Burnout of the New Graduate Nurse - Essay Example

Burnout amongst new graduate nurses Stress, of is part of nursing. But complicating factors make today's nurses more stressed than ever. The symptoms of burnout in nurses are as different as the sufferers themselves. Some people become irritable, shouting or growling at anyone who they face. Some try to let aggression, large or small, out, on external objects. Others become calm, introverted and isolated, which can be a sign of the start of a serious depression. Burnout in particular nurses can be seen in under or overeating or using alcohol or even drug substances. The most spread physical symptoms experienced by these people are chronic disease, high blood pressure and regular headaches. Some people on the edge of burnout in fact become fixated workaholics. Others become periodically late or psychologically absent. The change from student nurse to practicing RN can seem too fast, even after years of training. Many nursing educators assert it's too sudden-and one reason why so many recently graduated nurses leave the practice after just a few years. First of all lots of new graduate nurses feel distressed after facing severe reality. They have to transit into a completely new environment, get accustomed to many new things, and I don't think all of them are adaptable enough. In addition, such work might seem exhaustive, energy-consuming, as the new graduate nurse faces real people with real problems. So initially they feel some kind of disappointment and then -dissatisfaction. Job satisfaction for nurses is important for retention and performance. If a job is fun to do, it is more satisfying and performance improves (Gaskill,2000, par.1). Yet, since nurses are in a profession that is continually developing and often have limited control over job changes, job satisfaction is often difficult to reach. In fact, many workplace issues have been identified by the nursing profession as having an impact on work environment and job satisfaction. Stress or stress related health conditions are becoming one of the most important health concerns in Australia. Stress, connected with work, is an important problem facing everyone. People meet increased demands and limited resources in the workplace.This leads to stress resulting in numberless emotional, mental and physical health problems. These troubles can include increased absenteeism, low moral, eating disorders, asthma, depression and heart disease. Workplace stress, especially chronic stress,causes burnout. Let's examine researches, related to the issue, in order to see the figures of statistics. The first research printed in Journal for Nurses in Staff Development, May/June 1999, explored transition of new graduates to 'reality'. For the period of the first 3 weeks of an adjustment to a clinical unit in an intensive care hospital, graduate nurses and their preceptors used feedback sheets to fix in the learning activities of the graduate nurse, meet the need for assessment of learning experiences, and plan activities to meet the continued needs of graduate nurses. Daily feedback sheets from 27 orientees and preceptors were examined by content analysis. Also preceptors developed a model representing the procedure and components of role transition. The model was based on five themes which emerged from the data: Real Nurse Work, Guidance, Transitional Processes, Institutional Context, and Interpersonal Dynamics (Schweiger, Godinez, Gruver, Ryan,1999,p.17). Analysis of results revealed that the initial transition of a graduate nurse to the role of a staff nurse was a dynamic and interactive process occurring between the graduate nurse and the preceptor (Schweiger, Godinez, Gruver, Ryan, 1999,p.19). Guided learning led to progress in harmonizing ever more complicated care within a specific institution. Interpersonal dynamics among staff, preceptors, and graduate nurses affected the process of role transition. Nevertheless, 20 orientees confessed to feeling more or less strong so-called 'reality shock', caused by work dissatisfaction and frustration. One more interesting research was published in Australian Electronic Journal of Nursing Education. Twelve prospective nurses in their final year of study were asked to talk about their predictions and expectations for the future of nursing and their position in that future. Analysis of these answers exposed a great commitment to the nonstop incorporation of holism into the care delivered. The respondents also specified that there would be growing autonomy in the role of the nurse along with an increase of duties. The responses also contained a visible level of pessimism concerning future resource allocation with a subsequent impact on the quality of care delivered. The participants showed a well-developed sense of accountability towards their clients; especially in the area of delivering holistic and quality care (Kevin, Kendall, 2000, par.5). This accountability was also reflected in the desire to be more involved in the decision-making processes which influenced health care (Kevin, Kendall, 2000, par.5). Perhaps a third area highlighted is the effect that health policy has on direct client care' (Kevin, Kendall, 2000, par.5). All of the respondents also expressed a pessimism regarding the future direction of the nursing profession if the future is affected by a cutback in resources. Many participants made a direct statement that a reduction in resources will cause a lack of time to perform the basic care. All respondents tremendously identified the idea of holism as being a powerful determinant in the delivery of nursing care. This theory is demonstrated by the commitment to client-centered care and client participation during the planning of care. This concept is in contrast to the pessimism expressed by many about the expectation that the future of nursing will be affected by a reduction in funding and so this will cause less opportunity to do basic nursing care. I'm hoping that it wont, but I think youll probably get less patient contact, it will probably be more computerised'( Kevin, Kendall, 2000 ,par.7) The workload has increased (Kevin, Kendall, 2000, par. 8).You used to have time to sit and talk to a patient but now there are so many other things to be done that you just cant manage the time.( Kevin, Kendall, 2000, par. 8) This pessimism asks question of how long a new graduate will stay in a profession in which he or she feels less than entirely optimistic. "If students don't understand what a nurse does [in an actual workplace setting], they don't know what to expect (Williams, 2003, par.1). They tend to burn out early and leave the profession," (Williams, 2003, par.1) says Connie Rowles, RN, DSN, CNNA, a clinical associate professor at Indiana University School of Nursing (IUSON) in Indianapolis. Nowadays there appeared so-called transition programs also known as Graduate Nurse Programs (GNP). They have been created to help the graduate nurses in their work during their transition to registered nurse. They also give employing organization opportunity to recruit and train future personnel. Yet, these programs have been severely criticized for being needlessly long and costly, lacking consensus regarding the requirements of graduate nurses and participation from the higher education sector. In addition, there is quite low-level evidence that these programs reach their needed results and no reliable cost-benefit evidence. In fact, the experiences of new graduate nurses have not changed. Graduates are often expected to work at levels similar to experienced staff, so GNP are to stimulate ongoing professional development rather than imitate current practices in order to improve the future professional growth of junior staff, so that quality of nursing care is higher. The interval of training and arrangement to the requirements of the nursing role and the particular requests of the place of work is the main task of the transition period. It is a time when most hospitals present a structured complex program that activates the graduate's skills, knowledge and values to be developed so that they can assimilate into the nursing team successfully. Nursing care becomes contextualised and affected by changing workplace pressures, demanding from graduate to establish a balance, which meets patients' needs, the workplace's requirements, and their own ability to meet these needs. These programs have a tendency to being based on either a deficient model, which concentrates on rectifying graduate insufficiency, or skill consolidation model, which focuses on improving the knowledge and professional skills of an undergraduate. The transition program helps set up the graduate's identity as a registered nurse. A mediated entry into the profession is often provided by such programs. They make nurse know what to expect, what is expected from him or her, how the system operates and activates them to learn the working routines. The transition relates to the infusing specimens of adjustment, so the prospective nurse learns to solve related problems, and knows when and where to look for support. This assignment is influenced by good role patterns, but the process of role definition itself can cause irritation or depression. In 1974 Kramer named such irritation 'reality shock', as it arises from the shock like realization that the world of nursing doesn't always work according to the principles taught at the university. To some extent it can be treated as discomfort and uncertainty, which always accompanies any transition into a new workplace. The compound clinical learning environments to which the university student is exposed during their undergraduate program may worsen it stronger than singular clinical environment, which is experienced by the future nurse during the hospital training. The basic distrust concerning the graduate's skills and knowledge can exacerbate reality shock; negative talk about them demoralizes them and makes their angst stronger. Research undertaken by Madjar showed that most clinicians do not expect newly graduated nurses to be satisfied with their work. They see graduates as those 'who have not had enough realistic clinical, who will need support' (Madjar, 1997,par. 82). The graduates, in turn, state that they haven't got enough competence and experience, so this enlarges their feelings of anxiety and uncertainty. In addition, Madjar discovered the level of support the graduate receives affects feeling of competence. The worth side of the transition year for 64 per cent of participants is the devastating feeling of having inadequate knowledge to make reasonable clinical judjement and work competently. This is often expressed as feeling of 'being thrown in at the deep end to sink or swim'. (Madjar, 1997,par.84). Some graduates say they are expected to perform the role of an experienced nurse before they are confident enough to take such responsibilities. They are under huge pressure to work as if they were experienced RNs, which increases uncertainty about their performance and causes serious stress symptoms such as headaches, nausea, back aches. Future nurses are sure there are a number of factors influencing the lack of self-confidence. The most significant one is negative attitude towards university preparation from within the profesion, which continues unstoppable perpetuating a crisis in confidence in the graduate regarding his or her own capacity, and in employers and clinicians concerning the graduate's competence. Many prospective nurses confess to a lack of knowledge of applied pharmacology and medication management making them worry about the potential of making decisions in this field. Usually there is a gap between the graduate's opinion about his future activities and what they allowed to do in fact, and such gap might create some kind of tension. Graduates have angst as they suppose they may come across something they do have not understood completely, or miss something essential, or do something incorrectly, which will have serious consequences and possible unfavorable results for a patient. This is a major factor influencing feeling of angst or even despair in the new graduates. Patient-centered approach in nursing practice is one more important factor. Nurse is often afraid to do anything, as the graduate believes he/she is incompetent and can only exacerbate poor client's health. Kramer distinguishes four phases of reality shock. The first one is called honeymoon period, when the graduate is energized by career horizons. After Honeymoon period comes shock period when one realizes that personal targets and objectives may be limited by the environment or lack of experience. Then the new graduate has recovery phase, which may be reached when a new vision of perspective appears that is congruent with personal objectives and desires. Finally, resolution period comes when one can establish complete self-identity that joins him to the organization and his colleagues. In some cases there might be never-ending shock period where the depression arises from. First of all, the neural system becomes drained, furthermore comes feeling of inescapability and the person locks himself or herself within the cell of his/her own angst. One more interesting research among Australian graduates showed interesting results. Participants (n=137) were asked to name the best aspects of the transition experience. Graduates identified such aspects as nurses' good attitude towards them; becoming an independent problem solver and decision maker, integration into the team and working professionally in it; being able to consolidate skills and constantly learning new things; receiving support and encouragement from hospital personnel; the availability of a support person/s to supervise procedures on call; variety of experience rotating through different areas; feeling productive since you are able to apply your knowledge. Not everybody had a positive experience. Negative replies were quite similar: I didn't finish my grad program because the workload and expectations were too high, support was always offered but was never given due to lack of staffin the end I thought better of it and left (Watts, Robertson, 2005, p.35) - 15 per cent of graduates gave similar answers. I was put into the operating room before I had ever seen a ward for my first placement, so when I got my first ward after six months they thought I should know it all, but I'd lost my confidence completely (Watts, Robertson, 2005, p.36). I wanted to run away then and there (Watts, Robertson, 2005, p.36) - similar responses were given by 13 per cent of participants. 65 per cent of new graduate nurses confessed to the feeling of incompetence and some kind of irritation about that. In 1979, graduates 'complained of feeling overwhelmed, helpless and inadequate' (Alhadeff,1979, p.201). In 2001 graduates are still complaining about similar feelings! Why Using Kramer's approach to transition stages, one can guess that advanced support could be mobilized in order to ease transition 'from campus to hospital' and create a sense of integration and job satisfaction. This is the best reached by using peer support and creating so-called coping strategies concerning orientation in the profession and transition programs. Literature First of all it was necessary to look through the professional standards of nursing practice. Nurses and midwives in Queensland must work according to: the national code of ethics, which explains the main moral commitments and values that nurses and midwives can be supposed to hold, and the ACMI Code of Ethics for Midwives ; the national code of professional conduct which identifies the minimum standards for professional conduct ; the Australian Nursing and Midwifery Council (ANMC) competency standards for the registered nurse , the Australian Nursing and Midwifery Council (ANMC) competency standards for the enrolled nurse and the Australian College of Midwives Inc (ACMI) national core competency standards which outline the scope of practice of a nurse or midwife who is beginning practice. (The Principles for the Assessment of National Competency Standards for Registered and Enrolled Nurses provide information on how to assess a nurse's ability to meet these standards.) ;Code of Practice for Midwives incorporating Guidelines for Midwifery Practice; Guidelines for RNs and ENs regarding the Boundaries of Professional Practice; Guidelines on Standards of Practice for RNs with Drug Therapy Protocol Endorsement ; Responsibilities for Employers, Nurses and Midwives under Changes to the Nursing Act 1992 ; Scope of Practice Framework for Nurses and Midwives 2005 (Framework) ; QNC and Health Practitioner Boards' Statement on Sexual Relationships Between Health Practitioners and Their Patients; Notification of Convictions, Judgments, Settlements and Disciplinary Action by Licensed Nurses and Midwives . Suzanne Gordon's Nursing Against the Odds is a reflection of the denursification of modern world health care and the related nursing shortage. Gordon (a member of the Center's advisory panel) connects the nursing crisis with the three factors cited in her subtitle. She uses research and jokes to give details why qualified nursing is essential to patient outcomes, and she 'spares virtually no one with responsibility for the crisis, including nurses themselves. The book could be more balanced. Parts seem to reflect a lack of respect for nurses who do not work at the "bedside" and for some key nursing principles' (Summers, 2005, par.6). The book shows that nurses are in actual fact physician "subordinates" with no real autonomy, and that nurses' approach of holism and patient advocacy is largely false. Among the most interesting and books about nursing are Kramer's 'Why nurses leave nursing' and 'Why does reality shock continue'. Yet they were published twenty or more years ago, the problem described stays hot and urgent. In my opinion, Kramer successfully clarified the key issue and underlines the strategies, which can be helpful in coping with reality shock. Alhadeff's 'Anxiety in a new graduate' is also worth keen attention, as there were given details concerning the feeling of anxiety in new graduate nurses and it's consequences for these people. Madjar's 'Project to review and examine expectations of beginning registered nurses in the workforce' is interesting for inquisitive students, who are interested in statistics and results of research made by the author. As for me, the results are not unexpected, they are just a fact of modern reality. One more significant research was done by Greek professors and is titled 'Burnout among nurses in intensive care units, internal medicine wards and emergency departments in Greek hospitals'. This thorough investigation showed the importance of physical comfort and friendly environment in nursing practice. Jim Kevin and Sharon Kendall did research (published in AEJNE Volume 6 - No.1 June, 2000) among Australian prospective nurses. They explored graduates' expectations having conversed thoroughly with all participants. Article 'Nursing around the world: Australia' by Jane Stein, which is available online, discusses the fundamental principles of nursing education and practice in Australia, also about the governmental policy concerning nursing in general. Also I used Australian Faith Community Nurses Association's 'Response to the National Review of Nursing Education', in which there was mentioned 'reality shock' and necessity of applying new coping strategies. Reference list 1) Adali E., Priami M., 2002, 'Burnout among nurses in intensive care units, internal medicine wards and emergency departments in Greek hospitals', http://www.nursing.gr/burnout.pdf 2) Aiken L., Clarke S., Sloane D.2000, Hospital staffing, organization and quality of care: cross-cultural findings. http://www.anmc.org.au/ 3) Aranda K., 2005. Community nurses' talk of equality and discursive constitution of selves. Journal of Advanced Nursing, July -2005, vol.51, issue 2. 4) Alhadeff, G. 1979, 'Anxiety in a new graduate', American Journal of Nursing, vol.79, No.4 5) Australian Faith Community Nurses Association, 'Response to the National Review of Nursing Education', http://www.apna.asn.au/site/index.cfx 6) Cameron P., Thompson D., 2005. Changing the health-care workforce. International Journal of nursing practice, February, 2005, Volume 11, issue 1. 7) Ct J., Pepler C., 2005. Intervention of new experience into the nursing practice. International Journal of nursing practice, February, 2005, Volume 11, issue 1. 8) Florin J., Ehrenberg A., Ehnfors M., 2005. Patients' and nurses' perceptions of nursing problems in an acute care setting. Journal of Advanced Nursing, July -2005, vol.51, issue 2. 9) Gaskill M.,2000. Breaking point: faced with burnout in the workplace, nurses take care of each other. http://www.nurseweek.com/news/features/00-11/stress.html 10) Gordon S., 2005, Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care, Cornell University Press 11) Kevin J., Kendall Sh. 2000 'The student nurses view of the future of nursing', The Australian Electronic Journal of Nursing Education' http://www.scu.edu.au/schools/nhcp/aejne/archive/vol6-1/kevinj.html 12) Kramer, M. 1974, Reality shock: Why nurses leave nursing, C.V. Mosby, St Louis 13) Kramer, M. 1985, 'Why does reality shock continue' in Current issues in nursing, McCloskey Dochtermann, J & Kennedy Grace, H., Blackwell Scientists Publications, Boston 14) Lopez V.,2001. Advanced nursing practice: Development in Australia. http://www.anf.org.au/ 15) Madjar, I. 1997, Project to review and examine expectations of beginning registered nurses in the workforce 1997, Nurses Registration Board of New South Wales. (Online) http://www.nursesreg.health.nsw.gov.au/corporate-services/hprb/nrb_web/exp_brns/title.htm 16) Nurses Board of Western Australia, Guidelines, 2000 http://www.nbwa.org.au/2/23/50/Guidelines.pm 17) Queensland Nursing Council, 2005. Nursing practice standards. http://www.qnc.qld.gov.au/home/content.aspxcontent=Nursing_&_Midwifery_Practice/Practice_Standards 18) Queensland Nursing Council, 2005. Scope of practice framework. http://www.qnc.qld.gov.au/home/content.aspxcontent=Nursing_&_Midwifery_Practice/Scope_of_Practice_Framework_2005_ 19) Queensland Nursing Council, 2002. Setting the standards for nursing. http://www.qnc.qld.gov.au/upload/pdfs/corporate_publications/QNC_Public_Information_Brochure.pdf 20) Schweiger,J. Godinez, G., Gruver, J. ,Ryan, P.,1999 , Journal for Nurses in Staff Development - May/June 1999 21) Stein J.,2000, 'Nursing around the world: Australia', http://www.nursingworld.org/ojin/topic12/tpc12_3.htm 22) Summers H, 2005. Fighting the future. http://www.nursingadvocacy.org/media/books/nursing_against_odds.html 23) Thorne S. , 2005. Conceptualizing in nursing: what's the point Journal of Advanced Nursing, July -2005, vol.51, issue 2. 24) Watts R., Robertson J, 2005 . Nursing: Expectations among new graduate nurses. International Journal of Evidence-Based Healthcare, May -2005, vol.3, Issue 5. 25) Williams D., 2003. Welcome to the real word. http://www.minoritynurse.com/features/nurse_emp/06-06-03.html . Read More