Burnout in Inpatient Nurse Managers Assignment
Nurse managers have a crucial role in leading their teams, promoting cohesions, encouraging diversity, and ensuring smooth operations of their units while overseeing safe patient care. Their high-stress duties of managing staffing shortages, implementing policies, managing budgets, and addressing patient concerns are multifaceted roles that require extensive hours and elevated levels of stress. These individuals must manage chronic stress, avoid emotional exhaustion and depersonalization, and reduce personal accomplishment. As the high stress levels negatively affect the well-being of nurse managers, their units, peers, and patient care are not spared. Burnout in nurse managers leads to decreased quality patient care and unit efficiency, resulting in high turnover rates. Burnout in Inpatient Nurse Managers Assignment
PICO Question/Sources/Literature Search
Burnout among nurses has become a widely discussed topic among healthcare professionals. As nursing demands continue to escalate, many institutions are geared towards increasing nurse retention. While much of the focus remains on bedside nursing, nurse managers play a prominent role in hospital functions. Bressler and Ghazal (2024) stress that after the COVID-19 pandemic, nurse managers increasingly continue to leave their jobs. Nurse managers are a valuable resource that provides stability to nursing units and influences a deep sense of professional efficacy. The study highlights the high nurse manager turnover is similar to other clinical nursing staff turnover. The literature attributes burnout and moral distress to being driven by unsustainable workloads. The lack of work-life balance and role clarity, coupled with an ever-increasing scope of responsibility, creates psychologically unsafe wards, units, and departments (Bressler & Ghazal, 2024). Focusing on the unrealistic expectations placed on nurse managers, many companies have looked to mental health resources to combat nurse burnout. The AMN Healthcare 2023 Survey of Registered Nurses found that reducing stress and utilizing mental health services leads to greater career and job satisfaction than facilities that negate initiatives to address nurse mental health (Wood, 2024). With the data focusing on bedside nursing and highlighting the growing concern for retaining nurse managers, exploring options for increasing retention must be of great concern.
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A search utilizing the Cumulative Index to Nursing and Allied Health Literature (CINAHL) helped find articles specific to using mental health resources amongst nurse managers by providing several articles focusing solely on this purpose. Simple Google searches and Google Scholar searches provided many articles that explored the use of mental health resources and their benefit to the nursing workforce in recent years. Although many were not concentrated on the nurse manager as its target population, Boolean searches through CINAHL allowed for a more focused approach to finding articles on nurse managers. Upon analysis of the articles, it was noted that many recent studies were questionnaires or cross-sectional. Some quantitative data was found, but a lack of pertinent data was seen amongst high-quality meta-analysis/RCT. Nurse burnout, specifically burnout amongst nurse managers, has become a topic of recent interest, which may contribute to the lack of meta-analysis and randomized control trials, all considered level 1 types of studies. The subject inherently focuses on qualitative information, so this can be anticipated. Limiting the search with additional Boolean phrases, such as “inpatient nurse managers AND burnout” and “inpatient nurse managers AND mental health resources AND burnout,” led to more focused results. It, however, limited the number of results to a few applicable peer-reviewed articles. Articles that allowed for full-text capabilities were also added to the search criteria. The search led to three articles in Table 1 that appeared most applicable to our developed PICO question. Burnout in Inpatient Nurse Managers Assignment
PICO Question Formatted
“How does offering a comprehensive employee assistance program with mental health resources compared to current practice affect burnout in nurse managers of inpatient units?”
Literature Appraisal
To distinguish between high- and low-quality research, the Johns Hopkins Nursing Evidence-Based Practice Model helps researchers appraise studies to determine their evidence level. These levels range from I-V, with I being the highest quality study. Literature analysis is a critical step in evidence-based practice as it allows the researchers to review and evaluate the existing research to inform decision-making systematically. Utilizing the Johns Hopkins Evidence-Based Practice model provides a structured framework to ensure that only high-quality research is implemented into practice. The quality of research is based on the rigor of the study design, such as randomized control trials, considered the gold standard of research. Using this model to research fosters a systematic and methodical approach to literature analysis, which enhances the credibility and effectiveness of implementation. Below are three research studies broken down into a matrix table, and the level is based on the Johns Hopkins Evidence-Based Practice Model. Burnout in Inpatient Nurse Managers Assignment
Table 1
Literature matrix
| Author/Title/ Journal/Year Published | Purpose/Problem/Objective/Aims | Data collection/Measures | Analysis/Outcomes | Strengths and limitations | Level of the Study |
| Pallesen, K. S., McCormack, B., Kjerholt, M., Borre, L. Z., Rosted, E., & Hølge, H. B. (2022). An investigation of the level of burnout and resilience among hospital-based nurse managers after COVID 19 — A cross‐sectional questionnaire‐based study. Journal of Nursing Management, 30(8), 4107–4115. https://doi-org.ezproxy.umary.edu/10.1111/jonm.13868 | To investigate burnout and resilience of hospital nurse managers to recommend more people orientated leadership support. – Understand/address factors that influence burnout – Improve well-being of nurse managers Problem: High prevalence of burnout among ward managers | Data was obtained through the head office of the hospital from all ward managers employed on 11 January 2021.
A survey was distributed to all ward managers (n-59) through work email using SurveyXact – a web-based tool for creation and distribution of questionnaire-based surveys. The survey started from 25th November and 10th December 2021. The questionnaire had two sections: background information and a validated survey on burnout and resilience.
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Descriptive statistics employed in summarization and organization of characteristic data in relation to frequency, central tendency, and variability- Demographics data (age, gender years of experience and number of employees), Brief Resilience Scale (BRS) and (Copenhagen Burnout Inventory (CBI) scores. Burnout in Inpatient Nurse Managers Assignment | Strengths: Correlation between young manager/years of experience and burnout – Burnout is modifiable in relation to work environment – Some correlation between preparation for management role and degree of burnout Limitations: – No relationship between years of experience as a nurse manager and burnout
Descriptive statistics as opposed to inferential |
III |
| Hewko, S. J., Brown, P., Fraser, K. D., Wong, C. A., & Cummings, G. G. (2015). Factors influencing nurse managers’ intent to stay or leave: a quantitative analysis. Journal of Nursing Management, 23(8), 1058–1066. https://doi-org.ezproxy.umary.edu/10.1111/jonm.12252 | To identify and report on the relative importance of factors influencing nurse managers’ intentions to stay in or leave their current position. | Ninety‐five Canadian nurse managers participated in a web survey. Respondents rated the importance of factors related to their intent to leave or stay in their current position for another 2 years. Descriptive, t‐test and mancova statistics were used to assess differences between managers intending to stay or leave. | The most crucial factors were work overload, inability to ensure quality patient care, insufficient resources, and lack of empowerment and recognition. Managers intending to leave reported significantly lower job satisfaction, perceptions of their supervisor’s resonant leadership and higher burnout levels. | Strengths: Quantitative data.
Focused on Nurse mangers specifically and their intent to stay in a role. Limitations:
Small sample size. |
III |
| Tafveli, S., Nielsen, K., von Thiele Schwarz, U., & Stenling, A. (2019). Leading well is a matter of resources: Leader vigour and peer support augments the relationship between transformational leadership and burnout. Work & Stress, 33(2), 156–172. https://doi-org.ezproxy.umary.edu/10.1080/02678373.2018.1513961
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The purpose of this study was to study the relationship between transformational leadership and employee burnout. This study particularly studied the leader’s perceptions of internal and external resources in terms of vigor and peer support and how it changed the relationship between transformational leadership and employee burnout in a sample of workers and their leaders. | Data was collected from 29 leaders and 217 of their employees. These employees were from a variety of work forces with the mean age of 45.2, 68% worked full-time, 32% worked part-time. Leaders were asked to take part in a collaboration with a leadership development unit where they received written and verbal information regarding the projects, they were able to ask any questions and were able to participate or not. A link to a web-based survey was sent out to employee emails 4 months apart. The first point of the survey data was collected on background, perceptions of their leader’s transformational leadership, and leaders’ perceived peer support and vigor. The second survey assessed burnout. It was a questionnaire that really focused on leader vigor, leaders’ peer support, employee burnout, and transformational leadership. | The analysis was performed using Mplus software. This showed that employee-perceived transformational leadership was negatively related to employee related burnout at the team and single levels. Team level transformational leadership was positively associated with leaders’ self-rated peer support and vigor, and leaders’ peer support and vigor were positively associated. It is discussed that when leaders experience a large amount of vigor and support, the negative relationship between transformational leadership behaviors and follower burnout is strengthened. When these leaders feel strong and energetic they engage in transformational leadership behaviors. Leaders also need certain levels or resources to act transformational such as supportive social network, social support, peer support, and increase their resources where needed. Burnout in Inpatient Nurse Managers Assignment | Strengths: multiple time points, levels, and raters, this strengthens the conclusions. From a conceptional point of view, they used COR theory to examine boundary conditions of transformational leadership that have not been examined before.
Limitations: reliance on self-reports. This makes findings vulnerable to common method bias. Small number of leaders which reduces statistical power. All data was taken from one sample.
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III
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Literature Synthesis Summary
With the nursing shortage being a growing concern, support for nurse managers is essential in decreasing burnout. Burnout adversely affects nurse leaders by reducing morale and productivity, resulting in high absenteeism and turnover rates (Tafvalin et al., 2019). Leaders heavily impact overall employee health and efficiency. Tafvalin et al. (2019) suggested that burnout decreases when nurse managers have a high level of peer support and external resources. The onus is on healthcare organizations to invest in leadership development programs that teach transformational leadership and help nurse managers develop resilience and build supportive networks. This initiative can help engage teams, promote trust and efficiency, and promote social and professional well-being. By adopting programs that include resources to improve mental health, they can create a work culture that understands the growing need to address these concerns by supporting leadership that supports the well-being of their staff.
The article by Hewko et al. (2015) suggested that addressing key burnout factors such as work overload, lack of resources, and insufficient empowerment is critical to maintaining healthy work relationships among nurse leaders. Therefore, facilities must focus on crucial burnout factors that aim to reduce stressors. Adequate staffing levels and professional development opportunities can help alleviate manager burnout. It is incumbent upon all facilities that wish to retain managers and decrease turnover to provide a nurturing work environment that reduces stressors and burnout. While this study identified several factors that influenced a nurse manager’s intent to leave their current job, the institution of a mental health-inclusive health plan was not one of them. This can raise concerns about mental health resources and the retention of nurse managers. The study stated that institutions should be accountable for fostering support environments. Mental health inclusion in employee assistance programs could provide a catalyst for support and decrease the burnout and moral injury experienced by nurse managers.
The COVID-19 pandemic exacerbated the mental health crisis in healthcare, further underscoring the graveness of the resilience and commitment of nurse managers. Pallesen et al. (2022) analyzed nurse managers’ integral role in healthcare and the importance of considering their mental health among bedside nurses. The authors further magnified the importance of resilience in effectively managing healthcare teams in high-stress situations. Pallesen et al. (2022) attributed resilience-building, stress alleviation initiatives such as teaching self-management, having readily available resources to master emotional intelligence, conscientizing nurse leaders on the need to recognize and adopt self-care strategies, awards nurse leaders the flexibility to recover from adverse experiences. As a result, Pallesen et al. (2022) advocated for a person-centered approach to leadership, prioritizing the well-being of healthcare workers. This can be realized through flexible scheduling, adequate staffing levels, and the availability of mental health resources. Healthcare facilities must be in the forefront to implement interventions that mitigate burnout. Regular mental health check-ins, stress management workshops, and peer support groups are vital initiatives that influence employees’ well-being. Furthermore, incorporating resilience training as part of leadership development programs undeniably will empower nurse managers to curb burnout and impact resilience. A vibrant and resilient workforce reflects mindfulness and emotional intelligence as it adapts coping strategies utilized during crises (Pallesen et al., 2022).
Application
It is clear burnout and moral injury are factors heavily affecting the nursing workforce. Managers that work on inpatient units are no exception to this phenomena but are rarely considered as much as their majority counterpart. Many of the articles agree that leadership that is supported creates environments for their staff to also grow and be content in their current role. What many articles did not cover was how access to mental health resources affects retention in nurse leadership. As the role of the nurse manager grows in scope, and the nursing workforce grows in demand, access to mental health resources must become a staple among hospital assistance programs. There are many factors that can influence an individual nurse manager’s decision to leave their current position, but more research into if mental health resources can buffer these effects are needed. While mental health resources may not be a singularity of change, it can allow for a clearer lens of appreciation and create environments for individuals in leadership positions to then create more opportunity for decreased burnout amongst their staff.
References
Bressler, T. & Ghazal, L. (2024). The nursing staffing crisis has hit one role particularly hard:
The nurse manager. STAT. https://www.statnews.com/2024/01/12/nurse-manager-staffing-crisis-hospitals
Hewko, S. J., Brown, P., Fraser, K. D., Wong, C. A., & Cummings, G. G. (2015). Factors
influencing nurse managers’ intent to stay or leave: a quantitative analysis. Journal of Nursing Management, 23(8), 1058–1066. https://doiorg.ezproxy.umary.edu/10.1111/jonm.12252
Pallesen, K. S., McCormack, B., Kjerholt, M., Borre, L. Z., Rosted, E., & Hølge, H. B. (2022).
An investigation of the level of burnout and resilience among hospital-based nurse managers after COVID-19: A cross‐sectional questionnaire‐based study. Journal of Nursing Management, 30(8), 4107–4115. https://doiorg.ezproxy.umary.edu/10.1111/jonm.13868
Tafvelin, S., Nielsen, K., von Thiele Schwarz, U., & Stenling, A. (2019). Leading well is a
matter of resources: Leader vigour and peer support augments the relationship between transformational leadership and burnout. Work & Stress, 33(2), 156–172. https://doi.org/10.1080/02678373.2018.1513961
Wood, D. (2024). The best mental health resources for nurses. AMN Healthcare.
https://docs.google.com/document/d/1vaulk1h_HwaxEuIWa0fGpbbT4jXUEFW7NCgZvDAmmW8/edit
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