Nurses burned out and want to quit

August 28, 2020

Science Daily/European Society of Cardiology

A survey of nurses caring for children with heart problems has revealed that more than half are emotionally exhausted. The analysis, presented today at ESC Congress 2020, also found that good working environments were linked with less burnout.

"Nurses' wellbeing is central to ensuring the best outcomes for patients," said study author Dr. Annamaria Bagnasco of the University of Genoa, Italy. "When wards have poor leadership and fragmented teams with no development prospects for nurses this should raise an alarm that there is a risk of burnout."

Previous research has shown that burnout rates are higher in paediatrics than in other specialties, and that burnout is connected to patient safety. Strategies to reduce burnout and its impact on patient safety are needed.

This study examined emotional exhaustion in nurses providing routine care on paediatric cardiology wards and whether it was related to the working environment.

Data were obtained from the RN4CAST@ITPed study. A web survey was distributed to 2,769 nurses working in children's hospitals throughout Italy between September 2017 and January 2018. A total of 2,205 (80%) nurses responded, of whom 85 worked in cardiology wards and intensive care units (ICUs). Additional data were collected from hospital administrations. Topics included workload, skill mix, work environment, and emotional exhaustion.

The following definitions were used: Workload referred to how many patients each nurse was caring for (nurse-patient ratio). Skill mix included both the education level of nurses working in one unit and the number of nursing assistants providing support during each shift.

Work environment was measured with the Practice Environment Scale of the Nursing Work Index (PES-NWI), which covers issues such as: having a nurse manager or immediate supervisor who is a good manager and leader; opportunities for advancement; opportunities to participate in policy decisions; and collaboration between nurses and doctors.

Emotional exhaustion was investigated using the Maslach Burnout Inventory, which measures feelings about work. For example, feeling emotionally drained, used up, fatigued in the morning, burned out, frustrated, working too hard, stressed, or "at the end of my rope."

This analysis focused on responses from the 85 nurses working in cardiology wards and ICUs at five hospitals. Interviews were also conducted with these nurses. More than half (58%) were emotionally exhausted. The main causes were related to working conditions, including being responsible for high numbers of patients and the complexity of caring for sick children.

"The most important consequence was that 30% of the nurses we interviewed wanted to either go and work in another hospital or even change their career," said Dr. Bagnasco.

The researchers then analysed the relationship between emotional exhaustion and the working environment. Improving the workplace environment was associated with an 81% fall in emotional exhaustion -- even with the same skill mix and nurse-patient ratio.

"Our study shows that nurses value good leadership, being involved in decision-making, having chances to develop their career, and team working," said Dr. Bagnasco. "The lack of these conditions is connected to burnout, which we know from prior research could compromise patient safety."

Dr. Bagnasco noted that paediatric cardiac nurses must collaborate with children and their families, who often feel concerned and afraid. She said: "Establishing a trusting relationship is essential but burned out nurses may find it 'too heavy' to bear emotionally. If the working environment is positive for the nurses who work in it, children and their families will receive better and safer care."

https://www.sciencedaily.com/releases/2020/08/200828081037.htm

Front-line physicians stressed and anxious at work and home

New study reports moderate to severe stress levels in ER doctors during the frenetic early phase of COVID-19 pandemic

July 21, 2020

Science Daily/University of California - San Francisco

Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to a new analysis led by UC San Francisco.

In the first known study to assess stress levels of U.S. physicians during the coronavirus pandemic, doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.

"Occupational exposure has changed the vast majority of physicians' behavior at both work and home," said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF. "At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line."

The results, which appear July 21, 2020, in Academic Emergency Medicine, found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.

Lack of PPE was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.

But the survey also showed clear-cut ways of mitigating anxiety:

• Improve access to PPE;

• Increase availability of rapid turnaround testing;

• Clearly communicate COVID-19 protocol changes;

• Assure access to self-testing and personal leave for front line providers.

The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.

The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana and New Jersey. Researchers noted that the majority of study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. But the study found that median levels of anxiety in the California sites were similar to those in the New Orleans and Camden sites, which were experiencing surges at the time.

"This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally," Rodriguez said. "Some of our findings may be intuitive, but this research provides a critical early template for the design and implementation of interventions that will address the mental health needs of emergency physicians in the COVID-19 pandemic era."

The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the ER, and possible development of long-term post-traumatic stress.

https://www.sciencedaily.com/releases/2020/07/200721084205.htm