Burnout, empowerment, workplace relationships and the practice environment : an intervention programme for critical care nurses

Abstract

BACKGROUND: A recent national study showed that critical care nurses and medical-surgical nurses in South Africa have high levels of burnout – higher than most other countries in the world. These high levels of burnout amongst registered nurses in South Africa were particularly associated with the practice environment and also with nurse staffing ratios. However, such burnout levels cannot be explained by the status of the practice environment and nurse to patient ratios alone. Other variables that are associated with high levels of burnout in the literature include issues such as empowerment (structural and psychological) and workplace relationships (incivility and bullying). AIM: The aim of this research study was to develop an intervention programme to decrease the levels of burnout amongst critical care nurses in a private hospital group in the Gauteng Province of South Africa. METHODS: This cross-sectional correlational survey study was conducted in a private hospital group in the Gauteng Province of South Africa. The sample included 15 private hospitals from the selected private hospital group. 20 critical care units from the selected private hospitals were included. A total of 209 critical care nurses participated in the study with a response rate of 49%. The methods used in Phase 1 of the study included the Maslach Burnout Inventory (measuring burnout), Conditions for Work Effectiveness Questionnaire – II, (measuring structural empowerment), Psychological Empowerment Instrument, (measuring psychological empowerment), Nursing Incivility Scale (measuring incivility), Negative Acts Questionnaire – Revised (measuring bullying behaviour) and the Practice Environment Scale of Nurses Work Index – Revised (measuring the status of the practice environment), together with a demographic checklist for the participants and the critical care unit. In Phase two, an eclectic method of curriculum and strategic development was applied to develop an intervention programme to decrease the levels of burnout amongst critical care nurses. RESULTS: The analysis revealed that critical care nurses in general are moderately burned out, with 42.1% experiencing high levels of emotional exhaustion. Participants were moderately structurally empowered, with adequate access to opportunities. On average the participants had mean values above 4.5 indicating that they are psychologically empowered within their practice environment. With regards to incivility, the participants agreed to the experience of general hostility in the practice environment (M = 3.51), and inconsiderate behaviour towards them (M = 3.46). Specific issues that were highlighted were unacceptable noise levels (79.5%), verbal abuse from physicians (59%) and patients and family members taking out their frustrations on them (55.5%). With regard to work, personal and physical bullying, 12.9% of the participants felt that they are exposed to an unmanageable workload on a weekly to daily basis, 10.5% of the participants felt that they are humiliated or ridiculed in connection with their work on a weekly to daily basis and 6.2% of the participants felt that they are the targets of spontaneous anger on a weekly to daily basis. The elements experienced most negatively in the practice environment were inadequate staffing and resource availability (M = 2.33), and collegial and nurse/physician relationships (M = 2.48). The staffing and resource adequacy subscale of the Practice Environment Scale of the Nurse Work Index - Revised had the highest correlation towards Emotional Exhaustion (-.470), followed by the work-related bullying behaviour subscale of the Negative Acts Questionnaire - Revised to Depersonalisation (.456), thirdly, the access to resources sub-scale of the Conditions for Work Effectiveness Questionnaire - II to Emotional Exhaustion (0.425) and finally, the displaced frustration subscale of the Nursing Incivility Scale to Emotional Exhaustion (0.350). CONCLUSION: 75 problems contributing to the development of burnout were identified. The problems formed the evidence base for the development of an intervention programme for critical care nurses in a selected private hospital group in Gauteng province. The findings of this research study suggest that improving staffing levels might decrease burnout levels experienced by critical care nurses. The collegial and nurse/physician relationships and patient and family interaction also need urgent attention to decrease the levels of burnout. All hospitals, in the private hospital group studied, need to adopt a policy of zero tolerance towards acts of incivility and bullying behavior.