Introduction to the Topic and Purpose of the Paper
One of the roles of Clinical Nurse Leaders (CNLs) is to create an atmosphere where nurses can prevent or cure any illnesses and injuries presented to them. Redfern (2012) argues that nurses monitor patients’ health conditions at the bedside, detect near misses and errors, interrogate the care system, and/or engage in administrative tasks, and other tasks aimed at ensuring that patients receive optimal quality care. The above tasks are strenuous to the extent that they may lead to burnout (Grubb & Grosch, 2012). This study focuses on the acute care setting, specifically the critical care unit, where CNLs are especially required to work as a team with other nurses in ensuring they do not experience excessive burnout in the process of offering care to patients. In line with Wada and Sasaki’s (2006) arguments, this paper argues that Clinical Nurse Leaders (CNLs) can use their core competencies to prevent and reduce hospice nursing staff burnout in-home hospice care. It holds that by using evidence-based practice methods, the CNLs’ core competencies of clinical prevention, quality improvement, interprofessional collaboration, and organizational leadership can help to decrease the prevalence of nursing staff burnout symptoms.
Relevance of the Topic to the CNL Role and its Place within the Nursing Profession
Rationale
The specific subset of CNLs’ core competencies chosen has the potential to prevent and reduce care deficiencies. AHRQ (2016) informs that contemporary people increasingly miss work or have poor work motivation due to burnout syndrome. Amid the lack of a standard definition of burnout, the article notes that exhaustion, an inability to cope with work demands, work-related stress, and restlessness characterize the phenomenon. According to Laschinger and Fida (2014), proper leadership and individual and institutional interventions such as inter-professional collaboration, clinical prevention, and quality improvement can help to address the issue of burnout. This finding supports the current study’s rationale for why the selected subset of CNLs’ core competencies can address the issue of burnout efficiently in an acute care setting, specifically, the critical care unit, where such issues are prevalent among nurses.
Role of Clinical Prevention in Decreasing Nursing Staff Burnout Symptoms
According to AHRQ (2016), if clinical nursing leaders can deploy their prevention role in mitigating these symptoms, they can help in reducing staff burnout in hospice care. However, prevention roles can only be effective when clinical nurses clearly understand the symptom of burnout to the extent that they can modify causative factors in the work environment (Sjetne, Casbas, Ball, & Schoonhoven, 2013). Nevertheless, signs such as emotional exhaustion, work alienation, and reduction in performance may also explain other disorders, for instance, depression. Such disorders undermine clinical nursing leaders’ ability to deploy the prevention role effectively in reducing burnout symptoms.
Stress prevention can effectively reduce burnout among nurses in hospice care. The National Health Services reported the situation in England as observed in 2013 (Wright, 2014). Based on the findings, nurses leave the profession due to work-related pressure and the failure to offer nurse-evaluated first-class services (Van Bogaert et al., 2017). Indeed, The Royal College studied 10,000 nurses in 2013 and found that 62% of them considered making decisions to leave the career due to stress (Henry, 2014). The findings suggest the possibility of quality improvement to help in preventing or decreasing staff burnout symptoms, which may explain the nurses’ rationale to leave the profession.
Role of Quality Improvement in Decreasing Nursing Staff Burnout Symptoms
Hospice care involves dealing with sick people while knowing well that a patient may not survive an illness. Such an understanding exposes nurses in hospice care homes to emotional and intellectual exhaustion, which are critical symptoms for burnout (American Nursing Association, 2013). Arguably, the higher the exposure levels to very ill people under hospice care, the higher the risk of burnout. Therefore, clinical nursing leaders in hospice care settings can decrease staff burnout symptoms by engaging in quality improvement, especially the nurses’ working conditions. Balanced and manageable workloads constitute one of the important hospice care work quality improvements that decrease burnout. Indeed, AHRQ (2017) reveals issues such as long shifts and subjecting nurses to overtime as among the elements that increase the risk of making errors.
A big portion of the causes of burnout among nurses relates to various organizational factors (Fillion, Dupuis, Tremblay, De Grace, & Breitbart, 2006). Nursing management and the leadership’s inability to address the quality improvement needs of working conditions take a big chunk of the increased exposure of nurses to the risk of burnout. Fillion et al. (2006) support this assertion by noting that management’s failure to provide support, the necessary supervision, and/or manage effectively job resources that relate to nurses exposes them to a work environment and conditions that mentally and physically exhaust them. Where nurses lack appropriate resources to enable them to deal with work-related and emotional pressure, they are exposed to burnout. Hence, to improve the quality of working conditions for nurses, CNLs create structures for enhancing teamwork cohesion and autonomy. Longhurst (2015) supports this claim by reckoning that poor autonomy and compassion fatigue contribute to burnout in palliative care settings.
Role of Inter-professional Collaboration in Decreasing Nursing Staff Burnout Symptoms
Palliative care nurses work in an environment of intense grief. They care for very ill patients and families that face the challenge of emotional stress. Nurses’ frequent subjection to grief and their experience with multiple fatal situations ultimately expose them to emotional overload (De Villers & DeVon, 2013). Hospice care nurses develop strongly bonded interpersonal relationships and collaboration with patients and their families. Consequently, when patients finally die, they suffer similar thresholds of bereavement. Such nurses are anticipated to move on with their daily life activities and work after experiencing multiple experiences of the deaths of their patients. In this case, an inter-professional collaboration between hospice nurses and clinical nursing leaders comes in handy to sanction emotional overloads experienced by nurses (Wada & Sasaki, 2006). Such collaboration can decrease the vulnerability of palliative and hospice care nurses to compassion fatigue. This situation attracts the risk of developing excessive empathy among nurses. As a result, they may withdraw from providing patient care. With reference to interpersonal collaboration, clinical nursing leaders have the responsibility of ensuring that end-of-life care nurses maintain their professional boundaries. Besides preventing such nurses’ loss of independence and increasing their intimacy levels, this strategy may shield them from suffering trust issues.
The Role of Organizational Leadership in Decreasing Nursing Staff Burnout Symptoms
Leaders influence the relationship between them and employees (other nurses) who act as the tool for change within an organization (Parola, Coelho, Cardoso, Sandgren, & Apóstolo, 2017). In a nursing setting, effective leadership is important in enhancing organizational commitment and work morale for nurses to ensure they do not consider leaving healthcare organizations over their working life. One way of accomplishing this goal is by ensuring that the work environment transforms to meet the emerging needs of the care providers while minimizing work stress that leads to burnout (Vargas, Cañadas, Aguayo, Fernández, & de la Fuente, 2014).
Clinical nursing leaders deploy different types of leadership. For example, transformational leadership encourages trust and confidence in a leader. Adriaenssens, De Gucht, and Maes (2015) posit that effective nursing leadership can change internal work values and structures to increase work proficiencies. Hence, it may find application in decreasing nurses’ burnout symptoms by addressing its possible work environment causes. The deployment of transformational leadership theory to change internal structures of nursing facilities’ systems may foster a fair distribution of tasks, hence reducing work strain and stress that lead to burnout (Lowe, Gakumo, & Patrician, 2016).
Clinical nursing leaders have traits such as Emotional Intelligence (EI), which enable them to adopt behaviors that change their work environments (Khalili, 2012). Clinical nursing leaders who possess a high degree of emotional intelligence can perceive and evaluate the extent to which they can attain various anticipations of hospice care nurse workers. One of such expectations entails working in environments that do not predispose nurses to burnout.
Future Implications for Nursing Practice
Clinical nursing leaders working with other nurse team members in the acute care setting influence various occupational factors in hospice care. For example, in the team, CNLs determine workloads, control nurse-practice environment, and/or set and manage work shifts (Lski, Weeks, Van Heusden, & Clarke, 2013). Thus, CNLs should embrace their responsibility and authority of making the necessary changes through the deployment of appropriate resources to prevent work-related stress, which ultimately leads to burnout among nurse team members. Future CNLs should also be at the forefront in establishing structures that promote teamwork, quality improvement, and proper leadership. CNLs play the role of lateral integrators in their respective groups. Hence, according to Begun, Tornabeni, and White (2006), the study also has a bearing for future CNLs who are expected to work with other nurses likely to be involved through lateral integration within the acute care setting and across the continuum of care. They need to appreciate that the entire plan of care will never be fully achieved without the incorporation of the specified core competencies, which require continuous training on the part of the CNLs.
Conclusion
Hospice care nurses work in an environment that makes burnout almost inevitable. Taking care of nearly dying or patients with minimal chances of survival increases their emotional and intellectual stress. Unfortunately, they are required to work for long in such a tormenting work environment. To minimize burnout symptoms, the paper has argued that clinical nursing leaders should deploy effectively their prevention, leadership, interpersonal collaboration, and quality improvement core competencies to create working conditions that are favorable to nurses to address the issue of burnout.
References
Adriaenssens, J., De Gucht., & 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.
AHRQ. (2016). Burnout among health professionals and its effect on patient safety. Web.
AHRQ. (2017). Nursing and patient safety. Web.
American Nursing Association. (2013). What is nurse burnout? Web.
Begun, J., Tornabeni, J., & White, K. (2006). Opportunities for improving patient care through lateral integration: The clinical nurse leader. Journal of Healthcare Management, 51(1), 19-25.
De Villers, J., & DeVon, A. (2013). Moral distress and avoidance behavior in nurses working in critical care and non-critical care units. Nursing Ethics, 20(2), 589–603.
Fillion, L., Dupuis, R., Tremblay, I., De Grace, G., & Breitbart, W. (2006). Enhancing meaning in palliative care practice: A meaning-centered intervention to promote job satisfaction. Palliative & Supportive Care, 4(4), 333-344.
Grubb, P., & Grosch, W. (2012). Alleviating job stress in nurses: Approaches to reducing job stress in nurses. Web.
Henry, J. (2014). Nursing burnout interventions: What is being done? Clinical Journal of Oncology Nursing, 18(2), 211-214.
Khalili, A. (2012). The role of emotional intelligence in the workplace: A literature review. International Journal of Management, 29(3), 355-370.
Laschinger, H., & Fida, R. (2014). New nurses burnout and workplace wellbeing: The influence of authentic leadership and psychological capital. Burnout Research, 1(1), 19-28.
Longhurst, C. (2015). Compassion fatigue in palliative nursing is due to understaffing. Nursing Standard, 30(4), 9-9.
Lowe, M., Gakumo, C., & Patrician, P. (2016). Coping strategies of nurses in a palliative care unit. Journal of National Black Nurses Association, 27(2), 50-54.
Lski, C., Weeks, M., Van Heusden, D., & Clarke, P. (2013). The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey. International Journal of Nursing Studies, 50(12), 1667-1677.
Parola, V., Coelho, A., Cardoso, D., Sandgren, A., & Apóstolo, J. (2017). Burnout in palliative care settings compared with other settings: A systematic review. Journal of Hospice & Palliative Nursing, 19(5), 442-451.
Redfern, J. (2012). Manage workplace chaos by building your resilience. Nursing Standard, 27(3), 63-63.
Sjetne, I., Casbas, T., & Ball, J., & Schoonhoven, L. (2013). Nurses’ intention to leave their profession: A cross-sectional observational study in 10 European countries. International Journal of Nursing Studies, 50(2), 174-184.
Van Bogaert, P., Peremans, L., Van Heusden, D., Verspuy, M., Kureckova, V., Cruys, Z., & Franck, E. (2017). Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: A mixed-method study. BMC Nursing, 6(5). Web.
Vargas, C., Cañadas, G., Aguayo, R., Fernández R., & de la Fuente, E. (2014). Which occupational risk factors are associated with burnout in nursing? A meta-analytic study. International Journal of Clinical Health & Psychology, 14 (1), 28-38.
Wada, Y., & Sasaki, Y. (2006). Characterization of burnout and interpersonal relationships — Overall and age-stratified analyses of nurses working in palliative care units. Journal of Japan Academy of Nursing Science, 26(2), 76-86.
Wright, K. (2014). Alleviating stress in the workplace: Advice for nurses. Nursing Standard, 28(10), 37-42.