Nurses burned out and want to quit

"Nurses' wellbeing is central to ensuring the best outcomes for patients," said study author Dr. Annamaria Bagnasco of the University of Genoa, Italy. "When wards have poor leadership and fragmented teams with no development prospects for nurses this should raise an alarm that there is a risk of burnout."

Previous research has shown that burnout rates are higher in paediatrics than in other specialties, and that burnout is connected to patient safety. Strategies to reduce burnout and its impact on patient safety are needed.

This study examined emotional exhaustion in nurses providing routine care on paediatric cardiology wards and whether it was related to the working environment.

Data were obtained from the RN4CAST@ITPed study. A web survey was distributed to 2,769 nurses working in children's hospitals throughout Italy between September 2017 and January 2018. A total of 2,205 (80%) nurses responded, of whom 85 worked in cardiology wards and intensive care units (ICUs). Additional data were collected from hospital administrations. Topics included workload, skill mix, work environment, and emotional exhaustion.

The following definitions were used: Workload referred to how many patients each nurse was caring for (nurse-patient ratio). Skill mix included both the education level of nurses working in one unit and the number of nursing assistants providing support during each shift.

Work environment was measured with the Practice Environment Scale of the Nursing Work Index (PES-NWI), which covers issues such as: having a nurse manager or immediate supervisor who is a good manager and leader; opportunities for advancement; opportunities to participate in policy decisions; and collaboration between nurses and doctors.

Emotional exhaustion was investigated using the Maslach Burnout Inventory, which measures feelings about work. For example, feeling emotionally drained, used up, fatigued in the morning, burned out, frustrated, working too hard, stressed, or "at the end of my rope."

This analysis focused on responses from the 85 nurses working in cardiology wards and ICUs at five hospitals. Interviews were also conducted with these nurses. More than half (58%) were emotionally exhausted. The main causes were related to working conditions, including being responsible for high numbers of patients and the complexity of caring for sick children.

"The most important consequence was that 30% of the nurses we interviewed wanted to either go and work in another hospital or even change their career," said Dr. Bagnasco.

The researchers then analysed the relationship between emotional exhaustion and the working environment. Improving the workplace environment was associated with an 81% fall in emotional exhaustion -- even with the same skill mix and nurse-patient ratio.

"Our study shows that nurses value good leadership, being involved in decision-making, having chances to develop their career, and team working," said Dr. Bagnasco. "The lack of these conditions is connected to burnout, which we know from prior research could compromise patient safety."

Dr. Bagnasco noted that paediatric cardiac nurses must collaborate with children and their families, who often feel concerned and afraid. She said: "Establishing a trusting relationship is essential but burned out nurses may find it 'too heavy' to bear emotionally. If the working environment is positive for the nurses who work in it, children and their families will receive better and safer care."