Many hospital nurses are experiencing burnout due to inadequate numbers of fellow nurses, inattentive management, and rising numbers of patients, according to a new survey that researchers say has implications that go beyond the hospital setting. "The overall problem in hospitals is affecting every arena in healthcare," says lead author Linda H. Aiken, PhD, RN, who is the director of the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research.
This study of more than 43,000 registered nurses in five countries shows high levels of hospital-nurse job dissatisfaction, particularly among US workers. Further, the researchers found that although relations between nurses and physicians are satisfactory across the survey countries, "core problems in work design and workforce management threaten the provision of care." Among the findings:
- More than 40 percent of the US nurses surveyed scored high on the Maslach Burnout Inventory.
- In the US, 41 percent of nurses working in hospitals reported being dissatisfied with their jobs, compared with 36.1 percent in England and 17.4 percent in Germany.
- The percentage of nurses under age 30 planning to leave their jobs within the next year is much higher than among nurses in general. (Thirty-three percent of nurses under 30 in the US, who make up just 19 percent of the US nurses surveyed, are planning to leave, compared with 22.7 percent of all of the US nurses surveyed).
- Only 30 to 40 percent of nurses across the survey reported that there are enough registered nurses to provide high-quality care as well as enough staff to get the work done.
- In the US, 83.2 percent of nurses surveyed reported that, in the past year, there's been an increase in the number of patients assigned to them, and 58.3 percent in the US say there's been a decrease in the number of nurse managers in that time.
- In the US and Canada, nurses were more likely to be dissatisfied with their working conditions than with their wages.
Dr. Aiken makes no bones about what she sees as the cause of the staffing problems and dissatisfaction, and it's not necessarily a nursing shortage. Hospitals, as she sees it, are not retaining their share of the pool of nurses, and management is to blame; it's their strategies, not low nursing numbers in general, that are leading to nurse restlessness and exhaustion. Says Dr. Aiken, "The deployment of nurses in the hospital sector is ineffective, and leads to brain-drain. There is so much turnover because of the dissatisfaction, and this movement creates the illusion of a shortage." The researcher points to what she sees as the pound-foolish strategy of laying off non-nurse support staff, such as aides and orderlies. This strategy leads tonurses being stretched to their limits, and hinders the abilities of nurses to utilize their specialized skills and maintain consistent patient care. More than 40 percent of the US nurses surveyed said they do non-nursing tasks such as delivering food trays or transporting patients.
In addition, explains Dr. Aiken, "White-collar RN options," such as consulting and teaching, "are offering more competitive benefits than hospitals," and taking nurses away from their traditional caregiving roles. A problem at the core of retention, according to Dr. Aiken and her team, is that hospitals look to short-term enticements, such as signing bonuses, to lure nurses who will not spend significant time at their facilities. She says, "Hospitals really have not adopted long-term strategies, the kinds of things that would link employees to their institutions," such as better benefits, more autonomy, support services, and "a reasonable combination of workers."
Dr. Aiken says the hard truth is, "Unless they change their ways, hospitals will always need more nurses than there are."
Not all of the news is worrying: A vast majority of those surveyed believe that they work with physicians who provide high-quality care and nurses who are clinically competent.