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Don’t underestimate damage caused by burned out nurses


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Alexandra Wilson Pecci, for HealthLeaders Media, August 7, 2012

Could urinary tract infections in hospitalized patients be caused in, in part, by exhausted, frazzled, emotionally drained nurses?

Yes, says a study published in the August issue of the American Journal of Infection Control. It shows that nurse burnout is linked to higher healthcare-associated infection rates (HAIs), and as a result, higher costs.

Reading the new findings about how nurses can negatively influence infection rates reminded me of another study with very different results. Those findings, presented earlier this year at the American Nurses Association's Nursing Quality Conference, showed that when nurses had certain specialty certifications, infection rates went down.

Comparing the results of these two studies should send up a red flag for nurse leaders. One study shows what happens to patient care when nurses are nurtured, encouraged, trained, and given the resources to succeed.

The other shows what happens when nurses are emotionally spent, loaded up, and weighed down by their work. The implications are clear.

"Based on our finding that the staffing-infection relationship is mediated by job-related burnout, practitioners should work to implement organizational changes known to build job engagement, such as educational interventions, performance feedback, and social support, as strategies to reduce nurse burnout and thereby help control infections in acute care facilities," wrote the authors of the APIC study.

As the authors point out, increasing job engagement in these ways can help reduce burnout, and since burnout is linked with higher infection rates, leaders should have an even greater interest in making sure that their nurses are happy and engaged at work.

Over the past several months, this column has highlighted a number of examples that show ways that nurse leaders can positively influence not only clinical outcomes, but also nursing satisfaction and retention.

I'll not only point to the example of increasing the number of specialty certifications to reduce infection rates, but also other factors that lead to job satisfaction, such as having more control over scheduling and emphasizing leadership and learning

The authors of the APIC study researched "job-related burnout in registered nurses to determine whether it accounts, in full or in part, for the relationship between nurse staffing and patient infections acquired during hospital stays."

They determined burnout by analyzing nurse survey responses through the lens of the emotional exhaustion subscale from the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The MBI-HSS filters 22 items on job-related attitudes into emotional exhaustion, depersonalization, and personal accomplishment, identifying emotional exhaustion as the key component to burnout syndrome.

More than one-third of survey respondents got an emotional exhaustion score of 27 or greater, the MBI-HSS definition for healthcare personnel burnout.

The researchers also found that nurses slip up when their workload is heavy. As one of the commenters noted when HealthLeaders covered this study last week, "Could it also be that the reason the nurses are burnt out is that they don't have time to contribute to infection control issues?"

Comparing catheter-associated urinary tract infections (CAUTI) with nurses' patient loads, the researchers found that for each additional patient assigned to a nurse, there was roughly one additional infection per 1,000 patients.

Also, each 10% increase in a hospital's high-burnout nurses corresponded with nearly one additional CAUTI and two additional and surgical site infections (SSI) per 1,000 patients annually.

"We found that increasing a nurse's workload by one patient was associated with increases in both urinary tract and surgical site infections," the authors wrote.

Hospitals that work to decrease nurse burnout can enjoy financial, as well as clinical improvements. The researchers found that in hospitals where burnout was reduced by 30%, there were a total of 6,239 fewer infections, for an annual cost saving of up to $68 million.

The numbers are stacking up and the results are clear: Making sure nurses are satisfied and supported in their jobs is critical, not only for employee retention, but also for patient care, and ultimately for hospital costs.

Source: HealthLeaders Media