Capella 6030 Assessment 2

Problem Statement (PICOT)

Name:

Capella University

School of Nursing and Health Sciences, Capella University

NURS-FPX 6030: MSN Practicum and Capstone

Prof. Name:

Date

Problem Statement (PICOT):

Amidst the ongoing COVID-19 pandemic, nurses are facing unprecedented challenges in providing specialized care to patients with the disease while also implementing intricate measures to prevent its spread to other patients. Consequently, nurses find themselves working longer shifts with more acutely ill patients and limited resources, leading to a potential increase in nursing burnout. Although nurse burnout was already a concern before the pandemic, the situation has intensified to a new level. Over the years, nurse burnout has been a prevalent issue in the United States, but the advent of the COVID-19 pandemic in 2020 exacerbated the problem. According to the Medscape Nurse Career Satisfaction Report 2021, 34% of licensed practical nurses and 35% of registered nurses reported experiencing burnout in the post-pandemic period.

The PICOT question to be addressed is as follows: How does improving the nurse-to-patient ratio in the post-COVID era, compared to the pre-COVID era, within a span of one year, impact reducing nurse burnout?

Population: Nurses
Intervention: Improving the nurse-to-patient ratio
Comparison: Pre- and post-COVID era
Outcomes: Reduction in nurse burnout
Timeframe: One year

Part 1: Problem Statement

Need Statement

The objective of this project is to address and minimize burnout rates among nurses resulting from patient overload in the post-COVID era. A targeted sample of nurses will be selected to participate in an experimental intervention to analyze its effects, ultimately determining its efficacy. The project’s duration is set at one year. Hospital management recognizes the critical importance of addressing nurse burnout rates. Existing research, as demonstrated by Schlak et al. (2021), consistently reveals the detrimental impact of burnout on nurses. Burnout not only reduces the quality of life, performance, and organizational commitment of nurses but also diminishes their intention to remain in their current work position (Zhang et al., 2019).

Moreover, the quality of care provided by nurses can be severely compromised due to burnouts. A study conducted in three hospitals between 2018-2019, as shown by Ruiz-Fernández et al. (2020), supports the need for minimizing burnout. The study found that 54 percent of sampled nurses experienced mild burnout during that period. Additionally, emotional weariness increased by 10 percent, and cynicism among nurses increased by 19 percent. Importantly, the study highlighted the substantial influence of burnout on organizational turnover, resulting in a 12 percent increase in the rate of nurses quitting.

Considering these concerning findings, the hospital management must take proactive measures to alleviate nurse burnout, leading to improved well-being for nurses and better patient care. The successful implementation of this project will provide valuable insights into the effectiveness of the intervention and lead to enhanced strategies for mitigating burnout among nurses. (Ruiz-Fernández et al., 2020).

Population and Setting

The focus of this project centers on the nurses in the state of Minnesota. Amid the COVID-19 pandemic, numerous hospitals in Minnesota experienced strikes, during which the nurses affiliated with the Minnesota Nurses Association emphasized the necessity for enhanced resources and the importance of reducing burnout rates in the post-COVID era. Addressing this need among nurses is of significant concern and holds considerable rationale. Nurse burnout can cause anxiety about work, emotional and physical weariness, sleep problems, and depression in the nurses (Ruiz-Fernández et al., 2020). Mental fatigue is another result of nurse burnout, which causes nurses to disconnect from their patients (Ruiz-Fernández et al., 2020). Nurses who go through burnout may be less motivated and have lower cognitive functioning because of emotional weariness, which puts patient safety at risk (Ruiz-Fernández et al., 2020).

To test the burnout ratio among nurses, we will choose nurses who serve in the long-term care units. Ten nurses will be chosen through random snowball sampling from every hospital in Minnesota. The nurses in the long-term care unit usually serve patients who are going through severe diseases and the average length of stay is around 150 days. Nurses’ roles include a wide range of tasks such as medication organization, physical cleanliness, bathing assistance, providing medical assistance, checking vital signs, and nutrition management, as well as providing palliative care and respiratory care. I am choosing this setting because nurses make up most of the workforce of long-term care units. They are subjected to excessive workloads, time constraints, and physical exhaustion. As a result, nurses in these settings are particularly sensitive to emotional pressures, including burnout.

Intervention overview

Multiple interventions could be applied to reduce the burnout rate among nurses. The intervention I would apply to the nurses to reduce burnout is through the improvement of the nurse-to-patient ratio. The standards set by ANA are 1:2 in a critical care unit, and 1:4 or fewer in an emergency unit (Ohbe et al., 2022). The nurses that I will choose as a sample are going to be tested through their performance in the pre and post covid era. I will optimize their nurse-to-patient ratio to 1:2 and after one year I will check the results whether interventions have made any significant changes to their performance (Ohbe et al., 2022).

The nurses’ sample for this project will be selected using the random sampling method. Once the nurses are chosen, they will be informed about the project, and their consent will be requested for participation. Subsequently, routine visits to the hospital will be conducted to assess whether the nurses demonstrate improvements in key performance areas. The targeted settings for these assessments will be the long care units of the hospitals, with the overall goal of enhancing patient care during their stay.

The indicators chosen to analyze the nurses’ performance encompass various aspects of patient care, including patient medication organization, physical cleanliness, assistance with bathing, provision of medical support, monitoring vital signs, and management of nutrition. Additionally, the project will also focus on evaluating the quality of palliative care and respiratory care provided by the nurses.

By assessing these key performance areas, the project aims to gauge the effectiveness of interventions and identify areas for improvement, leading to enhanced patient care and better outcomes during their hospital stay.

My need is to reduce the burnout rate and the intervention that I have picked is to improve the nurse-to-patient ratio. It is evident from various literature that burnouts and nurse-to-patients ratio have direct relation. If the nurse-to-patient ratio increases, it will also increase burnout among the nurses and it will affect the overall performance of the healthcare sector.

Comparison of Approaches

An interprofessional alternative to the nurse-to-patient ratio is the introduction of meditational practices i.e., yoga, massage, and mindfulness (Friel, 2022). These interventions will help nurses to remain focused on their tasks and improve their mental capabilities such as improving stress and anxiety. The alternative intervention requires extra time for the practices but fits well with the targeted sample. The targeted nurses can do breathing at home or wherever they find suitable because it does not require any effort. Secondly, this intervention does not require practice any nurse can start meditational practice anytime. Literature also supports meditational practice for reducing burnout  (Green & Kinchen, 2021b). 

The targeted setting is compatible with the alternative intervention. The long-care unit nurses are under constant work stress due to workload. The alternative intervention will help to improve their performance through various techniques. The meditational practices help stress and burnout reduction in nurses by promoting present awareness, emotional control, and positive thinking.

Initial Outcome Draft

The outcome that I am expecting is to improve the burnout rate among the targeted nurses by decreasing the nurse-to-patient ratio. It will increase the quality of care given to the patients. Also, improving the nurse-to-patient ratio will enable nurses to focus on their work and will improve their overall decision-making abilities. Improving burnout rates will also increase the overall performance of the hospital in terms of services and management.

Reduction in burnout rate among nurses means improved stress management and lower anxiety levels (Janeway, 2020). Through the expected outcome I want to accomplish improved mental and physical health of the nurses and the continuum of care toward their patients. The suggested framework can be used to achieve quality healthcare services in healthcare facilities. Patient safety is influenced by organizational, and individual aspects that are dependent on physical and human resources. Burnout is also influenced by these elements, such as physical organizational features and human connections (Garcia et al., 2019).

Time Estimate

My rough estimate for developing an intervention is 2 months. And this time frame is realistic, during these two months I will analyze the need for improvement in burnout rate and do the literature review to see if the situation is severe or just a hypothesis. The challenge that would impact the time frame is to find the relevant sources of data about burnout rates and their impact on nurses and patients. 

This rough estimate for the implementation is one year. During this time frame, I will assess the impact of burnout in pre- and post-covid eras among the targeted nurses. The time frame is realistic because I can manage all my activities during this time. In one month, I will sample out the hospitals in Minnesota and reach the administrative units for the data of the nurses who are serving in long care units. Then I will do sampling and picking of nurses in the next two months. In the fourth month, I will start to analyze the indicator that I picked earlier as key indicators of performance, and then for the next six months, I will tally all the data of nurses in excel sheets to see the results at the end of the year. The potential challenge that will impact my implementation may be the low motivation of the nurses, government policies, and unavailability of nurses.

Part 2: Literature Review

A study conducted by Ryu and Shim points out the influence of burnout on patient safety management. The study depicts that a higher level of burnout rate is indirectly proportional to patient safety management. As a result, the study suggests compassion methods for reducing the burnout rate among nurses. The intervention suggested in the study is the improvement of the nursing work environment and compensation during emergencies situation like covid-19. It further suggests the need for elaborate research to find more reasons behind burnout and its associated implications (Ryu & Shim, 2021).

Another study conducted by Green and Kinchen observed that nurses who regularly confront trauma and high workload go through burnout and associated stress. They further strengthen their argument by expressing the detrimental effects of burnout on nurses’ mental and physical health. The strategy they suggest to tackle this situation is mindfulness-based stress reduction programs. The study concludes that mindfulness meditation can decrease stress and burnout in nurses by decreasing self-judgment. The study is supported by other relevant literature (Green & Kinchen, 2021).

Another piece of evidence that supports the importance of improving the nurse-to-patient burnout rate is Reith’s Burnout in US healthcare professionals. The reason he suggests for the given problem is the high nurse-to-patient ratio. He supports his arguments by suggesting that burnout is detrimental to patient care and may in the future widen the gap between patients and nurses (Reith, 2018). 

A study conducted by the American Nurses Foundation says, 34 percent of their workforce do not feel that they are emotionally healthy. While more than 40 percent of the nurses expressed that they have experienced trauma related to covid-19 cases. It further adds that 50 percent of the nurses have considered leaving their job (Arnetz et al., 2020).

Furthermore, a study conducted on 18,935 nurses during covid era observed that 31 percent of nurses went through emotional exhaustion. The following were the main risk factors that increased nurses’ burnout: younger age, decreased social support, low family and colleague readiness to cope with the COVID-19 outbreak, increased perceived threat of COVID-19, longer working time in quarantine areas, working in a high-risk environment, working in hospitals (Galanis et al., 2021). Another survey examines burnout and resilience among frontline nurses in the emergency department in North India. A simple random sampling procedure was used to pick the sample of 120 nurses working in the emergency department. The Maslach burnout inventory-general survey and the Connor-Davidson Resilience Scale were used to collect data. The study observed that the nurses had moderate-to-severe burnout, which caused emotional weariness and depersonalization (Dhandapani et al., 2020).

Healthcare Policy that Impacts the Approach to Address an Identified Need

The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act was filed in Congress in 2019. The bill proposes amending the Public Health Service Act to mandate a standard nurse-to-patient ratio in hospitals and healthcare institutions. The main point of the bill was to distinguish the nurse-to-patient ratio among various health units. The standards recommended by the bill were 1:4 for the medical/surgical unit, 1:3 for the emergency unit, and a 1:1 ratio in the intensive care unit (Clipboard Health, 2021). This policy directly suggests the improvement of burnout by setting standard ratios in the different care units. It addresses the need for alternative intervention for improvement in the overall performance of the healthcare sector. Research conducted in Queensland; Australia implemented minimum nurse-to-patient ratios in selected hospitals (McHugh et al., 2021).

The affordable care act is another policy that addresses the nurses’ high burnout rate. ACA believes that as millions of individuals get access to health insurance the influx of new patients seeking care will aggravate (Zhao et al., 2020). This suggests that the ongoing nurse shortfall is likely to reach more than 1.3 million by 2033. Because of these considerations, nurses are caring for a greater number of patients every shift and often spend a longer time with each patient (Glied et al., 2020). The affordable care act has assisted in the rising number of emergency visits which will in turn increase the nurse-to-patient ratio (Nurse Journal Staff, 2020). ACA has reduced the problem by creating a separate outpatient care unit and reserving hospitals for inpatient care for patients with acute diseases. This is a welcoming provision of the ACA; it will try to reduce the nurse-to-patient ratio by engaging out-patients out of the hospital (Courtemanche et al., 2018).

References

Arnetz, J. E., Goetz, C. M., Arnetz, B. B., & Arble, E. (2020). Nurse reports of stressful situations during the COVID-19 pandemic: Qualitative analysis of survey responses. International Journal of Environmental Research and Public Health, 17(21), 8126. https://doi.org/10.3390/ijerph17218126 

Clipboard Health. (2021, August 3). RN to patient staffing ratio — Here’s what the federal government says. Clipboard Health. https://clipboardhealth.com/rn-to-patient-staffing-ratio-heres-what-the-federal-government-says 

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on health care access and self-assessed health after 3 years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 004695801879636. https://doi.org/10.1177/0046958018796361 

Dhandapani, M., Jose, S., & Cyriac, M. C. (2020). Burnout and resilience among frontline nurses during COVID-19 pandemic: Cross-sectional study in the emergency department of a tertiary care center, North India. Indian Journal of Critical Care Medicine, 24(11), 1081–1088. https://doi.org/10.5005/jp-journals-10071-23667 

Friel, D. (2022). Yoga and Reiki as self-care interventions for professional nurses: A weekend retreat. Mindfulness Studies Theses. https://digitalcommons.lesley.edu/mindfulness_theses/65/ 

Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID‐19 pandemic: A systematic review and meta‐analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839 

Garcia, C., Abreu, L., Ramos, J., Castro, C., Smiderle, F., Santos, J., & Bezerra, I. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina, 55(9), 553. https://doi.org/10.3390/medicina55090553 

Glied, S. A., Collins, S. R., & Lin, S. (2020). Did the ACA lower Americans’ financial barriers to health care? Health Affairs, 39(3), 379–386. https://doi.org/10.1377/hlthaff.2019.01448 

Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in nurses. Journal of Holistic Nursing, 39(4), 089801012110158. https://doi.org/10.1177/08980101211015818 

Janeway, D. (2020). The role of psychiatry in treating burnout among nurses during the Covid-19 pandemic. Journal of Radiology Nursing, 39(3), 176–178. https://doi.org/10.1016/j.jradnu.2020.06.004 

McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905–1913. https://doi.org/10.1016/S0140-6736(21)00768-6 

Nurse Journal Staff. (2020, September 21). The Affordable Care Act and nursing | NurseJournal.org. NurseJournal. https://nursejournal.org/resources/affordable-care-act-nursing-guide/ 

Ohbe, H., Sasabuchi, Y., Iwagami, M., Ogura, T., Ono, S., Matsui, H., & Yasunaga, H. (2022). Intensive care unit versus high-dependency care unit for COVID-19 patients with invasive mechanical ventilation. Annals of the American Thoracic Society. https://doi.org/10.1513/annalsats.202206-475oc 

Reith, T. P. (2018). Burnout in United States healthcare professionals: A narrative review. Cureus, 10(12). https://doi.org/10.7759/cureus.3681 

Ruiz-Fernández, M. D., Pérez-García, E., & Ortega-Galán, Á. M. (2020). Quality of life in nursing professionals: Burnout, fatigue, and compassion satisfaction. International Journal of Environmental Research and Public Health, 17(4), 1253. https://doi.org/10.3390/ijerph17041253 

Ryu, I. S., & Shim, J. (2021). The influence of burnout on patient safety management activities of shift nurses: The mediating effect of compassion satisfaction. International Journal of Environmental Research and Public Health, 18(22), 12210. https://doi.org/10.3390/ijerph182212210 

Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021). Leveraging the work environment to minimize the negative impact of nurse burnout on patient outcomes. International Journal of Environmental Research and Public Health, 18(2), 610. https://doi.org/10.3390/ijerph18020610 

Zhang, Y., Wu, X., Wan, X., Hayter, M., Wu, J., Li, S., Hu, Y., Yuan, Y., Liu, Y., Cao, C., & Gong, W. (2019). Relationship between burnout and intention to leave amongst clinical nurses: The role of spiritual climate. Journal of Nursing Management, 27(6), 1285–1293. https://doi.org/10.1111/jonm.12810 

Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA: A Cancer Journal for Clinicians, 70(3). https://doi.org/10.3322/caac.21604