Introduction of a Nursing Dissertation

1.1 Introduction to the Study

Burnout among nurses have become a concern in patient care globally and is recognized even more in the last two decades. The situation has been dire to Accident and Emergency(A&E). Nurses work in health institutions where they offer care to patients through maintaining patient records, administering patient medication, observe and monitor patient progress, and liaise with doctors for advanced treatment. A nurse is the first point of contact for patients once they visit a health facility. Since they are the links between doctors and patients; they have to work extra hard to meet the expectations of both parties. A significant challenge faced by these employees is long working hours which often results in burnout.  They overwork because in most cases a nurse has to serve a large number of patients. The government has not been able to balance the ratio of nurses to patients (Gail et al., 2016).

In 2013, the National Health Service (NHS) in England published a report on nurses quitting their careers because of consistent pressure and incapacity to offer quality care. The Royal College of Nursing disclosed that in a 2013 survey entailing 10, 000 nurses, 0.62 of them intended to resign due to stress and work-related burnout. Of the respondents, 61% mentioned hectic schedules as a hurdle for nurses in providing high-quality care and 0.83 attributed increase in workload to the resignation of more than 5, 000 nurses within three years of their profession.

A survey conducted in ten European countries on 23,159 nurses who work in medical and surgical wards reported high burnout levels among nurses and healthcare assistants in distinct nations; 42 % in England, 25 % in Belgium, 30% in Germany,  22% in Finland, 40% in Poland,  24% in Norway,  41% in Ireland,  29% in Spain, 10% in Netherlands,  and 15% in Switzerland.  The nurse who experienced burnout were more motivated to quit their jobs. Radio Canada, in Canada, 40% of nurses who participated in the study encountered burnout daily. Therefore, burnout is a problem that is facing the nursing profession. The available literature shows the prevalence of burnout in the nursing profession, especially in accidents and emergency sections; which negatively affects the personal delivery of quality care. Such information is essential in developing policies and measures to improve patients care and nursing service delivery. The current situation violates the nursing code of ethics which require the nurse to serve the patient efficiently. It begs to understand how nurses can efficiently serve patients when they are experiencing burnout which can lead to medical errors and reduce patient outcomes.

The total demand for nurses has risen in England. There were approximately 690,773 nurses in England (Nursing and Midwifery Council, 2018). Four key aspects have bolstered the demand for nurses in recent times are reforms, population, and the changing role of nurses. In terms of changes, the shift towards integrating the NHS and social care, combined with an emphasis on 7-day working, has increased the demand for nurses. On 25th February 2015, the General Secretary of the Royal College of Nursing (RCN), Dr. Peter Carter noted that the shortage of nurses is significantly affecting service delivery. He attributed the problem to the long wait for treatment and poor working conditions for nurses (Yasuhiro et al., 2018). The irony is that while the demand for nursing services in England is increasing, more nurses quitting, which will amplify the problem of nurses’ shortage. The concerned authority and health stakeholders should address the problem as a matter of urgency. These issues have been the cause behind nurses burnout and decrease in quality of care. Based on the provided argument, this research paper aims to explore the frequency of burnout amongst nurses in England and determine if it affects care standards.

1.2 Background Information

Nurses work in health care facilities and other institutions to provide healthcare to patients. Nursing entails prevention of disease, promotion of health, taking care of the sick, disabled, and terminally ill patients. The first role of a nurse is to link the patient with other medical practitioners. Secondly, the nurse ensures that the patient undergoes all tests recommended by the doctor also and also administer the prescribed medication. The nurse also maintains patient records and monitors the patient’s progress after treatment. If the patient requires a follow up outside the hospital setting, it is the nurse who does the follow-up.

In society, the nurse has the responsibility of promoting the well-being of the population through self-care education that serves to prevent illnesses and improve the quality of life. Health education to communities and specifically caregivers help to prevent and manage illnesses. The nurse also has the responsibility of informing a population of health risks that are present in their lives. An example is educating teenagers and adolescents on the dangers of eating junk foods and not exercising.

The shortage of nurses in all parts of the world has raised concerns. Several authors, (Shereen and Hussein, 2018) have attributed related the shortage or nurses to increased working hours and high patients to nurses ratio that causes stress in the workplace and leads to burnout. According to Mäkikangas and Kinnunen (2016), signs of burnout include exhaustion, cynicism, and reduced professional efficacy. When an individual has burnout, they have insomnia, are easily irritated, anxious, and have a sense of hopelessness (Hayley et al., 2015). According to the Nursing and Midwifery Council (NMC), the headcount of nurses in England fell by 1,783 to 690,773 in the year leading up to March 2018 (NMC, 2018). The NMC also stated there was a widening gap between nurses who were joining the profession and those that were leaving. The NMC surveyed nurses who retired before their retirement date and found out that the majority were under the age of 40. The study attributed the outcome to among other reasons; poor working conditions, nurse shortage, long working hours, fatigue; a situation that led to burnout (NMC, 2018).

The challenges in the nursing profession have led to an imbalance between those joining the career and nursing turnover. Those that decide to remain are compelled by situations beyond their control to overwork to meet the growing demand for nursing care; a factor that has led to burnout (Anna et al., 2018). In the UK over 33,530 nurses left the National Health Service (NHS) between September 2016 and 2017 (NHS Digital, 2018). Burnout has been attributed to understaffing in hospitals and poor working environment for nurses (Fawcett et al., 2015; Stockwell, 2015).

Anna et al., (2018), conducted a survey that involved both patients and nurses in acute settings. The results showed that there is an inverse relationship between burnout and the level of job satisfaction among nurses. The study also established that where there are right working conditions and the nurse to patient ratio was favorable; there was improved quality of care to patients and reduced burnout. The NHS aims to provide high-quality medical care to the population which means that those who give the patient-care should also be provided with a conducive environment to serve the patients devoid of burnout. By identifying the relation between burnout and provision of quality care, managers will be able to identify burnout in nurses and intervene on time to ensure patients receive quality care.

1.3 Rationale of the Study

It is important to note that the impact of burnout amongst nurses and how it affects the delivery of patients care has been an area of interest for some time. Indeed, a review of the relevant literature shows that the impact of nurse burnout has dominated healthcare research for some decades. However, the available empirical literature is not conclusive and is characterized by inconsistencies right from determining the cause of burnout among nurses, the role of hospital management and workforce on burnout to measures of addressing burnout and quality of healthcare.

Regarding the causes of burnout among nurses, research has noted inconsistencies. For example, a study by Starc (2018) stressed on the demand by patients for nursing care and a despise by doctors and physicians, coupled with their knowledge and skills are underestimated while they are nevertheless expected to provide compassionate, humane, competent, culturally sensitive, and ethical nursing care as the primary challenge experienced by nurses. Yao et al., (2018) while studying burnout concluded that stress, introvert unstable personality, and General Self Efficacy (GSE), are the primary factors of job-related burnout among nurses. GSE controls the effect of stress on burnout in nurses with neuroticism personality or extroversion. Increasing GSE, reducing stress, and increased social support may reduce job-related burnout among nurses. The author concluded that introvert nurses with an unstable personality need more social support to reduce stress and enhance their GSE.

Szczygiel and Mikolajczak, (2018) explain job burnout as a disorder resulting from exposure to high work demands whereas there are not enough resources to manage the demand. The researchers attributed exhaustion among nurses to exposure to a variety of occupational stressors. These include heavy workloads, time pressure, interpersonal conflicts at work,  and patient-related factors that include verbal aggression from patients and their caregivers.

In summary, there is evidence-based literature showing that burnout and significant impact on patients nursing care. Most of the research on the relationship between burnout and quality of care has used self-reported perceptions of quality of care an essential but relatively weak measure. Nevertheless, the available literature is not comprehensive that demands a systematic and comprehensive review of the literature concerning these elements to generalize the findings and develop a conclusion. At the time this research, this area of study had not been explicitly covered for England, an aspect that explains why there are variations in the literature available concerning nurses burnout and quality of care. The above-noted lack of England specific review addressing the objectives covered herein underscore the importance of conducting a comprehensive literature review and integration of the available evidence-based literature on the impact of nurses burnout in England and its impact on the quality of care.

1.4 Aim and Research Objectives

The general aim of the study was to understand the impact of burnout on care given by Accident and Emergency nurses in England. In particular, the study will seek to;

  1. To explore the epidemiology on burnout in hospital settings.
  2. To identify the factors which lead to burnout.
  3. To examine how the hospital workforce is planned to ensure the retainment of staff while ensuring efficiency.
  4. To investigate how the application of Working Time Regulation 1998 by the Royal College of Nursing (RCN) and how it hinders managers from identifying burnout amongst staff.
  5. To examine how absenteeism caused by burnout impact on quality of care.
  6. To identify changes hospitals can implement to minimize burnout amongst staff while maintaining quality care.

1.5 Literature Search Strategy

The search strategy used identified the key terms and concepts, select relevant database and resources, combine search terms with Boolean operators, review, and refine search results. The research data was collected on primary research articles using randomized control trials were electronically identified using the key terms and concepts, selecting relevant database and resources which included; PubMed, CINAHL, SciELO (Scientific Electronic Library Online), Scopus, LILACS, Science Direct (Elsevier), and the Proquest Platform (Proquest Health & Medical Complete). A total of 21 articles were critically examined and analyzed for this study.

1.6 Ethical Consideration

The study adhered to research ethics and respect for human rights. The guidelines of the Belmont report using human beings in research were taken into consideration ensuring respect, justice, and beneficence of the respondents. Considering that the study used secondary data, the researcher did not need to seek prior consent from primary respondents. The materials selected for the literature review were critically examined and analyzed with the aim of hiding sensitive personal information of the participants and avoiding plagiarism. Personal beliefs and reflections were only in the discussion, introduction and conclusion chapters to safeguard results from bias.

1.7 Structure and Outline of the Dissertation

The dissertation has six chapters. The introduction; It has a brief introduction, background of the study, rationale of study, aim, and objectives of the study, ethical considerations, project outline, and a summary. Chapter two is the theoretical framework; this covers; job and demands-resources model, the Maslach theory on burnout, conservation of resources, measurement, and diagnosis of burn out, burn out, and nursing. Chapter three it the methodology; this covers; data collection, inclusion, and exclusion criteria, and ethical considerations. Chapter four covers the finding and analysis. Chapter five is a discussion while the last chapter is the conclusion and recommendation.

1.8 Summary

This chapter gives an overview of the study. It also gives a background of the study that shows the review of the study, the information around it and previous scholars on the topic and relevant history of the study. The chapter also describes the rationale of the study, aims, and objectives of the research, how to search literature, and how to conduct ethically.

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