Time to Stop Proving Burnout Exists and Start Researching Real Solutions

“Put simply, we know burnout exists and we know it’s getting worse. Let’s leave it at that and move forward. Let’s focus on what we know might mitigate burnout…”

That’s from this month’s Viewpoint, “Burnout Research at a Crossroads,” by Tim Cunningham and Sharon Pappas. Some readers may find it a relief to have this stated so baldly: let’s move on to solutions, say the authors. Let’s put research dollars, time, and energy behind the search for clearer information about what works and what doesn’t.

A two-pronged approach.

The authors see a crucial and legitimate place for investigation of what works and what doesn’t in wellness initiatives to support “personal resilience” through self-care (an increasingly nebulous term in itself).

But they caution against shifting the responsibility onto nurses’ shoulders and ignoring real systemic issues.

With this in mind, they call for research that first of all examines systemic factors:

“It’s only commonsensical that burnout and work experience are intimately tied. It’s time to look more closely at staffing, work hours, team nursing, equitable pay, and other work environment factors that may decrease burnout.”

[…]

DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that […]

How Research Starts: Choosing a Question That Passes the ‘So What’ Test

As an undergrad at the University of Michigan School of Nursing more than 40 years ago, I was among the few students who loved the required “research” course. I don’t know whether I looked forward to that class because I was an avid reader of Nancy Drew and saw research as detective work, or simply because nursing was so new to me that everything about it seemed exciting.

The main idea behind the course was that all nurses should be able to read and understand research reports. We didn’t get into the nuts and bolts of study design, complex statistics, or modeling, but we were expected to be able to analyze basic nursing research articles and to identify a study’s strengths and weaknesses.

This early experience didn’t lead me to pursue a career in research, but it left me with a respect for the research process and an interest in asking clinical questions.

Research basics explained.

Now, I have a chance to update my understanding of the field through AJN’s new series on research basics, Nursing Research, Step by Step. The first installment, “How Does Research Start?” is in the October issue of AJN. In this introduction to the subject, author Bernadette Capili makes it clear […]

Patient Input on Obstacles to Sleep Helps Focus One Unit’s Improvement Efforts

Do you know anyone who’s ever had a good night’s sleep in the hospital? As nurses, we hear the complaints; as patients ourselves, or as family members of patients, we’ve been there.

Differing views on the source of a unit’s sleep problem.

After their hospital’s 20-bed telemetry unit received a low HCAHPS survey score on a quiet-at-night question, nurse practitioner Christian Karl Antonio and his colleagues at a northern California community hospital took on the challenge of improving patients’ sleep experience on the unit.

Before designing an intervention, they spoke with patients as well as staff, and were surprised to learn that the two groups see the problem differently.

“Patients perceived being awakened for vital signs, blood draws, and medication administration as the most frequently occurring factors that contributed to noise at night. On the other hand, staff members perceived that noise at night came from staff conversations, equipment with alarms, announcements on the paging system, and delivery carts, among other sources.”

[…]

How Do Nurses Feel About Assessing for and Promoting Safe Gun Storage?

My grandfather and uncles were hunters, and they always looked forward to their forays into Michigan’s Upper Peninsula during deer hunting season. But while I was well aware of their activities, they never brought their guns into our house. So I never gave any thought to gun safety issues, even after I became a nurse—not even after caring for one memorable patient, a young man my own age who had been accidentally shot by a companion during a hunting trip.

What can nurses do?

“…a child finds an unlocked loaded gun and accidentally shoots themselves or someone nearby, a despondent teenager makes a rash decision to end their life with the family gun, a homeowner mistakes a family member for an intruder.”

It seems that we read about tragedies like these every day. Can nurses help prevent them? The American Academy of Nursing has recommended that health care professionals “assume a greater role in preventing firearm injuries by health screening.”

In “Nurses’ Knowledge and Comfort with Assessing Inpatients’ Firearm Access and Providing Education on Safe Gun Storage” in the September issue of AJN, Kimberly Smith Sheppard and colleagues report on their original research study, which examined nurses’ knowledge and comfort with assessing patients’ access […]

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