Nursing Case Study: Impact of Burnout on Nurses Performance in Australian Healthcare

Question

Task

Write a nursing case study addressing the reason behind the nurse’s burnout and its impact on their performance in Australian Hospitals.

Answer

Introduction
Nursing profession is a very important role in healthcare; and the professionals are involved in everyday care practices for patients. In order to do so, these professionals must possess required skills and expertise. The expertise, experience and commitment of these professionals are shaping the quality of healthcare service provision to the care users, as well as patient safety. Therefore, it is obvious that the job satisfaction, commitment are affecting the performance of these nursing staffs. Poor job satisfaction and higher work pressure among the nurses is a common phenomenon in the healthcare industry, which has been leading to some physical and mental consequences among the nursing professionals, identified as “burnout” (Khamisa, Peltzer & Oldenburg, 2013). “Burnout” of staffs is addressed as a “nursing outcome” in the workforce research, which need to understand the impact of context and inputs on outcome in healthcare environment. The term was first pioneered by Freudenberger in 1974, upon observation of lacking motivation and minimizing commitment among mental health clinic volunteers (Dall’Ora et al., 2020). Later, it has been identified as the “physical and mental status” of clinicians, resulted from lacing emotional resources, emotional exhaustion and poor commitment to work”. As the situation has become highly common throughout the world, affecting the performance of nurses and patient outcomes, the following study is being proposed to analyze the phenomenon and its impact in the Australian healthcare context.

Overview
Nursing shortage is long sustaining and continuous problem, which is creating the healthcare environment with high work pressure for the existing nursing staffs. This issue has been researched a lot, as it has been seen to affect the physical and mental health of the nursing staffs, while affecting their performance significantly. In this regards, it has also noted that due to exhaustion and other wellbeing related issues, nurses working with burnout condition, are prone to undergo error prone practices within healthcare context (Shahzad, Ahmed & Akram, 2019). The issue is being noted as “burnout”, meaning exhaustion due to workload. The following study is going to emphasize upon the impact burnout upon the performance of ward nurses. In this regards, it is noteworthy that according to the employment legislations and policies in healthcare, the maximum hours of work is restricted. However, due to staff shortage issue, the issue of burnout is increasing and the issue is further causing increased turnover rate among the nurses. The organizational requirements should address the needs of ward nurses and should meet their needs of work-life balance, which is usually not met, due to longer working hours and lack of motivation. Organizational requirements for addressing this issue would require training and improved management infrastructure, along with increased efficiency in recruitment.

The Review

Topic and purpose
Nursing is a crucial job in the healthcare industry, which is under constrain for a long period. The persistent issue of staff shortage has affected the profession and burnout is being considered as the key consequence of the issue. Several research and reviews have identified the relationship between work organization variables and consequences, including “quality of care, patient safety, sickness absence, turnover, and job dissatisfaction” (Creedy et al., 2017). Recent Australian statistics are indicating escalating levels of over-work and burnout among nurses and midwives, which are considered among the highest valued professionals in Australia. The purpose of the current research is to address this issue.

Potential Significance
The national survey among 3000 nurses and midwives in Australia revealed that 32% among these professionals are experiencing as high level of burnout, which is making the to consider leaving the profession. It is indicating the estimation by federal government for a workforce shortfall of 85000 by 2025 and 123000 by 2030 (Holland & Tham, 2016). Therefore, in one hand, job demand is increasing in this sector, with complex needs of patients; on the other hand, the staff turnover is increasing due to burnout. This is making the issue worse and indicating that the issue should be considered now, analyzing its impact on performance and finding solution.

Research aim and objectives
The aim of the current study is to analyze the impact of burnout of ward nurses in Australian hospitals, upon their nursing performance. The researcher has set some key objectives, aligning with the aim.

• To conceptualize nursing burnout in healthcare sector
• To analyze the impact of burnout among ward nurses upon their performance in Australia
• To identify the factors (issues) responsible for influencing burnout among ward nurses in Australian hospitals
• To recommend strategies to the Australian hospitals for reducing burnout among ward nurses for their performance improvement

Research question
In order to meet the research aim, the following questions would be answered through the study.

• What is nursing burnout in healthcare?
• How burnout among ward nurses is impacting their performance in Australia?
• What factors (issues) is responsible for influencing burnout among ward nurses in Australian hospitals?
• What could be recommended to the Australian hospitals for reducing burnout among ward nurses for their performance improvement?

Limitations
The researcher has attempted to propose the study in the most effective way, but there are some limitations, which could affect the maximum outcomes of the research. For instance, it has been revealed that due to COVID-19 pandemic, it is difficult to gather primary quantitative data from the ward nurses directly; thus, the researcher would use the online platforms, for gathering survey data. On the other hand, it was also difficult to conduct face-to-face interview of managers, due to this issue. Thus, the researcher would arrange telephonic interview, to eliminate the issue. However, due to this limitation, the sample size became small, which might affect the overall quality of research findings.

Review of the Significant Literature

Concept of staff burnout
Staff burnout is a key term used in different industries, especially in healthcare, which indicates a “physical, mental, and emotional state” of staffs, raised due to overwhelming work pressure and a long term lack of job fulfillment and support. The term “burnout” was coined by “Freudenberger” in 1974, upon observing a loss of motivation and minimized commitment of volunteers working at a mental health clinic (Dall’Ora et al., 2020). Common symptoms of burnout among nurses could include “physical or emotional exhaustion, job-related cynicism, and a low sense of personal accomplishment, leading to a prolonged stressed and depressed situation”. Mostly, nurses complain about not having work-life balance, due to higher work pressure, as well as working for more hours than their shifts. Nursing leadership and nurse staffing levels have been found to be associated with the issue.

Factors contributing to staff burnout in nursing
Considering the nurse burnout as a key phenomenon affecting the patient safety and quality of healthcare practices, a lot research have been done on identifying the key factors contributing to the nurses’ burnout. The findings are diverse in nature. It is revealed by Boamah, Read and Spence Laschinger (2017) that both “personal and environmental factors” are contributing to the level of nurse burnout at a specific hospital. In this regards, from the other evidences, the education level as well as level of training of the nursing staffs have been seen to contribute significantly in their job satisfaction and level of nursing burnout.

Further, Zaki et al., (2016) has analyzed the factors related to burnout among the nurses in Saudi Arabia and revealed that it is a concept with three components, including “low personal accomplishment (PA), Depersonalization (DP) and Emotional exhaustion (EE)”, influenced by multifaceted context. In this context, the authors have highlighted that workload is a crucial factor leading to burnout among nurses. The researchers analyzed three aspects, including “Nurses' socio-demographic characteristics as regards their age in year, level of education; Work Conditions; and Burnout Inventory”. They found that around three quarters of nurses are facing high level of burnout. A significant correlation between “hospital duration and work duration” with the level of burnout among nurses, have been found. Further, level of “cooperation between nurses and physician as well as administrative support” has been found to be significant contributing factors in shaping the level of burnout among the nurses in Saudi Arabia hospitals.

Further, National Academies of Sciences, Engineering and Medicine (2019) has claimed that contributory factors are starting with “work system factors regarding demands and resources of a nursing job, followed by individual factors, which mediate burnout. Most of these contributory factors are under control of healthcare organization, which are deciding the performance of nurses. However, due to growing demand and pressure from emergency care for the geriatric population, the demand is rising, which makes it difficult for the healthcare organizations to manage situation and work pressure in a balanced fashion. Additionally, there is a direct negative effect of high job demands and low job resources on burnout. In this regards, the “job demand-resource model” has suggested that job resources can compensate the adverse impact of increased job demand. However, it is revealed that the lack of resources, training and development opportunities for healthcare and nursing staffs is hindering required level of recruitment, for addressing the job demand, which is having a direct negative impact upon work pressure and burnout of the existing staffs.

Theories related to staff burnout
Workplace reforms have been the prime and central focus of a number of hospitals that seek to provide refuge to the nurses. There are various theories that are witnessed within the healthcare sector, which is significant for meeting the need of the business. In the words of Dall’Ora (2020), there have been workforce studies dedicated to uncovering the consequences and the issues, which are faced by the business. These theories can be stated as most of the staff is subjected to low job decision-making and latitudinal workout. The high incidence of workload, incongruence, low control over job and other factors have an influence over the staff.

The empirical studies suggested that work related factors and the correlative association with stress are considered a problem for the generating person and the individual that help each other. There are various other limitations, that might also influence the high amount of stress and burnout, which is overtly faced by an individual. Staff burnout is also highly influenced via the nature of psychological and job complications. Motivation is intrinsic factors, which should influence the thinking and the strategy of the individual, who have an influence over the health of the population.

The utilization of the motivational theories can bring in intrinsic satisfaction for the staff and mitigate a number of problems, which are faced by them. It should be noted that most of the nurses are subjected to patient complexity, role conflict, decision latitude, autonomy and a number of other factors (Gagneur, et al., 2019). There are work related stress models, which have been procured by the researchers for the course of the proposal. It should be noted that social problems are the prime issue of staff burnout within the Australian hospitals. The utilization of the motivational theories such as Maslow’s Hierarchy of needs and Herzberg’s motivational theories, these social areas, and problems, can be mitigated for boosting the performance of the nurses within the hospital.

The burnout research for the staff has been researched via the utilization of structural models. These models can affect the development of the workout of the studies and feelings that are generated via the researchers (Simpson & Knott, 2017). There are various theories, which are conservative in nature and have the ability of influencing the relationship of the nurses via the institutional staff. Hence, these are some of the prominent areas, which would have an influence over the functioning of the business units in a better and appropriate manner

Impact of staff burnout on health care and nursing performance
Staff burnout poses critical risks and implicates the decrease in the productivity and well being of an employee. As per the systematic review, published within the article by Hall et al. (2016), there were quantitative empirical studies that were executed on the well-being of the healthcare professionals. The implications derived via the process of the research formulated that poor well being and high level of stress are responsible for negative mental stress suffered via the employees. Nursing performances are affected on a greater level as they are vested with various responsibilities for ensuring patient safety. Stress is one of the major indicators of staff burnout that have an influence over the employees. There are various types of stress, which range from cognitive to occupational stress. In the words of Torun & Cavusoglu (2018), the nurses, while tending to the need and responsibilities of the patients frequently experience emotional exhaustion.

Burnout syndrome as a psychosocial situation is also witnessed as chronic interpersonal stressors and within the area of the work environment. The working conditions of the nurses for example in a pediatric sector of the hospital can be worst, as patients tend to be vulnerable and desperate. The 24-hour service provided to the children within the hospital units might bring in stress within the ward nurses.

In the words of Kumar & Bhalla (2019) there are various nurses subjected to the throes of violence, within their working areas. It is imperative to note that nurses, working within hematology or oncology units are exposed to a major portion of burnout syndrome, with an increase in job dissatisfaction for the individuals. The shortage of nurses, within some prevalent units, compels organizations to increase work time hours, boost workload negativity and so on. This affects the job performance of the nurses and can affect the personal identity of the individual.

According to National Institute for Occupational Safety and Health (NIOSH), stress is regarded as one of the top ten related diseases for the nurses. The environment is significant because with an increased number of complications, there can be events such as high turnover, absenteeism and other factors that would also influence the institution in a negative manner. Mortality risk is high within the females working as nursing staff in comparison to other workers. The impact of staff burnout was also perceived in nurses with high emotional exhaustion with a patient ratio to 1:8 for the individuals.

Literature gap
There is a comparative understanding of the role of staff burnout on Australian nurses that form a major part of the hospitals. There are various areas of concern, which are not equally represented and are under explored in nature. It should be noted that the impact and the influence of staff burnout has been experienced by a number of nurses, yet there are various portions, that have underexplored the motivational theories, that could be utilized for the procurement of authentic information for the purpose of the research. Therefore, a better representation, in the case of role of the nurse and their responsibilities could have been carried on for a better understanding of the portion.

Methodology
As mentioned in the study of Mohajan, (2018) research methodology specifies the sense of growth of the procedure used to create hypothesis that is technical structure inside which the research is carried out. There are different types of methodological tool and method a research can adopt in order to conduct its research study. The given study stresses about the burnout impact on the performance of nurses. It is highly essential to select the appropriate methodological tool, which will aid in deriving the suitable data related to the topic.

Research design
Guest, (2013) states that mixed method design that is descriptive mixed method is distinguished by the grouping of at least one quantitative and one qualitative research elements. On the other hand, phenomenology is a method to qualitative research, which concentrates in the commoner of a lived understanding inside a specific group (Khan, 2014). Grounded theory can be stated as a set of methodical inductive technique for carrying out qualitative research pointed toward theory progress (Khan, 2014). Whereas, case study in qualitative research is common in social science that relies on thorough investigation of single person. Ethnography is another qualitative research, which collects inspection, interviews and chronicled data to create thorough and inclusive accounts of dissimilar social occurrence. Action research is a collective query procedure, which balances systematic actions executed in two-way framework with data driven combining analysis or research. Therefore, in the given research study the researcher will be selecting descriptive mixed method, which will comprise of both qualitative and quantitative method, which is essential for the study to gather the suitable data.

Additionally, there are different types of methods too for gathering data for the chosen topic. The selection of method highly depends on what the researcher is trying to explore. As noted in the study of Kumar, (2019) the method section has two key methods, which are known as qualitative and quantitative method. Each of the two methods has different sets of tools and techniques. The qualitative method comprise of interview, focus group, diary and observation. Each of the tools is very much different from each other however; they serve the same purpose to gain qualitative data. Taking in to account interview the initial qualitative tool is about interviewing individual related to the topic to gain their ideas and perspective. On the other hand, focus group is market research, which brings 6-10 people together for feedback related to the product, services etc. Whereas, diary study is a method in which qualitative data gathered from an individuals’ behavior, activities, and experiences. Observation method is a technique in which researcher observe the participants behavior and situation.

For the qualitative method, the researchers will be selecting interview, as they will be conducting interview of the nursing manager to gather data. On the other hand, quantitative data comprise of experimental, non-experimental, Quasi-experimental and survey. Experimental method is an approach where autonomous variables are influenced to dependent variable. Non-experimental method is completely observational and results in descriptive form. On the other hand, Quasi-experimental is a technique, which aims to recognize the affect of specific intervention, program or occurrence by contrasting treated units to control units. Lastly, survey method is the tool, which collected data by asking question related to a particular topic to a group of people in order to gain desired information. Therefore, in the given research study the researcher will be choosing survey technique in quantitative method. The survey will be carried out to get the desired information from the selected group of people.

Data sample/population
Data sample and population research are the pillars to successful research methodology. The researcher will be making the use of mixed methodology as witnessed within the tenets of the social research. It is important for the researchers to be able to provide an authentic sample and population for meeting the need and requirement of the researcher in a better and appropriate manner. The researcher is making the utilization of 100 ward nurses to procure the necessary understanding of the role and the impact of staff burnout within the nurses in the Australian hospitals.

It will be utilized for the non-probability sampling method. The non-probability sampling method will be used, as the sampling does not involve the use of random individuals for the purpose of the research (Kohler, 2019). In order to fulfill the primary quantitative analysis, these 100 nurses will be reviewed to procure an understanding of nursing performance and the high incidence of stress amongst the employees.

The research participants will be chosen from amongst the hospitality sector and will be examined for the primary data analysis. There will be three managers taken for the course of the qualitative research to provide authentic understanding to the interviews, which would be executed for the researcher.

The need of the sampling will be based on convenience and will be used to procure the related data within the portal of the research. It is imperative to note that snowball effect will be used to recruit the clients that would be a part of the research system. Hence, in order to corroborate for the better understanding of the secondary data resources. The secondary data resources, will be instrumental for heeding to the role of the researcher, as it would provide a mode and medium of information to the individual for the completion of the research.

Data collection tools
The data collection is a technique with the help of which appropriate data collection tool as selected to gather data for the research issue. There are different types of data collection method, which a researcher selects as per the desired topic. Survey qualitative, survey quantitative, focus group, interviews, field notes/ observation and audit are the prominent data collection tools. Qualitative research survey is less controlled research methodology, which is used to achieve thorough information about an individual’s fundamental reasoning and motivation. On the other hand, quantitative survey research is a method in which researchers present the identical set of question normally in print format to a group of individuals. These questions are predetermined. Whereas, in focus group the researcher will be fully prepared with the questionnaire that would be asked to the targeted or selected group. Additionally, the focus group will comprise of individuals who are related to the chosen research topic and have adequate knowledge and idea about it to share their perspective.

As mentioned in the study of Qu and Dumay, (2011) interview comprise of open-ended question that is asked from the selected few individual and to get their response and gather elicit data about the specify subject. The key feature of this method is to acknowledge and demonstrate their conversational tone. Fieldnotes are the notes, which are recorded by scientists or researchers in the course of field research during observation of particular phenomenon. Lastly, audit is a way of finding out about the work that is carried out which is done by following guiding principle and best practices. In the given case, the researcher will be carrying out quantitative survey and interview of ward nurse in Australian hospital and nursing manager respectively to gather the appropriate and desired data. The rationale of the selected tool is that it will aid gathering the required data in better way. Additionally, the researcher will be creating its own set of questionnaires for the procedure. In addition, the information collected from the tool is independent of other variables.

Data Analysis Method
Just like data collection method, there are different types of data analysis method too. The data analysis is divided in to two sections qualitative and quantitative. The qualitative comprise of constants comparison that means data-analytic procedure thereby every elucidation and finding are contrasted with existing findings. Comparative analysis is statistical approach in which two or more datasets are contrasted to conclude reliability with one another. Interpretative method comprises of going through transcripts, indentifies units, and develop theme to tie together the unit to get the result. Content data analysis is a tool, which determines the existence of definite word, themes and idea of qualitative data. Heuristic analysis is an approach to discover, learn and solve problem by using rules. Thematic analysis is about analyzing qualitative data by recognizing common themes. Discourse analysis is interpretive and qualitative method of evaluating data. For the given study, the researcher will be using qualitative interpretative analysis to get the desired outcome.

On the other hand, the quantitative data analysis method comprise of different techniques such as central tendency that is summary of center point of dataset and standard deviation and variance. In addition, frequency distributions, relationship between variable, correlation and regression and table and graphs are other tools of quantitative method. Therefore, in the given section the researcher will be using frequency distribution. Additionally, for the inferential statistics, which includes Confidence levels, Statistical significance and Probability levels, the researcher will be using confidence level for the research study.

Ethical Consideration
The concept of ethical consideration is considered a primary aspect for the purpose of the research. It is vital for meeting the need of the research participants who form the sole givers to the information based on the research. The researcher will take into account the viable information for the process of the research, which is significant as per the ethical role and requirement for the purpose of the research. The researcher will abide by the rules and regulations, which will set the base of the research.

The researcher will make the utilisation of informed consent, which should be significant for the voluntary participation of the research. It will address the societal and psychological issues suffered by the nurses and most of the information will be stored within the data convertibles. The research will be conducted as per the Data Protection Act of 2018. It is central for the purpose of the General Data Purpose Regulations (GDPR) and the researcher will undertake the role and understanding of the ethical approval.

The 3 managers and 100 nurses would be assessed under the mixed research and would withhold the information that would not be manipulated for the purpose of the research. Some of the major responses have been confidential and anonymous as per the role of the researcher. The National Ethical standards will be utilised to execute the role of the research (neac.health.govt, 2020). The following steps are.

• Collective understanding of social and clinical value will be provided during the interview of the nurses
• Scientific validity will be the core of the research idea
• Fair selection of managers for the purpose of the qualitative interview
• An independent review of the potential participants and favourable risk ratio will be maintained

These primary standards would be utilised by the researcher to procure a critical and scientific understanding of the research idea. Hence, the data will be used for analyses of the research aim and objectives. With the onset of Covid-19 the qualitative interviews will be telephonic and primary interview will be in the form of online survey questions for the nurses.

Reference List
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Creedy, D., Sidebotham, M., Gamble, J., Pallant, J., & Fenwick, J. (2017). Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy And Childbirth, 17(1). doi: 10.1186/s12884-016-1212-5

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources For Health, 18(1). doi: 10.1186/s12960-020-00469-9

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