Nurse Self-Care and Burnout in Australian Healthcare

Introduction

Nurses, as primary caregivers, are at the heart of healthcare provision. However, changing times have affected the nursing profession, creating a situation in which the caregivers themselves require self-care in order to avoid a total collapse. As elsewhere in the world, Australia experiences a growing nursing shortage that results in nurses being overworked. This, coupled with a lack of proper workforce planning, leads to increased work-related stress and high attrition. These pressures in turn affect not only the physical and emotional well-being of nurses but also the quality of care they provide. As the struggle to balance the demand and supply of critical care nurses continues, it is important that nursing professionals are given adequate support mechanisms to help them overcome job-specific stressors. A brief overview of the nurse burnout issue and the need for nurse self-care provides a better insight into the problem.

Overworked Nurses

Nurses' overworking is a real problem, as hospitals are driven by organizational policies of cost-cutting and downsizing. A University of Pennsylvania research project that surveyed nursing issues in the United States, United Kingdom, Australia, and New Zealand concluded that nurse overworking and nurse-to-patient ratios have a significant impact on the quality of care. The study reported that a 10% increase in registered nurses correlated with a 3% decline in mortality. It also found that improving nurse staffing ratios, educational levels, and overall working conditions could save as many as 40,000 American lives every year (Linda H. Aiken).

A 2006 Australian government study reported approximately 452 "high risk events," and an earlier national study had indicated 2,324 adverse medical events, half of which could have been averted by attentive nursing. These reports clearly suggest a link between extended shifts, sleeplessness, and work-related fatigue among Australian nurses, and how these factors can negatively impact healthcare outcomes.

One study by Dorrian et al. (2006) specifically examined the relationship between overtime, unpredictable hours, sleep deprivation, and error occurrence among Australian nurses. For the study, 23 full-time nurses from a metropolitan hospital were asked to record their daily working hours, sleep time, quality of sleep, fatigue levels, and nursing errors over a one-month period. The gathered data showed that nurses reported difficulty remaining awake during 36% of their shifts. Physical and mental exhaustion were reported during at least 40% and 36% of shifts respectively. Over the one-month observation period, more than 20 nursing errors were reported, with 4 errors having severe consequences. It was also found that nurses had problems sleeping during at least 26.8% of the days in the study period, and that around 14 of the 23 nurse subjects were resorting to sleeping aids, including prescription medications and alcohol. Statistical analysis revealed that sleep duration was directly related to error occurrence. Logistic regression analysis further confirmed that sleep duration was a predictor of error occurrence (χ²=6.739, p=0.009, eβ=0.727). This study clearly highlighted that sleep deprivation and work fatigue pose a threat to patient safety and that nurse self-care is warranted (Dorrian et al., 2006).

Conclusion

Nursing shortage is fast becoming an international health issue. In Australia too, the demand for nurses is on the rise, resulting in overworked and overburdened nursing staff and a consequent increase in occupational stress and nurse burnout. Despite growing evidence of the problem, the support services available to nurses remain minimal and are only slowly improving. An organizational climate that encourages participative management, nurse empowerment, and attention to educational and professional development needs is vital to reducing turnover rates among nurses. It is high time that healthcare organizations adopt a new perspective. Nurse self-care — encompassing social support services, regulated working hours, and access to academic programs — is indispensable to preventing environmental stress that could otherwise compromise the quality of healthcare provision.