.

Survey Shows Nurses Mostly Satisfied, While Challenges Loom

Of the 969 nurses who responded to a recent survey, conducted by Jackson Healthcare, 76% said they were satisfied or very satisfied in their jobs. However, 72% reported that risks loom ahead for the nursing profession.  Noted issues included workload increases, a nursing shortage and increased liabilities and litigation involving nurses.

Click here to read more about the survey on Nurse.com.

How to Better Motivate Nurses and Cut Costs

Yesterday, Karen Minich-Pourshadi, Senior Editor for HealthLeaders Media, published a fascinating piece that discussed innovative ways for hospital systems to cut costs while motivating their nursing workforce. Ms. Minich-Pourshadi recommends that hospitals take a cue from airline companies and utilize a point system, similar to 'travel miles', that rewards nurses for covering their colleagues shifts or providing exemplary care. The case study presented by Ms. Minich-Pourshadi demonstrates how hospitals are looking at other industries to solve some of their workforce issues that previously was viewed as unfeasible.

To read more about this innovative program, click here.

National Survey Finds Nurses in Physicians’ Offices See Salary Hike

The June edition of Healthcare Finance News featured the results from a survey that found nurses and nurse managers saw an average salary increase of 4% and 12% over the past year. The authors of the survey also found that on average, nurses working in private practices tend to make less than their counterparts in other sectors of health care. This could perhaps explain the rise in salaries in private practices in order to compete for the best and the brightest nurses. With the Accountable Care Act emphasizing community-based health, this trend is likely to continue.

Do any of you have any personal experience with salary hikes or reductions?

To read the full article from Healthcare Finance News, click here.

Philadelphia Hospital Boosts Use Of Registered Nurses In Bid To Improve care

Yesterday, Stacey Burling, reporting for the Philadelphia Inquirer, detailed how Hahnemann University Hospital plans to utilize more registered nurses (RNs) and reduce the amount of nurse assistants. This decision was spurred by a pilot study conducted in one nursing unit that found that using all registered nurses to care for patients instead of a combination of nurses and nursing assistants led to higher-quality care, and greater patient and nurse satisfaction. The hospital cites changing payment models that emphasize the importance of quality of care as a catalyst for this initiative. The hospital's decision also relates to INQRI studies that have found having higher levels of RN skill mix leads to better patient outcomes.

It should also be noted that the union representing the certified nursing assistants protested outside of the hospital yesterday in response to the new care model announcement?

What are your thoughts on this issue?

Click here to read the full story.

Study Finds Linkage 55 Percent of Nurses Are Overweight or Obese

Yesterday, Olivia Katrandjian, reporting for ABC News, shared the results of a recently published study that found 55% of nurses are overweight or obese. The study found that nursing schedules affected not only the health, in regards to the body mass index (BMI) of the nurses, but the quality of care they delivered to patients.While this study was published in the November 2011 issue of the Journal of Nursing Administration, it is now receiving press coverage around the country. This study also builds off of previous findings that found working long shifts and having too little time off were most often related to the death of patients.

Click here to read the news article.

Click here to read the study as published in JoNA.

Non-Profit Nursing Home Staff Happier Than Their For-Profit Counterparts

Last week, Paula Span, of the New York Times, detailed the findings of a recently published study that found nursing home ownership status was significantly related to job satisfaction. The study, published in the September 2011 issue of The Gerontologist, was conducted by a research team that included INQRI grantee, Linda Flynn, PhD, RN, FAAN, as well as INQRI NAC member, Linda H. Aiken, PhD, RN, FAAN. While this study may not have been published in 2012, Ms. Span's discussion of the study's findings in last week's New York Times demonstrates that this issue will be of great importance as the baby boomer generation continues to age and more adult children are faced with the task of finding the best care facilities for their loved ones.

Click here to read Ms. Span's article.

Click here to read the study as published in The Gerontologist (subscription required).