Nurse Burnout and Patient Satisfaction

Introduction

Background and Rationale for the Study

The level of patient satisfaction depends on various factors that affect the health care processes. Recent research has revealed a connection between contentment displayed by the patients and the overall state of the nursing personnel. The negative condition of nursing staff may be provoked by different factors, both personal and related to the working environment. Vahey, Aiken, Sloane, Clarke, and Vargas (2004) admit that an increased amount of working hours results in nursing burnout and dissatisfaction with the job.

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Various aspects of the condition demonstrated by the nurses affect their attitude to the patients and the overall quality of their professional performance. The given connection is implicit, but the recent studies that will be used as a background for the present research proposal reveal the dominating effect of nurse burnout affecting both professional performance and the relationship with patients and colleagues. Nurse burnout is considered to have an impact on patient satisfaction and the overall level of health care provision.

It is crucial to detect the key predetermining factors that may lead to the condition of nurse burnout in order to be able to adjust them. Moreover, it is of ultimate importance to identify the main potential effects that may follow burnout symptoms for both nurse health condition and its impact on the level of patient contentment with nursing performance. Finally, it is relevant to address potential solutions to the given problem relying on the acquired evidence. The data that will be collected in the process of research will be employed to develop recommendations and alterations that are expected to result in the nurse burnout elimination and augmented level of patient satisfaction.

The significance of the present research proposal is multidimensional. To be more precise, the outcomes of the study may be applied to three domains of the healthcare scope, namely:

  • the applicability of research results is important for the nursing personnel and will contribute to the in-depth insight of their professional performance, that is expected to lead to the eradication of the core factors provoking nurse burnout;
  • the outcomes will be instrumental for making improvements for the patients in terms of the acquired results;
  • the ramifications of the study will help to administer healthcare establishments to manage negative effects of the nurse burnout as well as to identify it timely and provide all the necessary adjustments in order to decrease its rate among the nursing personnel and to guarantee that patients do not face its outcomes.

According to Polit (2010), an evidential basis is necessary to support the proclaimed hypothesis and guarantee the credibility, validity, and reliability of the study. Therefore, it is crucial to investigate both primary and secondary sources for the current study. The significance of primary data is apparent as far as it supplies the field of concern with more insightful and detailed information, and innovative perspectives (Polit & Beck, 2012). Nonetheless, the direction for primary data collection should be based on finding credible authoritative sources in order to achieve maximum efficiency.

Constructive research can be molded only if the preliminary investigation provides a sufficient amount of relevant and up-to-date information. Such an approach will contribute to the potentially effective choice of research methods and justified hypotheses. This will increase the degree of validity and trustworthiness of the study. Hence, much depends on the thorough review of relevant secondary sources which should be done prior to designing the methodology and delineating budget.

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Review of the Relevant Literature

Any kind of work is often associated not only with accomplishments and motivation, but also with tension, especially if the job is connected with frequent contacts with people (Shorofi, Jafari, Lolaty, Cherati, & Karimzadeh, 2016). The scholars also emphasize that recent research on the issue in question reveals the following tendency: jobs in the health-care sector demonstrate the highest degree of occupational injuries (Shorofi et al., 2016). One of the most disturbing injuries is burnout that is defined by scientists as a direct cause of nurse turnover (Shorofi et al., 2016).

Furthermore, the authors state that “the majority of nurses enter their profession with enthusiasm, but usually, after a while, they get exhausted and even wish to stop working or take early retirement due to job pressure and work-related stress” (Shorofi et al., 2016). It means that the initial desire to work and the actual level of professionalism suffice for satisfactory performance, whereas subsequent professional activity leads to decreased motivation and low level of contentment. Vahey et al. (2004) claim that such a tendency not only affects the level of patient satisfaction but also threatens the patient safety.

The hazardous nature of the nurse burnout is increased by the fact that it is a syndrome of exhaustion in three key spheres of a nurse’s life, namely, physical, emotional, and mental ones (Shorofi et al., 2016). Moreover, the researchers underline that such exhaustion may lead to “negative self-image, negative attitude towards work and a lack of personal connection with clients and may sometimes cause a variety of health problems” (Shorofi et al., 2016). As a result, the overall health condition provokes diverse effects connected with professional competence, attitudes, and relations with other people, and self-conception. Vahey et al. (2004) identify such key causes of nurse burnout as augmented workloads that are provoked by a range of factors, namely: “shorter hospital stays, rising average patient acuity, fewer support resources, and a national nurse shortage” (p. 57).

Furthermore, the scholars claim that a high level of patient dissatisfaction with the professional performance of nursing personnel results in the tendency to bring on the caregiver to the hospital (Vahey et al., 2004). The alarming occurrence is confirmed by the following statistics: “more than 40% of hospital staff nurses score in the high range for job-related burnout” (Vahey et al., 2004, p. 57). In addition, approximately one out of five nurses at hospitals demonstrate the intention to quit their current job within one year of employment (Vahey et al., 2004). The same tendency is revealed by the study conducted 8 years later by Aiken (2012). Such results lead to another crucial issue in question, namely, the extent of nurses’ dissatisfaction that may have a negative impact on their professional performance.

McHugh, Kutney-Lee, Cimiotti, Sloane, and Aiken (2011) tried to identify the major factors that provoke nurse burnout in the scope of working conditions and working environment. For instance, 24% of the nurses who worked at the hospitals and 27% of those who worked as home nurses showed serious discontentment with the place of their work (McHugh et al., 2011). In addition, health care and retirement benefits were another reason for dissatisfaction for the prevailing majority of the surveyed nurses (McHugh et al., 2011). The researchers also revealed the tendency that a good working environment augmented the overall satisfaction of nursing personnel judging from other aspects of their job position (McHugh et al., 2011).

It is vital that McHugh et al., (2011) also explored the level of patient satisfaction, and the outcomes positively confirm that the contentment of patients directly depends on the satisfaction or burnout condition of the nurses who provide the primary care for the patients. Even when the diversity of important hospital characteristics and effects of the work environment were controlled and regulated in a proper way, “the percentage of patients who would definitely recommend the hospital to friends or family decreased by about 2 percent for every 10 percent of nurses at the hospital reporting dissatisfaction with their job” (McHugh et al., 2011). Such statistics confirm the claim that there is a serious deficit of primary caregivers at present, and the working environment is partially responsible for such outcomes.

A further stage in the given literature review is devoted to the discussion of the core elements that accompany the progression of the nurse burnout. Vahey et al. (2004) underline that the key constituent elements of the nurse burnout include dissatisfaction with personal achievements and emotional exhaustion. Such problematic outcomes may be eliminated by ensuring the following conditions of nursing professional performance: “staffing adequacy, administrative support for nursing practice, and better relations between nurses and physicians” (Vahey et al., 2004).

It is essential that the given aspects are modifiable, and the hospitals should take them into consideration, especially when it apparently affects the level of patient satisfaction and provokes intentions to leave the job position at the escalating rates. Vahey et al. (2004) also emphasize that “The cyclical nature of nursing shortages has failed to provide a consistent force for permanent changes in nurses' work environments.” Hence, nurse burnout should be treated as a serious issue of administration and personnel management.

Shorofi et al., (2016) provide the following striking evidence regarding the issue in question. 83,2% of nurses report a serious degree of emotional exhaustion. In addition, depersonalization is also a solid threat in terms of nurse burnout as far as 22,5% of surveyed nurses report such an experience. The scholars have also identified the possible ramifications of the nurse burnout that include “absenteeism, mental and physical exhaustion, decreased work productivity, decreased quality patient care and the consequent patients’ dissatisfaction with medical services” (Shorofi et al., 2016).

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Such statistics delineated a topical need to increase the level of awareness among students about possible distress and tense nature of the nursing profession in order to provide a background for the prevention of exhaustion among nurses (Shorofi et al., 2016). Moreover, the students should be provided with the instruments that can help to eliminate the stressful effects of regular nursing performance. It means that proper priorities should be taught in educational establishments. The main focus should be put on the constructive training process and efficient motivation of the future nurses to contribute to self-development and to enhance the overall contentment of the patients with the level of health care quality (Shorofi et al., 2016).

The scale of the studies is significant as far as it provides ultimately objective and relevant outcomes of the research, not only local tendencies. Aiken (2012) conducted a broad exploration concerning the level of satisfaction, quality, and safety of the health care provision. The research involved representatives of twelve countries living in Europe and the United States of America. The scholars underline the urgent need for innovative incentives and guidelines that will help to provide balanced health care in terms of quality enhancement and containment of expenses (Aiken, 2012).

Such directions, or to be more precise, challenges for the modern medical organizations were delineated in two important documents, namely, “The World Health Report 2000” issued by the World Health Organization and the report “Crossing the Quality Chasm” developed by the Institute of Medicine. These cornerstones of medical performance outlined the underlying principles of health care delivery in the new millennium. The bottom line of both documents posited that “responsiveness to citizens’ expectations was a valued and desired outcome of health system performance” (Aiken, 2012).

Hence, the scientists contributed to the delineated direction by means of thorough and detailed investigation. The research revealed that the healthcare system is differently organized, and, therefore, no universally applicable solutions should be expected (Aiken, 2012). Nonetheless, the results of the research in every target country revealed particular problematic issues, challenges, and dilemmas in terms of safety and quality of services and satisfaction of patients directly affected by nurse burnout and contentment of the nursing personnel. The scholars underline the escalating rates of the job positions intentionally abandoned by nurses regardless of the global downturn and serious shortage of medical personnel.

The research by Stimpfel, Sloane, and Aiken (2012) focuses on the popular tendencies that are preferred by the nursing personnel and encouraged by the authorities of medical establishments and the ones that simultaneously provoke nurse burnout. One of such aspects is excessively long shifts that are acceptable for the majority of the surveyed nurses in four states (80%) but are harmful to both the health of nursing personnel and patients’ treatment and care (Stimpfel et al., 2012).

Furthermore, the traditional length of the shift is extended not only to twelve hours, but even more, which causes the ultimate exhaustion of personnel and frequent failures to provide adequate services. Apparently, there are significant advantages that support the tendency of working for twelve hours, namely, “a three-day workweek, potentially providing better work-life balance and flexibility” (Stimpfel et al., 2012, p. 2501). The scholars also highlight the importance of examining the impact of excessively long shifts on nursing performance and health conditions.

Therefore, the research by Stimpfel et al. (2012) targeted three major outcomes of the nursing activity, namely, job dissatisfaction; nurse burnout; and intention to abandon current job positions. The majority of the surveyed nurses revealed a regular tendency to work a 12-hours shift (Stimpfel et al., 2012). The results demonstrated that “The percentages of nurses reporting burnout and an intention to leave the job increased incrementally as shift length increased” (Stimpfel et al., 2012, p. 2504).

Along with such tendency, the level of dissatisfaction did not reveal a serious discrepancy in terms of final ramifications. It is vital that the odds of nurse burnout augmented and intensified in the case of long shifts that delineated a direct and vivid link between traditional shift impact and destructive effects of its extended alternative. Aiken (2012) also supports the claim that exhaustion due to intense or extended workload usually results in complications of nurse burnout and poor performance of nurses. The scholars' highlight that the length of the shift is not only hazardous for nursing personnel but also increases the number of additional patients per nurse (Aiken, 2012).

The need for adjustments in the given sector is dictated by the aforementioned statistics as well as by the deficit of regulations of shift lengths that are vague and insufficient in the given context. Moreover, the evidence reveals that even those shifts that last ten hours have a negative impact on the nursing personnel and may eventually lead to nurse burnout and intention to leave. The aspect of patient satisfaction with the level of health care quality in terms of extended nursing shifts was also addressed in the study by Stimpfel et al. (2012). The results of the study reveal that “seven of the ten outcomes were significantly and adversely affected by the proportion of nurses in the hospital working shifts of more than thirteen hours” (Stimpfel et al., 2012, p. 2505).

At the same time, the acquired negative results do not have such a destructive impact on the overall satisfaction with the job demonstrated by surveyed nursing personnel. The prevailing contentment of nurses with their working schedules has even led to such considerable ramifications as they transition to regular employment of 12-hour schedule at some medical establishments (Stimpfel et al., 2012).

 

Therefore, the regulations and adjustments that are recommended to be implemented in the canvas of the contemporary healthcare system should be a paradigm shift aimed at developing a solid foundation for the prevention of nurse burnout and enhancement of quality of delivered care. Furthermore, it is a challenge as far as the researchers underline that a 12-hour shift is a preferred choice of the nursing personnel.

Finally, it is crucial to present a brief theoretical foundation in nursing. The nurses should comprehend their role properly and transparently. Otherwise, patient discontentment and nurse burnout will be the expected ramifications. The core elements of nursing performance involve not only a patient and a nurse but also environment, health concerns, and medical treatment. Therefore, the harmonization of every element and efficiency of treatment should be the ultimate goal for every nurse.

Both physical and mental health should be taken into consideration since body and soul are closely interrelated, and it is impossible to cure them separately. This approach may be regarded as a basic philosophy of nursing practice. Major philosophical stances form an important part of nursing competence along with theoretical knowledge and practical skills. Practice in clinical settings precedes the real practice at hospitals or clinics, and this contributes to the enhancement of overall nursing performance. These key aspects of nursing performance should be the major elements of the nurses’ understanding of their role and vocation.

Aims, Objectives, and Expected Outcomes of the Study

The present study focuses on the impact of nurse burnout on the level of patient satisfaction with the quality of health care provision. As a result, the core research aims and objectives will reflect the main stages of research development in terms of the expected progress.

Research Aims

The research aims are the following:

  1. To synthesize the major results of previous studies in the field of interest.
  2. To collect primary data focusing on the connection between nurse burnout and patient contentment with health care services.
  3. To analyze the acquired outcomes of the study.
  4. To design an enhancement model targeting the elimination of the causes of nurse burnout and the improvement of the level of patient satisfaction.
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Research Objectives

The research objectives delineate the main steps of the course of exploration:

  1. The secondary data will be extracted during the preliminary study of the issue in question; five credible and authoritative sources will be used for that purpose.
  2. The survey will be designed in order to delineate the core aspects of the research.
  3. The nursing personnel will be surveyed.
  4. The acquired data will be thoroughly analyzed.
  5. A set of guidelines will be developed relying on the outcomes of the analysis.
  6. An enhancement model will be created on the basis of acquired results of the survey, evidence-based cornerstones, and challenges of the scope of nurse burnout and patient satisfaction.

Outcomes of the Research

The expected outcomes of the research are as follows:

  1. The secondary sources are expected to confirm considerable dependence on the level of patient satisfaction on the nurse burnout and related aspects.
  2. The survey outcomes are expected to support the connection between nurse burnout and patient contentment with the quality of services.
  3. The core predetermining factors of nurse burnout is expected to be revealed.
  4. The main domains of patient satisfaction are expected to be detected.
  5. The range of adjustments will be developed focusing on the quality of patient care, safety of patients, and concern for the health condition of the nursing personnel. The major incentives are also expected to be identified during the research.

Methods

The research method chosen for this study is a qualitative one. The ultimate purpose of the investigation is to evaluate the correlation between nurse burnout and patient contentment with the quality of health care services. Therefore, it is important to acquire qualitative data that will contribute to thorough and detailed outcomes. Hence, a survey has been chosen to serve the function of a research instrument. To be more precise, a study will be based on a cross-sectional survey that is targeted to examine the relationship between several variables, namely, the level of patient satisfaction with healthcare provision and nurse burnout. It is crucial for both nursing personnel and patients to be invited to take part in the survey.

It is important since such an approach permits conducting objective research providing examples of both employees’ and clients’ parties. The participants will be sampled randomly. The potential participants will be invited to partake after the permission of the authorities of the chosen medical establishment. The confirmation of participation should be made in order to ensure the consent of the respondents. The process of invitation will take place during the conference at each hospital, and the nurses who are willing to partake will be asked to fill in the short form with their valid e-mail address and telephone number. The invitations with the exact date of the survey and other relevant information will be delivered to the provided address.

It is also vital to ask every recipient to confirm participation by following the link. In such a way, a more realistic number of final participants will be delineated. The surveys will be conducted within the sample from three local medical establishments, namely, Glendale Adventist Hospital, Verdugo Hills Hospital, and Glendale Memorial Hospital. An additional group will also be formed as a back-up strategy in case some of the claimed respondents fail to complete the survey entirely, partially, or timely. The overall amount of the participants will be 300 respondents, one hundred from each medical establishment. Such a group will comprise 10% of the overall quantity of the participants needed for the given study, namely, thirty people in total, five nurses and five patients from each hospital.

In such a way, the probability of deficit of the completed surveys will be solved without delay in the process of holistic research. It is also essential to motivate the participants to deliver completed surveys because even the lack of one question will be a reason to disqualify the survey as an invalid one for further analysis. It is also recommended to send the preliminary e-mails a day before the survey date to remind the potential participants about their consent to respond to fifteen questions.

The survey will comprise of thirty questions in total, fifteen questions per each category of the respondents. To be more precise, half of the questions will be developed to survey the responses of nursing staff, and the other half will be intended for the representatives of patients. The questions will focus on the correlation between nurse burnout and patient satisfaction. Six questions will be close-ended, and the rest will be open-ended. In such a way, the participants will be able to provide maximum details regarding their opinion on the issue of concern and even listing cases of their personal practice or experience.

Such an approach is expected to expand the scale of the study. The participants will be provided with eighty hours in order to have sufficient time to complete the survey properly for it not to interfere with their professional and personal life. The delivery of survey results will include filling in the blank spaces for responses under each question in a separate file. The participants will also be encouraged to send additional commentaries concerning the topic of research or survey in general, but this will be optional. Each participant will receive a thank-you note upon completion of the survey. Moreover, it will be relevant to send the results of the survey and final research outcomes to each participant as soon as the study is finished.

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The ethical and legal considerations should also be taken into consideration in the course of the research.

  1. First, the principle of voluntary participation will be followed. The surveys will be sent via e-mails only to those recipients of the initial invitation who confirmed their participation. No claims will be made concerning those who confirmed participation and either failed to deliver the surveyor provided an incomplete one.
  2. Second, the survey results, as well as personal data of the respondents, will be guaranteed to remain confidential.
  3. Third, the anonymity of participation will be also guaranteed.

The limitations of the study are related to the number of participants and the scale of sampling. The number of respondents permits to draw particular conclusions, but the scale is medium. Moreover, the probability of bias is also taken into consideration. Finally, the issue of subjectivity may also impact the final outcomes of the study. Nonetheless, the participants will be asked to provide only factual information in their responses and not to include emotional elements in the survey replies. However, the influence of the human factor may emerge in the delivered responses that will subsequently affect final research outcomes.

Analysis

The acquired data from delivered surveys should be properly structured before the analysis is carried out. To be more precise, three main domains of research should be delineated and the data should be structured accordingly. These three domains will include the impact of the nurse burnout on the outcomes of professional performance and the relationship with patients and colleagues, and the major problematic issues of nurse burnout that decrease the level of patients’ satisfaction with the quality of health care delivery.

The next step of analysis will require the arrangement of the outcomes in the list of main concerns in the given context. This list will be the background for the guidelines aimed at eliminating the occurrence of nurse burnout and simultaneously increasing the degree of patient contentment due to qualitative improvements in the course of nursing performance. Finally, an enhancement model will be developed. It will identify the major adjustments that should be made in order to achieve an optimal consensus of nursing professional performance and satisfaction of the patients.

Budget

The chosen type of research design is a low-cost one. The budget for the proposed research will include the costs needed for conducting a survey and completing an analysis of the acquired data. The costs will be spent on the materials that need to be prepared for efficient communication with potential participants. An approximate amount of expenses required for the study has been calculated as a preliminary budget for the research and is equal to $200. The costs will be covered due to donations that will be provided for the initiatives in the scope of medical research. Moreover, the issue in question is a topical one. Therefore, further financial support may be expected if the present research results in credible outcomes that will be significant for the healthcare field. Hence, the proposed study is expected to be continued.

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