"By far the worst burnout levels I've ever seen"

February 27, 2006 -- Yesterday canada.com posted a generally good Canadian Press piece by Sheryl Ubelacker about a new study finding that a "high proportion of nursing graduates are reporting severe burnout less than two years into their jobs--primarily because of crushing workloads." The piece uses information from nursing leaders, including nursing research, and the story of a young nurse who fled the bedside, to paint a grim picture of a nursing crisis driven largely by short-staffing. The piece might have briefly explained how much nursing burnout and short-staffing hurt patient outcomes. But its failure to do so is consistent with the overall media and social view that nurses may matter in their own sphere, but they do not play a key role in fundamental health issues generally. For instance, a Canadian Press piece by this same reporter today examined a physician-conducted study that indicated dying hospital patients valued their relationships with their physicians above all else. Based on this entirely physician-sourced story, it is not clear if nursing was even among the 28 issues about which the physician survey asked respondents, despite the far greater role nurses play in the end-of-life care of most patients. Even so, we thank Ms. Ubelacker and the Canadian Press for yesterday's important piece on nurse burnout--and for following up today with some evidence as to why nursing does not receive the clinical resources it needs to function effectively.

The burnout study's principal investigator was "Heather Laschinger, associate director of nursing research at the University of Western Ontario." (Laschinger has a Ph.D., though the piece does not indicate that.) Dr. Laschinger and her colleagues reportedly surveyed 225 junior hospital nurses working across Ontario. They found that a whopping 66% were experiencing "symptoms of burnout, including emotional exhaustion and depression." Earlier studies by Laschinger reportedly put burnout rates at 58% of nurses who had been working for a wider range of periods, and 54% of nurse managers. Laschinger notes that in all three studies, nurses "pointed to work overload, a perceived lack of fairness in the workplace, poor interpersonal relationships and lack of empowerment as precipitating burnout." With regard to the new study about recent graduates, Laschinger is quoted as saying: "This is by far the worst burnout levels I've ever seen." Laschinger describes hallmarks of burnout as "feeling ineffectual at work, cynical about the job and experiencing overwhelming fatigue that no amount of sleep seems able to cure." She reportedly notes that the syndrome is "rife" among nurses, other health providers and teachers, all of whom work constantly with other people. As for nurses in particular, Laschinger explains: "It's not only bad for the nurses but it's bad for the patients, because the nurses aren't able to work the way they want to work and [have] been trained to work...Nurses are really good copers, but sooner or later those coping resources kind of get depleted and that's when they get into that high level of burnout."

The piece goes on to explore some reasons for the extremely high nursing burnout rates. It reports that Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU), blames it on working conditions. Silas points to inadequate nurse staffing stemming from "[t]ight hospital budgets," even though levels are higher than in the 1990's, "when thousands of nurses across Canada had their jobs cut." Silas also focuses on the specific effects on the new nurses involved in Laschinger's study. She notes that the short-staffing means few hospitals can spare experienced nurses to mentor new ones, and as a result new nurses are confronting full hospital patient loads one week out of school. Silas also explains that the current hospital practice of discharging patients more quickly--"As soon as you're able to stand up, eat and pee, you're going home"--means the nurses are trying to handle even sicker patient populations.

The piece also includes material on the larger effects of these trends on the nursing profession. Silas notes that CFNU surveys indicate almost one third of Canadian nurses under 30 want to leave the profession. In addition, "a predicted slew of early retirements" by the many nurses over 50 suggest the problem is even more urgent. Silas warns that the system will "crumble" unless health care management and policy makers (in the reporter's words) "quit talking about nursing shortages and [] do something about it." That's good, though the piece would have benefited from some response from those managers and policy makers, and perhaps some discussion of potential solutions.

The piece features the story of "Karen," who says she experienced burnout just a year into her first nursing job after graduation, which was in a British Columbia cancer unit. Karen's job was part-time, and it involved "irregular shifts" and being called in on short notice "when the hospital was even more understaffed than usual." She says she began to feel "mildly depressed, exhausted all the time and physically unwell," and that she was "doing an uncharacteristically sloppy" job. Karen says she was "really excited" when she first started, but she left nursing completely after just 14 months. She says she misses it, that she was a "great nurse" who earned respect from patients and colleagues.

The piece does a very good job in explaining how widespread nursing burnout now seems to be, short-staffing and other key reasons for the burnout, and the consequences for nursing as a profession. We also commend Ms. Ubelacker for reporting on an important piece of nursing research, and for her use of nurse experts. The piece might have explored some of the other reported sources of burnout, such as lack of empowerment and poor personal relations. And it might have explained more clearly what the consequences of nursing burnout and short-staffing are for patients. It's not just that affected nurses do a sloppy job or can't provide the care they want. Studies have shown that nurse short-staffing has a considerable effect on patient outcomes, including mortality.

And speaking of death, Ubelacker's end-of-life piece the very next day suggests a fundamental reason why nursing has so much trouble gaining the clinical resources it needs: it does not seem to enjoy sufficient understanding or respect from the media. Today's lengthy discussion of what dying patients want does not even use the word nurse until a passing reference in the final paragraph. This piece, "Trust in doctor, time to say goodbye among top needs of dying patients: study," reports that what mattered most out of 28 choices presented to Canadian hospital patients surveyed was "trust and confidence in the doctors looking after you." Another "top priority" was that "[t]he doctor communicate information about one's condition honestly." It's not clear from the article if nursing appeared anywhere in the 28 choices, despite its central role in hospital care, especially the care provided to dying patients. And although the piece relies on quotes from four different physicians, particularly the study author, no nurse is cited. This is a typical mainstream press story about a general health matter in which nurses play a leading role that gives readers the sense that only physician care matters. And the study results suggest that the media and its society are on the same page about this, although it's not clear what opportunity the respondents in this physician-driven survey had to express a view about the importance of nursing in end-of-life care. It appears that some journalists regard nursing as having some importance as a stand-alone subject--it matters enough to merit a story when there is a serious problem, such as a shortage--but not as a profession that is particularly relevant to the key overall health issues of our time, the matters of life and death.

Finally, the nursing burnout piece might have identified nursing scholar Heather Laschinger as "Dr. Laschinger" or noted that she has a Ph.D., since the same reporter identified all four physicians in today's piece as "Dr." Here again, some health care workers seem to be a bit more equal than others.

Despite these concerns, we commend Ms. Ubelacker and the Canadian Press for yesterday's powerful and helpful piece about nursing burnout and short-staffing.

See the article: "High proportion of recent nursing grads experiencing burnout: study" by Sheryl Ubelacker in the February 26, 2006 edition of the Canadian Press.