Date of Award

4-25-2016

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Constance Sheets

Abstract

Nursing burnout and workload is a complicated issue with far-reaching effects. Nursing burnout and inappropriate nursing workload have been linked to increased risk of urinary tract infection, respiratory infections, decreased patient satisfaction, decreased quality and safety of care, and increased mortality. The purpose of the project was to decrease nursing burnout on a Medical Progressive Care Unit (MPCU) by moving patients with high workloads and medical instability to a higher level of care. Within this project, Rosabeth Kanter’s Theory of Structural Power was used for the theoretical framework, and the Stetler Model guided the implementation. The intervention consisted of a presentation to Intensive Care Unit (ICU)/ Pulmonary physicians on the correlation between workload, burnout, and other issues pertinent to MPCU such as current turnover rates and the inexperience of the nurses. The project also included a daily workload tool for each patient in the progressive care unit for the first two months in order to gather reliable data for the submitted proposal to improve nurse: patient ratios. The last four weeks of the project consisted of identifying patients at risk for transfer to the ICU due to their medical instability and then calculating the Nursing Activities Score (NAS). The NAS is a validated ICU level nursing workload tool utilized for this project. If the patient reached an ICU level workload of 54 and was deemed ICU appropriate, the goal was to move patients due to their workload and acuity. If the patient could not be moved due to extraneous factors such as lack of nursing staff in the ICU, then the pulmonary consult team, if appropriate, would consult. The Maslach Burnout Inventory (MBI) was utilized to measure burnout. It is made up of three subscales that are scored individually: Emotional Exhaustion (EE), Personal Accomplishment (PA), and Depersonalization (DP). Review of literature shows that emotional exhaustion correlates the most with nursing workload. Pre and post burnout scores were gathered with a burnout score mean for the EE subscale of 29.88. Post EE scores were 23.32. The paired t tail for emotional exhaustion was 5.55 with a p-value of <. 001. The NAS mean score was 43.56 per patient that is lower than the ICU score of 54, but when considering increased number of patients per nurses in progressive care units, the workload may be higher. Results demonstrate that decreasing workload can improve the emotional exhaustion aspect of burnout. Results for the DP and PA subscales were not found to be significant.