Analysis of Nurse Burnout Using Neuman Systems Model

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The current culture of nursing has shifted its focus to maintaining quality, safe patient-centered care. This has caused nurse to face new challenges in the healthcare setting. Many nurses are faced with deciding between leaving the profession or trying to “stick it out” and ultimately fall victim to nurse burnout. The nursing shortage is expected to increase to 260,000-400,000 nurses by 2025. (Brown, Whichello, Price, 2018) This is a staggering number to a current nurse who is already overworked and knows the burden will only increase. It is imperative that nursing leaders, healthcare employers and staff nurses advocate for nurses and look for ways to lessen burnout. Research suggests that one nursing quality, resilience, is necessary to overcoming burnout and encourage the continuity of a long, happy career. Every current nurse in the healthcare profession should focus on burnout as a top issue nurses face today. It is necessary to draw attention and awareness to the graveness of how burnout may affect the nursing profession for many years to come.

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The literature presented in this paper is current, relevant and accurate in relation to nurse burnout and the steps nurses can take to improve. Each of the journals offers a different insight on the ways for nurses to combat burnout and the effects on mental, physical and emotional health. Although nurse burnout is very common in the healthcare industry, many of the articles and journals that were found during research were patient specific and geared toward caregiver burnout. These articles that were chosen all focus on nursing as a whole, not just on a specific facet in nursing. These journals were also chosen because they suggest ways to combat burnout, with one being resilience. Each of these articles also speaks about the current effects that nurse burnout has on healthcare delivery and the future of nursing in a culture of quality patient care.

The article, “The Impact of Resiliency on Nurse Burnout”, formed the basis of research. It focuses on the correlation between resiliency and nurse burnout and suggests strategies to increase nurse resilience. The research conducted in this article used nurses from several different countries, mostly females, with a wide variety of ethnicities and education levels from diploma nurses to master’s degrees and beyond. Several factors were found to contribute to nurse burnout which includes increased workload, moral distress, poor support systems and bullying. (Brown, Whichello, Price, 2018) The study also found that nurses dealt with prolonged work-related stress were likely to experience anxiety, depression, sleep deprivation, compassion fatigue, nurse turnover, depersonalization and burnout. (Brown, Whichello, Price, 2018) The way in which nurses can withstand burnout includes being able to maintain optimism, self-efficacy, hope and flexibility within oneself. (Brown, Whichello, Price, 2018) This article also focused on the ways to increase nurse resiliency. “Mindfulness-based stress reduction (MBSR) training, emotional distancing, conflict training, and event trigger exercises had a positive impact on resiliency.” (Brown, Whichello, Price, 2018) Specifically, workshops and trainings related to improving resiliency were helpful to teach the ways in which nurses can cope. Overall, this article recognizes how common nurse burnout is in the profession, how nurses can recognize the symptoms of it, and the ways to improve resilience and decrease the overall chance of burnout.

Two journals, “Neuman Systems Model as a Conceptual Framework for Nurse Resilience” and “Conceptualization of Burnout from the Perspective of the Neuman Systems Model” relate the Neuman’s conceptual framework to nurse burnout. The article written by Turner and Kaylor focuses on exploring nurse resilience and the appropriate strategies to build resilience in nurses. It then goes on to use the nurse as the client and resilience as part of the line of defense. Resilience is a protective factor to manage, reduce and prevent stress reactions. (Turner, Kaylor, 2015) Resilience to stress has been linked to psychological empowerment, increased communication skills, effective workplace conflict resolution and higher retention of nurses. (Turner, Kaylor, 2015) The article uses the interrelationship between the variables- physiological, psychological, socio-cultural, development, and spiritual- to determine the amount of resistance a nurse has to the environmental stressors. (Turner, Kaylor, 2015) Once the variables have been distinguished, resilience building begins by using primary, secondary and tertiary interventions. These interventions use the processes of preventing potential stressors and identifying risk factors, recognize problems and address them before the nurse’s line of defense is targeted, and decreasing or eliminating stress response to maintain stability. (Turner, Kaylor, 2015) Overall, this article recognizes a feasible framework to analyze resilience in nurses. The second article written by Gunusen, Ustun, and Gigliotti focuses on the core response. Most of the Neuman Systems Model research relates to stressors, flexible line of defense, and normal line of defense invasion but neglect the overall core response. (Gunusen, Ustun, Gigliotti, 2009) The burnout process recognized in this article is concurrent with other research. The burnout process occurs through the overwhelming feelings, exhaustion, detachment from the job, and feelings of cynicism. (Gunusen, Ustun, Gigliotti, 2009) This article suggests that much of the current Neuman Systems Model research and examples only recognize the physiological response and neglect to recognize the core response. However, the core response does not have to mean death or even the basic life processes, such as temperature, blood pressure, or breathing. A core response can affect any of the variables. (Gunusen, Ustun, Gigliotti, 2009) This article offered insight into the many unique ways stress can affect a person, whether it be physiological, psychological, sociocultural, development, and spiritual. It also recognizes that the only way for nurses to handle any stressors in their work environment must be accomplished by practicing and nurturing their resiliency.

The literature presented above all supports the professional issue of nurse burnout. Each article recognizes burnout, the reasons why nurses face burnout, and the ways nurses can overcome it. All of the articles recognize nursing as a high-stress job. Nurses are given the ability to be present with others during the most intimate times of vulnerability. Nurses must remain resilient and stand firm by the patient’s side, offering support, knowledge, advice, skilled actions, and re-establish well-being for the patient and family. (Turner, Kaylor, 2015) Nurses must practice resilience and strengthen the qualities associated with it. Nurse burnout may have dire effects on nursing if it is not stopped. If a nurse is experiencing burnout and is not receiving support from nurse leaders, hospital executives, or co-workers, the patient’s care will suffer. Nurses may potentially suffer legal or ethical conflicts and may even face professional licensure issues. A nurse suffering from burnout may also experience depersonalization and no longer value their job or license as a mindful and healthy nurse would. An overworked nurse may experience medical or medication errors, which account for the eighth leading cause of death among Americans. (Sherwood, Zomorodi, 2014) A nurse may feel a decrease in job satisfaction which will increase the levels of burnout. This may result in practicing harmfully, frequently facing ethical problems, or provide a decrease in the overall quality of service with patients. In order for nurse leaders to recognize problems and make the most accurate decisions regarding issues nurses face, a high level of ethical sensitivity is critical. If a nurse makes a medication error, does not follow the hospital’s policies and procedures, or does not adhere to proper care within their scope of practice, they may face losing their nursing license. Nurses must be attentive of their responsibilities and not allow burnout to get in the way of quality, safe patient-centered care.

Overall healthcare delivery has changed to now being safe, quality patient-driven care. Facilities use interdisciplinary teams, along with the patient and family, to decide upon care and address concerns. Nurse burnout directly affects how well a nurse can deliver safe and quality care. The current nursing shortage is not only affecting nurses, but also patients and staff. The nursing turnover rate is steadily increasing and is a major contributing factor to the problematic nursing shortage facing the profession today. (Brown, Whichello, Price, 2018) In this current culture, it is very common for more and more nurses to leave the profession, many times because of burnout, which adds to the shortage and worsens conditions for already overworked nursing coworkers. Nurse burnout is also responsible for poor patient satisfaction scores and an increase in hospital-acquired infection rates. (Brown, Whichello, Price, 2018) Similarly, patients and their families may be unsatisfied with patient care and experience unfavorable outcomes when nurses experience burnout. The healthcare team may also feel the effects of stress and burnout during interdisciplinary relationships with nurses. Nurses can suffer from impaired sleep, poor physical and mental health, and poor patient outcomes. (Brown, Whichello, Price, 2018) Nurses may become apathetic and lack care toward their patients due to compassion fatigue, depersonalization and prolonged stress. However, the research available suggests different ways for nurses to handle burnout. Building self-esteem, resilience, and leading with optimism help nurses to overcome burnout. It is imperative that nurses demand that healthcare leaders offer support, training, and the necessary measures to decrease work-related stress and grow their abilities to build their resilience.

The conceptual framework that parallels nurse burnout is Neuman Systems Model (NSM). The basic philosophy of the NSM is “helping each other live”. This framework focuses on the types of stressors that may cause harm to a person’s health or well-being as well as ways to reduce the impact of stress. (Turner, Kaylor, 2015) Neuman created this framework as a way for a client to be able to heal and recover through nursing interventions that reduce stress. The patient will develop a set of defenses to protect themselves against the outside stress. However, the line of defense is only a buffer and the way the client reacts and adjusts to the stress will determine how successful they are. This framework can easily be related to nurse burnout. Outside factors such as workload, exhaustion, moral distress, poor support and communication and bullying may all be stressors that affect a nurse’s well-being. If the stressors impact the nurse’s line of defense, the nurse may begin to have symptoms of work fatigue, emotional exhaustion, and burnout. (Turner, Kaylor, 2015) Once the stressors are recognized to which variable they have affected- physiological, psychological, developmental, socio-cultural, or spiritual, interventions then take place to overcome the effects of the stressors. Primary interventions, such as recognizing workplace environmental factors or opening the lines of communication among colleagues, would be examples of risk factors that are used to prevent stressors. Secondary interventions are responsible for recognizing problems and address them before the line of defense is impacted. If a nurse finds a stressor that will cause harm, it is imperative that the nurse seeks out help or advice from a leader or friend within that workplace. Lastly, the tertiary intervention is aimed at building resilience to decrease or eliminate the stressors and promote stability and balance. Once a nurse is successful at creating resiliency, the outside stressor that once impacted the core is not longer considered a stressor. Overall, this conceptual framework is designed to find an outside stressor and build a resistance to it using the client’s resilience to overcome and eliminate the stress.

A second conceptual framework that may apply to nurse burnout is Orem’s Self-Care Theory. The main points of the Self-Care Theory revolve around promoting normalcy. The patient should be given the support and autonomy to practice self-care. However, as nurses provide Orem’s Theory to their patients, it may be appropriate to turn the theory around to apply to nurses suffering from burnout. Nurses would need to look at themselves as patients. They would need to recognize the areas where they are lacking care- physical, psychological, emotional. Once it is learned what they can or cannot do for themselves, what they need help with, and when to ask for help, the nurse must learn the coping strategies. For example a nurse suffering from burnout and working a high-stress job would need to recognize the signs for the decline. The nurse may need to reach out for help from coworkers or nurse leaders. Self-care maintains factors that affect development and basic functioning in the interests of life, health and overall well-being of an individual. (Kearney-Nunnery, 2016) Healthcare facilities should offer more support for nurses suffering from burnout. The creation of policies and procedures to support the health and well-being of individual staff members will benefit the interdisciplinary team, strengthen the organizations in which they practice and promote the overall retention of nurses in the face of nurse shortages. (Andrews, 2006) According to Orem’s theory, if an individual has needs of self care that out-weighs their ability to engage in self care, that individual is said to be in a self care deficit and then requires nursing interventions. (Simmons, 2009) Orem's theory encompasses the self-care theory which describes why and how patients’ care for themselves. The self-care deficit theory explains the why and how patients can be helped through nursing. The theory of nursing systems describes relationships between the nurses and patients and further develops the importance of these relationships for quality nursing care. (Younas, 2017) Quality self-care is needed to sustain and foster a healthy patient through body and mind.

Through years of nursing experience, any nurse can attest to the fact that nurse burnout is alive and well. It is one of the unfortunate situations that many nurses face or experience in their work setting. With a shortage of nurses in hospitals, this writer will further practice nursing in various other settings. As a nurse in a hospital setting who is overworked, tired, and suffering from burnout, medical errors would be very likely to happen. This could affect the status of the nurse’s license or force the nurse to resign from their job. Patients suffer when nurses make errors. Nurses are constantly pull in numerous different directions with high patient assignments, more acuity, and less nurses picking up slack. Studies indicate that nurses were interrupted on average of almost twelve times per hour and 22% of the time while administering medications, as well as frequently while performing safety-critical tasks. (Sherwood, Barnsteiner, 2017) This can be detrimental to the nurse or patient. It is daunting to read that more people die from medication errors than from car accidents or breast cancer. (Sherwood, Barnsteiner, 2017) This writer plan to further practicing nursing as a lawyer or in pharmaceutical sales. Although both professions are competitive, the challenges are different. It is too risky to put faith in another’s hands when a nursing license and character are at stake. Having experienced burnout from colleagues in a rehabilitation setting, it is very toxic environment. Burnout is very easily influenced upon others and may cause nurses to be pulled down to the level of the burnt out nurse. It is also extremely difficult to be a nurse leader with staff members who are burnt out. Nursing is heavily reliant on teamwork and having a coworker suffering from burnout only brings the entire team down. Overall, healthcare delivery is deeply affected by nurse burnout. As said above, nurse burnout also contributes to poor patient satisfaction scores and increased infection rates. Patients and families are less satisfied with care and experience poor outcomes when nurses experience burnout. (Brown, Whichello, Price, 2018) Quality patient care is reliant on knowledgeable, skilled nurses to practice safely and efficiently. Nurses must be at their best mentally, physically and emotionally to effectively perform their job. It is imperative that all nurses, not just the ones suffering from nurse burnout, practice self-care and recognize any early signs of burnout.

In closing, nurse burnout is a dire issue facing the current state of nursing. The nursing shortage is increasing, patient care is suffering, and the culture of nursing is fading. It is important that the current problems within nursing are analyzed and evaluated for ways in which they can be minimized. Nurses must have support and training on the signs of burnout and understand the ways they can overcome it. Nurses have a responsibility to themselves, their patients, their license, and their colleagues to always practice safe nursing care and ensure that the healthcare industry continues to flourish with innovative and quality nursing care for many years to come.

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