Burnout equals HAIs and higher costs
Jacqueline Vance, RN
According to a study published in the American Journal of Infection Control nurse burnout and has been linked to higher rates of healthcare associated infections (HAIs).
A team of researchers at the University of Pennsylvania used a survey tool called the Maslach Burnout Inventory to analyse nurse burn out, or what they defined as a “burnout nurse”. (For those of you who were “children of the 80's” the term “burnout” here has a different meaning than it did then. Just an FYI from your Aunt Jackie!) Now, if you ask, me, just look around any hospital or especially any nursing home and you don't need a survey tool to tell you that you're working your average nursing staff to death. But hey, this is research and we have to have a quantitative tool. But the thing is, when you are working “short” you take “shortcuts” or you can't get the work done. It's that simple. These researchers found that hand washing was one shortcut people were taking, (either not washing at all – just using gels, or washing an inadequate amount of time, etc.) Not being careful in handling contaminated objects was another “shortcut” or not following certain isolation precautions, all of which take time.
I find the next part really interesting. The study compared the hospital's percentage of “burnout nurses” to its rates of catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs). The researchers found that every 10 % increase in the number of “burnout nurses” correlated with one additional CAUTI and two additional SSIs per 1,000 patients annually. This actually equates to a lot of money annually. According to the Association for Professionals in Infection Control (APIC), if you look at the per-patient average cost associated with CAUTIs ($749 to $832 each) and SSIs ($11,087 to $29,443 each), the researchers estimated that if nurse burnout rates could be reduced to 10 % from an average of 30 %, (using PA costs) hospitals could prevent an estimated 4,160 infections annually with an associated savings of $41 million.
Of course we don't do surgery in LTC, but we do have many UTIs and other HAIs, especially C-Diff that is on the rise (I believe the PA nursing home data, the only registry of nursing home data available, shows something like an increase of 28% and growing). And I also realize that costs associated with HAIs in LTC are less than in an acute care facility (except for the fact that our patients are frail and have a higher chance of mortality with an infection-but no one actually puts a monetary cost on mortality), but cutting down on staff to save money just isn't a smart thing to do. (Either is burning out your nursing staff!)
With research, one of the things we do is called extrapolation. That is, we take data that is meaningful and see if we can draw conclusions from it for our setting. Nursing facilities are now chronic care hospitals filled with chronically ill frail elders. No arguments. The facts speak for themselves. If you want to extrapolate further, I think this issue goes beyond increasing HAIs and flows into every aspect of patient safety. Typically our licensed nurse to patient ratio isn't all that outstanding. Now, since I don't live under a rock, I know LTC has “reimbursement issues”, but we need to “rob Peter to pay Paul” here. We need more nursing staff to match our patient acuity. Period!
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.