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Prevent Compassion Fatigue and Burnout With a Magnet Culture

Graystone, Rebecca, MS, MBA, RN, NE-BC

JONA: The Journal of Nursing Administration: May 2019 - Volume 49 - Issue 5 - p 231–233
doi: 10.1097/NNA.0000000000000743
Departments: Magnet® Perspectives
Free

Compassion fatigue and burnout are 2 of the most serious issues facing the nursing profession today. Both can lead to emotional exhaustion and job disillusionment. Both contribute to lowered productivity and quality of care. Healthcare providers around the world are on the lookout for ways to prevent and mitigate these critical issues. In this month's Magnet Perspectives column, we take a deep dive into the latest research on nurse burnout and compassion fatigue, examine contributing factors, and consider steps organizations can take to make sure their nurses are not running on empty. We also explore how the fundamentals of a Magnet® culture, especially an autonomous practice environment, strong nursing leadership, and meaningful recognition, can keep nurses engaged and build a resilient workforce.

Author Affiliation: Vice President, Magnet Recognition Program® and Pathway to Excellence Program®, American Nurses Credentialing Center, Silver Spring, Maryland.

The author declares no conflicts of interest.

Correspondence: Ms Graystone, American Nurses Credentialing Center, 8515 Georgia Ave, Suite 400, Silver Spring, MD 20910 (rebecca.graystone@ana.org).

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It is no secret that nurses play host to a high level of compassion fatigue. In hospitals and healthcare organizations around the world, nurses may struggle to function in environments that present constant challenges. High patient acuity, intense work hours, safety imperatives, workplace incivility, and violence all can leave nurses feeling emotionally drained and raise their risk for disengagement.

Compassion fatigue manifests itself in many ways. Low job satisfaction, job-related stress, and burnout are some of the most common consequences. Stressed nurses put the entire healthcare organization at risk. They are more likely to make poor decisions that can lead to errors. They are less likely to interact with patients or each other, leading to strained relationships. They are more apt to leave their jobs. Conversely, satisfied nurses thrive in an environment that is safe, empowering, and satisfying.1

In today's increasingly complex healthcare system, Magnet® recognition from the American Nurses Credentialing Center® addresses many of the elements that can lead to compassion fatigue and burnout. Pursuing the credential helps bolster factors that create a holistic, caring, and inclusive workplace—factors such as a healthy environment; appropriate resources; strong, supportive leadership; nurse engagement and recognition; mutual respect; and a collaborative culture.2

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Healthy Work Environments

In their study of burnout syndrome in hospital nurses, Holdren et al3 found that a poor work environment and heavy workload were major contributing factors. They recommend that hospitals focus on creating an environment in which nurses feel supported by coworkers and management and implement lower patient-to-nurse ratios.

Similar findings emerged from the international setting. Sillero and Zabalegui4 explored the influence of organizational factors on burnout among perioperative nurses in Spain. The authors found that working conditions increasingly impact job satisfaction and burnout, with 3 areas in particular playing a significant role: nurse leadership style, staffing, and support. Positive, inspirational leaders who support nurses with an engaging work environment, adequate resources, and genuine recognition sustained a more resilient workforce than those who did not. The study notes that Magnet hospitals are able to provide this type of environment because of their “capacity to attract and retain professionals as they promote quality patient care, safety, interdisciplinary collaboration, positive communication, professional models of care practice, opportunities for professional development, and better practice environments than other hospitals.”4

Wei et al5 conducted an overview of studies on healthy nurse environments in the United States. The authors found a strong link between a positive workplace and nurse outcomes such as psychological health, emotional strain, job satisfaction, and retention. When nurses perceived higher caring behaviors in the work setting, they had significantly lower scores on compassion fatigue, stress, and burnout and higher scores on work relationships, job satisfaction, and compassion satisfaction.

Examining burnout among emergency room nurses, Abellanoza et al6 echoed the emphasis on workload as a critical factor. Leaders must get creative to solve this problem, including strategic scheduling and shift management. The authors cite workplace engagement as a critical buffer that gives nurses the energy and enthusiasm to remain on the job, despite a high workload. Similarly, research by Moloney et al7 found that a high workload leads to higher burnout and is the strongest predictor of a nurse's intentions to leave.

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Support and Recognition

Meaningful recognition of nurses, another Magnet hallmark, can impact engagement and reduce stress. Barnes et al8 found that recognizing compassionate and extraordinary nursing care in a meaningful way is a powerful tool that supports a healthy work environment, engages nursing staff, and impacts the patient care experience.

A survey of intensive care unit nurses in US hospitals with an established meaningful recognition program and nurses in hospitals without such a program found that recognition was a significant predictor of decreased burnout and increased compassion satisfaction.9

A study of compassion fatigue and burnout among new nurses transitioning to practice found that creating awareness of the problem, and offering support, during nurse orientation was a mitigating factor later on.10

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Strong Leadership

In Magnet organizations, strong nursing leaders provide support and mentoring, while promoting a culture of teamwork that underscores a commitment to care delivery excellence and a safe, respectful environment. Such transformational leadership is a positive influence on the workplace environment. As noted with Sillero and Zabalegui's4 findings above, supportive nurse managers can shape the workplace to reduce many of the factors that lead to compassion fatigue and burnout. Other recent research supports this. In a study investigating the effects of nurse managers' leadership behaviors on job satisfaction and patient safety outcomes, Boamah et al11 uncovered a strong positive connection. The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

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The Magnet Link

With burnout and compassion fatigue approaching epidemic levels, it is more critical than ever for healthcare organizations to create a cultural environment where nurses can thrive. The Magnet Recognition Program's value proposition centers on the link between a positive work environment and improved outcomes, including nurse engagement and retention. It not only advances the fundamental principles that enhance nurse satisfaction, but also enriches nurses' resilience so they continue to find joy in their work.

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References

1. Dempsey C, Reilly BA. Nurse engagement: what are the contributing factors for success? Online J Issues Nurs. 2016;21(1):2.
2. Kutney-Lee A, Stimpfel WA, Sloane DM, Cimiotti JP, Quinn LW, Aiken LH. Changes in patient and nurse outcomes associated with Magnet hospital recognition. Med Care. 2015;53(6):550–557.
3. Holdren P, Paul DP, Coustasse A. Burnout Syndrome in Hospital Nurses. Paper presented at BHAA International, Chicago, IL; 2015. http://mds.marshall.edu/cgi/viewcontent.cgi?article=1141&context=mgmt_faculty. Accessed February 14, 2019.
4. Sillero A, Zabalegui A. Organizational factors and burnout of perioperative nurses. Clin Pract Epidemiol Ment Health. 2018;14:132–142.
5. Wei H, Sewell KA, Woody G, Rose MA. The state of the science of nurse work environments in the United States: a systematic review. Int J Nurs Sci. 2018;5(3):287–300.
6. Abellanoza A, Provenzano-Hass N, Gatchel R. Burnout in ER nurses: review of the literature and interview themes. J Appl Biobehav Res. 2018. https://doi.org/10.1111/jabr.12117. Accessed February 13, 2018.
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8. Barnes B, Barnes M, Sweeney CD. Putting the “meaning” in meaningful recognition of nurses: the DAISY Award™. J Nurs Adm. 2016;46(10):508–512.
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10. Lopez J. Compassion Fatigue and Burnout: Awareness and Prevention for the Novice Nurse Population. Walden University; 2015. https://scholarworks.waldenu.edu/dissertations/5094.
11. Boamah SA, Spence Laschinger HK, Wong C, Clarke S. Effect of transformational leadership on job satisfaction and patient safety outcomes. Nurs Outlook. 2018;66(2):180–189.
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