Burnout and Coping Strategies of Certified Registered Nurse Anesthetist
Burnout is commonly reported among healthcare professionals working in the emergency departments of hospitals. Examples of nursing professionals who often experience burnout include certified registered nurse anesthetists (CRNAs), emergency room nurses, and intensive care unit (ICU) nurses (Sevinc et al., 2022; Gualano et al., 2021). As healthcare organizations continue to face nursing shortages, they have no choice but to have available nurses work for longer hours with heavy caseloads. The psychological distress caused by increasing workload and patients’ suffering usually causes burnout among emergency room and ICU nurses, preventing them from performing their roles effectively (Sevinc et al., 2022). Burnout negatively affects the well-being and performance of nurses thereby leading to poor patient outcomes. This calls for the need to implement evidence-based strategies to address burnout. This paper will explore the causes, prevalence, effects, and effects of burnout among CRNAs, emergency room nurses, and ICU nurses. The author of this paper will further recommend strategies that healthcare organizations can implement to address burnout among these groups of nurses.
Understanding Burnout
Understanding the meaning of burnout is a crucial step toward addressing it. Petrino et al. (2022) define burnout as a work-related psychological syndrome attributed to stressors that are encountered at the place of work. The three primary clinical manifestations associated with burnout include reduced personal accomplishments (PA), depersonalization (DP), and emotional exhaustion (EE). One can display these symptoms in isolation or in combination. A person who has emotional exhaustion usually presents with debilitation, fatigue, and loss of energy. Signs of depersonalization include loss of dedication towards work, irritability, and a negative attitude towards patients. Employees who are experiencing reduced personal accomplishments always feel inadequate, are unable to perform tasks as required, and have difficulties coping with daily duties (Kakeman et al., 2021). People in different jobs and professions normally experience varied levels of burnout. Using the Maslach Burnout Inventory (MBI), one can measure and classify the severity of burnout experienced by an individual (Petrino et al., 2022). However, it is still possible to tell the level of burnout based on the severity of features associated with reduced personal accomplishments, depersonalization, and emotional exhaustion.
Prevalence of Burnout Among Certified Registered Nurse Anesthetists, Emergency Room Nurses, and ICU Nurses
Burnout among CRNAs, emergency room nurses, and ICU nurses is a global concern because it is negatively affecting healthcare delivery across healthcare systems. The prevalence of burnout among healthcare workers in the emergency department and the ICU remain high globally (Gualano et al., 2021). According to Gualano et al., (2021), complex healthcare issues such as the COVID-19 pandemic have led to significantly increased incidences and prevalence of burnout in the ICU and emergency rooms of most hospitals. The authors further report that the overall global prevalence of burnout among nurses in the emergency departments and ICU across hospitals ranges from 49.3% to 58%. Nurses usually experience different dimensions of burnout. Before the COVID-19 pandemic, 40% of ICU and emergency department nurses reported burnout with most of them displaying high levels of emotional exhaustion combined with low personal accomplishments, and high depersonalization. These levels rose to between 41% and 71.4% during the pandemic (Gualano et al., 2021). Based on this data, it is clearly evident that factors within the work environment cause stressors which lead to psychological syndromes that are classified as burnout.
The nature of impacts caused by burnout on the nurses’ quality of life, patient outcomes, and healthcare costs increasingly influence researchers to conduct investigations around burnout. For example, Kakemam et al. (2021) conducted a study with the aim of understanding the association between burnout and adverse events and patient care in the emergency department and intensive care units of an Iranian-based hospital. The researchers captured data describing the relationship characteristics of participants, their levels of burnout using the Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS) questionnaire, the quality of patient care based on participants’ self-reports, and nurses’ perceptions of the relationship between burnout and adverse events. From the study, the researchers discovered that 36% of Iranian nurses experienced burnout with approximately 50% of them displaying features of high emotional exhaustion and more than 50% presenting with symptoms of reduced personal accomplishments. Additional study findings indicate that nurses perceive that there is a relationship between burnout and both poor patient care and adverse events in the emergency department (Kakemam et al., 2021). There is a great concern regarding the increasing rate of burnout in the emergency and ICU departments, which calls for the need to implement the right strategies to improve the psychological well-being of CRNAs, emergency room nurses, and ICU nurses.
Causes of Stress in Nurse Anesthesia, Emergency Room, and the ICU
Several factors are linked with high incidences and prevalence of burnout among CRNAs, emergency room nurses, and ICU nurses. These nurses handle patients with complex medical conditions and are sometimes required to work long hours considering the nursing shortage that is experienced by most healthcare organizations today. According to Lima et al. (2022), the demands of the emergency rooms and the ICUs cause situational stress triggered by the need to respond to complex and sometimes unique patient situations. CRNAs, emergency room nurses, and ICU nurses might sometimes be required to implement measures to control infections and alleviate patients’ pain. Such situations exacerbate emotional exhaustion among nurses which causes them to develop negative attitudes towards patients and their profession in general (Gualano et al., 2021). CRNAs, in their advanced role, are often required to make speedy changes within their work environments to address patients’ problems. Some of these nurses find it challenging to withstand the pressures that are caused by job demands and they eventually develop psychological distress that is characterized by reduced personal accomplishments (PA), depersonalization (DP), and emotional exhaustion (EE).
Intensive care units and emergency departments are generally viewed as work environments that cause professional distress to the workers. As Gualano et al. (2021) explain, burnout in the emergency department and ICU is primarily attributed to work overload which caused nurses to work for prolonged hours without resting. Additionally, emergency room and ICU nurses often complain of low salaries and interpersonal conflicts which cause them to develop professional dissatisfaction and an intention to leave their organizations. Although nurses across all departments in a healthcare organization usually experience burnout, research indicates that rates of burnout are higher among healthcare professionals deployed in the emergency rooms and ICU (Lima et al., 2022). From this evidence, it is appropriate to conclude that CRNAs, emergency room nurses, and ICU nurses are at a higher risk of experiencing burnout when compared with members of the health multidisciplinary team.
The huge number of patients admitted to the emergency room and the ICU places a substantial healthcare burden on ICU nurses and anesthetists. For example, there was a rise in the prevalence of burnout among anesthetists and ICU nurses during the COVID-19 pandemic (Sevinc et al., 2022). The author gives an example of a healthcare facility that had 31 COVID-19 patients and 21 patients with other conditions admitted to the ICU at the same time. Nurse anesthetists at the facility had to work 8 night-shifts every month with extended working hours in an extremely busy healthcare environment. The nurses reported high levels of burnout and anxiety during this period (Sevinc et al., 2022). The situation encountered in the facility justifies the association between workload and burnout among CRNAs, emergency room nurses, and ICU nurses. According to (Gualano et al., 2021), The ICUs and emergency rooms of most hospitals are usually understaffed. Nurses in these departments work overtime due to work overload and are unable to predict how their work environment will be the following day. A sudden rise in the number of patients causes work disruption as the nurses are sometimes compelled to attend to patients who need very close care (Gualano et al., 2021). The degree of psychological distress caused by such situations is inevitable and the nurses just have to face it and bear the emotional burden caused.
Effects of Burnout: Reduced Job Performance Due to Stress
Burnout generally affects the well-being and quality of life of nurses which negatively affects their abilities to perform their roles effectively, which subsequently leads to poor patient outcomes. Kakeman et al. (2021) associate high levels of burnout among nurses with nurses’ diminished ability to provide high-quality and safe care to patients. Although the core priority of all nurses is to provide quality and safe care to patients, their ability to concentrate is affected by the key features of burnout such as emotional exhaustion, depersonalization, and reduced personal accomplishments. Nurses are likely to make medical errors when they are experiencing emotional distress. Additionally, such nurses cannot work effectively with teams to address patients’ problems (Kakeman et al., 2021). Generally, burnout causes CRNAs, emergency room nurses, and ICU nurses to develop feelings of reduced professional efficiency which translates to low work productivity.
Burnout also affects healthcare costs as it results in the wastage of healthcare resources and prolonged length of hospital stay. Emergency room nurses, ICU nurses, and CRNAs handle patients who require specialized care that can best be achieved using costly medications and expensive diagnostic tools. Inappropriate use of medications and diagnostic tools negatively affects the hospital budget (Ramirez-Elvira et al., 2021). Moreover, patients visiting the emergency rooms and those admitted to the ICU can only leave the hospital when their health conditions have improved. Therefore, their prolonged admission due to poor quality care attributed to burnout is an added cost to the hospital.
Burnout causes professional dissatisfaction among CRNAs, emergency room nurses, and ICU nurses. This explains why most of these nurses usually develop an intention to leave their organization. High rates of turnover not only affect the workflow but also lead to negative patient outcomes and increase healthcare costs associated with the hiring and training of new employees (Ramirez-Elvira et al., 2021; Ribeiro et al., 2021). Nurses can also get into depression and drug abuse due to burnout experienced at their places of work. Such behaviors can result in reduced self-esteem, suicide ideation, and actual suicide (Petrino et al., 2022; Ribeiro et al., 2021). Generally, it is important to note that burnout among CRNs, emergency room nurses, and ICU nurses is of great concern because it affects the nurses themselves, their families, patients, healthcare organizations, the nursing profession, and the community.
Stress Management and Coping Strategies
The negative consequences of high rates of burnout among CRNAs, emergency room nurses, and ICU nurses is a wake-up call to relevant stakeholders to implement strategies to prevent burnout among these groups of nurses. It is important to note that reducing and preventing burnout is the responsibility of the affected nurse, the organization where he or she works, policymakers, and family members (Sasidharan & Dhillon, 2021). According to Shbeer and Ageel (2022), adequate staffing is one of the best strategies to prevent and reduce burnout in the ICU and emergency rooms. Increasing workloads and working overtime are the main causes of psychological distress among CRNAs, emergency room nurses, and ICU nurses. To address these factors, healthcare organizations should ensure that there is appropriate staffing in their ICUs and emergency room to allow proper job allocation. Leaders of healthcare organizations should assess their work environment and hire enough nurses to handle patients within the recommended working hours. Alternatively, nurses can advocate for the formation of staffing policies (Shbeer & Ageel, 2022). Such policies will compel healthcare organizations to employ a fixed number of nurses to work for specified hours in their emergency departments and emergency rooms based on their sizes and patient populations.
CRNAs in the emergency rooms and ICUs play a key role in initiating the process of preventing and eliminating burnout. In this regard, equipping these g nurses with burnout prevention and elimination strategies is an effective approach to improving their emotional well-being. Patel et al. (2019) recommend comprehensive professional training that focuses on teaching ICU nurses about stress-reduction activities such as engaging in group activities and mindfulness training. Bateman et al. (2020) confirmed the effectiveness of Death Café debriefing sessions in preventing burnout among ICU nurses. Nurses can be allowed to participate in the debriefing sessions either virtually or in face-to-face settings.
The successful implementation of burnout prevention and coping strategies in emergency rooms and ICUs highly depends on organizational commitment. It is important to note that nurses normally lack control of their work environments, especially in crisis situations because they have to abide by the conditions set by their employers (Cole & Siddiqui 2022). According to Cole and Siddiqui (2022), a healthcare organization can prevent and eliminate burnout among emergency room and ICU nurses when it is committed to improving the well-being of employees through appropriate staffing, recognizing stressors, employee motivation, effective communication, collaboration, and providing resources to enhance workplace efficiency.
Conclusion
CRNAs, emergency room nurses, and ICU nurses increasingly experience burnout due to nursing shortages, heavy workloads, and the complex nature of the diseases that they strive to manage in their work settings. Burnout among these nurses negatively affects their quality of life, patient outcomes, and healthcare costs. The strategies that can help to prevent and eliminate burnout and stress among CRNAs, emergency room nurses, and ICU nurses include adequate staffing, limiting working hours, professional training, and employee motivation. Organizational commitment to employee well-being is a key requirement for the successful implementation of stress and burnout management strategies in ICUs and emergency rooms.
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