Reducing Nurse Burnout: Evidence-Based Practice Proposal

This proposal focuses on finding ways to reduce job burnout for nurses due to increased demand and shortage of nurses in the US. The report suggests strategies to increase employee engagement, investment in nursing education, and creation of positive work environments. The proposal also includes an implementation plan, potential barriers, and evaluation process.

EVIDENCE BASED
PRACTICE PROPOSAL

Abstract
 Across the various medical fields, there is a shortage of nurses
 Increased life expectancy has caused the increase in demand for nurses
 Organizations have to meet a certain criteria for the recruitment of
nurses without which the profitability of the medical facilities can be
affected
 This also leads to longer working hours for the existing nurses who have
to stretch their work shifts which affects the quality of service
 The report is focused towards finding ways to reduce job burnout for
nurses

Introduction: Problem statement
 Nurses in the US are working under increased stress due to strained public healthcare
system as the aged population increases
 According to the US bureau of labor statistics report that by 2022, 500 thousand registered
nurses are due to retire
 This creates opportunities for the other nurses however has implications that are negative
 100, thousand vacant spot for nurses will be present throughout the year
 Long working hours and extended work periods can negatively affect the nurses
 The main identified problems for nurse are burnout, ageing and career and family

Introduction: Foreground question
 What can be the implications of proper change management and
readiness of the organization towards reducing nurse shortages and
minimizing health administration that is improper?

Organizational culture and Readiness
 Selected tool for the organization culture survey: the Organizational Readiness for
System-wide integration of the Evidence-Based Practice.
 The tool will help in the identification, investigation and evaluation of
organizational readiness in the medical practice through practice that are evidence
based

Organization’s Readiness level
 changes readiness is the capability of an
organization to implement a change or
embrace the changes that are necessary
 One of the toughest identified issues is
concerning dealing with the
organizational changes
 This include dealing with changes in
degree of centralization, education and
training programs, job specialisation,
control and planning systems, and
organization structures.

Organization Culture and Readiness
assessment tool
 Change in the degree of centralization, education and training
programs, job specialisation, control and planning systems, and
organization structures are significant challenges
 The tool used is Organizational Readiness for System-wide integration of
the Evidence-Based Practice (OCRSIEP)
 The tool is a 25 scale item and measures the extent to which the various
factors affect the organization
 the Likert scale assigns a score of 1- which is equivalent to none at all;
5- represents very much.
 Greater than 0.85 is found to the value of internal consistency reliability

Literature Review
 Literatures have highlighted that organizational readiness helps in the
change of the healthcare setting and enhances policy making, practices
and programs effectively
 According to Hauck, Winsett & Kuric (2013) high organizational change
induces more cooperation, persistence, effort and focus among
members
 The inter rater agreement and the inter rater reliability statistics
supported the aggregation at the individual level readiness perceptions
towards the organizational level analysis.
 ORIC is a valid tool as it has helped to effectively measure
organizational readiness and the determination of consequential effects
various situations can affect organizations (Melnyk et al., 2018)

Literature Review
 Literatures have highlighted that proper measurement of the
organizational readiness can effectively reduce the number of change
efforts conducted by healthcare organizations
 At the same time it is important to mention that such efforts can
definitely lead to not achieving the desired benefits and also not fail
altogether (Kaplan et al., 2014)
 Usage of OCRSIEP survey has proved to be successful towards
enhancing the organizational readiness and the organizational culture
for the purpose of evidence based practice
 The literatures highlighted that the evidence based programs help
towards shaping the nursing along with organizational culture (Schaffer,
Sandau & Diedrick, 2013)

Description of solution
 Some unique set of factors can determine the services to patients
 Hiring managers and recruiters to improve the skills of hiring of
personnel
 Nursing institutions should promote nursing as a lifesaving service to the
general public
 The facility and the federal leaders should be creative towards the
application of critical thinking for the recruitment and sustenance of
nurses

Description of solution
 Early recruitment to nursing aspirants to the position of registered
nurses especially the final years students of nursing schools
 The support staffs at healthcare services should increase to facilitate
and sustain the newer nursing aspirants
 Healthcare facility leaders should maintain strong leadership for
enhancing the workforces to create engaging and satisfying
environment for nurses
 Experienced nurses should be recruited in the place of leadership to
facilitate the better mentoring of young nurses
 Essential rewards and recognition should be provided to nurses to
facilitate the long standing commitment of nurses

Description of solution
 Job sharing can be implemented for nurses in order to help them make
their work more flexible in the organization
 Phased form of retirement plans could be formulated
 Statutory requirements and standards need to be created to implement
less than 12 hour work schedules
 Proper communication programs need to be developed
 Employee engagement
 Investment in nursing programs should be made more

Model of Change
 Responsibilities of the leaders in nursing
have increased due to the increasing
demand of the reduced lengths of hospital
stay, advancements in the medical
technology, cost cuttings, demands of
rationalization
 Firstly, it is important to mention that the
nurse leaders must incorporate the
abstract concepts into their daily practice
 Secondly, it has been seen that the
representative theories primarily focus on
the top managers instead of the change
agents or the middle managers
 According to Radtke (2013) studies indicate
that the empowerment of nurses help to
obtain better achievement of project goals

Model of Change
 Kurt Lewin developed a psychological theory that emphasized on the
theory of planned change
 Creation of healthcare environments that will be conducive for the
promotion and providing optimal conditions for patients and increase
the outcomes of the staff outcomes
 A positive framework can help in the development of a positive
workplace change
 There is an association between the heightened staff turnover and the
ambiguity in role of the staff nurses and this demand a quick response
from the nurse leaders

Implementation plan
 The plan will be based on reduction of nurse workforce shortages
through increasing reduction rates
 4 essential strategies will be created
 Strategy 1: development of the communication programs
 Strategy 2: increasing employee engagement
 Strategy 3: Increasing investment in the nursing education sector
 Strategy 4: Creation of positive work environments

Implementation plan: Change
maintenance
 A change manager will be given responsibility to maintain the change by
actually acting as a nurse manager
 The same manager would also handle all forms of miscommunications
and conflict issues
 Managing conflicts need to be done effectively

Implementation plan : Potential
barriers
 Excessive or over control of the leadership
 Improper workforce of planning
 Poor project management

Evaluation
 Evaluation of the plan will be based entirely on the results from the
implementation process
 Evaluation process will start from the 1st of March 2019 to February 29th
of 2020
 Collected data will help in the process of evaluation

Conclusion
 Increased demand of nurses was found to be directly related to the
increased life expectancy
 Retirement of the baby boomers caused increased incidents of chronic
conditions
 Strong leadership need to be maintained to facilitate the greater
participation of people into the nursing profession
 Job sharing opportunities can increase the job participation prospects of
nurses in the country

Bibliography
Aarons, G. A., Green, A. E., Trott, E., Willging, C. E., Torres, E. M., Ehrhart, M. G., & Roesch, S. C.
(2016). The roles of system and organizational leadership in system-wide evidence-based
intervention sustainment: a mixed-method study. Administration and Policy in Mental Health and
Mental Health Services Research, 43(6), 991-1008.
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover–an
integrated review of issues and tools. Journal of clinical nursing, 24(5-6), 662- 671.
Auerbach, D. I., Staiger, D. O., Muench, U., & Buerhaus, P. I. (2013). The nursing workforce in an
era of health care reform. New England Journal of Medicine, 368(16), 1470-1472.
Beech, N., & MacIntosh, R. (2017). Managing change: Enquiry and action. Cambridge University
Press.
Couper, I. D., & Hugo, J. F. M. (2014). Addressing the shortage of health professionals in South
Africa through the development of a new cadre of health worker: the creation of Clinical
Associates. Rural & Remote Health, 14(3).
DeNisco, S. M., & Barker, A. M. (Eds.). (2013). Advanced practice nursing: Evolving roles for the
transformation of the profession. Jones & Bartlett Publishers.
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., ... & Astin, F. (2018). The effect
of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a
systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22.

Bibliography
Golden, A. G., Silverman, M. A., & Issenberg, S. B. (2015). Addressing the shortage of geriatricians: what medical
educators can learn from the nurse practitioner training model. Academic Medicine, 90(9), 1236-1240.
Harris, R. C., Rosenberg, L., & O'Rourke, M. E. G. (2013). Addressing the challenges of nursing student attrition. Journal of
Nursing Education.
Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence‐based practice in an
acute care hospital. Journal of advanced nursing, 69(3), 664-674.
Huston, C. J. (2013). Professional issues in nursing: Challenges and opportunities. Lippincott Williams & Wilkins.
Kaplan, L., Zeller, E., Damitio, D., Culbert, S., & Bayley, K. B. (2014). Improving the culture of evidence-based practice at a
Magnet® hospital. Journal for nurses in professional development, 30(6), 274-280.
Kodama, Y., & Fukahori, H. (2017). Nurse managers’ attributes to promote change in their wards: a qualitative study.
Nursing open, 4(4), 209-217.
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale, causes, and implications of
the primary care nursing shortage. Annual Review of Public Health, 35, 443-457.
Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014).
Facilitating Lewin's change model with collaborative evaluation in promoting evidence based practices of health
professionals. Evaluation and program planning, 47, 82-90.
Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study
on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety,
and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1).
Parkinson, A. M., & Parker, R. (2013). Addressing chronic and complex conditions: what evidence is there regarding the
role primary healthcare nurses can play?. Australian Health Review, 37(5), 588-593.
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse
Specialist, 27(1), 19-25.

Bibliography
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change:
overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.
Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for
implementing change: a psychometric assessment of a new measure. Implementation Science, 9(1), 7.
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration,
43(2), 69-72.
Steege, L. M., & Rainbow, J. G. (2017). Fatigue in hospital nurses—‘Supernurse’culture is a barrier to addressing
problems: A qualitative interview study. International Journal of Nursing Studies, 67, 20-28.
Stefancyk, A., Hancock, B., & Meadows, M. T. (2013). The nurse manager: change agent, change coach?. Nursing
administration quarterly, 37(1), 13-17.
Storkholm, M. H., Mazzocato, P., Tessma, M. K., & Savage, C. (2018). Assessing the reliability and validity of the
Danish version of Organizational Readiness for Implementing Change (ORIC). Implementation Science, 13(1),
78.
Sutherland, K. (2013). Applying Lewin's change management theory to the implementation of bar-coded medication
administration. Canadian Journal of Nursing Informatics, 8(1-2).
Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care
nursing staff: systematic literature review. International journal of nursing studies, 51(1), 63-71.
Wojciechowski, E., Murphy, P., Pearsall, T., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s
system approach for change. Online journal of issues in nursing, 21(1).
Yackel, E. E., Short, N. M., Lewis, P. C., Breckenridge-Sproat, S. T., & Turner, B. S. (2013). Improving the adoption of
evidence-based practice among nurses in Army outpatient medical treatment facilities. Military medicine,
178(9), 1002-1009.