Healthcare Worker Well-being and Burnout

This assignment delves into the multifaceted issue of healthcare worker well-being, focusing on the prevalent challenges of stress and burnout. It analyzes various contributing factors, such as long working hours, emotional demands, and limited resources. The assignment explores the concept of compassion fatigue and its impact on healthcare professionals. Furthermore, it examines strategies for mitigating stress and burnout, including multicomponent home-health interventions and self-care practices. Finally, it discusses the implications of these issues for healthcare systems and patient care.

Running head: NURSING RESEARCH
Nursing research
Name of the student
University name
Author’s note

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Table of Contents
Introduction..................................................................................................................................2
Research question, aim and hypothesis........................................................................................3
Aim:.................................................................................................................................................3
Research question............................................................................................................................3
Hypothesis.......................................................................................................................................3
Key pieces of evidence relevant to chosen scenario....................................................................3
Research pilot design...................................................................................................................6
Background analysis........................................................................................................................6
Feasibility of the research................................................................................................................8
Time.................................................................................................................................................8
Cost..................................................................................................................................................9
Adverse events.................................................................................................................................9
Effect size......................................................................................................................................11
Methodology of the research......................................................................................................11
Research approach.........................................................................................................................12
Sampling........................................................................................................................................12
Data collection...............................................................................................................................13
Data analysis..................................................................................................................................13

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Research ethics..............................................................................................................................13
Evidence in support of decisions and approaches.........................................................................14
Discussion of barriers in implementation of the research objectives............................................15
Conclusion.................................................................................................................................16
References..................................................................................................................................18

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Introduction
Work life balance is one of the most talked about concepts within the current day
workplace scenario as stress in the place of work has been seen to affect the physical and mental
health of individuals considerably. The current study focuses upon the impact of long working
hours upon the health of nurses within an acute healthcare setup. The current research project
conducts a pilot study of the various factors within a workplace setting that can have a profound
effect on staff health and attendance. Here, sudden increases in the absence of the nursing staffs
have been noted which could be attributed to long working hours. The sudden changes in the
shift duration of 7.5 hours to 12 hours have drastically increased the sickness rate among the
staffs.
The longer duration of work, lack of sleep and rest can be some of the instigating factors
in deteriorating the health of employed nurses within a health care set up. Reports and evidence
have also directly correlated increased rate of accidents to overtired healthcare staffs (Leow &
Chan, 2017). The absence of an adequate number of staffs can also affect the care quality and
the services offered within a clinical, set up. In the current assignment, we have tried to focus
upon the key pieces of evidence which reflect upon the chosen scenario. The methodology of the
research had also been designed in accordance with the requirements of data analysis and
interpretation. The goal of the assignment is to highlight the contributing factors towards
increasing work pressure which has a negative impact on the mental, emotional and physical
well being of a staff. Apart from longer shift durations, there are other contributing factors which
also affect the well being of the staff such as workplace infrastructural support which is a
necessary component and should be planned carefully (Penkunas et al., 2016).

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Research question, aim and hypothesis
Aim:
To investigate the claim about the effect of significant long working hours over the health of
nursing professionals
Research question
What is the impact of long working hours upon the health of nursing professionals?
Hypothesis
H0= Long working hours are not responsible for deterioration of health of the nursing staff
H1= Long working hours are responsible for health deterioration in the nursing staff
Key pieces of evidence relevant to chosen scenario
There has been evidence in the past where an overtired nurse has forgotten to brief
regarding the most important details pertaining to the health of a patient in emergency trauma
care to the concerned staff during shift change. As commented by Lin, Liao, Chen & Fan (2014),
such overtired staff has also been represented by a massive number of employee or staff
turnover. Therefore, a detailed study had been conducted over here exploring the different areas
of work division and maintenance of work-life balance within an acute care setup. As
commented by Zboril-Benson (2016), long durations combined with rotational shifts may
actually take the health of the nursing staff adding to fatigue which may impact the quality of
healthcare services. However as argued by Kuo, Lin & Li (2014), despite regulations for

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cumulative shift length for residential physicians and workers in other industries such policy and
framework are lacking the nurses. The long working hours have been seen to result in greater
amount of ‘burnout’ within the nursing professionals (Steinmetz, de Vries & Tijdens, 2014).
Burnout could be characterised by emotional exhaustion, lack of attachment to patients, which
could greatly impair the care services (Jamieson, Kirk, Wright & Andrew, 2015).
In this respect, additional data collection and research analysis mentioned that nurses
working overtime would often not communicate well with the patients; neither were some of the
crucial things such as pain well managed or controlled (Volpe et al., 2014). Some of the
regulatory bodies such as Accreditation Council for Graduate Medical Education (ACGME)
have restricted the working or shift hours of the physicians. In this respect, three separate aspects
could be discussed in detail which consecutively impacts the health of the nursing professionals
such as lack of sleep, extended work hours and rotational shifts. The lack of sleep has been one
of the most common factors affecting the health of the nursing professionals. As commented by
Griffiths et al. (2014), less sleep can result in a number of problems such as mood disorders,
deficit of attention at place of work. These factors can significantly contribute to the
deterioration of overall health and well being of a person. The extended work hours and
consecutive shifts have often been related to digestive disorders, hypertension within the nursing
staffs. Reports and evidence have shown that a clear link exists between sleep deprivation and
obesity. As commented by Allen, Holland & Reynolds (2015), short sleep duration has been seen
to develop the tendency of glucose tolerance and promote incidents of diabetes in women. In this
respect, insufficient sleep has been seen to result in occurrences of cardiovascular diseases
among the healthcare professionals. Additionally, less sleep has been seen to cause hormonal
misbalance by disturbing the levels of leptin, cortisol and thyrotropin (Gross, 2017). Some of

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these hormones have been seen to control the menstrual cycles in women. Thus, disruption in the
normal hormonal levels can result in mood disorders and related health problems.
The lack of sleep has also been correlated with less immunity in the healthcare staff
(Sanso et al., 2015). However, workings for more than 40 hours per week affect the health of the
nursing professional to a great extent (Jennings, Clifford, Fox, O’Connell & Gardner, 2015). The
extended shifts have been associated with increased musculoskeletal injuries, cardiovascular
conditions and development of hypertension. The increased neck and muscular discomfort due to
working long hours have also been seen to affect the staff attendance (Sacco, Ciurzynski, Harvey
& Ingersoll, 2015). In this respect, the nursing professionals have often been seen to take longer
holidays or miss duties owing to stiffness or pain in the body. As asserted by Arnold, Teijlingen,
Ryan & Holloway (2015), a satisfied staff have been seen to reduce incidents of massive
turnover at workplace.
Hierarchy of evidence

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Figure 1: Hierarchy of evidence
(Source: Allen, Holland & Reynolds, 2015)
The literature sources used above are cross-sectional studies conducted under
randomised control trials and helps in comparing between control and intervention groups. The
hierarchy of evidence can be further divided into seven different levels or cycles. The level 1
emphasizes upon systematic review of randomised controlled trials. In the second level, the
search strategy is further narrowed down where singly randomised trials are taken into
consideration. From level 3 to 4 correlational and observational studies are conducted where
different case studies are analysed further to find out the common patterns. This further helps in
addressing the identified gaps or loopholes in the current situation. The level 5 to 6 focuses on
data collection methods such as quantitative/qualitative research design. For the present study,
we have taken into consideration face-to-face interview methods along with survey for collection
of data regarding the problem situation of increased rate of health-related absence from work.
The responses will be further compared with expert opinions and management authorities in
charge of the nursing services delivery.
Research pilot design
Background analysis
There have been incidents where the nurses have failed to keep a record of the exact
medication doses to be delivered to the patients. This had resulted in cases of casualties within an
acute care set up and often endangers reputation of the hospital. As per reports and evidence,
several states such as California and Maryland have restricted longer work hours for the nurses

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(Jamieson, Kirk, Wright & Andrew, 2013). However, no restrictions are imposed upon the
voluntary overtime by the staffs of the hospital. Further research has highlighted two major
contributing factors for wilful overtime by the nurses. These conditions could be summarised as
shortage of nurses leading to more pressure on individual staffs along with weaker economy.
However, such restriction of timings is yet to develop for the nurses. Reports and
evidence have suggested that the normal accepted length of duty hours was put at 12 hours for
most hospital set up on a larger scale. As argued by Lesuffleur, Chastang, Sandret &
Niedhammer (2014), most of the nurses have been found to be satisfied with long duty hours and
would never complain. The reason was thought to be low salary being paid to the nurses; where
a hike in the work hours would also mean a hike in the last drawn salary.
Working on consecutive extended shifts can also increase the risk of workplace accidents
(Sorenson, Bolick, Wright & Hamilton, 2016). These accidents are often misinterpreted as
carelessness by the staff. However, such carelessness often results due to excessive amount of
fatigue present in the workers. Thus, the ergonomics or the workplace infrastructure are some
other contributing factors and needs to be worked upon. As commented by Hassard et al. (2014),
providing the staff with proper resting areas can help them to relax and unwind. Additionally,
some of the other factors are provision of adequate facilities such as clean drinking water,
changing rooms.
Reports and evidence have suggested that providing the nursing professionals with
suitable ergonomics can also help in reducing the grievances faced by them (Cheng & Cheng,
2017). As commented by Harris, Sims, Parr & Davies (2015), sufficient counselling and training
could help the nursing professionals in coping up with increasing tension and work pressure. The

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training has also been seen to generate sufficient motivation in the staffs (Munabi, Buwembo,
Kitara, Ochieng & Mwaka, 2014). In this respect, providing the staff with performance bonus
and incentives has also been seen to generate sufficient motivation within the staffs.
Feasibility of the research
In order to conduct a research successfully the feasibility options for conducting the
research successfully have to be taken into consideration. In the current study, we have used both
survey and questionnaire for the collection of relevant data regarding the increased absence of
nursing staff from their place of work. Some of the feasibility issues which were faced by the
researcher in conducting the survey and the interview were getting proper support from the
management and the nursing staffs. Additionally, being at an arm's length from the hospices also
affected the data collection procedure. The remote locations of some of the hospitals also
resulted in accessibility issues, which further affected the authenticity of the results.
Time
The timing is a very important factor in ensuring the rate of success of a research project.
In this respect, the limited time allotted for conducting the research study limited the scope of the
research. Since the research had to be conducted within the hospital premises; therefore prior
consent had to be taken from the respondents of the survey and interview process. Otherwise,
any interruption within a busy hospital setting would have been considered as a violation of the
research ethics and practices (Byrne & Martin, 2014).

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Cost
The budget allocation and costs associated with conducting a research project also have
significant impact on the success rate of the project. The allocation of the budget could be done
based upon the set of activities which are to be performed for the process of data collection and
evaluation. A data plan entailing the amount spent upon each component of the research has been
provided below.
Activities Figures (in singapore dollars)
Advertising (online promotion, designing
posters, templates)
S$ 0.2 million
On –field expenses (organizing surveys) S$ 0.3 million
Research (collection of primary and secondary
data about the issues faced by theworking
professionals in healthcare)
S$ 0.2 million
Fundraising activities (inviting tenders,
expression of interest)
S$ 0.5 million
Table 1: budget allocation
(Source: author)
Adverse events
The adverse events in the context of healthcare could be described as any untoward
incident that may occur during the process of care delivery by the nursing professionals. Some of
the common phenomena which could be described over here are overdosing of patients by the
fatigues or tired nursing staffs. The reporting of the adverse events can help in the identification

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of organizational, systematic and environmental problems (Ganster & Rosen, 2013). There are a
number of methods of reporting the adverse events including document review and surveillance
of the clinical data. Therefore, the detailed analysis of the clinical data would help in analysing
the factors which contributes towards increased rate of absentees among the nursing staffs.
Database: NCBI, Pubmed, Cochrane library, MEDLINE.
Is lack of sleep the cause behind increased rate of sickness absences in nursing staffs?
Search topic Number of hits generated
Workplace stress 52
Effect of stress on the
physical and mental health of
nursing staffs
65
Stress on absenteeism in
workplace
50
Work life balance in
improving health of the
nursing staff
42
Systematic reviewed journals
only
40
Limit the journals to last ten
years only
35

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Limit the journals to English
language only
40
Table: search criteria
(Source: Author)
The literature has been supported through evidences from Randomised control trials
(RCT) methods which belong to level 1 of evidence based studies.
Effect size
The effect size in a pilot study is a hypothetical focus group considered by the researcher
initially which helps him in conducting a priori sample size calculation for future larger study. It
further helps in the development of adequate statistical knowledge in the researcher.
Methodology of the research
The research had been conducted with the help of primary mixed methods (quantitative
and qualitative research design). Here, quantitative study has been conducted with the help of
designing a survey questionnaire. In this respect, an open-ended questionnaire is been presented
to the health care staffs working in the hospital. The questions are designed pertaining to work-
life balance, availability of growth opportunities, sufficient perks and incentives. The responses
collected are used to design statistically significant results. Additionally, an interview is
conducted by the hospital managers where the nursing staffs are questioned regarding the
benefits of reducing shift hours on their physical and mental health. The comparative analysis
helps in arriving at sufficiently evidence-based results. The methodology of the research has
been further discussed with the help of individual research parameters as philosophy of the

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research, design, approach, strategy, type, data collection, data analysis, ethical and accessibility
issues.
Research approach
There are two different types of research approaches such as inductive and deductive
approaches. A thin line of difference lies between the two approaches being followed by the
research methodology. In the current study, we have taken into consideration both the research
approaches. The deductive approach is based upon testing an already published hypothesis
whereas an inductive approach is concerned with new theory generation form the emerging data.
The deductive approach is considered for quantitative studies; whereas the inductive approach is
considered for conducting a qualitative study (Selamu et al., 2017). In the following assignment,
we have taken into consideration both quantitative and qualitative study design. In the current
study, we have conducted both survey and interviews for the purpose of data collection.
Therefore, we have taken into consideration both the research methods and approaches.
Sampling
There are two main types of sampling methods such as simple random sampling methods
and non-random sampling methods. In random sampling methods, we are providing each and
every respondent equal opportunity to participate in the data collection process. In case of non-
random sampling one generally follows a purposive mode of selection of the focus group for
conducting the survey or the interview. For the current study design, we have followed a simple
random sampling method. This provides every respondent equal opportunity of participating in
the interview process.

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Here, the nursing staffs have been divided into two group where one of the groups have
been put into twelve hours long shifts(control group) and the other group had been put into 8 to 9
hours shift (intervention group). The control and the intervention groups of nursing staffs have
been reversed and vice-versa. The process has been executed for a period of four months and the
comparative data collected for further analysis.
Data collection
The data collection is the most crucial part of a research project based upon which the
entire evaluation is done. For the current study, primary data collection methods have been
chosen. The primary design of data collection could be further divided into quantitative and
qualitative methods. The quantitative data are collected through tools such as survey
questionnaire. The responses collected through the survey questionnaire are represented into
statistically significant results such as graphs and charts.
Data analysis
For the analysis of the data of primary mixed research design had been followed where
the data have been collected through both interviews and surveys. In this respect, the recordings
of the interview had been made into transcripts (Selamu, Thornicroft, Fekadu & Hanlon, 2017).
The statistically significant results collected through the survey are compared with the interview
transcripts to arrive at cumulative responses.
Research ethics
A number of ethical considerations had to be taken into consideration during the conduct
of the research. Some of the factors include taking proper consent from the respondents

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participating in the survey and interview process. In this respect, the participants have to be
informed much in advance regarding the venue, timing of the interview process. The respondents
could be reached over through a mail or by giving gentle reminders on the phone. In this respect,
utmost care should be taken that none of the participants is forced to participate in the data
collection process. Additionally, the entry and exit to the interview methods were kept open; that
is the respondents were free to leave the premises of the interview at any point in time. With
respect to reporting of adverse events, the survey respondents or participants of the interview
need to given sufficient room for safeguarding their personal details. The Singapore Personal
Data Protection Act (2012), ensures that confidentiality concerns of the participants are
maintained and no personal data are shared without their consent ("About SingHealth -
Singapore's Largest Healthcare Group - Singapore Health Hospitals and Doctors", 2018).
Evidence in support of decisions and approaches
For the dissemination of the objectives related to the pilot study, a number of steps could
be followed. Firstly, strict rules limiting extensive work hours of the nursing professionals need
to be imposed as per regulatory bodies such as ACGME. In the context of long working hours,
the nurses need to be provided with sufficiently longer breaks, which would help them relax and
freshen up before the next shift. In this respect, meetings could be organized with the board of
directors giving them exact figures and statistics regarding the rates of untoward incidents which
happen due to negligence at the time of delivery of duty by the overtired staffs. A well-entailed
study of the past could be taken as an example for highlighting the problem areas where
sufficient reforms and measures need to be implemented. The lack of proper scheduling during
the roster preparation of the nurses can also lead to mishaps within healthcare settings. In this

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respect, steps could be taken to reduce the number of consecutive rotational shifts within a single
day for a nursing professional. This could be established by providing a sufficient number of
backups and involving more number of staffs within the care procedure. Therefore, emphasis
needs to be placed upon hiring and recruitment of more number of nursing professionals.
In order to support the above-mentioned facts detailed study had been conducted with the
help of sufficient literature analysis. Here, a number of questions related to compassionate
fatigue have been asked to the participants of the survey and interview process as it is a common
phenomenon among nursing staffs. In this respect, recurrent health checkups of the nursing
professionals have been conducted. The results from repeated randomised control trials (RCTs)
have shown that the healthcare staffs exposed to long duty hours reported gradual deterioration
of health. The details from such health tests pointed at sudden increase in the blood glucose level
and amount of hypertension. Therefore, sufficient measures need to be taken for checking and
preventing rapid deterioration in the health of the nursing staffs. The concerned staffs could be
provided with longer holidays for once in a while; which helps them in refreshing and
rejuvenation.
Discussion of barriers in implementation of the research objectives
The current research has been designed with a view to investigating the claims of the
manager who stated that inconscessantly long working hours contributes significantly to
deteriorating the health conditions of the nursing professionals. For the dissemination of the
objectives of the research project, a detailed qualitative and quantitative study method had been
followed over here. In this respect, the individuals or participants taking part in the study design
need to be informed well in advance regarding the venue, dates and timing of the interview

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process. Additionally, the personal and private details of the participants need to be preserved so
that no confidential information is leaked out or misinterpreted.
The consent from the respondents needs to be attained on signed papers highlighting in
full details the terms and conditions of the survey process. In order to conduct the interview
three different management lines of the organisation will be chosen such as the frontline
manager, middle-level manager and the executive manager. The interview responses and later
retrospection helps in highlighting the loopholes within the system and administration which are
crucial in providing the staffs with a proper work-life balance.
However, there are a number of barriers which are faced in the conduct of the research
study. Some of the factors which play a governing role in the success of the research project are
cost and timing of conducting the research. For designing of the interview and study design
support and funding from the state and federal level is required. The entire consent and approval
cycle takes huge amount of time which could have been otherwise vested in gathering sufficient
and authentic data for the research project.
Conclusion
The current research project evaluates the effect of long working hours on the health of
the various staffs and healthcare professionals. The study conducted here analyses the various
factors which contribute towards the development of conditions where the nursing professionals
have been absent from their work for a longer period of time. Further study and analysis have
supported the supported and drawn various links between errors within the hospital and care set
up and overworked staff. In the current study, a mixed research methodology has been followed
for gathering and collection of sufficient data supporting the hypotheses. In this respect,

18NURSING RESEARCH
implementation of alternative strategies and solutions such as provision of longer break hours
along with paid holidays, work-based incentives can help in generating sufficient motivation in
the staff. Additionally, providing the nurses with free health check-ups regularly can also reduce
the occurrence of mishaps within a care setup.

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