Systems Theory in Nursing

The problem of burnout within the nursing progressive care unit (PCU) is one that can be addressed using systems theory. The PCU is a very busy unit and nurses can sometimes feel overworked or burned out as a result of long hours, extended shifts, and other stress factors. As a result, they often feel low job satisfaction, which has been shown to lead to high turnover as well as to low patient satisfaction (Hudgins, 2016). Within a systems theory framework, this problem is situated in the throughput—i.e., the nursing suprasystem (Meyer & O’Brien-Pallas, 2010).
The inputs within this system consist of the materials, people and energies of the unit (Meyer & O’Brien-Pallas, 2010). The materials include schedules that are produced by the unit manager that can impact how many hours nurses are working, the instruments and monitors that are used to evaluate patients, which can cause alarm fatigue and also lead to nurses feeling burned out (Ryherd, Waye & Ljungkvist, 2008; Horkan, 2014). The people include the nurses, their managers, the patients, and the physicians, with whom there can sometimes be a lack of effective communication that adds to nurses’ feelings of poor job satisfaction and contributes to a lack of retention in the unit (Tandon & Kaushik, 2015). The energies include the attitudes and expressions of the nurses and the workplace culture itself, which promotes communication but lacks a proper support system for ensuring that nurses are not overburdened and have an effective means of communicating their needs to other professionals.
The throughput consists of the nursing unit’s organization structure, which does not have a good handle on scheduling in order to keep nurses from getting burned out. Nurses routinely work longer than 8-hour shifts, which can drain them physically and emotionally. The throughput also lacks a mechanism whereby nurses can communicate more effectively with colleagues to ensure that patient care is continuous and that nurses are not stressed by gaps in patient care that they must then address on top of their other concerns.
Output consists of the unit’s service towards the patients, which should be of high level of quality care so that patient satisfaction is high. Patient satisfaction and job satisfaction for nurses go hand in hand, and in when the former is not achieved, the latter is not either, and vice versa. Ensuring that the nurses are having enough rest and support within the workplace can better help to ensure that patients are receiving quality care and that nursing retention is better effected overall.
Cycles of events in the unit refer to the “process of exchanging and transforming energy [which] must renew the system thus creating a repeated series of activities” (Meyer & O’Brien-Pallas, 2010). The cycle of events in this case would be for turnover rates to be reduced and patient satisfaction to be increased through better scheduling of nurses. Shorter hours would or max 8-hour shifts would help. Negative feedback as a “corrective device used to adjust energy intake and expenditure” (Meyer & O’Brien-Pallas, 2010) would include nursing turnover numbers and patient complaints.
The desired outcome for the unit is to alleviate nursing burnout and reduce turnover rates by increasing job satisfaction among nurses and thereby improving patient satisfaction overall. These objectives would facilitate the overall aim of the PCU to be more effective in adhering to the vision of the health care facility. Goals that would help to achieve the desired outcome are: 1) reduce the noise of alarm fatigue, 2) reduce the hours that nurses are expected to work—limiting them to 8 hour shifts, 3) implement a system whereby better communication between personnel is effected to help ensure continuity of care, and 4) promote a more positive and supportive workplace culture where professionals show empathy towards one another and not just towards patients.
Relevant professional standards include: collaboration among health care professionals, communication, and empathy. These standards are expected of health care professionals and should be promoted through proper cultivation of a workplace culture, effective scheduling, and appropriate approaches to collaboration. Continuing education could also help nurses to better understand how their role is important to the facility and thus provide them with the background to be more engaged in maintaining a positive and empathetic workplace culture.
This proposed solution would uphold the organization’s mission and values and improve the culture and climate of the unit by, first, putting the patient at the heart of the problem—because if nurses are burned out or overworked, they will be less likely to show the right kind of care to patients and may even commit more errors. Thus, this approach is aligned with the mission and values of the health care facility, which essentially are to provide patients with quality care. They would also help to improve the culture and climate of the organization by creating a workplace where nurses are more comfortable, less distracted or overworked, and have a systematic method in place to ensure that communication is taking place among care providers so that there are no gaps in patient care and fewer reasons for low job satisfaction to be a real or major issue among the nurses. This in turn would help to cut down on turnover rates and provide the facility with a more stable group of nurses in the PCU who can tend to the needs of the patients.
References
Horkan, A. M. (2014). Alarm fatigue and patient safety. Nephrology Nursing Journal,
47(1): 83-85.
Hudgins, T. A. (2016). Resilience, job satisfaction and anticipated turnover in nurse
leaders. Journal of Nursing Management, 24(1), 62-69.
Meyer, R.M & O’Brien-Pallas, L. (2010). Nursing services delivery theory: an open
system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
Ryherd, E., Waye, K. & Ljungkvist, L. (2008). Characterizing noise and perceived work
environment in a neurological intensive care unit. Journal of the Acoustical Society of America, 123(2), 747-756.
Tandon, R., & Kaushik, P. (2015). Quality of Life and Interpersonal Communication
among Nursing Professionals. International Journal of Nursing Education and Research, 3(3), 325-329.