NUR 700 Discussion 6.1: Work Engagement Versus Burnout
NUR 700 Discussion 6.1: Work Engagement Versus Burnout
Nursing Burnout and Work Engagement
Nursing is a profession that is both physically and emotionally demanding. Long work hours, increased workload, and lack of support are just a few of the factors that can lead to nursing burnout, a widespread phenomena seen in healthcare. Burnout is described as a state of depletion of resources of an employee and is a result of negative perception of the work environment (Adriaenessens et al., 2014). It is characterized by exhaustion, decreased levels of work engagement, and reduction in work efficacy. Nursing burnout can have lasting effects on both the nurse and the healthcare organization as it can lead to decreased quality of care and safety issues.
According to Thomas (2018), organizational culture is defined as the various beliefs, values, assumptions, and interactive strategies contributing to an organization’s unique social and psychological environment. Positive working culture is developed when employees and employees share aligned values with each other and the organization. To ensure the success of organizational culture, the first step is for all employees and employers to clearly understand the organization’s values and the belief of the organization. Barriers caused by an organizational culture can cause nursing leaders to feel powerless, and one of those barriers is a negative environment. For example, having a facility or hospital poorly managed by administration personnel or having an administration team that does not communicate with front-line staff creates low workplace morale. When there is a negative environment created around front-line staff, there is a lack of production, increased call-outs, and high turnover rates. “Authority Is maintained centrally, reducing the effectiveness of front-line staff” (Jackson et al., 2021). Employees begin to feel excluded start to feel that the facility or hospital is not ensuring their beliefs and values stay aligned in the best interest of the patients.
Wilmar Schaufeil, a Dutch psychologist, researched the concept of work engagement and offers that engagement includes the psychological components of dedication, absorption, and vigor (Murphy, 2014). In this theory, dedication is characterized by a strong involvement in one’s work and the feeling of enthusiasm and significance, absorption is described as the worker being fully engrossed in one’s work, and vigor is the worker demonstrating high levels of energy and mental resilience in the workplace (Murphy, 2014). His work engagement framework can be used to combat nursing burnout and hopefully lead to increased patient safety and quality of care. Using Schaufeil’s work engagement framework, I would work with my nursing staff to target emotional exhaustion. This can be accomplished with steps such as increasing amounts of administrative support and ensuring staffing adequacy. Additionally, I would combat demanding work conditions, such as lack of control and work overload, by implementing a more empowering work environment. This would include having more opportunities for career development, ensuring that staff has adequate amounts of information and recourses to provide safe and quality care, and allowing for more autonomy. When the work environment does not allow for the nursing staff to have access to these empowering conditions, they may feel as though their role is meaningless. This sense of doubt and insignificance can in turn lead to nursing burnout. Implementation of individual-focuses and organizational-focused interventions can also help foster engagement in the workplace. On an individual level, I would aim to provide staff with activities such as self-care workshops, mindfulness training, and massage to help reduce burnout and increase levels of dedication, vigor, and absorption. I would also target the healthcare organization as a whole by implementing the option for short shifts and self-scheduling, by having stress management workshops, and by having debriefing sessions after stressful events, such as codes. A few weeks ago, my hospital offered 15-minute acupuncture and shoulder massages for the nursing staff. This allowed for us to step away from the hectic emergency department and clear our minds, even if it was only for a few minutes. Introducing similar activities may help increase work engagement in the hospital.
References
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies, 52(2), 649–661. https://doi.org/10.1016/j.ijnurstu.2014.11.004
Murphy, M. O. (2014). Theory of work engagement. In J. J. Fitzpatrick & G. McCarthy (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit (pp. 183–200). Springer. https://doi.org/10.1891/9780826164056
Work Engagement Versus Burnout
Nurse Burnout
Nursing burnout is becoming more common throughout the field of nursing. Nurses experience decreased motivation and energy
while simultaneously experiencing an increase in exhaustion and frustration. Burnout is a national issue that continues to persist, as does the ongoing nursing shortage. The shortage has placed further strain on current nurses, such as unrealistic job expectations, poor working conditions, lack of resources, and increased work demands (Mudallal et al., 2017). I recently left my position at a level four trauma center hospital as Med/Surg nurse due to burnout. Our hospital was small but usually full. I was working the night shift, and each nurse always had at least five patients. We had one CNA for twenty-five patients. Our monitors were from the 1990s, and most of our bed alarms failed to work. The night shift nurses had a few experienced veterans who treated new nurses with respect and were welcoming, but most of the staff seemed interested in getting their paycheck and surviving their shift. The day I decided to resign, I had responded to a code blue near the end of my shift. The staff was disengaged, unorganized, and demonstrated a lack of empathy. Despite this, the patient, fortunately, managed to survive. I had never witnessed such a disorganized code in my career and was appalled. Multiple providers were undergoing burnout, and I knew I did not want to follow the same path.
Work Engagement
Kahn, Schauefeli, Maslach, and Leiter described work engagement as the opposite or antithesis of burnout. Maslach and Leiter described burnout as exhaustion, cynicism, and inefficiency. Schaufeli, Salanova, Gonzalez‐Roma, and Bakker denoted that engagement is consists of vigor, dedication, and absorption and concluded that these three terms are opposites of exhaustion, cynicism, and inefficiency (Knight et al., 2017). However, the most helpful theory to my future practice as DNP is Kahn’s Work Engagement Theory. Kahn discusses three psychological factors that are demonstrated in an individual’s behavior: meaningfulness, safety, and availability. Psychological meaningfulness can be implemented into my future practice by allowing my coworkers to work independently to foster new skills and to be praised for their current value in their role. An example of this would be bringing attention to a nurse’s development of a new skill or technique that fosters a greater efficiency for the workplace and expressing gratitude for their efforts. Demonstrating appreciation to everyone I work with is something I strive for in my current practice and will continue to do moving forward. As a DNP, I will be in a management position. Developing trust with those I work with is critical to success. Therefore, I will have an open-door policy to hear ideas and see how others identify areas for improvement. An example of providing psychological safety would be approaching a new nurse on how to decrease back injuries within our facility. By approaching a new nurse, I would demonstrate the importance of each nurse being able to voice their opinion, develop trust among staff, show a concern for the safety and well-being of the staff, and improve the quality of care delivered. Providing psychological availability begins with providing positive energy myself. As a future leader, it is my responsibility to set an example for those I work with (Murphy, 2014).
I previously worked for IV therapy at a larger hospital. We started all IVs, managed all central lines, and inserted PICC lines. This experience has allowed me to be resourceful in my current job as my coworkers rely on my skill set to start difficult IVs or if a patient has access issues. This allows me to feel useful to my patients and my coworkers. When I achieve my DNP, I will learn my team’s strengths to provide them opportunities to express their abilities. As a future Nurse Practitioner, I plan to promote health interventions to reduce stress, increase energy, and help my coworkers sustain healthier lifestyles. The benefits of health interventions will provide psychological stability and foster psychological safety. In addition, I plan to attend leadership events to improve my management techniques to develop a supportive and resourceful attitude. My current manager demonstrates psychological availability through action (Knight et al., 2017). She has presented an approachable mentality, joyful attitude and is eager to help out our staff at any time. I seek to exemplify this behavior as I move forward to the leadership position of Nurse Practitioner.
References
Knight, C., Patterson, M., & Dawson, J. (2017). Building work engagement: A systematic review and meta-analysis investigating the effectiveness of work engagement interventions. Journal of organizational behavior, 38(6), 792–812. https://doi.org/10.1002/job.2167
Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses’ burnout: The influence of leader empowering Behaviors, work conditions, and demographic Traits. Inquiry : a journal of medical care organization, provision and financing, 54, 46958017724944. https://doi.org/10.1177/0046958017724944
Murphy, M. O. (2014). Theory of work engagement. In J. Fitzpatrick & G. McCarthy (Eds.) (PDF), Theories guiding nursing research and practice (pp. 183–200). New York: Springer.
Even before this current pandemic, the growth in healthcare has provided challenges with increasing expectations, workload, and fewer resources. Frontline nurses are prone to developing job stress and burnout (Remegio et al., 2021). Burnout is a state of exhaustion or excessive stress at work and seems to be caused by high job demands and a sense of feeling emotionally drained and empty (Dall’Ora et al., 2020). Schaufeli and colleagues define work engagement theory as a positive effect, motivational state of fulfillment about work characterized by vigor, dedication, and absorption. Vigor is characterized by high levels of energy and the effort put forth into work. Dedication is a sense of enthusiasm, inspiration, and taking pride in one’s work. The ability to be fully engrossed in one’s work so much that time passes quickly is absorption (Murphy, 2014). As a Doctorate of Nursing Practice (DNP)-prepared nurse, I plan to use compassion satisfaction as a framework to help influence my teams’ perspectives of their working environment and job expectations to prevent burnout and improve patient safety and quality of care. Compassion satisfaction is the pleasure an individual feels from the success of helping others (Remegio et al., 2021). Being open among coworkers regarding decisions, communication, and workload are a few ways to create an efficient, positive, and empowering atmosphere. Providing educational advancement and professional development with mutual respect and social support helps increase job satisfaction, commitment, and engagement while showing one’s growth. I am lucky enough to work in an environment where advancement in education is highly encouraged, and management is willing to work with staff in furthering their professional development through education. It is essential to balance one’s physical and psychosocial health to achieve an efficient work environment to reduce burnout and increase vigor, dedication, and absorption. A recent study done by Remegio and colleagues showed that nurses with master’s and doctoral degrees had a higher level of compassion satisfaction and lower level of burnout than nurses with a bachelor’s degree. Leaders with a higher level of burnout and stress have lower levels of engagement, potentially affecting overall productivity and performance (Remegio et al., 2021). As a DNP-prepared nurse, I will lead by example and exemplify compassion satisfaction to positively affect work engagement with a high level of energy, pride, and compassion towards staff and clients.
Reference
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review.
Human Resources for Health, 18(41). https://doi.org/10.1186/s12960-020-00469-9
Murphy, M. O. (2014). Theory of work engagement. In J.J. Fitzpatrick & G. McCarthy (Eds.),
Theories guiding nursing research and practice: Making nursing knowledge development explicit
(pp.183-200). Springer. https://doi.org/10.1891/9780826164056
Remegio, W., Rivera, R. R., Griffin, M. Q., & Fitzpatrick, J. J. (2021). The professional quality of life
and work engagement of nurse leaders. Nursing Leader, 19(1), 95-100.
https://doi.org/10.1016/j.mnl.2020.08.001
Work Engagement Versus Burnout
As a future DNP-prepared nurse, I could use the Broaden-and-Build Theory to combat nursing burnout and improve patient safety and quality of care. The Broaden-and-Build Theory suggests that “positive emotions exist, not only in the present but over time, and they have a cumulative effect, in a sense supporting health and well-being (Murphy, 2014, p. 187). I believe it is important to support each other, as nurses, mentally and emotionally, during times of high stress in the care we provide to our patients. According to Murphy (2014), “positive emotions…allow individuals to flourish and build personal resources that are physical, intellectual, social, and psychological” (p. 187). Rapid response events in the hospital inpatient setting can be times of high stress amongst all team members involved. I can appreciate it when the House MD or NP reassures me that I am doing my job correctly and debriefs with me following the rapid response event. Personally, this reassurance gives me the confidence boost I need to continue caring for the patient who is declining, as well as for my other patients. Currently, at the hospital for which I work, we are experiencing a nursing shortage. We are seeing an increased number of patients needing inpatient status and not enough nurses to care for all of these patients; therefore, the nurses who continue to show up for work are being assigned more patients during their shift. Unfortunately, more patients coming to the hospital are of higher acuity. Consequently, nurses are working overtime to meet the needs of staffing. All of these factors contribute to burnout which is a real problem amongst the nurses with whom I work.
Nursing burnout can negatively impact patient safety and quality of care. The presence of social support, whether it be from supervisors, coworkers, or family, can “enhance resistance to burnout…which tend[s] to strengthen personal commitment, foster positive results and raise the efficiency of nursing staff” (Cañadas-De la Fuente et al., 2015; as cited in Velando-Soriano et, al., 2020). As a leader and future DNP-prepared nurse, I hope to create a space that is safe for my patients and coworkers. I want to lead by example and promote positive work ethic by enhancing self-esteem. There is no compliment that is too little and it will go a long way.
References
Murphy, M. O. (2014). Theory of work engagement. In J. Fitzpatrick & G. McCarthy (Eds.) (PDF), Theories guiding nursing research and practice (pp. 183–200). New York: Springer.
Velando-Soriano, A., Ortega-Campos, E., Gómez-Urquiza, J. L., Ramírez-Baena, L., De La Fuente, E. I., & Cañadas-De La Fuente, G. A. (2020). Impact of social support in preventing burnout syndrome in nurses: A systematic review. Japan journal of nursing science: JJNS, 17(1), e12269. https://doi.org/10.1111/jjns.12269
Nurse burnout is considered a common phenomenon in the nursing profession. It is characterized by a loss of energy in nurses that manifests as emotional exhaustion, a lack of excitement, and feelings of dissatisfaction, in addition to a drop in work efficacy. According to work engagement theory, work engagement is described as a positive emotional motivating state of fulfillment towards one’s work that is characterised by passion, vigor, and absorption. Patients with high acuity levels are increasingly being encountered in hospital settings, which can be attributed to the quick introduction of new technologies, an increase in workplace violence, and budgetary restrictions. These factors have been associated with increased levels of job-related stress, both collectively and personally. Because of these job-related stressors, in combination with the emotional labor of the job (a nurse may appear competent on the surface, but the work is physically and emotionally demanding), nurses come to believe that they are undervalued (Riedl & Thomas, 2019). This results in a disengaged culture of teamwork among nursing staff, as well as a lack of motivation at work. Ineffective communication skills, inability to manage disagreements, and inability to assist colleagues in critical times can all be caused by a lack of an engaged workforce and unproductive teams. There is evidence to suggest that high levels of employee engagement and teamwork increase the overall quality of an organization’s results (Wan et al., 2018).
Consequently, the involvement and participation of nursing personnel are vital to providing safe patient care. An engaged workforce contributes to a safe, efficient, and successful workplace for nurses as well as their patients. As a future DNP-prepared nurse, I feel I will be able to apply one of its frameworks to battle nursing burnout, improve patient safety, and improve the overall quality of care through affecting nurses’ opinions of their nurse practise environment and employment outcomes. Being aware of the extent of their perceived workload, having a sense of control, providing incentives, fairness, and shared values, and allowing them to participate in joint decision-making are all examples of how to improve job satisfaction and commitment as well as engagement, productivity, patient safety, and quality of care. To establish and maintain stable and high-performing nurse work-forces, it is also necessary to display a balanced, healthy, and supportive nurse practice environment and a psychosocial work environment for all nurses. Diligent work is associated with proactive support of exceptional employment experiences, such as competent leadership, fair nurse-physician interaction, policy development, and adequate nursing staffing.
References
Riedl, E. M., & Thomas, J. (2019). The moderating role of work pressure on the relationships between emotional demands and tension, exhaustion, and work engagement: an experience sampling study among nurses. European Journal of Work and Organizational Psychology, 28(3), 414-429.
Wan, Q., Li, Z., Zhou, W., & Shang, S. (2018). Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement. Journal of Advanced Nursing, 74(6), 1332-1341.
Work Engagement to avoid Nurse/Staff Burnout
Nursing burnout, job burnout, poor performance, and just being overall tired can contribute to many on-the-job errors (Shaufeli et al., 2006). Nurses who are less engaged in their work can exhibit poor work performance, increasing the lack of taking care of patients and giving them their best. This burnout can happen when individuals do not get enough support, resources, and technical help to assist them with their specific job. The role of nursing staff is vital in our healthcare industry (Wan et al., 2018).
When nurses can work together in harmony in an institution, they will have a high success rate of patients healing, improving, and recovering. An example I can share is when the pandemic hit, we had to transition our center to become safer and to decrease exposure and contamination of the virus. We decided to discard any item that had the potential to become a fomite. Fomites are objects or materials likely to carry infections, such as fabrics, utensils, or furniture (Merriam-Webster, 2002).
Teachers had to throw away papers, books, blocks, soft toys, rugs, pillows, and anything that did not have a surface that could be cleaned. I saw a teacher with tears forming in her eyes as she had to pack her beautiful items in bags and throw them away. She was broken and traumatized. She displayed signs of “burnout” from the pandemic. I used Shaufeli’s work engagement theory and began to create a positive space dispelling the negative cloud that had started to cover our world. I recognized that we needed to create an environment of positivity, vigor, and care. I took the time to celebrate her accomplishments and the labor of love she had given to families over the years. This act of compassion allowed her to consider the years of dedication provided to her children as a fantastic teacher. Her focus shifted from a place of pain to reward.
Shaufeli defines work engagement as an individual possessing a positive, fulfilling state of mind distinguished by vigor, dedication, and absorption (Shaufeli, 2006). Embracing the dedication of the staff and commitment of the team was vital, as many staff had been with the company for over ten years. As a future DNP leader, I recognize the importance of supporting my staff and the importance of avoiding nurse/staff burnout. I understand that our job has high demands and that many times resources are limited. However, if we want to create workspaces that have positive outcomes with staff, our families, and the communities we serve, we must ensure that all team members take care of their minds, bodies, and spirits.
References
Merriam-Webster collegiate dictionary (11th ed.). (2002). Springfield, MA: Merriam Webster
Shaufeli, W., Bakker, A., Salanova, M. (2006) The measurement of work engagement with a short questionnaire: A cross-national study. Educational and Psychological Measurement, 66 (4), 701-716.
doi:10.1177/0013164405282471
Wan, Q., Li. Z., Zhou, W., Shang, S,. (2018) Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement. Journal of Advanced
Nursing, 74:1332-1341.