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NRS 493 Benchmark Capstone Project Change Proposal

Capstone Project Change Proposal


NRS 493 Benchmark Capstone Project Change Proposal

The problem of burnout is a major healthcare problem as it affects nurses, their productivity, ability to work, errors committed during the practice (Nowrouzi et al., 2015), and other health care aspects such as poor work environment, quality of care (Ang et al., 2016), satisfaction levels of patients and nurses, and overall outcome. Thus, it is important to address the burnout issue in nurses by adopting strategies (Cañadas-De la et al., 2018). However, different aspects affect burnout in nurses, which includes nurse to patient ratio, organizational support, self-efficacy (Magtibay et al., 2017), stress management, staff scheduling, work-life balance (Lahana et al., 2017), and other aspects (Jang et al., 2016). As a result, a multimodal intervention with different strategies to address each aspect is important to achieve the desired outcome.   

NRS 493 Benchmark Capstone Project Change Proposal

Clinical problem statement

 The burnout in nurses increases when number of patients assigned per nurse increases, staff scheduling is poor, nurses feel fatigued, poor organizational support, and failure to cope up with the burden to manage the stress through self-efficacy (Lahana et al., 2017). The issue further increases health care errors such as medication errors, errors in health records, patient management, and other errors (Rees et al., 2019). As a result, quality of care reduces and cost of care increases due to increased hospital stay and time required to rectify and resolve the errors (Yao et al., 2018). The prevalence of the issue is high in the nurses working in emergency departments (ED) as they handle a high number of cases and cases are of high priority. The issue of burnout can also pose a threat to patient security and safety (Guixia & Hui, 2020). Thus, the clinical problem needs to be addressed. 

Purpose of the change proposal  

The purpose of the change proposal is to design and implement a multimodal intervention with strategies including increasing nurse to patient ratio, training and educating nurses to manage stress through mindfulness, self-efficacy, and education and training, increase quality care and reduce health care errors, promote interprofessional collaboration (Wei et al., 2017), increase patient satisfaction (ALmutairi & El.Mahalli, 2020), nurse satisfaction, and sense of accomplishment through organizational support. The change proposal also aims to increase patients’ safety and security (Alotaibi & Federico, 2017). 

NRS 493 Benchmark Capstone Project Change Proposal

PICOT question

P- Nurses in emergency department

I- Multimodal intervention with increased nurse to patient ratio, dynamic scheduling, self-efficacy, stress management, and organizational support.

C- Only stress-based intervention

O- Reduced burnout and health care errors and increased quality care, patient satisfaction, and job satisfaction

T- Six months

The PICOT question formed is: do multimodal interventions reduce burnout effectively in ED nurses compared to stress management programs alone after six months?   

Literature search strategy employed

The literatures were searched by using keywords and combination of keywords such as burnout in ED nurses, burnout prevention strategies, nurse to patient ratio and burnout, self-efficacy burnout, mindfulness and stress management strategies, depersonalization and burnout, and sense of accomplishment and burnout. The databases such as EMBASE, Cochrane library, EBSCO, CINAHL, and PubMed (MEDLINE) were used. The filters such as articles published in the last five years, peer-reviewed articles, and study methods were used. After filtering the articles, only articles with ED nurses as center of study were selected. Further, abstracts were reviewed to filter 12 primary articles and 8 relevant articles. 

NRS 493 Benchmark Capstone Project Change Proposal

Evaluation of literature

ALmutairi & El.Mahalli (2020) conducted a cross sectional survey study to analyze prevalence of burnout in ED nurses and impact of coping strategies to reduce burnout in 623 nurses. The authors used Maslach Burnout Inventory (MBI) and Coping Methods Checklist (CMC) to collect the data and found that coping methods such as stress management, self-efficacy, and mindfulness strategies were effective in reducing burnout. Similarly, Guixia & Hui (2020) conducted a cross sectional descriptive study on 92 nurses by using Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and MBI and found that burnout was high in nurses especially during COVID-19 and factors such as nurse to patient ratio, increased work burden, and external aspects such as COVID-19 pandemic increased burnout. Both the studies highlighted that anxiety, depression, depersonalization, and lower levels of job satisfaction levels were the outcomes of burnout. Further, it increased nurse turnover rate leading to more burnout. The authors also highlighted the need for organizational support and stress management programs to reduce burnout. 

Bruyneela et al. (2021) conducted a web-based survey and quantitative study on 1135 nurses working in ICU units to assess the increased risk of burnout during COVID-19 and strategies to reduce burnout. The author found that emotional exhaustion and depersonalization were observed in most of the nurses who experienced poor work culture, staff scheduling, and low nurse to patient ratio. Similarly, Montgomery et al. (2021) highlighted that organizational culture and work culture were beneficial in reducing burnout and increasing job satisfaction levels. Cañadas-De la et al. (2018) highlighted that along with work culture, marital status, children, gender, and other personal factors also affected burnout levels in the nurses. Also, the authors highlighted the need to implement different interventions including family and organizational support to reduce burnout. 

NRS 493 Benchmark Capstone Project Change Proposal

Ivanić et al. (2017) analyzed long-standing burnout and other burnouts in ED nurses and found that nurses with better work culture, family support, and organizational support showed less burnout compared to other nurses. Likert scale and Copenhagen Burnout Inventory and Copenhagen psychosocial questionnaire were used to analyze the data as they aided in effectively analyzing nurses’ perspectives and psychological aspects. Magtibay et al. (2017) proposed self-efficacy, stress management, resilience, and blended learning training for nurses to reduce burnout and the study highlighted that the approach reduced burnout significantly. Wei et al. (2017) also recommended active intervention to reduce burnout and Yao et al. (2018) recommended self-efficacy to prevent and manage stress better and increasing nurse to patient ratio were effective. 

Change or nursing theory

Kurt Lewin’s change theory and Rogers’ change theory are two critical theories that promote change and aid in successfully implementing the change and evaluating the outcome (Hussain et al., 2018). For this project, Rogers change theory is used as it includes an evaluation stage and low resistance for long-term implementation (Barrow et al., 2016). Further, Bandura’s self-efficacy theory was used to promote better coping to stress in the nurses (Pfitzner-Eden, 2016). Apart from this, transformational leadership theory was used to motivate and empower nurses to accept the changes. 

NRS 493 Benchmark Capstone Project Change Proposal

Proposed implementation plan with outcome measures

The implementation plan starts from increasing nurse to patient ratio and then educating nurses about the change plan and its objectives to promote effective change (Magtibay et al., 2017). The next step is to create training and education sessions to train nurses to manage self through mindfulness, stress management, active management, self-efficacy, and burnout management programs (ALmutairi & El.Mahalli, 2020). Then creating a supportive environment, work culture, and establishing interprofessional collaboration through knowledge-sharing, shared decision-making, and group discussions will be implemented. Further, dynamic scheduling will be implemented (Rees et al., 2019). The plan will be implemented at small scale and then implemented at large scale by evaluating the outcomes (Guixia & Hui, 2020). The outcome measures include turnover rate, cost of care, satisfaction levels of both nurses and patients, quality of care, reduced health care errors, and nurse perception analysis. 

Use of evidence-based practice in intervention plan

General self-efficacy is an EBP as it promotes better management of self and prevents nurses from facing emotional exhaustion, depersonalization, anxiety, and lower job satisfaction. Stress management is an EBP intervention where nurses use different stress management strategies such as hobbies and recreational activities to manage stress (Guixia & Hui, 2020). The EBP intervention of high nurse to patient ratio is effective as high nurse to patient ratio increases quality care, patient safety, and nursing outcome (ALmutairi & El.Mahalli, 2020). Interprofessional collaboration, shared decision-making, knowledge sharing, and organizational support are EBP interventions because they promote better work culture and prevent depersonalization in nurses (Magtibay et al., 2017). 

NRS 493 Benchmark Capstone Project Change Proposal

Plan for evaluating proposed nursing intervention

The plan is to use the pre and post intervention statistical analysis of number of health care errors, turnover rates, satisfaction levels of nurses and patients, cost of health care, throughput, and quality of care (Cañadas-De la et al., 2018). Further, psychological tool scales will be used to determine whether the nurses and patients experienced positive outcomes of the interventions in improving quality of care and reducing burnout. Also, analyzing and comparing nurses’ perception and before and after intervention will aid in evaluating effectiveness of interventions (Guixia & Hui, 2020).

Potential barriers and plan to overcome barriers

There are four key barriers. The first barrier is resistance to change as nurses might feel work burdened due to sessions. The solution is to increase nurse to patient ratio and pay the nurses even during the sessions and educate them about the importance of the sessions (Guixia & Hui, 2020). The second barrier is related to financial resources and this can be resolved through crowdfunding, federal support programs, involvement of community, and taking investment or loan. The third barrier is to hire more nurses immediately and this can be solved by hiring new graduates as assistant nurses (Yao et al., 2018). The fourth barrier is measuring outcome statistically and this can be solved by using scaled tools to measure the perceptions on the scale of one to ten.

NRS 493 Benchmark Capstone Project Change Proposal


ALmutairi, M., & El.Mahalli, A. (2020). Burnout and coping methods among emergency medical services professionals. Journal Of Multidisciplinary HealthcareVolume 13, 271-279. https://doi.org/10.2147/jmdh.s244303

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal38(12), 1173-1180. https://doi.org/10.15537/smj.2017.12.20631

Ang, S., Dhaliwal, S., Ayre, T., Uthaman, T., Fong, K., & Tien, C. et al. (2016). Demographics and personality factors associated with burnout among nurses in a singapore tertiary hospital. Biomed Research International2016, 1-12. https://doi.org/10.1155/2016/6960184

Barrow, J., Annamaraju, P., & Toney-Butler, T. (2016). Change management. Retrieved 28 July 2021, from.

Bruyneel, A., Smith, P., Tack, J., & Pirson, M. (2021). Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive And Critical Care Nursing65, 103059. https://doi.org/10.1016/j.iccn.2021.103059 

Cañadas-De la, G., Ortega, E., Ramirez-Baena, L., De la Fuente-Solana, E., Vargas, C., & Gómez-Urquiza, J. (2018). Gender, marital status, and children as risk factors for burnout in nurses: a meta-analytic study. International Journal Of Environmental Research And Public Health15(10), 2102. https://doi.org/10.3390/ijerph15102102

Guixia, L., & Hui, Z. (2020). A Study on burnout of nurses in the period of COVID-19. Psychology And Behavioral Sciences9(3), 31. https://doi.org/10.11648/j.pbs.20200903.12

Gutsan, E., Patton, J., Willis, W., & Coustasse, A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. MGMT Research. Retrieved 29 July 2021, from https://mds.marshall.edu/mgmt_faculty/196/

Hussain, S., Lei, S., Akram, T., Haider, M., Hussain, S., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal Of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

NRS 493 Benchmark Capstone Project Change Proposal

Ivanić, D., Adam, V., Srzić, I., Stepić, A., & Pintarić, H. (2017). Burnout syndrome in emergency medicine. Hong Kong Journal Of Emergency Medicine24(6), 290-297. https://doi.org/10.1177/1024907917740094 

Jang, H., Park, J., Choi, Y., Park, S., & Lim, H. (2016). Effect of general hospital nurses’ perception of patient safety culture and burnout on safety management activities. Journal Of Korean Academy Of Nursing Administration22(3), 239. https://doi.org/10.11111/jkana.2016.22.3.239

Kuritsyn, M., & Fomichev, D. (2020). Emotional burnout syndrome in workers of emergency medical services. Medsestra (Nurse), (11), 53-57. https://doi.org/10.33920/med-05-2011-06 

Lahana, E., Papadopoulou, K., Roumeliotou, O., Tsounis, A., Sarafis, P., & Niakas, D. (2017). Burnout among nurses working in social welfare centers for the disabled. BMC Nursing16(1). https://doi.org/10.1186/s12912-017-0209-3

Magtibay, D., Chesak, S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout in nurses. JONA: The Journal Of Nursing Administration47(7/8), 391-395. https://doi.org/10.1097/nna.0000000000000501 

Montgomery, A., Patrician, P., & Azuero, A. (2021). Nurse burnout syndrome and work environment impact patient safety grade. Journal Of Nursing Care QualityPublish Ahead of Print. https://doi.org/10.1097/ncq.0000000000000574 

Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R., & Belanger-Gardner, D. (2015). Occupational stress management and burnout interventions in nursing and their implications for healthy work environments. Workplace Health & Safety63(7), 308-315. https://doi.org/10.1177/2165079915576931

Pfitzner-Eden, F. (2016). Why do I feel more confident? bandura’s sources predict preservice teachers’ latent changes in teacher self-efficacy. Frontiers In Psychology7. https://doi.org/10.3389/fpsyg.2016.01486

Rees, C., Eley, R., Osseiran-Moisson, R., Francis, K., Cusack, L., Heritage, B., & Hegney, D. (2019). Individual and environmental determinants of burnout among nurses. Journal Of Health Services Research & Policy24(3), 191-200. https://doi.org/10.1177/1355819619840373

NRS 493 Benchmark Capstone Project Change Proposal

Rezaei, S., Karami Matin, B., Hajizadeh, M., Soroush, A., & Nouri, B. (2018). Prevalence of burnout among nurses in Iran: a systematic review and meta-analysis. International Nursing Review65(3), 361-369. https://doi.org/10.1111/inr.12426

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal Of Emergency Nursing43(2), 145-149. https://doi.org/10.1016/j.jen.2016.07.011

Yao, Y., Zhao, S., Gao, X., An, Z., Wang, S., & Li, H. et al. (2018). General self-efficacy modifies the effect of stress on burnout in nurses with different personality types. BMC Health Services Research18(1). https://doi.org/10.1186/s12913-018-3478-y

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