Nursing professionals face multiple stressful situations daily that substantially affect their physical and mental health. This paper aims to investigate the issue of fatigue and stress in nursing based on a peer-reviewed literature review. The significance of this study is determined by the fact that stress and fatigue experienced by nurses are frequently underrated. At the same time, they may lead to highly negative consequences in any medical setting and impact not only health care providers but patients and their family members as well. That is why it is essential to identify the issue of stress, burnout, and fatigue of nurses at work, factors that contribute to their development, and potential ways of their minimization.
Nurses’ Stress and Fatigue in the Workplace
In general, nurses’ workplace environment that presupposes a dynamic workload and long working hours is strongly associated with stress and fatigue. In their article, Khanade et al. (2018) investigated how stress and fatigue influence nurses in hospitals, especially in intensive care units, and how modern technologies may help health care providers to cope with stress and prevent burnout. According to the authors, stress and fatigue in nursing reduce workers’ efficiency and contribute to serious medical errors. The Institute of Medicine (IOM) reports that in the United States, “100,000 deaths are caused by preventable medical errors,” and almost 2 errors per patient are reported daily (Khanade et al., 2018, p. 29). In addition, based on multiple surveys conducted in various medical settings all over the world, it is possible to conclude that more than half of all nurses experience considerably high levels of stress at work (Khanade et al., 2018). At the same time, their wellbeing is frequently not prioritized and even neglected.
Stress and fatigue in nursing are not expressed only as a physical or emotional reaction to a challenging situation in the workplace. For health care providers, interaction with patients can be already regarded as a source of these phenomena. In her research, Peters (2018) analyzed the concept of compassion fatigue that occurs “when nurses develop declining empathetic ability from repeated exposure to others’ suffering” (p. 466). The significance of this analysis is determined by the fact that all health care practitioners are vulnerable to compassion fatigue while compassionate care may be defined as a basis of nursing practice. At the same time, fatigue can corrupt the perception and expression of empathy and cause the erosion of a health care provider’s body, mind, and spirit (Peters, 2018). As a result, without recovery, nurses are forced to leave the profession contributing to increasing shortages of health care workers.
Originated as compassion discomfort and progressed to stress, fatigue culminated in a set of emotional and physical symptoms. They do not include conditions only like emotional burnout, anxiety, depression, headaches, or insomnia. Compassion fatigue may lead to alcohol or substance abuse, weight fluctuations, and holistic health decline (Peters, 2018). In general, a nurse feels disconnected from patients and does not have any desire and strength for support and care. There are several reasons for compassion fatigue to be defined as an occupational hazard, and nurses are at risk simply being in this profession (Peters, 2018). These health care professionals differ from others due to their constant proximity to people’s tragedy, and fatigue along with stress is a natural result, especially when a source of distress cannot be removed. Compassion fatigue is a threatening condition that may put at risk not only a nurse’s health but a patient’s wellbeing as well. From an ethical perspective, it causes the transformation of clinical values. Thus, a nurse with fatigue traditionally experiences insufficient performance and may display a lack of attention and poor judgment that increase the risk of medical errors.
Compassion fatigue attracts the attention of multiple researchers who want to understand this phenomenon to develop an efficient response for minimization. Through the meta-analysis of extracted data, Zhang et al. (2018) conducted research dedicated to the interrelatedness of compassion fatigue and burnout and factors that contribute to the development of compassion fatigue. As nurses provide healing, support, and encouragement for individuals who face emotional, spiritual, and physical anguish, their continuous self-giving may lead to the development of both physical or emotional burnout and compassion fatigue that are closely interconnected. In general, compassion fatigue is defined as “the progressive and cumulative outcome of prolonged, continuous, and intense contact with patients, self-utilization, and exposure to multidimensional stress leading to a compassion discomfort that exceeds nurse’s endurance levels” (Zhang et al., 2018, p. 1). It traditionally causes negative attitudes toward nursing practice, powerlessness, feelings of frustration, and the absence of a wish to achieve work goals – in other words, burnout.
At the same time, compassion fatigue may be caused not only by workload and the peculiarities of the occupation. A particular type of personality characterized by the tendency toward social inhibition and negative affect is significantly associated with burnout and fatigue (Zhang et al., 2018). In other words, due to individual characteristics, some people are more vulnerable to stress and fatigue in comparison with others. In addition, multitasking and frequent logistics and managerial tasks along with patient care duties cause compassion fatigue. Moreover, even such factors as age, marital status, ethnicity, and education are important for the possibility of stress management along with professional factors, including patient care time, hours per shift, and work settings (Zhang et al., 2018). At the same time, positive emotions, job satisfaction, professionalism, friendly relationships with co-workers, and social support minimize the risk of stress and fatigue for nurses.
Stress and fatigue are associated not only with workload and compassionate care but with changes as well.
According to Brown et al. (2017), hospitals “constantly engage in change to become more competitive and cost-effective, and actions taken to achieve these types of goals can exert a tremendous impact on employees” (p. 306). At the same time, the impact of frequent changes on nurses’ well-being has always been largely overlooked. However, the goal of medical settings to stay competitive leads to health care providers’ inability to get used to constantly changing environments and regulations. As a result, their perceptions of stress, job-related disability, and time away from work increase, while reduced organizational commitment and loss of productivity may be observed (Brown et al., 2017). Thus, non-stop organizational changes may lead to so-called change fatigue characterized by nurses’ stress, burnout, and exhaustion due to constant introduction to new rules in the workplace.
Change fatigue substantively differs from change resistance – while change resistance presupposes an active expression of disagreement, change fatigue is associated with apathy and the absence of interest in work and corporate goal achievement. In addition to personal negative consequences on mental and physical health, organizational changes increase nurses’ turnover and contribute to the general shortage of health care providers. As a result, due to turnover costs, the quality of health care delivery and patient safety may be negatively affected.
Factors to Consider and Potential Solutions
Occupation-related stress and fatigue may significantly impact not only nurses’ physical and mental health but work performance too. As nurses face stressful situations daily, factors that may prevent and reduce the emotional breakdown of health care providers attract particular attention. Thus, Mar Molero Jurado et al. (2019) conducted research using developed predictive models, a study sample of more than 1700 nurses, and multiple scales to evaluate the relationships of emotional intelligence and self-efficacy with perceived stress in medical practice.
According to the results of this study, emotional intelligence defined as a person’s ability to understand, feel, and manage his and others’ emotions and act based on them plays a highly important role in perceiving and responding to stress. Thus, in nursing professionals, it is related to well-being and job satisfaction protects from burnout, and predicts job commitment, competence, and efficient problem-solving (Mar Molero Jurado et al., 2019). Nurses with emotional intelligence can indicate negative emotions and minimize their intensity and impact – thus, stressful situations are managed most appropriately. Therefore, emotionally intelligent health care providers are frequently more attentive and cope with their work better. In the same way, general self-efficacy or an individual’s perception of competence in stressful situations protects from emotional and physical burnout. The research’s authors emphasized the significance of the development of emotionally intelligent and stress management practices within the nursing framework.
As previously mentioned, modern technologies are investigated from the perspective of the minimization of stress and fatigue in nursing. According to Khanade et al. (2018), “in recent years, advancements in mobile technology have made wearable tools such as smartwatches easily accessible and widely used” (p. 30). The authors suggest that these devices may be helpful for health care providers with their daily work activities if electronic medication administration and health records are included. Moreover, according to recent research, nurses and patients in multiple clinical settings respond favorably to sensor technologies and see them as an easy and useful way to monitor health conditions, especially in critical care areas (Khanade et al., 2018). Thus, wrist-wearable devices are becoming popular among health care providers due to the ability of permanent control and accuracy. In addition, these devices help nurses perform more efficiently and, as a result, minimize the risk of stress and fatigue at work.
Based on a literature review dedicated to stress and fatigue in nursing, it is possible to conclude that this issue requires particular attention. Emotional and physical burnout of nurses leads to serious health problems, including sleep disturbances, depression, and alcohol or substance abuse. At the same time, medical facilities are also affected by nurses’ fatigue and stress as they lead to apathy, poor performance, the loss of work value, medical errors, turnover, and shortages of health care providers. At the same time, all factors that increase stress or contribute to its minimization should be examined to define the best approaches how to protect nurses from stress and fatigue.
Brown, R., Wey, H., & Foland, K. (2018). The relationship among change fatigue, resilience, and job satisfaction of hospital staff nurses. Journal of Nursing Scholarship, 50(3), 306-313. Web.
Khanade, K., Sasangohar, F., Sadeghi, M., Sutherland, S., & Alexander, K. (2018). Deriving information requirements for a smart nursing system for intensive care units. Critical Care Nursing Quarterly, 41(1), 29-37. Web.
Mar Molero Jurado, M., Carmen Pérez-Fuentes, M., Ruiz, N. F. O., Mar Simón Márquez, M., & Linares, J. J. G. (2019). Self-efficacy and emotional intelligence as predictors of perceived stress in nursing professionals. Medicina, 55(6), 237. Web.
Peters, E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing Forum, 53(4), 466-480. Web.
Zhang, Y. Y., Zhang, C., Han, X. R., Li, W., & Wang, Y. L. (2018). Determinants of compassion satisfaction, compassion fatigue and burn out in nursing: A correlative meta-analysis. Medicine, 97(26), 1-7. Web.