DiversityNursing Blog

Study: ICU Nurses Benefit From Workplace Intervention To Reduce Stress

Posted by Erica Bettencourt

Wed, May 20, 2015 @ 02:25 PM

http://news.nurse.com 

stress resized 600A small study by researchers at The Ohio State University Wexner Medical Center found that a workplace mindfulness-based intervention reduced stress levels of employees exposed to a highly stressful occupational environment, according to a news release.

Members of a surgical ICU at the academic medical center were randomized to a stress-reduction intervention or a control group. The eight-week group intervention included mindfulness, gentle stretching, yoga, meditation and music therapy in the workplace. Psychological and biological markers of stress were measured one week before and one week after the intervention to see if these coping strategies would help reduce stress and burnout among participants.

Results of this study, published in the April 2015 issue of Journal of Occupational and Environmental Medicine, showed levels of the chemical salivary alpha amylase, were significantly decreased from the first to second assessments in the intervention group. The control group showed no changes. Chronic stress and stress reactivity have been found associated with increased levels of salivary alpha amylase, according to the release. Psychological components of stress and burnout were measured using well-established self-report questionnaires. “Our study shows that this type of mindfulness-based intervention in the workplace could decrease stress levels and the risk of burnout,” one of the study’s authors, Maryanna Klatt, PhD, associate clinical professor in the department of family medicine at Ohio State’s Wexner Medical Center, said in the release. “What’s stressful about the work environment is never going to change. But what we were interested in changing was the nursing personnel’s reaction to those stresses.”

Klatt said salivary alpha amylase, which is a biomarker of the sympathetic nervous system activation, was reduced by 40% in the intervention group.

Klatt, who is a trained mindfulness and certified yoga instructor, developed and led the mindfulness-based intervention for 32 participants in the workplace setting. At baseline, participants scored the level of stress of their work at 7.15 on a scale of 1 to 10, with 10 being the most stressful. The levels of work stress did not change between the first and second set of assessments, but their reaction to the work stress did change, according to the release. 

When stress is part of the work environment, it is often difficult to control and can negatively affect employees’ health and ability to function, lead author Anne-Marie Duchemin, PhD, research scientist and associate professor adjunct in the department of psychiatry and behavioral health at Ohio State’s Wexner Medical Center, said in the release. “People who are subjected to chronic stress often will exhibit symptoms of irritability, nervousness, feeling overwhelmed; have difficulty concentrating or remembering; or having changes in appetite, sleep, heart rate and blood pressure,” Duchemin said ih the release. “Although work-related stress often cannot be eliminated, effective coping strategies may help decrease its harmful effects.” 

The study was funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience Program, part of Ohio State’s Neurological Institute.

Topics: employees, ICU, studies, Medical Center, health, healthcare, research, nurses, doctors, medical, burnout, stress, medical staff, surgical, stress levels, mindfulness

When 'Mean Girls' Wear Scrubs

Posted by Alycia Sullivan

Fri, Jun 28, 2013 @ 02:57 PM

By Alexandra Wilson Pecci

Source: Health Leaders Media 

For many nurses, leaving high school doesn't mean leaving the bullies behind. Bullying has been called nursing's "dirty little secret," but judging by the numbers, it's hard to believe it could be kept secret at all.


Cheryl  Dellasega, PhD, RN, CRNP


Cheryl Dellasega, PhD, RN, CRNP

Most women can relate in some way to the 2004 Lindsay Lohan movie Mean Girls, in which her character encounters a group of bullying high school girls who say things like this: "Half the people in this room are mad at me, and the other half only like me because they think I pushed somebody in front a bus."

But while most women can leave memories like this behind when they graduate from high school, for those who enter nursing and become victims of nurse-on-nurse bullying, leaving high school hasn't made the mean girls disappear; they're just wearing scrubs now.

Bullying has been called nursing's "dirty little secret," but judging by the numbers, it's hard to believe it could be kept secret at all.

Twice as many nurses as other Americans have experienced bullying in the workplace. According to study of 612 staff nurses in theJournal of Nursing Management, 67.5% had experienced bullying from their supervisors, while 77.6% had been bullied by their co-workers. Compare that to the 35% of Americans outside healthcare who've reported workplace incivility, says the Workplace Bullying Institute.

Not only is bullying among nurses an issue, it's one that most nurse managers aren't equipped to handle properly, according to Cheryl Dellasega, PhD, RN, CRNP, co-author with Rebecca Volpe of the new book Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil.

Bullying "is a huge problem now in the workplace," Dellasega tells me. "I think a lot of nurse managers don't get a lot of training in conflict resolution."That's especially true when they have little more management experience than any of their co-workers but were promoted to the role because they have a bachelor's degree and a few extra years of seniority, Dellasega says.

Dellasega's new book is a follow-up her to When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Nurse Bullying, and aims to help managers and administrators understand and deal with bullying among their nurses.

In order to write the new book, the authors not only conducted a literature review, but also reviewed hundreds of blogs written by nurses about situations of conflict. By doing so, Dellasega and Volpe were able to identify key themes and scenarios that are common to bullying, as well as which groups of people were commonly involved in bullying.

Finally, the authors interviewed nurse management experts to give insight into dealing with such situations. "There were different pockets of nurses who seemed to be really engaged in the situation, as either a victim of the aggressor," Dellasega says. For example, new nurses are often victims.

"I think that brand new, young nurses [are] sort of the classic targets," Dellasega says. Often, these nurses are idealistic about their work and excited about how they're going to make a difference, but the older, established, more jaded nurses engage in bullying to knock them down a little. In fact, Dellasega says, sometimes the young nurses' preceptors are the ones who are doing the bullying because they feel like the role is a thankless one.

"I know that even…the literature…supports that preceptors often don't feel well prepared to do the job and often don't want to do the job," she says.

Another group of nurses who are often bullied are part-time, agency, or floater nurses who are picked on because they're not part of the regular nurses' clique.

Yes, clique. Dellasega says the regular nurses who are in the clique often make rude or sarcastic comments to or about the new person, or even go so far as not sharing supplies. Even nurses who come in from other floors can be left of out, even though they're just there to help.

Dellasega says that the cliques and bullying in a hospital comes with the same kind of baggage that most of us thought we left behind in high school. But for nurses, there's the added stake of patient safety. Although studies haven't explicitly linked increased bullying to decreased patient safety, research does say that happier nurses do their jobs more effectively. (Conversely, nurse burnout is linked to higher healthcare-associated infection rates).

"It's not a big leap to figure that when you go into work… if there's a toxic environment… you won't be able to give your full attention to patient care," Dellasega says.

Bullying also leads nurses to call in sick more often in order to take mental health days. Abusive behaviors can even cause nurses to develop post-traumatic stress disorder, anxiety, depression, or insomnia, a Joint Commission survey has found. Hospitals can also lose valuable employees to bullying and many nurses have left their jobs because of it.

"Things get to a point where they just can't take it," Dellasega says. Sometimes nurses feel like they're "going into the battle zone every day."

Nurse managers shouldn't let things get to that point. Managing relationships should be day-to-day work, not something that only happens during moments of high tension.

"Don't wait for it to get to the point that there's explosive conflict," Dellasega says.

Just as Dellasega discovered which nurses and situations tend to breed bullying, she and her co-author also discovered which environments are healthy. Bullying is rarer when there is a sense of teamwork, collaboration, and authentic communication with coworkers.

Dellasega says the ideal nurse manager is transparent, letting the staff ask questions and answering honestly, even if the answer is "I don't know, but I'll find out."

Feelings of empowerment are also important to reduce bullying and satisfaction. And upper hospital management should provide appropriate training for new nurse manager about how to effectively and positively deal with bullying.

Finally, Dellasega says nurses managers should monitor their own behavior to ensure that they're not engaged in bullying themselves, even if inadvertently. For example, sighing heavily after someone speaks could be interpreted as negative. Other behaviors to watch out for are favoritism, certain body language, gossiping, and speaking in a raised voice.

"I think nurse manager have to really monitor their own behavior and be cognizant of anything they might do," Dellasega says. "The nurse manager sort of sets the standards.

Topics: nurses, burnout, bullying, Mean Girls, coping

Evidence-Based Staffing Helps Eliminate Nurse Burnout And Hospital-Acquired Infections

Posted by Alycia Sullivan

Fri, Jun 07, 2013 @ 02:40 PM

Nearly seven million hospitalized patients each year acquire infections while being treated for other conditions. The culprit, according to a study published in the American Journal of Infection Control, is nurse burnout and has been linked to higher rates of hospital-acquired infections (HAIs).

“There is a tendency for nurses to get tired and want to take a break when they are taking on a heavier than normal load of patients, so they may cut corners to get work done,” says Cheryl Wagner, Ph.D., MSN/MBA, RN, associate dean of graduate nursing programs at American Sentinel University. “Nurses may ‘forget’ proper nursing care, such as dressing changes and emptying of drainage bags, or not pay attention to details such as hand washing and careful handling of contaminated articles, and this can be a major cause of hospital-acquired infections.”

Nurse burnout is that feeling of emotional exhaustion and disillusionment nurses feel about their current job that can creep up when working with heavy patient loads and under stress. These problems affect nurses both personally and professionally, and it may affect their patients as well.

A team of researchers at the University of Pennsylvania used a survey tool called the Maslach Burnout Inventory to analyze nurses’ job-related attitudes. It then compared a hospital’s percentage of burnout nurses to its rates of catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs).

The researchers found that every 10 percent increase in the number of high-burnout nurses correlated with one additional CAUTI and two additional SSIs per 1,000 patients annually.

At first glance, this might not seem like a big deal, but according to the Association for Professionals in Infection Control (APIC), using the per-patient average costs associated with CAUTIs ($749 to $832 each) and SSIs ($11,087 to $29,443 each), researchers estimate that if nurse burnout rates could be reduced to 10 percent from an average of 30 percent, Pennsylvania hospitals could prevent an estimated 4,160 infections annually with an associated savings of $41M.

Impact of Work Environment
A study by the Agency for Healthcare Research and Quality (AHRQ) offers evidence that nurse-to-patient staff ratios has been linked with patient outcomes. It seems rather clear-cut that, from time constraints alone, fewer caregivers would translate into a lower standard of care. But this study goes a step further, suggesting the issue is not simply the number of nurses on staff, but the quality of the work environment.

When nurses feel there is a lack of teamwork, or that management’s values conflict with their own – putting financial concerns ahead of patient safety, for instance – stress can build up to the point that some nurses simply detach from their work.

Because Medicare and some private insurers are no longer reimbursing for CAUTIs and SSIs, it only makes sense that hospitals would do everything possible to eliminate these adverse events. That includes not only encouraging nurses to adhere to infection control practice guidelines, but also to improve the work environment as well.

“By reducing nurse burnout, we can improve the well-being of nurses while improving the quality of patient care,” says Dr. Wagner.

Dr. Wagner notes that one common method to reduce nurse burnout is to make sure that staff has adequate time for rest periods.

“This means ensuring that nurses get their days off and are not asked to work additional hours due to shortages, or that they get the regular breaks that they need throughout their workday,” she adds.

More importantly, Dr. Wagner believes that evidence-based staffing standards play an important role in reducing nurse burnout.

“Evidence-based staffing standards will help organizations to staff adequately and avoid nurse burn out, but this evidence must be brought forward by highly educated nurses so that it can have the proper impact.”

Dr. Wagner points out that just complaining about poor staffing does nothing to alleviate the situation and that the evidence needs to be presented by well-educated nurses in formal proposals to administrators.

The needs of the patients grow more complex in today’s health care environment and if a nurse is to be able to handle a multitude of patients with varying maladies, then they need to have the education that will give them the best abilities to improve patient outcomes.

Infection Control Resources
Dr. Wagner reminds nurses that there are simple steps they can take to help reduce the incidence of HAIs. Hand washing is at the top of the list. Other preventive measures bring a nurse’s role as patient advocate into play.

Dr. Wagner recommends that nurses conduct daily reviews of all their patients who have catheters and advocate for the removal of those that are no longer necessary.

Research shows that ‘forgotten catheters’ are often inappropriate catheters, so it’s important that nurses don’t assume that physicians are always aware of a patient’s catheter status.

This is just one way a nurse can identify a problem simply by implementing a daily practice, which increases the quality of patient care and deliver the most cost-effective nursing care possible.

Dr. Wagner encourages nurses to check online resources that recommend nursing interventions for preventing common types of HAIs. The CDC’s latest recommendations are compiled in the 2009 Guideline for Prevention of CAUTIs and in the Guideline for Prevention of Surgical Site Infection, 1999.

Nurses interested in planning, implementing and evaluating infection prevention and control measures should consider making this their career specialty. Earning a degree in this growing field, such as an MSN with an infection prevention and control specialization, is one way to ensure knowledge of best practices – and perhaps new career opportunities.

For more information or to register for American Sentinel University’s MSN, infection prevention and control specialization, visit http://www.americansentinel.edu/health-care/m-s-nursing/m-s-nursing-infection-prevention-and-control.

For more information or to register for American Sentinel University’s health care and nursing programs, visit http://www.americansentinel.edu/health-care.

About American Sentinel University
American Sentinel University delivers the competitive advantages of accredited online nursing degree programs in nursing, informatics, MBA Health Care, DNP Executive Leadership and DNP Educational Leadership. Its affordable, flexible bachelor’s and master’s nursing degree programs are accredited by the Commission for the Collegiate Nursing Education (CCNE). The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.

SOURCE: American Sentinel University

Topics: nurse, burnout, staffing, rest

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