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https://infirmiere-canadienne.com/blogs/ic-contenu/2020/12/07/pleine-conscience-sabrer-les-couts-en-reduisant-le

Dec 07, 2020, By: Justin Burkett

Mindful nurses translate to mindful patient care

Issue

The phenomenon of burnout, a condition that results from prolonged physical, mental and emotional stress (University of Texas at Arlington Online, 2016) is on an alarming rise in Canada; a recent Canadian Federation of Nurses Unions report revealed that 29.3 per cent of nurses show clinical symptoms of burnout (Stelnicki, Carleton, & Reichert, 2020). This is leading to increased rates of turnover, absenteeism and illness, and decreased quality of patient care (Price, 2015) — all costing health-care organizations millions of dollars per year.

According to the 2020 NSI National Health Care Retention & RN Staffing Report, the average cost of turnover for a bedside RN ranges from US$33,700 to US$56,000 (NSI Nursing Solutions, 2020). Due to high attrition rates, especially among new graduates, hospitals can each stand to lose US$3.6 million to US$6.1 million annually; “[e]ach percent change in RN turnover will cost/save the average hospital an additional [US]$306,400/yr” (p.1).

One in five nurses working in Canadian hospitals leaves their job each year at an average cost to the institution of C$25,000 per nurse (Canadian Nurses Association, n.d.; Rondeau & Wagar, 2016). According to a 2014 review of nurse turnover across four countries, this figure is US$6,091 more per nurse than in the U.S., a difference largely due to decreased productivity and the use of temporary replacements (Duffield et al., 2014). Sadly, the primary causes for burnout and attrition are the working conditions nurses find themselves in, and these do not appear to be changing any time soon.

An article by Manzano-Garcia and Ayala (2017) revealed that the working conditions of nurses have not changed much, with work overload, excessively long working days, conflict, lack of autonomy and connection to their work topping the list of frustrations. Eventually, under these stressful conditions, a substantial percentage of nurses become burned out, leading to physical and mental illnesses that drive up costs and push new nurses to look for greener, calmer pastures.

Until now, health-care organizations have focused on top-down approaches to employee well-being, investing enormous resources on respect in the workplace and mental health awareness campaigns directed toward improving work-life balance among their staff. Unfortunately, there has been little evidence that these measures have been effective in curbing burnout.

Mindfulness is a skill that can be developed through exercises like meditation.

What is mindfulness?

Mindfulness in the workplace has been gaining widespread acceptance among large corporations such as Apple, Nike and Google, not only for its benefits in reducing burnout and increasing job satisfaction, but also for its effects on the bottom line (Levin, 2017). Mindfulness is defined by Jon Kabat-Zinn, an American medical education teacher and founder of the well-known mindfulness-based stress reduction (MBSR) program, “as awareness that arises through paying attention, on purpose, in the present moment, nonjudgmentally” (Jon Kabat-Zinn, 2017). Mindfulness is a skill that can be developed through exercises like meditation. It has been proven to be effective (Burton et al., 2016) and can be facilitated and sustained in organizations at minimal cost. Not an extrinsic solution, mindfulness has been scientifically shown to alter brain regions that regulate stress, altering the experience of it to a more manageable state (Arunas, 2015).

In essence, the nurse would prepare for stress like he or she would for any other element of the job, such as therapeutic communication, psychomotor skills, emergency preparedness and digital health. The status quo, by contrast, is to react to the event; we generally help nurses process experiences that have already passed. Mindfulness training could enable the nurse to engage with those experiences in a more purposeful, non-reactionary way.

It is important to note, however, that “it’s not enough to simply offer one-off courses in mindfulness. It needs to go deeper and become part of the business’s DNA” (Matthews, 2017). Burnout pillages too many financial and human resources and must be reined in to prevent further undue costs to the health-care system. A cultural shift toward mindfulness in the workplace is a sustainable, cost-effective way that can achieve immediate and long-lasting human-centred and financial results.

Impact

Mindfulness in the workplace saves money

“Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to [US]$68 million” (Cimiotti, Aiken, Sloane, & Wu, 2012).

Mindfulness, no longer viewed as a mystical eastern philosophy, has been shown in many rigorous scientific studies to be effective in reducing symptoms of physical, mental and emotional stress that lead to low productivity, burnout and illness. In one example, the health-care insurance company Aetna estimated that since instituting its mindfulness program, it has saved about US$2,000 per employee in health-care costs and gained about US$3,000 per employee in productivity (Levin, 2017; Pinsker, 2015).

Employees who incorporate work-site mindfulness use fewer resources on therapy, book less time off and take fewer leaves of absence and medications to treat acute and chronic illnesses tied to personal well-being (Klatt, Sieck, Gascon, Malarkey, & Huerta, 2016). In the hospital and health-care industry, copious reports have revealed the colossal costs incurred by medication errors and oversights in patient care. These unnecessary events translate to poor health outcomes, increasing the economic burdens and moral despair experienced by nurses who are too burned out to perform their jobs to the level of excellence to which they were trained.

Instituting mindfulness in the workplace has the potential to affect all areas the nurse works in simultaneously in a preventive way. By reducing stress and increasing attentiveness, the nurse has the potential to participate completely in the patient care experience, reducing errors and improving the health-care provider’s relationship with the patient and the family.

Mindfulness in the workplace reduces burnout

In a recent study by De Keyrel (2017), 98 per cent of hospital nurses reported their work as mentally and physically demanding. Sixty-three per cent noted that their work has resulted in burnout. Forty-one per cent have considered changing hospitals in the past year due to burnout. Another study by Albendín et al. (2016) showed a burnout prevalence rate of 32.2 per cent in nurses working in emergency services in 13 countries, including the United States, the United Kingdom and Spain. Although these rates seem high, the reality is that nursing is not simple work and in many cases is unavoidably stressful.

A cultural shift toward mindfulness in the workplace is a sustainable, cost-effective way that can achieve immediate and long-lasting human-centred and financial results.

Workplace violence is one of the predominant catalysts driving burnout in Canada. It is a multifaceted problem facing nurses everywhere in this country. Many of the patient characteristics that lead to aggression towards hospital staff are well known, like acute psychiatric disorders, disease-related deliriums, and alcohol and drug intoxication. What may not be as commonly discussed are “patient care and situational events — indicating that patients became violent as a reaction to staff actions or behaviour. … [T]hese incidents suggest the need for increased awareness and sustained vigilance among staff working in close proximity with cognitively impaired patients” (Arnetz et al., 2014, p. 344). Developing the practitioner’s inherent abilities of situational awareness, with mindfulness training, could provide greater skills in stress reactivity, potentially reducing violent incidents and subsequent burnouts.

Mindfulness in the workplace reduces attrition

In a 2010 pan‐Canadian study, increased workloads leading to conflict and burnout were identified as central impacts and determinants of nurse turnover (O’Brien-Pallas et al., 2010). Early-career nurses, those with the highest attrition rates, are looking for supportive work environments that assist them in adjusting to these increased workloads and job demands while maintaining a focus on high-quality patient care (Price, 2015). Retaining and attracting the knowledge workers of the future will require a sustained and innovative approach that looks to balance these competing desires.

Highly researched evidence-based programs, such as Kabat-Zinn’s MBSR program, have proven that ongoing mindfulness practices in the workplace are able to provide nurses with the mental resiliency and emotional capacity to manage deepening care complexities and ever-changing population health needs.

Stress is an expensive threat to the balance sheet. Mindfulness is an antidote to stress (Goodman, 2015).

Implications

The implications for health-care agencies adopting a policy for mindfulness in the workplace are profound. As Canada’s demand for nursing outpaces supply (Stonebridge & Hermus, 2017), health-care organizations will be forced to hire short-term agency nurses at premium rates and revolving entry-level practitioners with high onboarding costs for relief of a burned-out workforce. Evidence clearly shows that even three minutes a day of mindfulness meditation practice can change brain structure, effectively decreasing stress and boosting resiliency (Davidson, 2019). Practitioners of mindfulness report that these skills add increased emotional capacity and cognition, which are translated into more empathy for their patients, improved interpersonal relationships, better sleep and a deeper sense of purpose. Health-care organizations that embed mindfulness practices in their workplace cultures may not only positively affect their budgets, but may also attract and retain a new generation of nurses who are committed and mentally prepared to address tomorrow’s challenges.

Recommendations

Provide mindfulness opportunities

On a recent post-intervention questionnaire, 84.9 per cent of nurses said they used a mindfulness exercise at work, with 57.1 per cent finding it effective in reducing stress. At the conclusion of the study, 57.6 per cent of nurses said they were interested in learning more about mindfulness (Montanari, Bowe, Chesak, & Cutshall, 2019). In another example, night shift nurses were led through a five-minute meditation three times a week at midnight (Resnicoff and Julliard, 2018). Initially, nurses were unsure of what benefits the activity may bring, with one discounting the practice outright. But after eight months, all participants stated that they wanted it to continue. One nurse said, “It would be beneficial for everyone to have those moments to simply breathe — it will be a mental reboot to help get through a stressful shift. It will help us to give the best possible care to our patients” (Resnicoff and Julliard, 2018).

Leverage technology

By capitalizing on the availability and use of mobile technology, health-care organizations can provide employees with the tools and support to begin their mindfulness training in a personalized way. With innovations such as the Healthy Minds Program app (Healthy Minds Innovations, 2020), individuals can practise the skill of mindfulness and organizations can analyze the data and report on use and well-being.

Create a supportive environment

Mindfulness in the workplace is a culture shift, and it will take nurse leaders to model behaviours, such as practising mindfulness, that reduce burnout, (Masterson, 2017). Health-care organizations in Canada are beholden to their stakeholders to provide them with the best valued health-care services in a supportive and psychologically safe work environment. Instituting mindfulness in the workplace will improve not only the economic outlook of health care in Canada but also the human factor, creating a more resilient, empathetic and energetic nursing workforce for the future.

“It would be beneficial for everyone to have those moments to simply breathe — it will be a mental reboot to help get through a stressful shift.”

References

Albendín, L., Gómez, J. L., Cañadas-de la Fuente, G. A., Cañadas, G. R., San Luis, C., & Aguayo, R. (2016). Prevalencia bayesiana y niveles de burnout en enfermería de urgencias. Una revisión sistemática. [Bayesian prevalence and burnout levels in emergency nurses. A systematic review.] Revista Latinoamericana de Psicología, 48(2), 137-145. doi:10.1016/j.rlp.2015.05.004

Arnetz, J.E., Hamblin, L., Essenmacher, L., Upfal, M.J., Anger, J., & Luborsky, M. (2014). Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. JAN, 71(2), 338-348. https://doi-org.ezproxy.lib.ucalgary.ca/10.1111/jan.12494

Arunas, A. (2015). Mindfulness in the workplace: Benefits and strategies to integrate mindfulness-based programs in the workplace. OOHNA Journal, 34(2), 39-43.

Burton, A., Burgess, C., Dean, S., Koutsopoulou, G.Z., & Hugh-Jones, S. (2016). How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress and Health, 33(1), 3-12. Retrieved from https://doi-org.ezproxy.lib.ucalgary.ca/10.1002/smi.2673

Canadian Nurses Association. (n.d.). Costs and implications of nurse turnover in Canadian hospitals. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/roi_nurse_turnover_2009_e.pdf

Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486-490. doi:10.1016/j.ajic.2012.02.029

Davidson, R. J. (2019, October). How mindfulness changes the emotional life of our brains [Video]. Retrieved from https://www.ted.com/talks/

De Keyrel, A. (2017, April 13). Is nurse burnout on the rise? Startling statistics on nurse well-being. Retrieved from https://www.mededwebs.com/blog/well-being-index/is-nurse-burnout-on-the-rise-startling-statistics-on-nurse-well-being

Duffield, C.M., Roche, M.A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 79(12), 2703-2712. Retrieved from https://doi-org.ezproxy.lib.ucalgary.ca/10.1111/jan.12483

Goodman, P. S. (2015, April 1). Why companies are turning to meditation and yoga to boost the bottom line. Retrieved from https://www.huffingtonpost.ca/entry/mindfulness-capitalism_n_3572952?ri18n=true

Healthy Minds Innovations. (2020). Healthy Minds Program App [Mobile application software]. Retrieved from https://tryhealthyminds.org/#workplace

Kabat-Zinn, J. Defining mindfulness. (2017, January 11). Retrieved from https://www.mindful.org/jon-kabat-zinn-defining-mindfulness/

Klatt, M. D., Sieck, C., Gascon, G., Malarkey, W., & Huerta, T. (2016). A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention. Complementary Therapies in Medicine, 27, 139-144. doi:10.1016/j.ctim.2016.05.008

Levin, M. (2017, June 12). Why Google, Nike, and Apple love mindfulness training, and how you can easily love it too. Retrieved from https://www.inc.com/marissa-levin/why-google-nike-and-apple-love-mindfulness-training-and-how-you-can-easily-love-.html

Manzano-Garcia, G., & Ayala, J.-C. (2017). Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study. PLoS One, 12(4), e0175352. doi:10.1371/journal.pone.0175352

Masterson, L. (2017, May 12). Nurses are burnt out. Here’s how hospitals can help. Retrieved from https://www.healthcaredive.com/news/nurses-are-burnt-out-heres-how-hospitals-can-help/442640/

Matthews, K. (2017, April 25). The problem with mindfulness that companies aren’t addressing. Retrieved fromhttps://www.inc.com/kayla-matthews/were-totally-screwing-up-mindfulness-at-work.html

Montanari, K. M., Bowe, C. L., Chesak, S. S., & Cutshall, S. M. (2019). Mindfulness: Assessing the feasibility of a pilot intervention to reduce stress and burnout. Journal of Holistic Nursing, 37(2), 175-188. doi: 10.1177/0898010118793465

NSI Nursing Solutions. (2020). 2020 national healthcare retention & RN staffing report. Retrieved from https://www.nsinursingsolutions.com/

O’Brien-Pallas, L., Murphy, G. T., Shamian, J., Li, X., & Hayes, L. J. (2010). Impact and determinants of nurse turnover: A pan‐Canadian study. Journal of Nursing Management 18(8), 1073-1086. doi:10.1111/j.1365-2834.2010.01167.x

Pinsker, J. (2015. March 10). Corporations’ newest productivity hack: Meditation. Retrieved from https://www.theatlantic.com/business/archive/2015/03/corporations-newest-productivity-hack-meditation/387286/

Price, S. (2015). Bridging the generational divide. Ottawa: Canadian Federation of Nurses Unions. Retrieved from https://nursesunions.ca/wp-content/uploads/2017/05/Bridging-the-Generational-Divide-Jan-2016-FINAL.pdf

Resnicoff, M., & Julliard, K. (2018). Brief mindfulness meditation with night nursing unit staff: A qualitative study. Holistic Nursing Practice, 32(6), 307-315. doi:10.1097/HNP.0000000000000293

Rondeau, K. V., & Wagar, T. H. (2016). Human resource management practices and nursing turnover. Journal of Nursing Education and Practice, 6(10), 101-109. doi:10.5430/jnep.v6n10p101

Stelnicki, A. M., Carleton, N., & Reichert, C. (2020). Mental disorder symptoms among nurses in Canada. Ottawa: Canadian Federation of Nurses Unions. Retrieved from https://nursesunions.ca/wp-content/uploads/2020/06/OSI-REPORT_final.pdf

Stonebridge, C., & Hermus, G. (2017). Future care for Canadian seniors: A primer on nursing supply and demand. Conference Board of Canada. https://www.conferenceboard.ca/temp/2467de40-c126-460c-a5e6-29029c448968/8679_Seniors_Care_Nursing_Supply_and_Demand_EN_BR.pdf

University of Texas at Arlington Online. (2016, November 22). The cost of nurse burnout. Retrieved from https://academicpartnerships.uta.edu/articles/healthcare/the-cost-of-nurse-burnout.aspx

Justin Burkett is a graduate student and instructor at the University of Calgary with a decade of rich experience in health care and education. A strong believer in the power of meditation in mitigating the effects of stress and enhancing one’s own inherent mental abilities, Justin aims to bring this knowledge and skill to bear by empowering others to engage more completely in their experience. Celebrated by peers for his creativity and visionary outlook, Justin uses his platform and passion for health leadership to advance progressive solutions to ongoing systemic problems. Justin currently resides in Calgary, Alta., where he enjoys spending time with his dog, running, and exploring the picturesque trails along the Bow River.