Nursing concepts and practice

¶ … Nursing burnout

Although both methodologies of quantitative and qualitative studies are present in the fields of medicine and nursing, the two approaches are occasionally pitted against one another. Quantitative studies are data-driven and numerical. They usually make use of an experimental or quasi-experimental study design and include both a control and an experimental group in terms of how they are structured. Qualitative studies, in contrast, usually are focused on small populations. Unlike quantitative studies which make use of the deductive method (generalized principles based upon a larger population which can then be applied to individual cases) qualitative studies make use of the inductive method, using a small population to create a theory which may then be generalized to others (or not, given that some qualitative studies are so focused on tiny subpopulations they may only have relevance to a very narrow subgroup). "Whereas quantitative research counts occurrences (eg, estimates prevalence, frequency, magnitude, incidence), qualitative research describes the complexity, breadth, or range of occurrences or phenomena" (Curry, Nembhard, & Bradley 2009). Versus the statistical testing used in quantitative research designed to test a hypothesis, qualitative research seeks to generate a hypothesis. Instead of "standardized processes and instruments with predetermined response categories" qualitative research deploys "open-ended discussions and observations" (Curry, Nembhard, Bradley 2009).

Although the value of qualitative research is sometimes disputed in medicine, a research study such as MacKusick & Minick, (2009) entitled "Why are nurses leaving?: Findings from an initial qualitative study on nursing attrition" is useful to conduct preliminary research upon a complex phenomenon with causes that are as not yet completely understood. The qualitative study consisted of semistructured interviews of ten nurses who had left or were leaving the profession. After a literature review of the various theories as to why nurses leave spanning from burnout to poor preparation which the researchers judged to be inadequate given the lack of input from nurses who had left themselves, "a phenomenological research design was used to provide an in-depth understanding of nurses' decisions to leave clinical practice" (MacKusick & Minick 2009: 336). Recruitment was conducted using "currently practicing RNs at various hospitals in the southeastern United States [who] were contacted by the primary investigator and asked if they knew nurses no longer in clinical practice" (MacKusick & Minick 2009: 336). A list of the ten common questions asked by the former nurses is provided by the researchers but interviewers were permitted to go 'off script' to elicit more full and more emotionally truthful replies, consistent with the phenomenological approach of the study. The study sought to gain a sense of all components of various aspects of a particular phenomenon in a fairly non-directive manner. Common themes which emerged were unfriendly workplaces with hostile coworkers; emotional distress related to the demands of providing care to patients; and fatigue and exhaustion due to long shifts.

The most obvious and acknowledged limitation of the study was its extremely small sample size of ten although it did encompass a diverse range of genders and levels of experience. Findings were presented in a narrative format. However, the feedback from these nurses willing to share their grievances could be useful in guiding future questions in a larger qualitative or quantitative study. The most illuminating implication of the study was the degree to which a hostile workplace contributed to negative feelings about nurses and how fellow nurses or indifferent administrative staff made the nurses believe that to continue was untenable.

Quantitative analysis, however, has also been conducted on the phenomenon of nursing attrition. A recent quantitative study by Deary, Watson, & Hogston (2003) with a longitudinal design to measure reasons for professional attrition drew upon a population of a complete cohort of nursing students in Scotland. A battery of instruments "to measure personality, intelligence, psychological morbidity, stress, coping and burnout" was used to amass data and "data were gathered on entry, at 12 and 24 months, and at the end of the nursing programme" (Deary, Watson, & Hogston 2003:71). Although the initial literature review conducted by the study designers found a common association drawn between high stress levels and high levels of nursing attrition, the actual quantitative data instead suggested that personality factors, including emotional resiliency were more important. This indicated that "stress, burnout and attrition may not be directly linked. Personality factors at course entry contributed significantly to the prediction of burnout and programme completion, but the relationships were not strong enough to be practically useful" (Deary, Watson, & Hogston 2003: 71). The psychological tests included the Alice Heim 4 test; the NEO-Five Factor Inventory; General Health Questionnaire-28 of psychological distress, and a burnout inventory ((Deary, Watson, & Hogston 2003: 74). Mental ability was less of a factor in preventing attrition than were traits such as conscientiousness and agreeableness (Deary, Watson, & Hogston 2003: 78-79).