This paper examines the causative factors that result in absenteeism within the environment of the nursing practitioner. Nursing has been considered as one of the most vulnerable professions to the concept of ‘burnout’ at work. This often the result of excessive working hours, high degrees of stress and imbalance in exercise and nutritional requirements. Numerous research studies have been carried out in this area. One strong correlation was with age of the nurse and burnout. Those over 45 years of age seemed much more prone than younger nurses. As such those older nurses needed a strategy in order to cope with stress and other factors that result in mental and physical exhaustion. (Kedem,Y. 2007)
The impact of prolonged absenteeism by nurses in hospitals can have serious ramifications both for the hospital and the patients. The hospitals measure this in terms of increased costs and a reduction in quality of care and treatments. The absenteeism also applies further pressure on the other nurses that have to pick up the slack. Where a hospital is getting multiple occurrences of absenteeism there is clearly something wrong that needs to be addressed. There are normally distinct signs of burnout in nurses, for example: (i) Drop in level of motivation (ii) Dislike of the job and indifference towards patients (iii) Reduction in quality of care (iv) signs of physical fatigue. (Miller DS, 1986).
Owing to the increased national shortage of nurses the nation is facing the high adverse outcome of nursing burnout and increased absenteeism at work. There is a need for hospital administrations to stand-back and re-examine their strategic policies and plans regarding the nurses working environment and conditions. Where these are excessive or creating unrealistic expectations upon the nurses than there is a need for immediate remedial action. The cause and effect table as illustrated below provides a snapshot of some of these concerns. (Vahey, D.C. et al 2004).
|Higher nurse workloads
Excessive hours, unrealistic demands
· Physical fatigue
|Job dissatisfaction||· Poor or inadequate planning
· Lack of break periods
|Age element (over 45 group)||· Less stamina
· Impact of stress greater
|Poor environmental conditions||· Insufficient resources to meet the demand of the job|
In general terms rural hospitals differ from that of the urban hospitals by being smaller in size i.e. they normally have less than 50 beds. In addition, the rural hospitals are more dependent upon Medicaid and Medicare in terms of obtaining payment for services rendered . The suburban hospitals tend to gain more preferential medicare funding. Financial viability is another key factor of differentiation between rural and urban hospitals. Research conducted across a sample range of different medical institutions revealed that rural hospitals were far more vulnerable in this respect. Because of the restriction on bed size the smaller hospitals have less pressure on the nursing staff.
High poverty regions in the US have the smallest proportion of hospital staff and professional medical care. This contrasts to the smaller rural hospitals that tend to be in more affluent areas and deal with more private patients. Hence urban poverty and poor economical regions are a factor in the determination of the level of medical care provided.
Studies carried out on urban/suburban areas have illustrated significant disparities in terms of gaps in quality and services found in such communities as Indianapolis, Seattle, Phoenix, Los Angeles and Miami. It is there that the health authorities are investing more money in improving the medical facilities in the more affluent suburban areas. A pilot study carried out in 2003 examined the poor suburban areas of Los Angeles, which are home to a large number of poor immigrant communities and here they are struggling with inadequate access to hospital care.
Investment in improvement of hospitals and the nursing environment are important in the remedial factors to address nurse burnout. At the moment nurses certainly get a better deal in the suburban hospitals where they are under less stress and conditions that result in burnout.
A recent study carried out in 2012 showed increased correlation between nurse burnout and patient infection rates. A research team at the University of Pennsylvania School of Nursing conducted a study over 7,000 Registered Nurses covering 161 hospitals. The team categorised three main forms of nurse burnout:-
- Emotional exhaustion – the concept of being drained of energy by overburden of work
- Depersonalization – the concept of detachment between nurse and patient
- Personal Accomplishment – How an individual feels about the level of competence in completing their work. (Olin, J. 2013).
Stage 1 | Nursing Turnover
A high degree of nursing staff turnover is a clear indication that all is not well with the organization. High pressure urban hospitals are often falling within this category.
Stage 2 | Nursing shortage
The concept of a national nursing shortage places a strain on the entire system. Most nurses will attempt to obtain the best pay and working conditions available. This often makes the suburban hospitals far more attractive as employers. This further adds to the strain on the urban hospitals suffering from staff shortage
Stage 3 | Inadequate Staffing
This is often the result of poor hospital administration where there inadequate resource and strategic planning. May also be poor leadership that is failing to keep abreast with the demands being placed upon the hospital. This results in excessive hours, unrealistic performance targets and low morale with the nurses struggling to keep up.
Stage 4 | Job dissatisfaction
The nurse’s frustration peaks with the stress being imposed upon the job. With no potential remedial action in sight the nurses become disillusioned with their jobs. This may result in quitting the job or trying to find a more workable environment.
Stage 5 | Burnout
The nurses become ineffectual because of stress and burnout. (Aiken, L.H. et al 2002)
There is no doubt that happy, dedicated and fit nurse’s lead towards better patient outcomes. In this sense finding the right nursing environment is essential to both the wellbeing of the nurse and patient. The hospital administration must play a more pivotal role in ensuring that they have adequate nursing resources in order to meet the demands of the hospital. This means effective forward planning and a sustained recruitment policy that facilitates both existing need and expanded needs in the future. (Vahey, D.C. 2004).
Statistics indicate that most nurses are working in extended shift patterns of between 12 hours or more at a time. Research from the University of Pennsylvania stated that this was very prone towards leading nurses to a state of job dissatisfaction and poorer patient outcomes. The more traditional eight hour shifts are slowly fading away. More progressive hospitals are moving towards the 12 hour shift model but on a 3 day week basis. This provides for improved work life balance and time to de-stress. It would seem that where hospitals exceeded these limits this rapidly increased the possibility of nurse burnout. In addition, many of the nurses became disenchanted and were considering leaving their job to find something less stressful and demanding.
There is also a nursing leadership issue. The hospitals need to develop a culture that promotes regular days off, vacation time and a limitation on the shift hours to be worked. Further nurses should be empowered to be able to refuse overtime working without retribution. There should be a culture of collaboration, sharing and working together in a constructive and productive manner.
Doris C. Vahey, P. R. (2004). Nurse Burnout and Patient Satisfaction. MedCare Vol 42(2), 1157-1166.
Kedem, Y. B. (New York). Burnout and absenteeism among nurses in health care management. Journal of Academy of Business and Economics Vol 5 (1), 1-36.
Linda H. Aiken, P. R., Sean P. Clarke, P. R., Douglas M. Sloane, P., Julie Sochalski, P. R., & Jeffrey H. Silber, M. P. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association Vol 288 (16), 1-10.
Miller DS, N. V. (1986). Absenteeism. Nursing services albatross. Journal of Nursing Administration Vol 16(3), 38-42.
Olin, J. (2013, 1 24). RN Study Finds Links Between Nurse Burnout and Patient Infection Rates. Retrieved from RN Central: http://www.rncentral.com/blog/2012/rn-study-finds-links-between-nurse-burnout-and-patient-infection-rates/