Job Burnout and Turnover in Mental Health Nurses

This research proposal aims to evaluate the primary factors responsible for the high rate of burnout among mental health nurses and the factors that motivate them to sustain in the profession. It also intends to shed light on the available organizational remedies for nurses to deal with burnout within a mental health care setting.

Running head: Job Burnout and Turnover in Mental Health Nurses
Research Proposal
Name of the Student:
Name of the University:
Author Note:

1Job Burnout and Turnover in Mental Health Nurses
Introduction:
According to Velimirovic et al. (2017), the incidence of burnout is common among
mental health nursing professionals. Job burnout can be defined as an attribute of work related
stress that leads to physical and mental exhaustion among the care professionals. Burnout is
characterized by a distinct sense of feeling under accomplished and a loss of personal identity.
According to a report published by Hayes et al. (2015), it has been stated that more than 60% of
the Graduate nurses who enter into practice quit the profession within 2 years of placement. In
addition to this, studies reveal that more than half a million of the registered nurses (RNs) all
over the world have already quit the profession. The most common reason for a high rate of
turnover includes, stretched shift timings and excessive workload (Allen et al., 2015). In addition
to this, other important factors such as emotional exhaustion and poor work life balance was also
stated as reasons for giving up the profession. In addition to this, the rate of turnover is highest
among the mental health nurses in Australia with an estimated average of 6% (Singh et al.,
2015). The reported statistical figures suggest that burnout among mental health nurses has
emerged out to be a problem of national importance. This research proposal therefore intends to
evaluate the primary factors that are responsible for the high rate of burnout among the mental
health nurses.
Problem statement:
The primary components that determine the quality of effective care include the physical
and mental wellness of the employee workforce in a healthcare organization. The existing
relationship between mental health wellness factors such as burnout, depression and anxiety and
the quality of life of the nursing professionals working in the mental health care unit have been

2Job Burnout and Turnover in Mental Health Nurses
overlooked (Singh et al., 2015). According to a survey report, it was mentioned that 43.8% of the
nurses working within the mental health unit experienced stress and burnout. Further, 20% of the
mental health nurses reported to feel extreme depression (Brunetto & Teo, 2013). In addition to
this, more than 25% of the professionals reported to feel saturated and considered the option of
quitting the profession within the next 12 months. (Allen et al., 2015) The statistical estimates
collected from the research study, indicated that burnout in the nursing profession is a concern of
great magnitude which must be researched further and given utmost importance. Nursing
professionals are integral within a healthcare organization that are responsible for rendering
quality in terms of care services. Also, when the world is already experiencing an acute shortage
of care professionals and is struggling to optimize the nurse to patient ratio for effective care, it is
extremely important to ensure that the turnover ratio is controlled (Laschinge & Fida, 2015). The
critical evaluation of the factors that lead to burnout would help in regulating the rate of turnover
and would also help in promoting positive patient outcomes.

3Job Burnout and Turnover in Mental Health Nurses
Research Questions:
Therefore, on the basis of the existing evidence base, the research questions that can be
articulated for the proposed research study would include the following:
RQ1: What are the factors that lead to burnout among nurses working in a mental health care
environment?
RQ2: What factors motivate nurses to sustain in the profession within mental health care unit?
RQ3: What organizational remedies are available for nurses to deal with burnout within a
mental health care setting?

4Job Burnout and Turnover in Mental Health Nurses
Research Rationale:
The rationale for conducting the research can be explained as the lack of substantial
evidence about the factors that lead to burnout among nursing professionals working in a metal
health care unit. Also, job dissatisfaction and burnout can significantly deteriorate the quality of
care provided to the patient and therefore, it is important to foster a healthy work environment
for the nurse (Khamisa et al., 2015). For the creation of a healthy environment, it is important to
evaluate the primary factors that cause the burnout syndrome and at the same time contribute to
the high turnover rate of the care professionals (Khamisa et al., 2016). This research would help
in the identification of the factors that lead to burnout and offer recommendations that could
improve employee retention and also promote positive patient outcome.
Theoretical Framework:
According to Field et al. (2014), a research study must be based upon a theoretical
framework so as to ensure relevance and feasibility. In order to conduct the research, the
knowledge to action framework would be used. The framework is broadly based upon the
identification of problem (burnout among mental health nurses) and articulation of the problems
into research questions. Further, the evidence base is used to retrieve answers to the research
questions and while dealing with novel research questions an appropriate research method is
adapted for addressing the research. While conducting a research in healthcare, it is important to
develop an idea from the existing evidence base so as to design a research aligned with the
nuances of the healthcare industry. The knowledge to action theoretical framework devised by
Graham and his colleague focuses on the two important aspects of knowledge creation and an

5Job Burnout and Turnover in Mental Health Nurses
action cycle to plan a research based on the existing knowledge base and implement it to practice
(Field et al., 2014).
Background:
The burnout syndrome is characterized with significant emotional and mental exhaustion
that affects care professionals working within a healthcare organization. It should be noted in this
context that the ‘burnout’ syndrome is not a medical diagnosis but is a critical aspect that
governs mental as well as physical wellness among the care professionals. Most importantly, a
number of nurses who experience burnout are not able to actively recognize the initial symptoms
of burnout. Nursing professionals as well as midwives in Australia are regarded as professionals
of high value. However, it is on account of workload and burnout that the national picture of the
healthcare industry is gradually changing. According to a national survey that included the
response of 3000 nurses, it was found that 32% of the professionals were physically and mentally
exhausted and were looking forward to quit the profession (Khamisa et al., 2015). At present the
federal government is already estimating a shortage of workforce equivalent to 85,000 by the end
of the year 2025 and 123,000 by the end of the year 2030 (Lachinger & Fida, 2014).

6Job Burnout and Turnover in Mental Health Nurses
Research Aim:
Therefore, on the basis of the background information, the aim of the proposed research
is to investigate the factors that lead to burnout among the nurses. In addition this, the proposed
research would also evaluate the factors that motivate the nurses to sustain in the profession. The
research also intends to shed light on the available organizational policies that are available for
the nurses to deal effectively deal with the burnout syndrome within a mental health care
environment.

7Job Burnout and Turnover in Mental Health Nurses
Research Objectives:
The following research objectives can be articulated from the research questions and
research aim mentioned above:
Research Objectives:
Objective 1:
To investigate the factors that contribute to burnout among nurses working within the mental health care
unit
Objective 2:
To evaluate the factors that motivate mental healthcare nurses to sustain within the profession
Objective 3:
To evaluate the existing organizational policies for mental health nurses to effectively tackle the burnout
syndrome
Literature Review:
While conducting a research, it is important to thoroughly investigate the evidence base
in order to derive an idea about the available research data and identify the existing research gap
(Crano et al., 2014). Upon evaluating the available research studies, substantial information
about the research background is developed which helps in developing an appropriate research
guideline (Parahoo, 2014). The literature review for this research would be conducted by
scanning the electronic databases of PubMed, MedLine and Google Scholar. The electronic
databases host a gamut of knowledge in the form of scholarly literatures which are used by
researchers to select an appropriate research study design and conduct a novel research. The
electronic databases would be used to retrieve relevant research papers that relate to the research

8Job Burnout and Turnover in Mental Health Nurses
topic. This would be done by using appropriate key terms and the retrieved research papers
would be stringently filtered on the basis of specific exclusion and inclusion criteria.
As mentioned by Parahoo (2014), exclusion criteria can be considered as the
characteristics that are used to eliminate research papers that are not relevant to the research
topic. On the other hand, inclusion criteria comprise of the characteristics that are used to include
research studies in the literature review section (Crano et al., 2014). The inclusion and exclusion
criteria that would be followed for retrieving relevant research studies are enlisted as under:
Exclusion Criteria: Research papers published prior to 2013 Research papers published in foreign languages other than English Research papers that are not fully accessible
Inclusion Criteria: Research papers published in between 2013-2017 Research papers published in English Language Research papers that are fully accessible
A total of four national surveys have been conducted in order to analyze the working
condition and estimate the well being as well as the organizational management practices
prevalent within the nursing profession (Rees et al., 2016). The survey responses collected in the
year 2011 and 2013 indicated the presence of dissatisfaction among the Nurses about increasing
work load (Craigie et al., 2016). On the other hand, the responses collected in the year 2015 and
2017 suggested an overwhelming rise of workload among the nurse. This was indicated by the

9Job Burnout and Turnover in Mental Health Nurses
rise in the percentage of nurses from 64% in the year 2013 to 71% in 2017 who stated that they
were subjected to overwhelming workload (Craigie et al., 2016). In addition to this, 67% of the
nurses stated that they were supposed to address tasks quickly multiple time in a day compared
to 61% as reported in the year 2013 (Singh et al., 2017). Also, 67% of the nurses mentioned that
they were supposed to put in extra effort multiple times in a day which was more than the
percentage (63%) as reported in the year 2013 (Khamisa et al., 2013). As mentioned by Jasperse
et al. (2014), the primary factors that contributed to excessive workload included, addressing
excessive administrative task, lack of appropriate skills to balance multiple tasks at the same
time and insufficient staff strength. Another study conducted by Velimirovic et al. (2017),
suggested that nursing professionals placed within the mental healthcare environment were
subjected to a combination of physical as well as psychological and emotional stress. Another
study conducted by Drury et al. (2014), mentioned that nurses working within the mental health
unit or psychiatry ward displayed an elevated level of emotional exhaustion in comparison to
nurses working in other care units. A number of external as well as internal factors were held
accountable for the high level of emotional exhaustion among the nurses working in the
Psychiatry ward (Alharbi et al., 2016; Gomez-Urquiza et al., 2017). Some of the factors were
studied to be suicide and patient violence. In addition to this, extrinsic organizational factors
such as lack of sufficient resources, crowded inpatient wards, higher work demand, poor defined
roles of consultants and conflict in responsibility towards the patient and organization were also
identified (Alharbi et al., 2016). A large number of studies also indicated that nursing
professionals were dissatisfied because of poor work life balance (Breen & Swseeney, 2013;
Stankiewicz & O’connor, 2014; Hayes et al., 2013). In addition to this, having to manage
patients that are suicidal or homicidal elicited stressful experiences among the care professionals.

10Job Burnout and Turnover in Mental Health Nurses
Another research conducted by Cheng et al. (2016), also mentioned that mental health nurses
experienced higher level of emotional exhaustion. The research study also suggested that the
nurses working within the mental health unit experienced a sense of non-accomplishment or
under accomplishment and emotional depersonalization when compared to nurses working in
other care units.
Research Gap:
On the basis of the literature review, it can be mentioned that a number of studies have
highlighted the issue of burnout and turnover (Alharbi et al., 2016; Drury et al., 2014; Cheng et
al., 2016). However, none of the studies in particular have analyzed the reasons that lead to
burnout among nurses working within the mental healthcare unit. Also, there is a substantial
research gap in terms of analyzing the factors that motivate nurses to sustain their profession.
Also, none of the research studies so far have tried to investigate the available welfare policies
that could help the nurses in dealing with the burnout syndrome.
Methodology:
According to Crano et al. (2014), while conducting a research to investigate about the
perception, attitude or other qualitative parameters, it is important to adapt a qualitative research
design. The qualitative research design is mainly used by researchers who intend to evaluate
human behavior, opinion, themes or motivational factors. In addition to this, qualitative research
data helps in evaluating features and attributes about a particular subject that can be interpreted
thematically (Parahoo, 2014). As in case of this research, we are majorly concerned with the
evaluation of factors that cause burnout among mental health nurses, the selection of the
qualitative research design can be deemed appropriate.

11Job Burnout and Turnover in Mental Health Nurses
The research study would comprise of selecting a total of 5 mental health nurses
randomly working within the mental health care unit for at least 2 years. A blog about the
research study would be created by the researcher which would be posted on two social media
platforms which would include Facebook and Instagram. The page would mention the purpose of
the research and would also contain other important details of the research. Viewers that show
interest and satisfy the criteria of experience and practice would be contacted through email.
Upon receiving response from the participants, a semi-structured interview would be conducted
with the selected participants. A higher preference would be given to the participants who belong
to the same location as that of the researcher. This is to facilitate a one on one, semi-structured
interview session in person. In case, the participant belongs to a different location, the interview
would be conducted via skype.
Data analysis:
As s stated by Crano et al. (2014), the most appropriate analysis method that can be used
to evaluate qualitative data is the thematic analysis. The thematic data analysis is characterized
by investigating, defining and recording themes that are present in the collected data (Crano et
al., 2014). Themes can be defined as patterns present within the data set that are important for the
analysis and description of a phenomenon and at the same time are also related to the research
question. Therefore, the responses of the participants collected would be recorded and then
evaluated using the thematic data analysis method.
Ethical Issues:
While conducting a research, it is extremely important to comply with the specified
ethical considerations (Parahoo, 2014). For this research, prior to conducting the interview, the

12Job Burnout and Turnover in Mental Health Nurses
researcher would brief the participants about the objectives and the significance of the research.
In addition to this, the researcher would also send the participants the letter of consent via email
and only recruit the participants after obtaining a hard copy of the signed letter of consent.
Limitation:
The most obvious limitation of the research study can be identified as the minimal sample
size. The minimal sample size of only 5 participants would not allow the research findings to be
generalized. However, on account of the time constraint and budget constraint, a total of only 5
participants can be considered for the research.
Conclusion:
Therefore, to conclude it can be mentioned that burnout in the nursing profession has
assumed national importance. Studies typically suggest that psychiatric nurses are prone to
experience higher emotional exhaustion than other nurses. In order to evaluate the primary
causes that lead to burnout, a qualitative research study would be conducted. The methodology
used for collecting data would comprise of conducting a semi structured interview. The
participants would be selected randomly on the basis of the response to a blog created online
containing the details of the research. The interested participants would be contacted online and
would be briefed about the research followed by seeking an approval or letter of consent. The
collected data in the form of interview response would then be evaluated in the form of thematic
data analysis.

13Job Burnout and Turnover in Mental Health Nurses
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14Job Burnout and Turnover in Mental Health Nurses
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15Job Burnout and Turnover in Mental Health Nurses
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16Job Burnout and Turnover in Mental Health Nurses
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