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Enhancing Compassion, Addressing Fatigue, and Burnout to Improve Nurse Retention

Shuntane Reaves-Dean

Table of Contents

1.0 INTRODUCTION   3

2.0 LITERATURE REVIEW    4

3.0 GAP ANALYSIS/ NEEDS ASSESSMENT  9

4.0 PROJECT CHARTER, SCOPE, AND OBJECTIVES  14

5.0 IMPLEMENTATION PLAN   14

6.0 TIMELINE AND SCHEDULE  18

7.0 BUDGET  18

Cost-benefit analysis  18

Potential Benefits and Savings  19

8.0 RISK MANAGEMENT PLAN   21

9.0 SUMMARY OF PROJECT IMPLEMENTATION STAGE AND BARRIERS  25

References  27

APPENDICES  31

1.0 INTRODUCTION

Burnout and occupational stress have been highlighted in a number of studies as most important impediments to “patient safety and care quality” (White, Aiken, Sloane & McHugh, 2020). Fatigue and burnout essentially aggregate a number of syndromes including emotional fatigue and skepticism and are believed to be a critical prognosticator of negative healthcare outcomes. To enhance compassion, and to address fatigue, and burnout and to improve nurse retention Mission Healthcare Facility will concentrate on the provision of a spectrum of high-grade, competitively priced services to deliver quality health outcomes to clients, while maintaining high standards of personal and corporate integrity. Greater health outcomes should be pursued to expand access to excellent health services for rural communities and marginalized populations within the community. Positive health outcomes will be achieved by addressing fatigue, burnout, and negative health outcomes through a supportive multidisciplinary team to cater for the comprehensive academic and educational relationships. Specifically, this project seeks to improve performance outcomes among nurses by increasing compassion, reducing fatigue and burnout by 30% and to improve nurse retention by an average of 5 years. This will be achieved by reviewing training programs for the next generation of nurses to include best practices by including self-care training in the training curriculum to inculcate stress and burnout management skills to the trainee nurse, teaching students how to practice healthy sleeping habits, and integrate staff, and peer mentorships in the teaching program. This section is structured as follows: the second section is the literature review, a concise summary of key findings from respected authors on nurse retention, burn out, and fatigue. The third part presents the Gap Analysis/ Needs Assessment, followed by project charter, scope, and objectives. The fifth part discusses the implementation plan, followed by the timeline and scheduling, budget, and risk management plan in that order.

2.0 LITERATURE REVIEW

This section draws from numerous studies to provide perspective on compassion, fatigue, and burnout, their reduction, and their impact on nurse retention. Studies by Adams, Hollingsworth and Osman (2019) propose a cultural change toolkit outlining certain components critical for reduction of burnout and exit. Paired t-test results delineate these components such as “meaningful recognition, shared decision making, and even the enhanced leadership involvement” expected exit and burnout numbers caused a quantifiable decline in general burnout tallies (Adams, Hollingsworth and Osman, 2019).

Research by Boamah, Read and Spence Laschinger (2017) has established positive correlation between leadership style and severity of “burnout, job satisfaction, and equality of patient care” in nurses. The authors demarcate “short-staffing and work-life interference” as critical antecedents to burnout new graduate nurses. Subsequently, the study idealizes the application of authentic leadership tendencies for the realization of enabling occupational settings critical for elimination of burnout, enhanced satisfaction, and superior nursing outcomes.  The proposed leadership trajectory is projected to cure insufficient recruitment and “work-life imbalance” which result in burnout, poor occupational fulfillment and poor healthcare outcomes.

Similarly, Cheung, Hernandez, Herold and Moskowitz (2020) recommend constructive sentiments towards work as panacea for reduction of burnout and enhancement of positive health outcomes. Consequently, most nursing and fatigue prevention strategies are heavily weighted in favor of decreasing destructive sentiments related to the nursing environment. These include psychosomatic strain, anxiety, and despair. Indeed, modern scholarship outlines growing focus on healthy occupational outlook as critical for management of work-related anxiety, and could yet be the basis of more sophisticated interventions.

A quasi-experimental study by Copeland (2020) highlights the criticality of ephemeral mediations by which nurses can minimize impacts of compassion fatigue and burnout. As collaboration and burnout are negatively correlated, the findings suggest that brief interludes involving “meditation, journaling, gratitude, outside, and control” are essential for attenuating the impacts of burnout.

A comprehensive review by Dyrbye, et al., (2019) associates burnout with elevated risk of absenteeism at least once a month and reduced output. All things considered, and taking patient-specific factors such as “age, sex, relationship and parental status, highest academic degree, practice setting, burnout, depression, and satisfaction with work-life integration”, into considerations, nurses who had a history of burnout exhibited increased absenteeism as peers with less exposure had fewer truancies.

Moreover, recent studies by Haizlip, McCluney and Hernandez (2020) have established positive associations between affirmative recognition and burnout. Consequently, the study associates positive sentiments around “mattering at work” reduces the probability of burnout (Haizlip, McCluney & Hernandez, 2020). In essence, the study delimited reduced burnout, and greater participation at work as significant precursor to positive perceptions of work. Additionally, research evidence shows that the positive sentiments are strongly related to social capital in clinical settings as provided by seniors, juniors and peers (Haizlip, McCluney and Hernandez, 2020).

Modern research has confirmed strong correlations between resilience and burnout in the case of nurses in intensive care settings (Jackson, et al., 2018). In other words, empirical evidence have routed for resilience as an intervention mechanism for minimizing occupational challenges which exacerbate burnout.

In clinical settings, occupational challenges have generally been traced to a number of conditions that adversely impact nurses of which burnout and empathy fatigue are part (Jackson, et al., 2018). In this regard, “workplace adversity” should be addressed through a raft of measures including “protecting, processing, decontaminating, and distancing” (Jackson, et al., 2018).

A cross-sectional research by Liu et al. (2018) on the significance of healthcare occupational settings in healthcare delineates three antecedents to improved patient outcomes: assigned tasks, extended deployment of nurses to non-clinical functions and burnout. The aforestated factors also lead to poor patient outcomes. The study proposes improvements to clinical working environment, such as adequate staffing of nurses, expanding provisions aimed at engaging nurses with core clinical functions as critical for better patient outcomes. The findings generally validates the hypothesis that improvements to work environment will encourage greater “patient safety both directly and indirectly” (Liu, et al., 2018). The study found that reduced workload was negatively correlated to better patient outcomes as “nursing care left undone and nurse burnout” negatively impacted patient safety (Liu, et al., 2018).

Correspondingly, studies by Nantsupawat et al (2020) on nursing turnover in Thai hospitals have positively correlated nurse burnout with increased frequency of “negative patient outcomes”. These findings underscore the importance of reducing nurse burnout as a critical step towards cultivating positive care outcomes. in addition, Additionally, the studies revealed a strong positive relationship between “emotional exhaustion” and 2.63 times increase in suboptimal care, a 47% rise in clinical mistakes, and a 32% risk of infection (Nantsupawat et al, 2020).

Registered nurses have recently showed disproportionately higher propensity for burnout, a phenomenon associated with personal engagement with patients, large volumes of work, and long durations of work. These outcomes highlight the need for urgent intervention (Naves, 2016). Specifically, the findings associate a number of “personal and organizational determinants and interventions” could preclude and diminish possibilities of burnout. However, theoretical evidence from extant literature recommends that nursing students should be equipped with suitable approaches to combat burnout, and to reduce employee burnout (Naves, 2016).

Studies by nurse managers in recent times have identified elevated “job demands” for high incidences of work-related stressors. Nelson (2017) contends that the situation is further compounded by the fact that some nurse managers are structurally bereft of power to make certain critical decisions in the line of duty, leading to further violence (Nelson, 2017). Elevated amounts of stress have been blamed for the increased possibility of “disengagement, burnout, and ultimately, to nurse manager turnover”. Some of the most energy sapping roles includes patient care, cross-team leadership and cooperation (Nelson, 2017).

While several studies have mainly zeroed in on individual nurse characteristics as the most important contributor to burnout and nurse turnover, a study by Virkstis, Herleth and Langr (2018) a study by Virkstis, Herleth and Langr (2018) have established linkages between individual attributes and factors in the immediate care environment. This essentially calls for greater focus on the “care environment rather than individual resilience building” (Virkstis, Herleth and Langr, 2018).  In modern nursing literature, there has been increased appreciation of factors in the care environment, also known as “cracks” in the care environment. These include, safety concerns; concessions in healthcare value chain, distressing episodes during practice; new equipment, added duties, and poorly designed policies that inhibit cross-team sharing among nurses (Virkstis, Herleth, & Langr, 2018).

Still on the healthcare environment, a study by Wampole and Bressi (2020) argues that nurses in strict “psychiatric nurses” exposed to “workplace stressors” which include “staffing shortages, along with interpersonal conflict with patients and colleagues” (Wampole and Dance, 2020). The findings show that nurses who have been exposed “emotional exhaustion” experienced high levels of burnout, and a more satisfaction with work. As a result, the study proposes that intervention should focus on programs that encourage effective “emotional regulation”. In clinical settings, it is essential to structure social worker education programs to attain “mindfulness techniques may represent an untapped resource for improving the emotional wellness and effective patient care” (Wampole & Bressi, 2018).

White, Aiken and McHugh (2019) argue that gaps in healthcare provision attributed to insufficient time and resources for the management of nursing homes has been blamed for increased burnout and job fulfilment. It follows that a sufficiently staffed facility with the optimal working conditions could forestall exits and improves healthcare qualities. In particular, the study found that some 30% of registered nurses exhibited extraordinary degrees of burnout, 31% had unfavourable outlooks in regard to their jobs, and 72% reportedly had tasks rescheduled as a result of inadequate and resources (White, Aiken and McHugh (2019). The study further suggests that RNs suffering from burnout were up to 5 times more predisposed to vacate critical care duties (White, Aiken & McHugh, 2019).

By the same token, a cross-sectional study by White, Aiken, Sloane and McHugh (2020) has revealed a strong relationship between “work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes”. These findings recommend a healthy work environment for removal of barriers to healthcare by focusing on measures to improve standards of healthcare and “nurse retention in nursing homes” (White, Aiken, Sloane and McHugh, 2020).

3.0 GAP ANALYSIS/ NEEDS ASSESSMENT

Gap Analysis

Project: Enhancing Compassion, Addressing Fatigue, and Burnout to Improve Nurse Retention

Organization: Mission Healthcare Facility

Student name:

Best Practice 1: include self-care training in the training curriculum to inculcate stress and burnout management skills to the trainee nurse. 

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Best Practice 2: Teach students how to practice healthy sleeping habits

Best Practice 3: Integrate staff and peer mentorships and modelling in the teaching program

Workflow Diagrams

Flowchart depicting the current nursing curriculum and related educational needs and knowledge gaps and workflow diagram depicting the future nursing curriculum with best practices are  attached in Appendix A and B respectively.

Summary

Gap analysis outlines variances in current practices in the Texarkana’s nursing curriculum and industry best practices. The most outstanding gap is heavy focus on hard skills in the current curriculum which precludes soft skills recommended in new curricula. This anomaly is highlighted and accentuated by requirement that students must clock upwards of 75% of theoretical lecture hours or risk discontinuation from the program. Effectively, the foregoing situation inhibits attainment of important non-academic skillsets, such as emotional intelligence, self-care care skills and mindfulness techniques which are critical predictors of low stress and burnout levels, as well as effective management of stressors in the work environment. Embedding healthy dietary practices by permitting students to carry healthy snacks could potentially minimize stress among student and practicing nurses.

Best practice curricula also differ from current curricula through emphasis on sleep quality and regular sleep patterns achievable by avoidance of mobile devices at least two hours before bedtime. Indeed, best practices paradigms appear to recommend that the two hours prior to bedtime should be dedicated to assignments, laboratory reports and group discussions.

This analysis also recommends supportive and free learning atmospheres which promote career guidance by peers and staff. This is essential for imparting vital communication skills as well as greater self-efficacy and self-esteem. Cumulatively, these practices are ideal for cultivating resilience against environmental stressors, such as role conflict and workplace incivility, which ultimately enhances their retention in a given healthcare facility due to increased compassion and reduced levels of stress and burnout.

Bridging the aforestated gaps will inevitably be mediated by barriers which must be overcome. For instance, large academic workloads and extended periods of theoretical learning will present new constraints as insufficient time will be dedicated for best practices recommended in the new curricula.  Additionally, prevailing financial limitations will limit access to healthy food and snacks. Further, sociocultural diversity means that certain self-care and mindfulness programs will not avail uniform outcomes for all students. Students from different faiths will respond differently to various meditation techniques. For instance, meditation techniques for Buddhists and Hindus are mostly different from Islam and other religious groups (John Paul Caponigro, 2015).

4.0 PROJECT CHARTER, SCOPE, AND OBJECTIVES

This section covers programmatic student learning outcomes (PSLOs) by means of which project charter, scope, and objectives are defined. Consequently, the PSLOs provide a basis for development of the program specifically suited for the stated objectives. Detailed description of the project charter, scope, and objectives, are contained in Appendix D.

5.0 IMPLEMENTATION PLAN

Project: Curriculum Lesson Plan on Strategies for Enhancing Compassion, Addressing Fatigue, and Burnout to Improve Nurse Retention

Organization: Mission Healthcare Facility

Student name:

Selected Best Practice 1 Identified in Gap Analysis: [Develop Initiatives to promote support and self-efficacy]

Selected Best Practice 2 Identified in Gap Analysis: [Incorporating stress management training]

Selected Best Practice 3 Identified in Gap Analysis: [Identify Stressors and the relevant coping mechanisms]

.

Define processes and procedures involved

            Work units, tasks/ activities

            Define project deliverables

            Define metrics that determine success (how will you measure that change is an improvement)

6.0 TIMELINE AND SCHEDULE

The project is planned and scheduled using Gantt chart, attached on an excel sheet.

7.0 BUDGET

Cost-benefit analysis

Table 1: Budget/Costs

Potential Benefits and Savings

Table 2: Potential Benefits and Savings

Table 3: Cost Benefit Analysis

Total Savings = $(338,500 – 278,400) = $60,100.

Payback time =  

                        =

                        = 0.85 of a year or approximately 10.2 months

            Identify all resources needed (tangible and intangible)

8.0 RISK MANAGEMENT PLAN

Project: Enhancing Compassion, Addressing Fatigue, and Burnout to Improve Nurse Retention

Organization: Mission Healthcare Facility

Student name: