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Issues

Discuss about the Burnout Issues Among Nursing Staff Working in Kims Hospital.

Stress is considered as a relationship between a person and his or her environment which is considered as exceeding ones resources resulting into endangering of the well-being of the person. Stress can cause health issues in humans. Work can be one of the reasons of stress in humans. Nurses working hospitals face stress as their jobs are filled with stress such as long working hours, human suffering, physical labour, and problems of interpersonal relationships. Among the nurses, the stress was recognized as a problem for the first time in 1960 when four sources causing anxiety in nurses were identified by Menzies that included patient care, change, responsibility, and decision making. By 1980s, additional causes were determined with the increased use of technology in hospitals which changed the work environment (IDDRISU, 2013).

The term burnout in people was coined by Freudenberger in 1974 which as described as reactions of workers to the chronic stress situations in their occupations. Burnout situation is conceptualized as a condition in which a person is disturbed by exhaustion, reduction in accomplishment and depersonalization.  Stress at work is often caused in a person because of the combined responsibilities of handling work and family which affects the person both at work and in family situations. Females make the majority of nursing staff and as they have higher responsibilities towards family, they face such kind of stresses predominantly. These stresses can lead to neuroendocrine responses that cause physiologic reactions that could further cause illnesses in nurses. This causes dissatisfaction in nurses which results into employee attrition. KIMS hospital is also facing a staff shortage among nurses because of burnout situations and it needs to work on improvement of the working environment such that nurses retention can be improved (Jennings., 2006).

KIMS hospital is facing dissatisfaction with job among nurses because of burnout situations and it needs to reduce the stresses of nurses to overcome the challenges caused by these burnouts in nurses. Factors that may be causing these issues include:

Work Environment: The hospital has long working hours that puts stress on the nurses. There are only few nursing students who are selected to work in the hospital after they have completed their studies which results into lack of nurses. With only a few nurses managing work at the KIMS hospital, the work load of individual nurses is significant. In such a n environment, several nurses are unable to cope up with the work pressures and leave the hospitals while others face the situation of burnout.

Possible Solutions

Demographics: Several nurses working in the hospital are either married or have marriage with kids. In the face of long working hours and work demands, these nurses are unable to balance their work with the personal family life.  Other nurses who do not have these responsibilities are young graduates who are not sufficiently trained and thus, find it difficult to manage the responsibilities of the job efficiently.

Recruitment and retention: Hospital reputation affects the recruitment and as the attrition rate of the hospital is high, the reputation as an employee would not be too favorable which would make it even more difficult for the hospital to attract as well as retain the nursing staff (Holdren & Coustasse, 2015).

Exposure to ill patients: Nurses have to deal with the patients who are ill and thus, they have to face continuous exposure to the illnesses. As they are involved in patient care, they tend to get emotionally attached to these patients which can cause emotional pressure especially in the cases of loss of lives. This can cause an emotional pressure that they do not get time to release as the new cases keep coming. This can cause burnout in nurses (Ericksen, 2015).

Job demands-Resources model

Figure 1:  Job demands-Resources model

The job-demands and resource model identify certain demands of a job that can affect the level of pressures that result from workload, working conflicts, job uncertainty and time management issues.  These demands can be social, physical or psychological. These job stresses are reduced if working people are provided with sufficient resources. These resources can include supportive management, good leadership, good relationships, positive environment, sufficient training, employee orientation, and recognition. If the job demands are higher than the job resources, it would lead to burn out of the worker. A balance has to be created between the resources and demands in a job to reduce the pressure on workers.  Thus, in order to reduce the burnout in nurses, resources may be increased beyond the work demands (Bakker & Demerouti, 2011). This can be done using following methods:

Hiring more staff:  If more nurses are hired, the workload would be divided between them. With more staff, the nurses would get more support and less of over time working hours. Thus, the burnout in nurses would be less (Narban, Narban, & Singh, 2016).

Administrative Support: If the support from the administrative staff is strong then it would keep the patients satisfied. It would also keep good relations between the nursing staff and doctors. This would create a supportive environment for the nurses and thus, would reduce the burnout in nurses (Vahey, Aiken, Sloane, Clarke, & Vargas, 2010).

Maslach theory of burnout suggests that burnouts are caused when there is a mismatch between the job demands and the capacity of the person who would be doing the work. The job demands have to be synchronized with the person doing the job which is possible when the person doing the job is made capable to handle the job with ease and efficiency (Maslach, Schaufeli, & Leiter, 2001). This can be done in following ways:

Providing Staff training: If the nurses are provided with the training on how to handle the work pressures then they would be more equipped to manage the work and yet not get burn out. This would need support from the senior staff and the human resource managers who would make arrangements for the training of nurses on aspects of work load management and stress management in addition to the regular training given for the understanding of the work (Alsaqri, 2014).

Hire experienced nurses:  If the hospital would hire nurses who already have experience of working in other hospitals instead of fresher’s, the workers would have the previous knowledge and experience of working in stressful situations and thus, they would be better equipped to handle the pressures of the job and do not get the burnouts due to work load pressures (Flemming, 2016).

As per the Maslach theory, there are six factors that can cause mismatch between the work demands and the worker. If these factors are taken care of, then a balance can be created between the resources and the demands. These factors include lack of control over work situation, values, fairness, workload, community, and reward. With these considerations, following solutions can be used:

Rewards and Recognition to nurses: As the nurses are not actively involved in taking decisions and thus, they tend to feel less important in the hospital. Over a long time of working in such a condition where they lack control over their work, burnouts can be caused as they would feel like trapped. In such a situation, providing rewards and recognition to nurses for their contribution would give them motivation and boost their morale (Lee, Scheunemann, Hall, & Payne, 2012).

Community Establishment: If communities of nurses or the hospital staff is established such that all the members are actively involved, strong relationships would be built in the staff which would keep the workers including nurses motivated as they would get support from team and there would be fewer conflicts between them (Maria, 2012).

Considering the case of KIMS hospital, the two most probable methods that would reduce the burnout rates in nurses could be:

Administrative Support: Administrative support would not need any additional resources to be hired but restructuring of the systems especially the administrative such that additional support can be sought from the administrative staff.

Staff training: Nursing staff can be trained on how to handle the work stress by the senior and experienced staff so that nurses can be better equipped for handling

Administrative support would need realignment of processes and probably some investment in providing support solutions through the implementation of technology for administrative support.  Administrative support can be improved by hiring new staff to provide support to the nurses and use of real time data management and analytics technology which can help nurses with the real time patient data recording as well as reduce the need of making manual entries every time. An alternative solution is provision of training on stress management to the nurses. This approach can be useful to some extent as it would help nurses deal with the stress better but it would not reduce their actual stress. Moreover, the solution would only be temporary and limited in the impact. However, provision of administrative support would provide a larger and long term benefit (OECD, 2012).

Administrative support would reduce the burnout among staff as it would help nurses carry out their work with lesser difficulties, with speed and with efficiency.  A feasibility study can be conducted on this solution by exploring a few questions like:

How would increase in the administrative reduce the burn out among nursing staff in the KIMS hospital?

Will it release the stress of the nurses? (Objective of the solution is to reduce the stress in nurses as it would reduce the probability of burnout in nurses and hence, this question would be useful)

Will administrative support create a positive working environment in the hospital? (A positive environment would be less stressful for the nurses and thus, if the answer to this question is yes then the method would be useful for reducing stress in nurses.)

Will nurses have access to more resources with the use of administrative support? (If more resources are made available to nurses then it create a better balance between demands from nurses and resources available to nurses)

Will it make it easy for the nurses to manage their work in the hospital with administrative support? (If the work of nurses becomes easy then it would be less stressful for the nurses in working)  (Carter, 2016).

Will it incur significant cost to the hospital? (For the management to approve the improvement in the administrative support, it is essential that the costs incurred in the implementation of the new technology for administrative support is justified for the hospital business)

Will the cost of acquisition and implementation of the administrative support system would be high? (If the cost of acquisition and implementation of the new technology is too high then the management may not approve the project)

Will the company gain more profits than the costs incurred in the system development? (If the company gets more profits than the costs incurred in the acquisition and implementation of the software then it would justify the cost and the project would get the approval of the management)

Will the company be able to breakeven within first year of the implementation? (If the company is able to recover the costs of development within the first year of the implementation then the project would be feasible and thus, would have higher chances of approval and would also ensure profitability of the hospital business)  (Daniel & Oyetunde, 2013).

Will it improve the relationship between the staff working for KIMS hospital? (Better relationships would make the work environment healthy and staff members would be helping each other which would make the work easy and enjoyable work nursing workers)

Will it provide more opportunities to the staff to communicate? (With more opportunities to communicate, chances of building strong relationships would also increase)

Will assistance from the administrative staff to nurses would be helpful? (If the administrative staff would be useful and helpful to the nurses then it would make nurses more positive about relationships)

Will it reduce the conflicts between the administrative staff and nursing staff? (reduced conflicts would ensure that good relationships are maintained in the staff)

Will it improve the productivity of nursing staff in the hospital? (Improved productivity in nurses would reduce the chances of burnouts in them)

Will the service delivery time for the nurses reduce with supportive technologies? (If the service delivery times are reduced then nurses would be able to serve more patients in less time)

Will services of nurses improve with the use of administrative technologies? (Better services provided to the patients by nurse reflect better productivity)

Will nurses be able to better track the patient’s information? (Better information tracking would help nurses work better and faster)  (Hannah, Lomely, Ruddick, & Bellamy, 2004)

Will make the work easier for the nursing staff? (When the work is easier for nurses, the stress would be less in nurses which would reduce the probability of burnout situations in them)

Will the information provided through supportive technology would make work of nurses easier? If work is easy then nurses would be less stressed)

Will technology help nurses remember the medications and nursing requirements of patients? (With technology assisting nurses by reminding them of nursing requirements, nurses do not need to remember everything but rely on technology for that which would reduce the mental pressure on them)

Will technology automate some of the nursing tasks? (With technology automating some of the nursing tasks, the work would become easier for the nursing staff)

Strengths of the administrative improvement as the solution include:

  • It would reduce the nurses burnouts
  • It would bring the long term benefits for the hospital
  • It would reduce the overload of nurses which would enhance satisfaction in them
  • With improved working environment resulting from administrative improvements, the reputation of the hospital would also improve which would be helpful in recruitment(Rechel, Wright, Edwards, Dowdeswell, & McKee, 2009)

Weaknesses of the administrative improvement as the solution include:

  • It is an expensive method as it would need new technologies to be implemented
  • It would be time consuming as seeking support from administrative departments would demand cultural changes in the hospital

Opportunities of the administrative improvement as the solution include:

  • More of the activities that are not value adding or monotonous can be automated with the use f technologies which would make the work of the nurses easier
  • With better technologies, the patients can be served better
  • With automation, the nurses would get some extra time and thus, proper scheduling can be done for optimum resource utilization.

Threats of the administrative improvement as the solution include:

  • If the staff resists using new technologies, it would not deliver benefits but would cause loses to the administration
  • Technologies used can fail which would result into dissatisfaction in patients(Singh & Chauhan, 2016).

Conclusions

This report explored the case of KIMS hospital that was facing an increasing burnout situations in their nurses causing attritions to rise. The report identified the causes behind these burnouts and explored some solutions that could possibility reduce these burnout situations. Possible cause of these problems was found to be stressful work environment, overload of the work, and more exposure to illness and family pressures. The report studied two key theories including job-demands and resource model and Maslach theory to identify solutions and these included increase in hiring, administrative support, employee training, experienced hiring, community establishment, rewards and recognition for nurses. Among these solutions, two were selected including administrative support and employee training It was found that the administrative support would have more long term benefits and thus, was the selected improvement plan. It was further explored to understand if it was feasible for the hospital to carry out. For this, the report explored the idea from different perspectives including cost, demand, stress relief, workload reduction and relationship management. A SWOT analysis was carried out which revealed that the use of administrative technologies can have cost implications and well as risk failure. However, it has certain long term benefits like reduced burnout and increased satisfaction in nurses.

References

Alsaqri, S. H. (2014). A Survey of Intention to Leave, Job Stress, Burnout and Job Satisfaction among Nurses Employed in the Ha’il Region’s Hospitals in Saudi Arabia. Melbourne Australia: RMIT University.

Bakker, A. B., & Demerouti, E. (2011). The Job Demands-Resources model: state of the art. Journal of Managerial Psychology, 309-312.

Carter, L. (2016). Operational productivity and performance in English NHS acute hospitals:Unwarranted variations . NHS.

Daniel, G. O., & Oyetunde, M. O. (2013). Nursing informatics: A key to improving nursing practice in Nigeria. International Journal of Nursing and Midwifery, 90-98.

Ericksen, K. (2015). Nursing Burnout: Why it Happens & What to Do About It. Rasmussen College.

Flemming, J. (2016). What if…my medical career starts here? Warwick Medical School.

Hannah, K. L., Lomely, C. P., Ruddick, P., & Bellamy, G. R. (2004). Hospital Administrative Staff vs. Nursing Staff Responses to the AHRQ Hospital Survey on Patient Safety Culture. West Virginia: Agency for Healthcare Research and Quality.

Holdren, P., & Coustasse, A. (2015). Burnout syndrome in hospital nurses. Marshall University.

IDDRISU, S. (2013). The Contribution of Ghana’s Development of Polytechnics to National Prosperity and Challenges to their Sustainability - Focusing on Staff Turnover. UNIVERSITY OF EDINBURGH.

Jennings., B. M. (2006). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. NCBI.

Lee, C., Scheunemann, J., Hall, R., & Payne, L. (2012). Low Staff Morale & Burnout: Causes & Solutions. University of Illinois.

Maria, N. (2012). Examining the causes, coping strategies and prevention: Examining the causes, coping strategies and prevention. ARCADA.

Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). JOB BURNOUT. Annu. Rev. Psychol., 397–422.

MK1, S., SK, J., S, S., & AK., H. (2001). Administrative support for addressing staff nurses' ethical concerns regarding staffing. Journal of Nursing Administration, 103-104.

Narban, J. S., Narban, B. P., & Singh, J. (2016). A Conceptual Study on Occupational Stress (Job Stress/Work Stress) and its Impacts. IJARIIE, 47-56.

OECD. (2012). PREVENTING UNEMPLOYMENT AND UNDEREMPLOYMENT FROM BECOMING STRUCTURAL. OECD.

Oy, F. (2016). Digital Health Technology Guide for Singapore and Southeast Asia. InterVentures.

Rechel, B., Wright, S., Edwards, N., Dowdeswell, B., & McKee, M. (2009). Investing in hospitals of the future. EuHPN.

Singh, R., & Chauhan, A. (2016). INFORMATION TECHNOLOGY ROLE IN HOSPITAL ADMINISTRATION PRACTICES . International Journal of Management (IJM), 108–115.

Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2010). Nurse Burnout and Patient Satisfaction. National Institute of Health.

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