Provider Burnout, in the Flesh

SEPTEMBER 09, 2015
Megan Weigel, DNP, ARNP-c, MSCN
Then There is the EMR

I come from the earliest part of the electronic generation, having entered nursing in 1998. I adapt easily to electronic changes, but that does not mean that I like them (I still use write in an old-fashioned planner). It does not mean electronic tools support me. Most of us went into nursing and medicine to care for patients.  A large part of care is looking a person in the eye, establishing a connection and rapport, and sharing humanity with patients. The EMR has taken away from this time as we make sure to double cross our T’s and dot our I’s, and code correctly. That connection with patients, if one is not very skilled in communication, becomes a thin tight rope to walk as we peck away at keyboards.
 
And I haven’t even mentioned the shortage of nurses, and of certain physician specialties, adding to increased demands and workloads. 
 
A study published in Archives of Internal Medicine in 2012 (172(18): 1377-1385) by Shanafelt TD et al., based on the Maslach Burnout Inventory, revealed that over 40% of physicians report at least one symptom of burnout, and that having a higher level of education (such as an MD or DO degree) correlated with increased burnout. The American Medical Association has actually created a series of modules to help physicians learn to be resilient, and to prevent burnout, in the face of today’s rapidly changing health care delivery system (see http://www.stepsforward.org). 
 
According to the Erickson & Grove, who published an article on burnout in Nursing World (2007, 13(1)), younger nurses are more likely to experience burnout and less likely to seek out measures of self-care. Burnout is associated with greater negative feelings towards ones job, and a greater likelihood of leaving the profession. According to a 2001 American Nurses Association (ANA) staffing survey, nurses report leaving work feeling “exhausted and discouraged (50%); “discouraged and saddened by what I couldn’t provide for my patients” (44%); “powerless to affect change necessary for safe, quality patient care."  In spite of this, for the 13th year in a row, nurses ranked highest in a 2014 Gallup poll asking Americans to rate the most honest and ethical professions. 
 
Burnout among ARNPs takes on a slightly different form, as we are not necessarily dealing with a nursing shortage, so to speak, but rather a shortage of resources. In busy clinical practice, there may not be a medical assistant, or a clinic nurse, for every provider. ARNPs often take the brunt of the paperwork for disability forms, prior authorizations, and step-edits, not just for their own patient base, but for that of the physicians for whom they work…because, well, they are “the nurse.” Sanjay Gupta, MD, references Linda Aiken, PhD, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Dr. Aiken notes that nurses tend to underestimate the time needed to recover from stressful clinical situations. In the American Nurse Today (2012, 7(4)), Gessler and Ferron also report the electronic medical record and patients who diagnose and treat themselves by Google as additional issues contributing to burnout. 
 


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