Megan Brooks

November 04, 2015

LAKE BUENA VISTA, Florida ― Nursing staff on an inpatient child and adolescent psychiatric unit in Michigan hope to build resiliency and reduce burnout among coworkers through positive psychology and character strength exercises, and the effort has been well received.

"I was seeing some symptoms of burnout in some of my coworkers," Paul J. Edick, BSN, RN, from the University of Michigan, Ann Arbor, who works on the unit, told Medscape Medical News. "I'm interested in staff burnout, turnover, and resiliency, so I thought to look at this further and also to try positive psychology techniques on the unit."

Edick presented his research at the American Psychiatric Nurses Association (APNA) 29th Annual Conference, where his poster tied for second place in the "Practice" award category.

For 8 weeks, staff on the unit voluntarily participated in 15-minute positive psychology and character strength exercises, which were offered on all shifts. In addition, a bulletin board highlighting character strength virtues was kept in the staff room and was changed weekly to highlight a different positive message.

Of 36 eligible staff, 30 participated (22 women) in at least one of the interventions offered. On average, participants were aged 42 years and had nearly 13 years' experience. The sample included 21 RNs and 9 psychiatric care workers.

Spike in Unit Acuity

Pre- and postintervention responses on the Maslach Burnout Inventory and the Connor Davidson Resilience Scale did not show any clearcut beneficial changes, but Edick said it is important to note that the sample was "too small to show statistical significance" and to say that the intervention did or did not have an impact. Importantly, he said, "the staff really enjoyed learning about positive psychology."

Another major issue is that at the start of the interventions, the unit acuity spiked ― on every shift, there occurred several episodes of patients acting out. This made it hard for staff to actively engage in interventions. The interventions were suspended during 1 week because staff could not safely participate, owing to the needs of the patients and families on the unit, Edick explains in his poster. "Postintervention data were likely impacted by staff's response to the complex and high acuity milieu that lasted through the 8 weeks," he notes.

Burnout is an ongoing concern for mental health professionals, and younger nurses are particularly vulnerable. Hallmarks of burnout are loss of interest and enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a diminished sense of personal accomplishment (career dissatisfaction). It affects not only the individual but also patients and institutions.

Prior research has shown that positive psychology exercises can lead to enhanced subjective and psychological well-being and less stress and depressive symptoms in populations other than psychiatric nurses, Edick noted.

His pilot data also suggest that older RNs experience more resiliency and less burnout than younger RNs. "Naturally, older RNs have more protective factors," he noted.

"We do have some concerning burnout in our younger staff," Edick told Medscape Medical News, "and we are looking at how we can continue to offer these types of interventions so that we can help staff at risk for burnout. We are planning to do some follow-up and look at how to target the different age groups that have more concerning scores, with the ultimate goal of reducing burnout," Edick said.

Help Available

Reached for comment, Mary Jo Assi, RN, NEA-BC, FNP-BC, director of nursing practice and work environment for the American Nurses Association (ANA), told Medscape Medical News, "Nurses are on the front lines of the healthcare system. When nurses are burned out, stressed out, and exhausted, patient care suffers. Nurses have less time to coordinate care, and there's a higher likelihood for medical errors and injuries. Burnout is not just a problem for nurses; it puts patients' health and safety at risk."

She noted that the ANA Code of Ethics for Nurses speaks to this issue.

"While a nurse's primary commitment is to the patient, the nurse owes the same duties to self as to others, including the responsibility to promote health and safety through self-care. An unsafe and unhealthy work environment is a significant contributing factor to nurse burnout," Assi said.

The ANA has developed a "body of work to support and promote a healthy work environment for nurses," Assi added. These include the Registered Nurse Safe Staffing Act and the ANA Principles for nurse staffing. "Appropriate nurse staffing protects patients by reducing medical errors, length of hospital stays, and costly readmissions," Assi told Medscape Medical News.

Other factors that contribute to nurse burnout are work-related stress and fatigue as well as incivility and bullying in the workplace. The ANA recently released position statements to address these issues of importance to nurses: Incivility, Bullying, and Workplace Violence, and Addressing Nurse Fatigue to Promote Safety and Health.

Additional resources that focus on a healthy work environment are available at www.nursingworld.org.

The study had no commercial funding. The authors and Mary Jo Assi report no relevant financial relationships.

American Psychiatric Nurses Association (APNA) 29th Annual Conference. Poster 72. Presented October 29, 2015.

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