Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

EVIDENCE- BASED CARE SHEET

ICD-9 V62.29

ICD-10 Z56.6

Authors Mary Woten, RN, BSN

Cinahl Information Systems, Glendale, CA

Nathalie Smith, RN, MSN, CNP Cinahl Information Systems, Glendale, CA

Reviewers Carita Caple, RN, BSN, MSHS

Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

July 6, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206. Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

Nurse Stress Index (NSI)

What We Know › Work-related stress occurs when the abilities, resources, and/or needs of an employee do

not match the requirements of his/her job(16)

• Workplace factors that increase the risk of work-related stress include a heavy workload, shift work (e.g., working evening or night shifts), poor interpersonal interactions, lack of support from colleagues and management, a nonparticipatory management style, unclear job expectations, job insecurity, inadequate training, lack of advancement opportunities, and a dangerous or unpleasant physical environment(6,14,16)

• Work-related stress can place employees at higher risk for cardiovascular disease, musculoskeletal disorders, urinary tract symptoms including overactive bladder, gastrointestinal disorders, sleep disorders, and psychological disorders(2,4,10,16,17)

› Nurses are at high risk for work-related stress(6,9)

• Work-related stress in nurses is a predictor of decreased job satisfaction, burnout (i.e., a syndrome characterized by emotional exhaustion, depersonalization [i.e., feeling withdrawn and disconnected from coworkers], cynicism, reduced perception of ability, and reduced personal accomplishment) and poor performance, and can compromise nursing care and place patients at risk(7,13)

– Healthcare organizations can increase job satisfaction among nurses by reducing sources of work-related stress(3)

– Nurse managers who have a high tolerance for stress may be less susceptible to occupational stress. Researchers performing a cross sectional study in five Brazilian hospitals found an inverse correlation between hardiness (a quality of having a stress resistant personality) and stress among 62 nurses in managerial positions(5)

– Researchers performing a quantitative systematic review of literature examining stress management interventions for nurse leaders found that interventions involving mental exercise components produced the most significant improvements in well-being. The researchers also concluded, however, that existing studies are in general of low quality(8). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

– Occupational well-being in first-line nurse managers can be predicted by job demands, job control, and social support of their team and management. Investigators conducting a cross-sectional survey of 318 first-line nurse managers in Belgian hospitals found that these three factors were the top predictors of stress outcomes. The researchers concluded that hospital management should work to influence these aspects to improve working conditions and employee retention for managerial nursing staff(1)

– Researchers conducting an integrative review of 22 articles on stress and ways of coping among nurse managers found that managers generally experienced moderate stress levels, primarily from heavy workloads, lack of resources, and financial responsibilities(11)

• Work situations that nurses often perceive as stressful include(9,15)

– managing the demanding workload – Sources of stress reported by nurses include inadequate time to complete nursing

tasks and being asked to complete non-nursing tasks (e.g., clerical work)

 

 

– interprofessional conflict – Nurses report poor communication, a lack of support from other staff members, and a lack of involvement in decision

making as sources of stress – inadequate preparation for a managerial role – dealing with death and dying – instances in which they lack confidence and/or skills regarding dealing with the emotional needs of patients and family

members › The Nurse Stress Index (NSI) was developed to evaluate perceived sources of work-related stress in nurses with managerial

responsibilities (e.g., charge nurses)(9)

• The NSI is a 30-item self-report instrument consisting of six subscales, each of which measures a different domain of work-relatedstress(3,9)

– The six domains of work-related stress measured are(3,9)

– managing workload 1 (MW1) – Included in this domain are workload issues related to time management, including

– not having enough time to accomplish tasks – having to meet deadlines – staff members who demand time – urgent situations taking time away from planning – having to perform trivial tasks

– managing workload 2 (MW2) – Included in this domain are

– workload issues related to resource shortages – prioritization – interruptions that prevent working on prioritized tasks – fluctuations in workload – conflicts between nursing and managerial roles

– organizational support and involvement (OSI) – Included in this domain are

– a lack of participation in organizational changes – a lack of support from senior managers – unsatisfactory relationships with senior managers – senior managers not understanding the needs of the unit – receiving only negative feedback

– home-work conflict (HWC) – Included in this domain are

– tensions involved in balancing home and work demands – senior managers not understanding demands related to home – home demands interfering with advancement at work – the need to take time off from work to focus on home demands – being too emotionally involved in work

– confidence and competence in role (CCR) – Included in this domain are

– the ability to effect change among staff members or in the organization – having to perform tasks beyond personal skill level – adapting to new technologies – lack of specialized training – uncertainty about role responsibilities

– dealing with patients and relatives (DPR) – Included in this domain are

– dealing with difficult patients – dealing with aggressive persons – dealing with family members

 

 

– dealing with life-or-death situations – providing bereavement counseling

• The NSI is scored using a 1–5 Likert scale in which a score of 1 represents no perceived stress and a score of 5 represents extreme perceived stress(7,9)

• The NSI has been shown to have acceptable concurrent validity, internal reliability, and split-half reliability(3,7,9,14)

– There are weaknesses in the content validity of the NSI, and the NSI has not been appropriately evaluated with regard to test-retest reliability(9)

What We Can Do › Learn about work-related stress and the NSI so you can appropriately assist management personnel in assessing perceived

sources of work-related stress among nurses with managerial responsibilities and in devising strategies to decrease work-related stress; share this information with your colleagues(12)

› Participate in any research initiatives in your facility in which the NSI is used to evaluate perceived stress among nurses with managerial responsibilities. Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

› Collaborate with your facility’s education department to provide continuing medical education on work-related stress for charge nurses and nurse managers

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Adriaenssens, J., Hamelink, A., & Bogaert, P. V. (2017). Predictors of occupational stress and well-being in first-line nurse managers: A cross-sectional survey study.

International Journal of Nursing Studies, 73, 85-92. doi:10.1016/j.ijnurstu.2017.05.007 (R)

2. Borchini, R., Bertu, L., Ferrario, M. M., Veronesi, G., Bonzini, M., Dorso, M., & Cesana, G. (2015). Prolonged job strain reduces time-domain heart rate variability on both working and resting days among cardiovascular-susceptible nurses. International Journal of Occupational Medicine and Environmental Health, 28(1), 42-51. doi:10.2478/s13382-014-0289-1 (R)

3. Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nursing in Critical Care, 15(3), 129-140. doi:10.1111/j.1478-5153.2009.00384.x (R)

4. Costa, G., Anelli, M. M., Castellini, G., Fustinoni, S., & Neri, L. (2014). Stress and nurses employed in “3×8” and 2×12” fast rotating shift schedules. Chronobiology International, 31(10), 1169-1178. (R)

5. de Freitas, F. M. B., Vannuchi, M. T. O., Haddad, M. D. C. L., de Carvalho Silva, L. G., & Rossaneis, M. A. (2017). Hardiness and occupational stress in nurse managers of hospital institutions. Journal of Nursing UFPE, 10(11), 4199-4205. doi:10.5205/reuol.10712-95194-3-SM.1110sup201725 (R)

6. Elovainio, M., Kuusio, H., Aalto, A. M., Sinervo, T., & Heponiemi, T. (2010). Insecurity and shiftwork as characteristics of negative work environment: Psychosocial and behavioural mediators. Journal of Advanced Nursing, 66(5), 1080-1091. doi:10.1111/j.1365-2648.2010.05265.x (R)

7. Flanagan, N. A. (2006). Testing the relationship between job stress and satisfaction in correctional nurses. Nursing Research, 55(5), 316-327. (R)

8. Haggman-Laitila, A., & Romppanen, J. (2018). Outcomes of interventions for nurse leaders’ well-being at work: A quantitative systematic review. Journal of Advanced Nursing, 74(1), 34-44. doi:10.1111/jan.13406 (SR)

9. Harris, P. E. (1989). The Nurse Stress Index. Work & Stress, 3(4), 335-346. (R)

10. Koh, S. J., Kim, M., Oh da, Y., Kim, B. G., Lee, K. L., & Kim, J. W. (2014). Psychosocial stress in nurses with shift work is associated with functional gastrointestinal disorders. Journal of Neurogastroenterology and Motility, 20(4), 516-522. doi:10.5056/jnm14034 (R)

11. Labrague, L. J., McEnroe-Petitte, D. M., Leocadio, M. C., Van Bogaert, P., & Cummings, G. C. (2018). Stress and ways of coping among nurse managers: An integrative review. Journal of Clinical Nursing, 27(7-8), 1346-1359. doi:10.1111/jocn.14165 (RV)

12. Middaugh, D., & Willis, A. (2018). Managerial burnout: Putting out the flames. MEDSURG Nursing, 27(2), 121-122. (RV)

13. Nabirye, R. C., Brown, K. C., Pryor, E. R., & Maples, E. H. (2011). Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. Journal of Nursing Management, 19(6), 760-768. doi:10.1111/j.1365-2834.2011.01240.x (R)

14. Rodrigues, V. M. C. P., & Ferreira, A. S. S. (2011). Stressors in nurses working in intensive care units. Revista Latino-Americana de Enfermagem, 19(4), 1025-1032. doi:10.1590/S0104-11692011000400023 (R)

15. Stecker, M., & Stecker, M. M. (2014). Disruptive staff interactions: A serious source of inter-provider conflict and stress in health care settings. Issues in Mental Health Nursing, 35(7), 533-541. doi:10.3109/01612840.2014.891678 (R)

16. United States Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Health and Safety (NIOSH). (2014, June 6). Stress at work (DHHS [NIOSH] Publication No. 99-101. Retrieved June 26, 2018, from http://www.cdc.gov/niosh/docs/99-101/ (GI)

17. Zhang, C., Hai, T., Yu, L., Lui, S., Li, Q., Zhang, X., & Wang, X. (2013). Association between occupational stress and risk of overactive bladder and other lower urinary symptoms: A cross-sectional study of female nurses in China. Neurourology and Urodynamics, 32(3), 254-260. doi:10.1002/nau.222 (R)

EVIDENCE- BASED CARE SHEET

ICD-9 V62.1

ICD-10 Z56.6

Author Tanja Schub, BS

Cinahl Information Systems, Glendale, CA

Reviewers Darlene Strayer, RN, MBA

Cinahl Information Systems, Glendale, CA

Bryan Boling, RN, DNP, CCRN-CSC Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

May 4, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206. Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

Job Stress and Burnout in Nurses

What We Know › Job stress, which can be defined as the harmful physical and emotional results of

a mismatch between job demands and the worker’s capabilities, has been cited as an occupational hazard since the mid-1950s. It is well documented that nursing is a profession that is associated with high levels of job stress(5,7)

• Burnout is typically described as a syndrome characterized by emotional exhaustion, depersonalization (i.e., having the perception of being disconnected or disengaged from one’s environment and lacking personal involvement with others), cynicism, reduced perceptions of ability, and reduced personal accomplishment. Burnout is a potential consequence of chronic job stress. Healthcare professionals, including nurses, are among the groups at highest risk for developing burnout(1,4,5,7,8)

– More than 40% of nurses report experiencing significant burnout(5)

– Despite the high prevalence of job stress and burnout, many of the subsequent health consequences to patients and healthcare professionals are not recognized in health care, resulting in lack of resources from hospital administration(11)

› Factors that can lead to job stress and burnout in nurses include coping with death and suffering of patients, conflict with physicians, inadequate training, high levels of personal stress, lack of social support, lack of self-efficacy and resiliency, conflict with nursing colleagues and supervisors, poor staffing and excessive workload, dissatisfaction with work-life balance, role conflict and ambiguity, uncertainty about treatments given, conflict with patients and family members, violence and abuse from patients, and lack of access to ongoing education(2,3,4,5,6,7,9,13)

• In a study of 417 hemodialysis nurses, older nurses and those with longer tenure in the field reported higher job satisfaction levels, less stress, and less burnout than younger nurses(7). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

• Authors of a systematic review found that insufficient staffing on oncology/hematology units was associated with more job dissatisfaction, stress, and burnout, all of which contributed to staff turnover(13)

• In a study of 676 nurses working in public health centers in Andalusia, Spain, investigators found that being agreeable, extroverted, conscientious, and neurotic were personality traits that predicted burnout(1)

• Researchers in a study of 1,061 nurses working in hospitals in China found a negative correlation between resilience and burnout(6)

• Investigators in a study of 596 nurses in Canada found that occupational coping self-efficacy, an individual’s belief in his or her ability to cope with external stressors in the workplace, was protective against incivility in the workplace and subsequent burnout and turnover(2)

• Researchers in South Korea reported that higher emotional intelligence—defined as the ability to identify, express, and evaluate emotions—was associated with lower stress and burnout.(9) (For more information on emotional intelligence in nursing, see Evidence-Based Care Sheet … Emotional Intelligence in Nursing Practice )

 

 

• Nurses working in certain specialized clinical areas—including oncology, hospice, and critical care—might be more susceptible to stress and burnout than those working in other clinical areas(10,11)

– Researchers in a study of 1,357 palliative care clinicians reported a burnout rate of 62%. Emotional exhaustion was found to be the most common cause of burnout. Nonphysician clinicians were more likely than physicians to experience burnout (66% vs 60%)(10)

– Nurses working in different clinical settings might report experiencing different stressors. For example, nurses working in the ICU might experience more stress due to coping with patient pain and suffering, and those working in a surgical setting might be more likely to experience stress due to excessive workload(4)

– Stressors experienced by hemodialysis nurses include risk of contamination through exposure to blood-borne pathogens and patient morbidity and mortality; older nurses and those with longer duration of work in hemodialysis report higher levels of burnout(7)

› Job stress and burnout produce a neuroendocrine response that results in other physiologic reactions that contribute to physical and mental illness. Potential consequences of chronic job stress and burnout include cardiovascular disease; migraines; hypertension; irritable bowel syndrome; insomnia; muscle tension; immune dysfunction; feelings of anger, shame and depression; anxiety; anorexia; and social withdrawal. The emotional consequences of job stress and burnout can lead to compulsive behaviors, including substance abuse and gambling(4,5,8,14)

• Job stress and burnout can contribute to absenteeism and turnover, both of which can reduce productivity and efficiency and compromise patient care(4,8). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

– In a cross-sectional study of 2,084 baccalaureate degreed nurses working in 94 community hospitals in Thailand, researchers found that higher nurse burnout was associated with negative patient outcomes, including patient falls, medication errors, and infections(12)

• Researchers in a study of 305 female nurses with cardiovascular disease observed that high levels of burnout at the beginning of the study were associated with decreases in health-related quality of life, including worsened physical and mental functioning, 1 year later(14)

› The Mayo Clinic implemented anti-burnout program, including the following five pillars:(8)

• Control: partnering with leaders and having a voice in the organization • Leadership: leaders who are transparent communicators and show appreciation to staff • Pebbles: the concept of determining the “pebbles in your shoes” and the work processes to remove them, whether through

policy changes or quality improvement techniques • Camaraderie: meeting with work colleagues to discuss positive characteristics of work and professional issues • Healthy habits: promoting and maintaining self-care, including diet, exercise, laughter, sleep, gratitude, forgiveness, and

meditation

What We Can Do › Learn about job stress and burnout in nurses, including risk factors and potential consequences; share this information with

your colleagues › Provide psychosocial support to your colleagues who might be experiencing stress and burnout(7,8)

› Focus on accepting change and on internal improvements and finding meaning and purpose in your work(8)

› In your role as nurse manager, • assess staff nurses for signs of stress and burnout(5)

• initiate strategies, when possible, to decrease the workload of nurses(4,8)

• increase nursing access to continuing education, including education regarding the development of skills for coping with workplace stress (e.g., education on cognitive behavioral strategies for specific problems to change from maladaptive to adaptive behaviors)(7,11). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

 

 

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Canadas-De la Fuente, G. A., Vargas, C., San Luis, C., Garcia, I., Canadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing

profession. International Journal of Nursing Studies, 52(1), 240-249. doi:10.1016/j.ijnurstu.2014.07.001 (R)

2. Fida, R., Laschinger, H. K. S., & Leiter, M. P. (2018). The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study. Health Care Management Review, 43(1), 21-29. doi:10.1097/HMR.0000000000000126 (R)

3. Flynn, L., & Ironside, P. M. (2018). Burnout and its contributing factors among midlevel academic nurse leaders. Journal of Nursing Education, 57(1), 28-34. doi:10.3928/01484834-20180102-06 (R)

4. García-Izquierdo, M., & Ríos-Rísquez, M. I. (2012). The relationship between psychosocial job stress and burnout in emergency departments: An exploratory study. Nursing Outlook, 60(5), 322-329. doi:10.1016/j.outlook.2012.02.002 (R)

5. Grønkjær, L. L. (2013). Nurses’ experience of stress and burnout: A literature review. Klinisk Sygepleje, 27(1), 15-26. (RV)

6. Guo, Y. F., Luo, Y. H., Lam, L., Cross, W., Plummer, V., & Zhang, J. P. (2018). Burnout and its association with resilience in nurses: A cross-sectional study. Journal of Clinical Nursing, 27(1-2), 441-449. doi:10.1111/jocn.13952 (R)

7. Hayes, B., Douglas, C., & Bonner, A. (2015). Work environment, job satisfaction, stress and burnout among haemodialysis nurses. Journal of Nursing Management, 23(5), 588-598. doi:10.1111/jonm.12184 (R)

8. Hilton, L. (2016). Beyond burnout. Urology Times, 44(10), 1-4. (X)

9. Hong, E., & Lee, Y. S. (2016). The mediating effect of emotional intelligence between emotional labour, job stress, burnout and nurses’ turnover intention. International Journal of Nursing Practice, 22(6), 625-632. doi:10.1111/ijn.12493 (R)

10. Kamal, A. H., Bull, J. H., Wolf, S. P., Swetz, K. M., Shanafelt, T. D., Ast, K., … Abernethy, A. P. (2016). Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. Journal of Pain and Symptom Management, 51(4), 690-696. doi:10.1016/j.jpainsymman.2015.10.020 (R)

11. Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessier, C. N. (2016). An official Critical Care Collaborative statement: Burnout syndrome in critical care health care professionals: A call for action. American Journal of Critical Care, 25(4), 368-376. doi:10.4037/ajcc2016133 (GI)

12. Nantsupawat, A., Nantsupawat, R., Kunaviktikul, W., Turale, S., & Poghosyan, L. (2016). Nurse burnout. Nurse-reported quality of care, and patient outcomes in Thai hospitals. Journal of Nursing Scholarship, 48(1), 83-90. doi:10.1111/jnu.12187 (R)

13. Toh, S. G., Ang, E., & Devi, M. K. (2012). Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. International Journal of Evidence-Based Healthcare, 10(2), 126-141. doi:10.1111/j.1744-1609.2012.00271.x (SR)

14. Zhang, M., Loerbroks, A., & Li, J. (2018). Job burnout predicts decline of health-related quality of life among employees with cardiovascular disease: A one-year follow-up study in female nurses. General Hospital Psychiatry, 50, 51-53. doi:10.1016/j.genhosppsych.2017.10.004 (R)

EVIDENCE- BASED CARE SHEET

Author Tanja Schub, BS

Cinahl Information Systems, Glendale, CA

Reviewers Darlene Strayer, RN, MBA

Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

April 13, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206. Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

Burnout in Oncology Nursing Staff

What We Know › Burnout is usually described as a syndrome characterized by emotional exhaustion,

depersonalization (i.e., a feeling of being disconnected from coworkers), cynicism, reduced perception of personal ability, and reduced personal accomplishment. Burnout is an important health condition that can result from chronic job-related stress (for more information, see Evidence-Based Care Sheet … Job Stress and Burnout in Nurses ). Healthcare professionals, including nurses, are among the groups that are most at risk for developing burnout(1,2,5,8,9,10,11,12)

• Burnout contributes to physical and psychological illness, which can lead to absenteeism and staff turnover, reduce productivity and efficiency, cause compassion fatigue (i.e., a severe malaise that develops as a result of caring for patients who are in pain or are otherwise suffering and that can lead to chronic fatigue, irritability, dread regarding going to work, aggravation of physical ailments, and lack of joy in life), and compromise patient care. Burnout can lead to nurses leaving the profession(1,5,8,11)

› Nurses who care for patients in certain specialty areas—including oncology—can be more susceptible to stress and burnout than those who work in other specialty areas(4,5,8,9,10,11,13)

• Researchers who conducted a study of 243 oncology/hematology nurses in Australia found that over 70% experienced moderate to high levels of emotional exhaustion and over 48% reported uncertainty regarding whether they would remain in the specialty for the next year(2)

– The Institute of Medicine and the National Cancer Policy Board predict that there will be an imminent crisis related to a shortage of sufficiently trained nurses to deliver the required care to the growing number of patients with cancer in the United States; this highlights the importance of retaining oncology nurses in the workforce(7)

› Factors that may lead to job stress and burnout in oncology nurses include coping with patient death and suffering, managing severe clinical symptoms and complex pathologies in patients who have a poor prognosis, and administering complex and invasive treatment that can diminish patient quality of life. Oncology nurses can feel unable to properly handle events related to death and dying, feel powerless to relieve patient suffering, and experience guilt and anger related to their nursing role(1,5,11,14). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

• Additional factors associated with stress and burnout in nurses include role ambiguity, lack of social support, poor staffing and excessive workload, and weekend and evening hours(11,13)

– Authors of a systematic review found that substandard staffing on oncology units was associated with increased job dissatisfaction, stress, and burnout, which contributed to turnover in nursing; nurses who had higher qualifications and a higher position, were working full time, and were working in a non-Magnet hospital were more likely to blame substandard staffing as a primary contributor to job dissatisfaction, stress, and burnout(14)

– Researchers in a study of survey data collected from 4,047 nurses who worked in 282 hospitals in three different states found that compared with medical-surgical nurses, oncology nurses reported less burnout, a more favorable practice environment

 

 

(specifically more favorable staffing, adequate resources, and collegial nurse-physician relationships), less job dissatisfaction, and less intent to leave their current position; these results suggest that improving the oncology nursing practice environment may help increase job satisfaction for oncology nurses, reduce stress and burnout, and decrease nurse turnover(13)

• The clinical practice setting for oncology nurses can affect the degree of burnout they experience(5,10)

– Researchers in a study of 92 oncology nurses in Italy reported that nurses working in a hospital oncology unit experience higher levels of burnout than nurses working in hospice(10)

– Most nurses working in a hospital unit experienced moderate to high levels of burnout, and the majority of nurses working in hospice experienced low levels of burnout – Although the authors were not able to identify the causes of this disparity in the level of burnout, they suggested

that the different goals of the two patient care settings—healing in the acute care/hospital setting versus receiving supportive care in the hospice setting—may be an important factor in reducing the nurses’ feelings of personal and professional failure and in diminishing the level of burnout in nurses working in hospice

– In a study of 74 oncology nurses working at a metropolitan oncology center, investigators found that levels of personal accomplishment were higher in nurses working in adult care settings compared with nurses working in pediatric care settings; emotional exhaustion was lowest in younger nurses and highest in nurses working in an outpatient setting(5). Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

› Self-care strategies that can help nurses cope with the stress of delivering hospice and palliative care include maintaining emotional control, attending continuing education courses, taking regular breaks from work, adjusting the pace of work, maintaining good nutrition,regular sleep schedules and maintaining quality sleep, engaging in regular physical exercise, maintaining stable interpersonal relationships outside of work, practicing meditation, journaling, performing breathing exercises, practicing cognitive reframing (i.e., reappraising a stressful situation in a positive manner), and finding a sense of meaning related to a patient’s death.(6) There is, however, limited published evidence specifically regarding strategies for lessening burnout in oncology nurses(1,3,5,8,9)

• Coping strategies used by oncology nurses to manage the effects of chronic job-related stress and reduce burnout include – incorporating certain self-care practices in daily life, including practices related to spirituality and religious faith, music,

art, and attention to personal health(1,5)

– Researchers in a pilot study of 65 physicians and nurses working in an adult or pediatric oncology unit reported that providing an art therapy intervention resulted in a significant reduction in the level of clinician burnout(8)

– fostering relationships with colleagues(5)

– using onsite professional resources such as employee assistance programs, the chaplain/pastoral care department, or a staff counselor or psychologist(1)

– Employee assistance programs vary by institution in terms of the allowed number of sessions and associated fees; most limit employees to three free sessions per year(1)

– attending educational programs to improve knowledge and skills related to coping, adaptation, and emotional self-care(1,9)

– Researchers reported that attending a communication skills training program for nurses in gynecologic oncology led to a significant decrease in the general level of nurse burnout. The program included a theoretical lesson related to providing care for patients with gynecologic cancer, a short film, role-playing exercises, and discussion of personal experiences(9)

– Maintaining good sleep quality(3)

– Investigators interviewing 94 oncology nurses regarding favored work time, sleep habits and sleep quality found that oncology nurses who sleep consistently at their preferred time and achieve good quality sleep on a regular basis exhibit significantly fewer signs of burnout than those who did not do so and concluded that working at one’s preferred time of day and maintaining good sleep quality contributes to decreased burnout in oncology nurses(3)

What We Can Do › Learn about burnout in oncology nurses so you can accurately assess your personal characteristics and those of other nurses

in order to attain appropriate education to prevent burnout; share this information with your colleagues › Collaborate with other nurses in your work environment to reduce burnout(1)

• Take advantage of services that are available through your employer (e.g. counseling, pastoral care) • Participate in training programs to enhance your skills related to communication, conflict resolution, and self-care. Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

 

 

• Provide psychosocial support to your colleagues who may be experiencing stress and burnout; develop and attend a support group for oncology nurses

Note › Recent review of the literature has found no updated research evidence on this topic since previous publication on July 1,

2016

 

 

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191.

doi:10.1188/09.CJON.183-191 (R)

2. Barrett, L., & Yates, P. (2002). Oncology/haematology nurses: A study of job satisfaction, burnout, and intention to leave the specialty. Australian Health Review, 25(3), 109-121. (R)

3. Bellicoso, D., Ralph, M. R., & Trudeau, M. E. (2014). Burnout among oncology nurses: Influence of chronotype and sleep quality. Journal of Nursing Education and Practice, 4(8), 80-89. doi:10.5430/jnep.v4n8p80 (R)

4. Braithwaite, M. (2008). Professional growth and development. Nurse burnout and stress in the NICU. Advances in Neonatal Care, 8(6), 343-347. doi:10.1097/01.ANC.0000342767.17606.d1 (RV)

5. Davis, S., Lind, B. K., & Sorensen, C. (2013). A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings. Oncology Nursing Forum, 40(4), E303-E311. doi:10.1188/13.ONF.E303-E311 (R)

6. Henry, B. J. (2014). Nursing burnout interventions: What is being done? Clinical Journal of Oncology Nursing, 18(2), 211-214. doi:10.1188/14.CJON.211-214 (RV)

7. Institute of Medicine (IOM). (2009). Ensuring quality cancer care through the oncology workforce: Sustaining care in the 21st century. Washington, DC: The National Academies Press. (G)

8. Italia, S., Favara-Scacco, C., Di Cataldo, A., & Russo, G. (2008). Evaluation and art therapy treatment of burnout syndrome in oncology units. Psycho-Oncology, 17(7), 676-680. doi:10.1002/pon.1293 (R)

9. Lupo, F. N., Arnaboldi, P., Santoro, L., D’Anna, E., Beltrami, C., Mazzoleni, E. M., … Didier, F. (2013). The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: An Italian experience. Palliative and Supportive Care, 11(3), 199-203. doi:10.1017/S1478951512000247 (R)

10. Ostacoli, L., Cavallo, M., Zuffranieri, M., Negro, M., Sguazzotti, E., Picci, R. L., … Furlan, P. M. (2010). Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices. Palliative and Supportive Care, 8(4), 427-432. doi:10.1017/S1478951512000295 (R)

11. Potter, P., Deshields, T., Divanbeigi, J., Berger, J., Cipriano, D., Norris, L., & Olsen, S. (2010). Compassion fatigue and burnout: Prevalence among oncology nurses. Clinical Journal of Oncology Nursing, 14(5), E56-E62. doi:10.1188/10.CJON.E56-E62 (R)

12. Romeo-Ratliff, A. (2014). An investigation into the prevalence of and relationships among compassion fatigue, burnout, compassion satisfaction, and self-transcendence in oncology nurses. Seton Hall University Dissertations and Theses (ETDs), 1939. Retrieved from http://scholarship.shu.edu/dissertations/1939 (U)

13. Shang, J., Friese, C. R., Wu, E., & Aiken, L. H. (2013). Nursing practice environment and outcomes for oncology nursing. Cancer Nursing, 36(3), 206-212. doi:10.1097/ NCC.0b013e31825e4293 (R)

14. Toh, S. G., Ang, E., & Devi, M. K. (2012). Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. International Journal of Evidence-Based Healthcare, 10(2), 126-141. doi:10.1111/j.1744-1609.2012.00271.x (SR)