Problem Statement (PICOT)

The current pandemic of coronavirus has posed several unique challenges for nurses the provision of highly individualized care for patients with the virus and adherence to complex measures to mitigate risks of infection spread among patients. Due to these special situations, nurses have been forced to work additional long hours, care for sicker patient populations, and have limited supplies, which could lead to nursing burnout. Nurse burnout was an issue that affected nurses not only before the covid but also a problem of burnout rates are escalating to another level (Ouslander et al., 2020). Although nurse burnout has long been an issue in the United States, the development of COVID-19 in 2020 made it worse. The following is the query that PICOT would try to answer: How can the nurse-to-patient ratio be improved to help nurses experience less burnout during the post-COVID year as opposed to the COVID time outside of the year?

• Population- Nurses
• Intervention- Reducing the ratio of the number of nurses to the number of patients
• Comparison: Before and after COVID
• Outcomes – Decrease nurse turnover
• Time- one year

Part 1: Problem Statement

Need Statement

The rationale behind the necessity for such an endeavor is to address the high rate of burnout that has occurred among nurses due to a large number of patients from the post-Covid period. Thus, it will be possible to select a specific nursing sample to try out the recommended course of action and assess the impact (Muz et al., 2021). Consequently, it will indicate whether or not the suggested intervention enhances the result. Regarding the project’s timetable, it will require a full year. Thus, hospital administration must constantly make sure that nurses don’t burn out. Many research works have been conducted to reveal that burnout is detrimental to the health of nurses.

Mandlut Burnout negatively impacts the lifestyle and performance of the nurses and decreases their organizational commitment and intention towards leaving work.

This is a concern because the quality of care that patients get from nurses can be compromised due to burnout (Duncan et al., 2020). A gender need for minimizing burn work supports the study among the three hospitals for the period between 2018 and 19 identified that 54 percent of the sample nurses with mild burn work. At the same time, it was possible to observe a ten percent increase in emotional fatigue. But cynicism among the nurses rose to 19 percent. This study pointed out that burnout boosted organizational turnover by a margin of 12 percent.

Population and Setting

I will be targeting the nurses of the Minnesota state through this project. During COVID-19, several hospitals in Minnesota went on strike, and the nurses of the Minnesota Nurses Association post-COVID also emphasized the scarcity of resources and the need to reduce the burnout ratio in the post-COVID world (Ouslander et al., 2020). It is worth acknowledging that the rationale of meeting the specific requirement that the nurses have 

has some severe questions. Nurse burnout makes the nurses have anxiety at work, they easily get emotionally and physically tired, they develop sleeping problems, and sometimes get depressed. Other effects of nurse burnout include mental fatigue in which nurses psychologically disengage from their patients (Kim et al., 2021). Nurses who experience Burnout may result in decreased motivation and cognitive capacity resulting in emotional exhaustion, a factor that jeopardizes patients’ safety.

To check the burnout ratio in our study, we shall select participants who are enrolled in the units as nurses who work in the long-term care units. Participants With the help of random snowball sampling and with an equal sample size of 10 nurses each, from every hospital in Minnesota will be selected. The nurses in the long-term care unit tend to attend to patients who are going through critical illnesses, and the length of patients’ stay is approximately 150 days (Bethell et al., 2021). Roles assigned to nurses include; administration of drugs, hygiene, washing, nursing, observing the patient’s health status, meal provisions, offering hospice care, and oxygen administration. I will select this location because a majority of the staff of the long-term care units is made of nurses. 

Intervention overview

As for the second research question, multiple interventions could be applied to reduce the burnout rate among nurses. The measure I would take to the nurses to mitigate burnout is through adjusting the ratio of nurses to patients. ANA standards are 1:2 in critical care and 1:4 or less in an emergency unit (Lasater et al., 2020). In this case, the sample that I am going to select is the nurses and they will be assessed in terms of their performance before and after COVID-19. About their nurse-to-patient ratio, I will try applying 1:2 and see after one year if those interventions have affected their performance in any way or not.

The sample that will be used on the nurses will be randomly selected. The next step will involve selecting the nurses whom I will then brief on the project and seek their permission. After that, I will make periodic checks on the hospital to see whether the nurses are displaying improvement in the various areas of concern (Lasater et al., 2020). My targeted setting areas are the long-term care units of the hospitals, and my intended impact is to enhance patient care throughout their stay. The patient care indicators that I will select for the improvement of the performance are patient medicine administration, environmental cleanliness, physical care, focusing on feeding, providing medical care, monitoring the health status of the patient, nutrition, offering end-of-life care, and giving respiratory care.

My need is to tackle the high burnout rate and the selected intervention is the enhancement of the nurse-to-patient ratio. From various literature, correlations between burnout and nurse-to-patient ratio are apparent. If this is done, then it will lead to increased burnout among the nurses and the general performance of the health sector will be affected.

Comparison of Approaches

An interprofessional counterpart to the nurse-to-patient ratio is the implementation of meditational practices, such as yoga, massage, and mindfulness. These interventions will assist in redirecting the nurses’ attention to their duties as well as enhancing other mental competencies such as stress and anxiety. The alternative intervention needs more practice time but is more suitable for the targeted sample (Lasater et al., 2020). As breathing is not an exercise that needs effort, the targeted nurses can breathe at home or wherever they want. Secondly, this intervention does not presuppose any practice that a given nurse can engage in, at any given time. Reading also affirms meditational practice to reduce burnout.

I will look at one setting in which the targeted intervention is compatible with the alternative intervention (Maniruzzaman et al., 2022). The long-care unit nurses experience work stress always because of workload. The proposed intervention will assist in enhancing their performance by utilizing the following strategies. Thus, meditational practices contribute to decreasing stress and burnout levels in nurses due to the enhancement of people’s focus on the present moments, positive emotions, and thoughts.

Initial Outcome Draft

The expected outcome is to increase the burnout rate of the targeted nurses through the reduction of the nurse-to-patient ratio. It will raise the standard of the treatment given to patients. Further, increasing the nurse-to-patient ratio will help in attending to patient needs and will also enhance the decision-making capacity of the nurses (Jones et al., 2021). Bettering the burnout rates will also lead to the overall enhancement of the services and hospital administration.

A decrease in the rate of burnout in nurses will translate to better stress coping mechanisms and low anxiety levels. By the expected outcome I expect to achieve enhanced mental as well as physical health of the nurses and the continuum of care as they attend to the patients (Zhou et al., 2021). The above-highlighted conceptual framework can, therefore, be implemented to enhance the delivery of quality healthcare services in healthcare facilities. Patient safety depends on organizational and individual factors that rely on physical and human resources. These elements include the physical features of an organization and people’s relationships, which are also involved in the burnout process.

Time Estimate

For the concept development of the intervention, the approximate time frame I am putting in is 2 months. This time frame is realistic, during these two months I will analyze the need for improvement in burnout rate and do the literature review to see if the situation is as severe or as a hypothesis (Maniruzzaman et al., 2022). The activity that brought the greatest threat to this time frame would be the search for the sources of data on the level of burnout prevalence and its effects on nurses and patients. This is approximately one year in terms of a rough estimate for the implementation. Within this period I will analyze the difference between what is considered burnout in the pre-and post-covid phase in the identified target population (nurses). This time frame is doable because all the activities that I have can be accommodated in this time frame. 

After one month, I will visit the hospitals within Minnesota and get to the administrative offices where I shall find data of the nurses working in the long-term care units. Then in the next two months, I will do sampling and picking of nurses (Maniruzzaman et al., 2022). For the fourth month, I plan to begin evaluating the indicators that I chose earlier as key indicators of performance, for the ensuing six months, I shall sum up all the data of the nurses in Excel sheets to see the outcome of the year. The potential challenge that will affect my implementation may be the lack of motivation among the nurses, government policies, and more so absence of qualified nurses.

Part 2: Literature Review

The study shows that a higher level of burnout is inversely related to patient safety management. Therefore, the study proposes the implementation of compassion methods in an attempt to lower the burnout rate among nurses. The intervention proposed in the study is enhancing the nursing work environment and remuneration in an emergency context such as the COVID-19 pandemic. It also propounds the need for extensive research to identify other causes of burnout and its related consequences.

In a related study, they found that professionals such as nurses, who constantly face distress and pressures of heavy workloads experience burnout and stress  (Jones et al., 2021). They add more weight to their claim by stating the impact of burnout on the psychological and physiological well-being of the nurses. The approach that they propose to address this issue is MBSR: mindfulness-based stress reduction programs. The research findings suggest that mindfulness meditation may help reduce stress and burnout in nurses by reducing self-criticism. The study is underpinned by other literature related to the subject.

In this case, another piece of evidence that supports the need to enhance the nurse-to-patient burnout rate is Reith’s Burnout in US healthcare professionals. The proposed reason for the problem is the high ratio of nurses to patients (Sun et al., 2022). He backs his claims by saying that burnout is non-beneficial to patients and may soon further extend the patient-nurse gap.

As per an assessment was out by the American Nurses Foundation, it showed that 34 percent of their employees are not emotionally healthy. A staggering 41% of the nurses said that they have suffered trauma from COVID-19 cases. It also goes on to reveal that half of the nurses have thought of leaving their current positions (Jones et al., 2021). Moreover, a study was carried out on 18,935 nurses throughout the toughest times of COVID-19 and it revealed that 31% of nurses faced emotional exhaustion. The following primary risk factors for burnout among nurses were: younger years, low level of social support, low preparedness from family and colleagues regarding the COVID-19 outbreak, higher perceived risk of COVID-19, lengthier workdays in quarantine areas, high-risk job duties, and hospital employment. One of the surveys discussed looks into the level of burnout and resilience of frontline nurses in the emergency department in North India (Zhou et al., 2021). A random procedure was used to choose the 120 nurses who work in the emergency department for the research sample. The Connor-Davidson Resilience Scale and the Maslach Burnout Inventory-General Survey were used to gather data. The study also noted that the nurses displayed moderate to severe levels of burnout leading to emotional exhaustion and depersonalization.

Healthcare Policy that Impacts the Approach to Address an Identified Need

The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act was proposed to Congress in 2019. The bill aims to expand section 1115A of the Public Health Service Act to prescribe the appropriate nursing staffing benchmarks in hospitals and health facilities. The main purpose of the bill was to differentiate the ratio of the nurse to the patient between the several health units. The ratios suggested by the bill were 1:4 for the medical/surgical unit, 1:3 for the emergency unit, and 1:1 for the intensive care unit (Kaszuba et al., 2023). This policy directly indicates an enhancement of RN burnout by proposing standard ratios within the various care units. It talks about the availability of other treatments for the enhancement of performance in the healthcare sector. Studies were carried out in Queensland; Australia to establish a minimum number of nurse-to-patient ratios in some of its health facilities.

Another policy is the Affordable Care Act which deals with the high burnout rate among nurses. ACA states that when millions of individuals attain health insurance status, there will be increased patient traffic, exacerbating status. This implies that the current shortage of nurses is expected to rise to over 1 million (Lee et al., 2023). Due to these factors, nurses are admitting and attending to more patients per shift and spending more time with each. The Affordable Care Act has contributed towards increased emergency department visits which in turn will increase the nurse-patient ratio. ACA has reduced the problem by making a new outpatient care unit where people who do not suffer from acute diseases will go, and the hospital, where people with acute diseases will be admitted as inpatients. This is a welcome concept of the ACA; it will attempt to lower the nurse-patient ratio by outsourcing outpatients from the hospital.

References

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