Scientific and Mathematical/Analytical Perspectives of Inquiry Paper

EVIDENCE- BASED CARE SHEET

Author Tanja Schub, BS

Cinahl Information Systems, Glendale, CA

Reviewers Darlene Strayer, RN, MBA

Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

April 13, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

Burnout in Oncology Nursing Staff

What We Know › Burnout is usually described as a syndrome characterized by emotional exhaustion,

depersonalization (i.e., a feeling of being disconnected from coworkers), cynicism, reduced perception of personal ability, and reduced personal accomplishment. Burnout is an important health condition that can result from chronic job-related stress (for more information, see Evidence-Based Care Sheet ... Job Stress and Burnout in Nurses ). Healthcare professionals, including nurses, are among the groups that are most at risk for developing burnout(1,2,5,8,9,10,11,12)

• Burnout contributes to physical and psychological illness, which can lead to absenteeism and staff turnover, reduce productivity and efficiency, cause compassion fatigue (i.e., a severe malaise that develops as a result of caring for patients who are in pain or are otherwise suffering and that can lead to chronic fatigue, irritability, dread regarding going to work, aggravation of physical ailments, and lack of joy in life), and compromise patient care. Burnout can lead to nurses leaving the profession(1,5,8,11)

› Nurses who care for patients in certain specialty areas—including oncology—can be more susceptible to stress and burnout than those who work in other specialty areas(4,5,8,9,10,11,13)

• Researchers who conducted a study of 243 oncology/hematology nurses in Australia found that over 70% experienced moderate to high levels of emotional exhaustion and over 48% reported uncertainty regarding whether they would remain in the specialty for the next year(2)

– The Institute of Medicine and the National Cancer Policy Board predict that there will be an imminent crisis related to a shortage of sufficiently trained nurses to deliver the required care to the growing number of patients with cancer in the United States; this highlights the importance of retaining oncology nurses in the workforce(7)

› Factors that may lead to job stress and burnout in oncology nurses include coping with patient death and suffering, managing severe clinical symptoms and complex pathologies in patients who have a poor prognosis, and administering complex and invasive treatment that can diminish patient quality of life. Oncology nurses can feel unable to properly handle events related to death and dying, feel powerless to relieve patient suffering, and experience guilt and anger related to their nursing role(1,5,11,14)

• Additional factors associated with stress and burnout in nurses include role ambiguity, lack of social support, poor staffing and excessive workload, and weekend and evening hours(11,13)

– Authors of a systematic review found that substandard staffing on oncology units was associated with increased job dissatisfaction, stress, and burnout, which contributed to turnover in nursing; nurses who had higher qualifications and a higher position, were working full time, and were working in a non-Magnet hospital were more likely to blame substandard staffing as a primary contributor to job dissatisfaction, stress, and burnout(14)

– Researchers in a study of survey data collected from 4,047 nurses who worked in 282 hospitals in three different states found that compared with medical-surgical nurses, oncology nurses reported less burnout, a more favorable practice environment

(specifically more favorable staffing, adequate resources, and collegial nurse-physician relationships), less job dissatisfaction, and less intent to leave their current position; these results suggest that improving the oncology nursing practice environment may help increase job satisfaction for oncology nurses, reduce stress and burnout, and decrease nurse turnover(13)

• The clinical practice setting for oncology nurses can affect the degree of burnout they experience(5,10)

– Researchers in a study of 92 oncology nurses in Italy reported that nurses working in a hospital oncology unit experience higher levels of burnout than nurses working in hospice(10)

- Most nurses working in a hospital unit experienced moderate to high levels of burnout, and the majority of nurses working in hospice experienced low levels of burnout - Although the authors were not able to identify the causes of this disparity in the level of burnout, they suggested

that the different goals of the two patient care settings—healing in the acute care/hospital setting versus receiving supportive care in the hospice setting—may be an important factor in reducing the nurses’ feelings of personal and professional failure and in diminishing the level of burnout in nurses working in hospice

– In a study of 74 oncology nurses working at a metropolitan oncology center, investigators found that levels of personal accomplishment were higher in nurses working in adult care settings compared with nurses working in pediatric care settings; emotional exhaustion was lowest in younger nurses and highest in nurses working in an outpatient setting(5)

› Self-care strategies that can help nurses cope with the stress of delivering hospice and palliative care include maintaining emotional control, attending continuing education courses, taking regular breaks from work, adjusting the pace of work, maintaining good nutrition,regular sleep schedules and maintaining quality sleep, engaging in regular physical exercise, maintaining stable interpersonal relationships outside of work, practicing meditation, journaling, performing breathing exercises, practicing cognitive reframing (i.e., reappraising a stressful situation in a positive manner), and finding a sense of meaning related to a patient’s death.(6) There is, however, limited published evidence specifically regarding strategies for lessening burnout in oncology nurses(1,3,5,8,9)

• Coping strategies used by oncology nurses to manage the effects of chronic job-related stress and reduce burnout include – incorporating certain self-care practices in daily life, including practices related to spirituality and religious faith, music,

art, and attention to personal health(1,5)

- Researchers in a pilot study of 65 physicians and nurses working in an adult or pediatric oncology unit reported that providing an art therapy intervention resulted in a significant reduction in the level of clinician burnout(8)

– fostering relationships with colleagues(5)

– using onsite professional resources such as employee assistance programs, the chaplain/pastoral care department, or a staff counselor or psychologist(1)

- Employee assistance programs vary by institution in terms of the allowed number of sessions and associated fees; most limit employees to three free sessions per year(1)

– attending educational programs to improve knowledge and skills related to coping, adaptation, and emotional self-care(1,9)

- Researchers reported that attending a communication skills training program for nurses in gynecologic oncology led to a significant decrease in the general level of nurse burnout. The program included a theoretical lesson related to providing care for patients with gynecologic cancer, a short film, role-playing exercises, and discussion of personal experiences(9)

– Maintaining good sleep quality(3)

- Investigators interviewing 94 oncology nurses regarding favored work time, sleep habits and sleep quality found that oncology nurses who sleep consistently at their preferred time and achieve good quality sleep on a regular basis exhibit significantly fewer signs of burnout than those who did not do so and concluded that working at one’s preferred time of day and maintaining good sleep quality contributes to decreased burnout in oncology nurses(3)

What We Can Do › Learn about burnout in oncology nurses so you can accurately assess your personal characteristics and those of other nurses

in order to attain appropriate education to prevent burnout; share this information with your colleagues › Collaborate with other nurses in your work environment to reduce burnout(1)

• Take advantage of services that are available through your employer (e.g. counseling, pastoral care) • Participate in training programs to enhance your skills related to communication, conflict resolution, and self-care

• Provide psychosocial support to your colleagues who may be experiencing stress and burnout; develop and attend a support group for oncology nurses

Note › Recent review of the literature has found no updated research evidence on this topic since previous publication on July 1,

2016

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191.

doi:10.1188/09.CJON.183-191 (R)

2. Barrett, L., & Yates, P. (2002). Oncology/haematology nurses: A study of job satisfaction, burnout, and intention to leave the specialty. Australian Health Review, 25(3), 109-121. (R)

3. Bellicoso, D., Ralph, M. R., & Trudeau, M. E. (2014). Burnout among oncology nurses: Influence of chronotype and sleep quality. Journal of Nursing Education and Practice, 4(8), 80-89. doi:10.5430/jnep.v4n8p80 (R)

4. Braithwaite, M. (2008). Professional growth and development. Nurse burnout and stress in the NICU. Advances in Neonatal Care, 8(6), 343-347. doi:10.1097/01.ANC.0000342767.17606.d1 (RV)

5. Davis, S., Lind, B. K., & Sorensen, C. (2013). A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings. Oncology Nursing Forum, 40(4), E303-E311. doi:10.1188/13.ONF.E303-E311 (R)

6. Henry, B. J. (2014). Nursing burnout interventions: What is being done? Clinical Journal of Oncology Nursing, 18(2), 211-214. doi:10.1188/14.CJON.211-214 (RV)

7. Institute of Medicine (IOM). (2009). Ensuring quality cancer care through the oncology workforce: Sustaining care in the 21st century. Washington, DC: The National Academies Press. (G)

8. Italia, S., Favara-Scacco, C., Di Cataldo, A., & Russo, G. (2008). Evaluation and art therapy treatment of burnout syndrome in oncology units. Psycho-Oncology, 17(7), 676-680. doi:10.1002/pon.1293 (R)

9. Lupo, F. N., Arnaboldi, P., Santoro, L., D'Anna, E., Beltrami, C., Mazzoleni, E. M., ... Didier, F. (2013). The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: An Italian experience. Palliative and Supportive Care, 11(3), 199-203. doi:10.1017/S1478951512000247 (R)

10. Ostacoli, L., Cavallo, M., Zuffranieri, M., Negro, M., Sguazzotti, E., Picci, R. L., ... Furlan, P. M. (2010). Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices. Palliative and Supportive Care, 8(4), 427-432. doi:10.1017/S1478951512000295 (R)

11. Potter, P., Deshields, T., Divanbeigi, J., Berger, J., Cipriano, D., Norris, L., & Olsen, S. (2010). Compassion fatigue and burnout: Prevalence among oncology nurses. Clinical Journal of Oncology Nursing, 14(5), E56-E62. doi:10.1188/10.CJON.E56-E62 (R)

12. Romeo-Ratliff, A. (2014). An investigation into the prevalence of and relationships among compassion fatigue, burnout, compassion satisfaction, and self-transcendence in oncology nurses. Seton Hall University Dissertations and Theses (ETDs), 1939. Retrieved from http://scholarship.shu.edu/dissertations/1939 (U)

13. Shang, J., Friese, C. R., Wu, E., & Aiken, L. H. (2013). Nursing practice environment and outcomes for oncology nursing. Cancer Nursing, 36(3), 206-212. doi:10.1097/ NCC.0b013e31825e4293 (R)

14. Toh, S. G., Ang, E., & Devi, M. K. (2012). Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. International Journal of Evidence-Based Healthcare, 10(2), 126-141. doi:10.1111/j.1744-1609.2012.00271.x (SR)