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NRS 493 Literature Review

Literature Review


NRS 493 Literature Review

Burnout in nurses and health care professionals has become a major problem for both nurses and health care organization as it affects nurses’ ability to function effectively and practice efficiently, quality of care provided, health care errors, patient satisfaction, and turnover ratio. In the US, the shortage of nurses is expected to grow from 3 million in 2020 to 3.3 million by 2029 with a growth rate of 7%. The purpose of this literature review is to critically evaluate different yet recent research on strategies to reduce burnout by comparing the research question, sample population, and limitation and provide recommendation based on analysis. Thus, nurse to patient ratio will decrease leading to a greater number of nurses working for longer shifts and handling more patients. The PICOT question formed was: Do multimodal interventions reduce burnout effectively in ED nurses compared to stress management program alone after six months?

High number of patients will result in increased work burden resulting in stress and fatigue. Fatigue is positively correlated with burnout and stress. Nurses who work in such environment have higher turnover rate, low sense of accomplishment, low resilience, high stress, intention to leave job, and are prone to errors (ALmutairi & El.Mahalli, 2020). Thus, it is important to educate nurses to practice stress management therapies, coping strategies, self-resilience, and other strategies to manage self. Further, it is the responsibility of the health organization to support the nurses, empower them, increase nurse to patient ratio, implement a culture of supportive, inclusive, and productive work environment, and implement strategies such as dynamic scheduling and incentive programs. Thus, it is critical to address different aspects or factors of burnout through different strategies to reduce burnout. Through the literature review, it is possible to asses effectiveness of strategies based on research question, sample population, and limitations. 

NRS 493 Literature Review

Comparison of Research Questions

ALmutairi & El.Mahalli (2020), Magtibay et al. (2017), and Yao et al. (2018) have similar research questions where they analyze the effectiveness of coping, stress management, mindfulness, and self-efficacy strategies in reducing burnout in nurses. Wei et al. (2017) considered active intervention including management strategies for burnout and emotional exhaustion to reduce the burnout and research question was to identify the effectiveness of only active interventions. On the other hand, Montgomery et al. (2021) considered to assess correlation between burnout and nursing errors in health care along with effectiveness of work environment and burnout on patient safety. 

Guixia & Hui (2020) conducted a research with research question linked to finding whether burnout increased during COVID-19 as the stress and work burden increased during the pandemic. The research differs from other articles as it highlights the effectiveness of pandemic and lower nurse to patient ratio on burnout in nurses. Similarly, research question in Bruyneel et al., (2021) was about finding effects of burnout on ICU nurses during COVID-19 and factors that associated with it. On the other hand, Ivanić et al., (2017) researched to find the prevalence of burnout syndrome in nurses working in emergency department along with effects of staff scheduling and interprofessional collaboration. 

NRS 493 Literature Review

Comparison of Sample Populations

The sample population size varied considerably as the studies were conducted at different health care settings and with different research parameters. However, all of the studies included nurses in ED and/or ICU. ALmutairi & El.Mahalli (2020) had a moderate to high sample size as total 623 nurses from EMS participated in it. Montgomery et al. (2021) and Yao et al. (2018) used moderate sampling size of 928 and 823 respectively. Bruyneel et al., (2021) used sample size of 1135 ICU nurses, which is highest in the literature review, but the size is moderate considering the theme of the study. 

On the other hand, other studies used adequate number of participants ranging from 50 to 120 nurses. Even though the sampling size is less in Magtibay et al. (2017), which is 50, it can still be adequate considering ED unit for research. The sample population in Guixia & Hui (2020), Wei et al. (2017) and Ivanic et al. (2017) were 92, 112, and 120 respectively. Apart from sampling population, sampling method also plays critical role as it removes or introduces biases in result. 

NRS 493 Literature Review

Comparison of the Limitations of the Study

The very first limitation of the studies is low sampling population and convenience sampling, which can lead to low generalizability and biases. For example, Guixia & Hui (2020), Wei et al. (2017) and Ivanic et al. (2017) have low sampling size, but sampling method varied as Wei et al. (2017) used survey mechanism and Guixia & Hui (2020) questionnaire. However, it was not explicitly mentioned whether randomized sampling method was used. On the other hand, limitation of Magtibay et al. (2017) were low sampling size, convenience sampling, and failure to identify indirect and direct effects of poor work environment on nursing errors. Limitations of study by Ivanić et al., (2017) it did not identify key interventions that can reduce burnout in nurses. 

Research by ALmutairi & El.Mahalli (2020) had limitations, which included inadequate information regarding factors that affect the burnout and inclusion of stress management programs in managing stress and reducing burnout. Limitation of Yao et al. (2018) is failing to include correlation between personality and effectiveness care along with general self-efficacy, and job-related stress. 

Conclusion and Recommendations for Further Research

 The research and studies highlighted the importance of adopting right sampling method especially randomized control trial and having adequate sampling population based on research question or theme to find the effectiveness of burnout on nurses and intervention in reducing burnout. In conclusion, the studies concentrated on nurses and health care professionals working in emergency department and medical emergency units including ICUs to assess impact of burnout on quality care, patient safety, and importance of mindfulness, stress management, self-efficacy, and coping strategies in reducing stress and found that these were effective. The four key recommendations were as follows: high sample size with RCT research will be beneficial; important to consider different aspects of nurses including nurse to patient ratio, organizational support, and stress management theories in reducing stress; find the direct and indirect correlation between burnout, personality traits, and quality of care and importance of adopting mixed model studies to assess both qualitative and quantitative aspects that reduces burnout in nurses. 

NRS 493 Literature Review


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 

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 

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/

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 

NRS 493 Literature Review

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 

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 

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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