Stress and Role Strain among Care Providers

Care Giver Role Strain and Nurse Burnout

Serole et al. (2021) found that dimensions of burnout were characterized by those surveyed as overinvestment, emotional exhaustion, and depersonalization; they also found that stress at work was highly predictive of burnout among nurses. Their study consisted of a self-reported survey questionnaire among 1774 workers in the health care industry at a university hospital. The findings of their study support the argument among other researchers that burnout is factor affected by stress in the workplace. Zhou et al. (2020), for instance, conducted a systematic review of trainees in the health care industry showing that stress and burnout were intricately linked in cases of health care trainees that burn out too soon. In their study, Zhou et al. (2020) argue that organizational interventions should be conducted to limit the risk of workplace stress so as to lower the incidence of burnout among new hires.

Bagheri et al. (2019) showed that stress-coping exercises and cognitive behavioral therapy interventions can help reduce nurse burnout. Their study consisted of a semi-experimental method with a sample of 60 nurses using a pre-test and post-test design. Nurses were assigned to a control and intervention group randomly, and the results indicated that the intervention group saw less burnout than the control group. Thus, Bagheri et al. (2019) provide support for the argument that nurses should have counseling services available to them so as to be able to cope with on the job stress and the other factors that contribute to burnout.

Care giver role strain is related to burnout in the sense that it appears to arise from apprehension about taking care of the care receiver or seeing the care receiver’s health decline (Vechia et al., 2019). Role strain occurs when a role player cannot meet the demands of the role—and for care givers this is a problem because it affects those who are on the receiving end of care. For nurses with burnout, role strain occurs as it does for any other care giver: it prevents the care provider from providing quality care to the patient (Schlak et al., 2021). Norful et al. (2018) argue that in some situations, co-management of care environments can alleviate care strain. However, not every environment is suited to the model proposed by Norful et al. (2018).

Moreover, burnout can affect the organization and lead to higher rates of turnover, which is costly for any health care organization as it means more capital and time must be spent on finding new hires, training and onboarding them, and so on (Kelly et al., 2021). Thus, it is in the best interest of any health care organization to find ways to alleviate or address the problem of burnout and role strain among care providers (Norful et al., 2018). The only problem is how to do that effectively.

That is where the intervention study of Baghieri et al. (2019) can provide some insight: it suggests that counseling services should be provided to care providers or coping strategies and cognitive behavioral therapies offered so that nurses are not overwhelmed by the stress, patients, and demands that they face day to day in the workplace. Environmental factors can add up, and they can include anything from alarm fatigue to exhaustion due to hours worked per day. They can include apprehensions and anxiety about particular patients as well (Vechia et al., 2019). Stress, burnout, job dissatisfaction, role strain, and intention to stay leave can all be signs of an unhealthy workplace culture or environment, mismanagement, or improper training, support services, or education. There is no clear one-size-fits-all framework that can be applied to this situation, primarily because every nurse or care giver is a unique individual with unique needs and concerns (Vechia et al., 2019).

To address the issue of role strain and nurse burnout, Norful et al. (2018) recommend applying a co-management model in which decisions about patients and interventions, management and support, can be made by more than one party. This approach, in theory, helps to lift the strain that a single decision maker may face when acting on his or her own. At the same time, it leaves unexplored any scenario in which it is not possible to have a co-management model. That is why Schlak et al. (2021) offer their argument in their study to leverage the work environment for the purpose of minimizing the negative impact of burnout. Schlak et al. (2021) focus not on preventing burnout from occurring in the first place but rather on preventing the effects of burnout from impacting the patient. Their approach, in other words, is one in which burnout and role strain are accepted as inevitable facts; the key is to keep this negative occurrence from harming the patient or reducing the quality of care the patient receives in that environment.

Schlak et al. (2021) note that a good work environment can make all the difference between a health care facility where nurse burnout negatively impacts patient care and a facility where there is no effect of burnout on patient mortality, rescue, or length of stay. The researchers explored this idea by conducting a cross sectional study of nurses and hospitals and patient claims data. They employed multivariate logistic regression analysis to examine the relationships between variables. Not surprisingly, the data showed correlations between high patient mortality, longer periods of stay, and failure to rescue and nurse burnout. To foster a better work environment, the researchers suggested that facilities utilize the Magnet recognition program in order to provide support for nurses dealing with burnout (Schlak et al., 2021). Admittedly, one of the limitations of the study is its use of cross-sectional data, which restricts its ability to identify causal relationships. Therefore, one must remember that correlation does not mean causation. However, the literature indicates that interventions should be considered as important in this issue. Identifying the right intervention will likely be an issue that must be addressed on a facility by facility basis, as some differences will be found, some models might work better than others depending on the organization and staff, and some might have a more supportive culture than others.

The main take away from the literature on this issue is that burnout and role strain are real issues that care givers and nurses face—but there are ways of coping with these problems and of helping care givers and nurses overcome them (Baghieri et al., 2019; Norful et al., 2018; Schlak et al., 2021). Whether the intervention can be as simple as teaching nurses and care givers to implement stress coping strategies or requires more hands-on cognitive behavioral therapy, or whether support must be institutional and organizational is another matter that cannot be easily answered. The literature on the best approach for addressing the issue of burnout is wide and the systematic reviews discussed here show only that stress is a leading factor in burnout and role strain (Zhou et al., 2020). The factors that are associated with this stress can include over-work, job dissatisfaction, exhaustion, work or family-related pressure, or any other extenuating circumstances. If not addressed role strain and burnout can negatively impact both the patient and the organization (Kelly et al., 2021).