Strategies to Overcome Nurse Fatigue and Stress Due to Long Working Hours

This scoping project proposal aims to suggest strategies and tools that can be implemented to help nurses overcome or prevent stress and fatigue at work due to their long working hours. The proposal includes a consultation program with occupational health advisors, sleep therapists, psychologists, and lifestyle consultants. Data collection will involve stress assessment tools, sleepiness scales, and patient satisfaction surveys. The inter-professional team involvement will be analysed through effective communication strategies.

Running head: SCOPING RESEARCH PROPOSAL
How can we help the nurses to overcome or prevent fatigue and stress at work due to their long
working hours
Name of the Student
Name of the University
Author Note

1SCOPING RESEARCH PROPOSAL
Introduction
Work time longer than 12 hours are quite common and popular among nurses working in
hospitals and directly affects the care that they deliver to the patients and the wellbeing of the
nursing professionals as well. The actual length of working shifts are most often unpredictable
due to the fluctuations in the needs and health demands of the patients and the unanticipated
charges of staffing. This subsequently results in working unplanned for overtime, beyond the
actual scheduled time of the nursing staff (Van Bogaert et al. 2013). Under circumstances when
the long working shifts are most often combined with overtime, and shifts that rotate between
night and day, the nursing staff show an increased likelihood of suffering from burnout and
fatigue that compromises the patient care.
Despite presence of certain regulations on the cumulative working time, and shift length
for the resident doctors, there are no appropriate policies on nursing work hours. In the words of
Caruso (2014) stress in workplace has been identified as a major risk factor that threatens the
health and safety of all employees. Owing to the constantly changing environment of the
healthcare sector, the working conditions are gradually becoming increasingly stressful and
demanding, thus increasing the work hours for the nursing staff and deteriorating their quality of
life and job satisfaction. This scoping project proposal will aim to suggest strategies and tools
that can be implemented to help the nurses overcome or prevent stress and fatigue at work, due
to their long working hours. This scoping project will act as the primary outline for the change
that is intended to be proposed in healthcare departments to reduce the workload, fatigue and
burnout among nurses, with the aim of lowering rates of clinical error. The scoping paper will

2SCOPING RESEARCH PROPOSAL
recognise the scope related to future work practice needed to help the nurses to overcome or
prevent fatigue and stress at work due to their long working hours.
Process and diagnostic tools for consultation
The proposal intends to conduct a consultation program over a period of one month,
where the nurses will be made to attend one hourly session with various stakeholders on alternate
days of a week. The consultation procedure will be observed from the perspective of both the
client and the consultant. Considering the different challenges that are associated with the
healthcare sector, nursing staff must be provided an opportunity to solve their problems that lead
to stress and fatigue due to workload and longer shift timings, and accomplish their goals. An
occupational health advisor will be involved in the program. Phillips et al. (2015) states that
occupational health advisors act as leaders of the public healthcare in workplaces and hold
specialization in caring and enhancing the wellbeing of all employees at work. Consultation with
such an advisor will enable the nursing staff to assess their needs and issues, with the aim of
promoting good health and reducing burnout. The nursing staff will be given the opportunity to
directly contact the advisors and approach them will stress related questions. This consultation
will have the direct benefit of assisting the nurses to identify and prevent their work-related
stress, assess their stress conditions, risk assessment, and understand the coping strategies.
Job stress most often creates hazardous impacts on the health of the nurses, besides
interfering with their capabilities to cope with the job demands (Faragher, Cass and Cooper
2013). Hence, the occupational health advisor will suggest different strategies that will help
nurses reduce their stress levels and burnout, thereby lessening the chances of medication errors

3SCOPING RESEARCH PROPOSAL
that occur thereafter. During the hour long session that nurses will be taught about various
relaxation techniques that they should adhere to, in order to remain at work, while reducing
stress levels. Sonnentag et al. (2016) took into consideration the fact that stress leads to a
disruption of sleep, among the affected people, consultation with a sleep specialist will also be
crucial. Sound sleep plays a crucial role in optimal health and wellbeing of individuals.
Difficulty in sleeping due to stress often reduces the overall health related quality of life.
Consultation with a psychologist will take place in the form of counseling session where
the nurses will be subjected to cognitive behavioural therapy (CBT) and acceptance and
commitment therapy (ACT) for relieving them of the stress symptoms that are a direct
manifestation of workload (Hayes et al. 2013). Physician support groups are responsible for
managing stress and averting burnout among professionals. During the program, physician will
create an environment that allows the nurses to share confidential information related to their
thoughts and concerns on clinical errors, effect of long working hours, and personal matter. The
physician will be responsible for fostering a trustworthy relationship with the nurses, thus
helping them cope with their stress.
A lifestyle consultant has the role of promoting drive and guidance to their clients for
enhancing their career, lives and relationship. The consultant will analyse the personal
environment and lifestyle of the nurses, assess their personal space, and formulate solutions
towards accomplishing different goals. Consultation with nursing supervisors will help in proper
assigning and scheduling of the nursing staff in an appropriate manner, in order to reduce their
work pressure and lessen working time to eight hours.

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Data collection
Following implementation of slow breathing, muscle relaxation techniques, and
counseling by the advisors, the nurses will be provided with the self-administered Ardell
Wellness Stress Test, a stress assessment tool that adopts a holistic approach towards stress
management. Making the nurses provide responses to the set of 25 questions that focus on
mental, physical, emotional, social, and spiritual aspects of health will help in determining the
efficacy of consultation with occupational health advisor for stress reduction (Agaoglu and Esen
2014). The Epworth Sleepiness Scale (ESS) tool will be used for assessing the impact of long
shift hours and workload on the daytime functioning of the nurses (Wright and Lack 2014). The
sleep therapist will provide assistance to complete the questionnaire that will measure the
daytime sleepiness of the nurses, which might lead to medication errors. Providing answers to
questions that focus on the likelihood of dozing off under certain situations. Upon obtaining
scores that establish a relation between stresses and sleep disorder, pharmacotherapy and/or
behavioural therapies will be implemented.
Progress of the patients following implementation of cognitive behavioural therapy
(CBT) and acceptance and commitment therapy (ACT) will be assessed with the use of the self-
administered psychological instrument, the Perceived Stress Scale, comprising of 10 questions.
This psychological instrument is most commonly used for determining the degree to which a
person perceives certain situations as stressful (Warttig et al. 2013). A patient satisfaction survey
tool will help in measuring quality improvement. According to Thayaparan and Mahdi (2013)
the Patient Satisfaction Questionnaire Short-Form (PSQ-18) will be used for the same where the
18 items will determine the general satisfaction, technical quality, interpersonal manner,
communication, time spent with doctors, financial aspects, and accessibility and convenience.

5SCOPING RESEARCH PROPOSAL
The incidence of adverse health incidents due to clinical errors will be measured by assessing the
database and clinical records of the hospital. This will help in the establishment of an association
between medical negligence and the number of clinical errors.
The McCloskey/Mueller Satisfaction Scale will help in reporting the nurse job
satisfaction, thereby providing an insight into the intention of nurses to stay employed in the
hospitals (Gurková et al. 2013). This will be followed by face-to-face interviews. Staff
productivity will be analysed via a 360-degree feedback method that will use comments from all
nursing staff and their co-workers, based on their interaction with each other (Bracken and
Church 2013). Employee retention rate will be calculated by dividing the number of nurses who
left during a certain time frame, by the total employees present at the end of the time period
(Bode, Singh and Rogan 2015). The aforementioned stress assessment scores will prove
beneficial in gathering information about the number of nurses who are affected due to burnout
syndrome. Accuracy of care and nursing competencies and qualification will be better measured
via the conduction of face-to-face interviews of the nursing staff and the hospital administrators
who monitor the former’s actions.
Analysis of the inter-professional team involvement and perspectives and how they will
impact on project plan
Inter-professional care is an essential part if the healthcare service delivery system. It
assists in achieving improved care and optimal output via working together through sharing of
the skills. Successful delivery of the inter-professional care depends on the overall contribution
of the inter-professional team members based on their respective skills and competencies (Kaini
2015). The members of the inter-professional team for this project plan include healthcare

6SCOPING RESEARCH PROPOSAL
professionals from different healthcare domains like psychologist, physicians, sleep therapist and
lifestyle therapist. The inter-professional team involvement will be done through proper
engagement. Engagement is an interactive approach where two parties engage in exchange of
dialogue with answers leading towards more questions and the final output is development of
understanding between the interactive parties. The process of engagement among the healthcare
professionals can be done through interactive communication process. According to Reeves et al.
(2013), active communication among the members of the multidisciplinary healthcare
professional team helps increase the overall team collaboration. Increase in the team
collaboration will help to promote better stress related outcome among the nursing professionals.
The main communication strategies that can be used among the healthcare professionals of a
multidisciplinary team in order to improve their overall involvement in the project plan include
SBAR approach. SBAR is a situational briefing guide that is used for standardised
communication format. SBAR is an acronym where S stands for Situation (what is going on with
the patient or the selected focus group), B stands for Background (the clinical background of the
patient), A stands for Assessment (proper assessment of the problem) and R stands for
recommendation (what needs to be done for the patients) (Whittingham and Oldroyd 2014).
Using SBAR approach will help the healthcare professionals: psychologists, physicians, sleep
therapist and lifestyle therapists to indulge in active decision making planning based on the needs
of the nursing professionals in order to cope up with their escalating workplace stress and job
burnout.
Among the inter-professional team, the role of the psychologist is effective counselling.
According to Conley, Travers and Bryant (2013), counselling helps in effective stress
management. It is the role of a psychologist to generate a sense of trust with his or her client and

7SCOPING RESEARCH PROPOSAL
thereby helping to look over different approaches of their life through different perspective. The
development of trust helps in the generation of therapeutic relation this in turn will help to
promote person-centred care plan for effective management of stress. The mental aspect of a
patient influences the physical health parameter. The main physical complication arising from
stress includes headache, constipation, nausea pain in joint and muscles. So it will be the role of
the physicians to take into consideration the physical health complications of the nursing
professionals arising out of stress (Toussaint et al., 2016). Nakamura (2017), highlighted that
increase level of stress leads to the development of insomnia due to disturbance in sleep. The
hamper in the sleep quality further affects the mental and the physical health status of the nursing
professionals and thereby increasing their level of job burnout and stress. It will be the role of the
sleep therapist to provide effective interventions in sleep management and this can be done under
active collaboration with psychologist and physicians. Lifestyle change also plays an important
role in modulating the level of stress. The change in the lifestyle through the modulation of the
diet plan under the active collaboration and engagement with the healthcare physicians will help
to promote better health-related outcome (Riekert et al. 2013). Thus effective engagement of the
inter-disciplinary team will help to reduce the level of stress among the nursing professionals
through comprehensive approach.
Reflection on inter-professional and multidisciplinary communication strategies
In order to promote active collaboration among the inter-professional team in by project,
I will employ multidisciplinary communication strategy. Multidisciplinary communication
strategy will help to increase the level of involvement and engagement among the healthcare
professionals and this will help to promote overall outcome of the project plan. The main
communication strategy that I will use in order to increase effective collaboration and

8SCOPING RESEARCH PROPOSAL
engagement among the multidisciplinary team members is verbal communication. According to
Keyton et al. (2013), verbal communication strategy can be broken down into two categories
written and oral communication. Write communication mainly includes e-mail, text and chats.
Oral communication strategy includes phone calls, video calls and face-to-face conversation. In
my project planning, I will emphasise over face-to-face mode of communication. Przybylski and
Weinstein (2013) highlighted that face-to-face communication helps in effective exchange of
thoughts through direct speech and eye contact along with exchange of ideas among the
interacting groups therefore helping to increase the overall engagement and better understanding
of the process. Mavridis (2015) stated that communication strategies also include non-verbal
mode of communication. Non-verbal mode of communication is mainly guided by the body
language, facial expression, and tone of voice. However, non-verbal mode of communication is
not effective in exchange of ideas however; the use of proper non-verbal mode of
communication among the healthcare professionals of the multidisciplinary team will help to
promote the effective and trustworthy relationship with the inter-disciplinary team. The
development of trustworthy relationship will help to increase the effective exchange of ideas and
information and thus facilitating collaboration among the team members.
In order to influence effective collaboration and engagement among the inter-professional
team, I will follow an amalgamation of the both verbal and non-verbal communication strategies.
According to Rowlands and Callen (2013), establishment of effective communication among the
healthcare professionals of a multidisciplinary team members helps in proper exchange of the
patient information (nursing professionals who are suffering from stress). The qualitative study
conducted by Rowlands and Callen (2013) through semi-structured interview face-to-face
communication among the healthcare professionals might not be feasible under all

9SCOPING RESEARCH PROPOSAL
circumstances. The reason highlighted against this is, the healthcare professionals like the
psychologist, occupational therapists and the physicians remain busy with the packed schedule
and hence it is not feasible from their end to take part in face-to-face communication. Such
initiatives are required to be taken in order to facilitate written communication through mails and
chats. However, though emails and chats will be allowed as a medium of communication among
the inter-professional team members, I will mainly highlight over the face-to-face
communication in order to increase the level of trust and understanding among the members of
the multidisciplinary team. Proper engagement among the team members will help to facilitate
development of effective strategies and tools for evaluating the level of stress among the nursing
professionals in the clinical ward.
Conclusion
Thus from the above discussion, it can be concluded that the main diagnostic tools that
can be used for the process of consultation in the project planning for reducing the level of stress
among the nursing professionals include Epworth Sleepiness Scale, Ardell Wellness stress test
and Perceived stress scale. The collection of the data from the perspective of the nursing
professionals who are suffering from stress include McCloskey/Mueller Satisfaction Scale. This
is a self-assessment scale. Multidisciplinary team members will be asked to use 360 degree
feedback method in order to evaluate the level of staff productivity. The level of patient
satisfaction will be measured through PSQ-18 survey. The paper also highlighted that effective
collaboration among the healthcare professionals of a multidisciplinary team will help to
improve the overall health-outcome of the stress-level among the nursing professionals. In order
to increase the level of engagement and collaboration among the multidisciplinary team,
amalgamation of the verbal and non-vernal mode of communication will be used.

10SCOPING RESEARCH PROPOSAL

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