The Issue of Healthcare Burnout: Research Critiques and PICOT Question

Nursing Practice Problem and PICOT Question

The issue of healthcare burnout remains highly relevant, especially at times of the severe strain on facilities due to the COVID-19 pandemic. While caring for patients is rewarding, the intensity of the workload that professionals can endure causes stress and, subsequently, burnout, which causes increased personnel turnover in healthcare sector. When nurses get extremely burnout, their performance suffers, with a higher likelihood of treatment mistakes occurring, including medication errors. Moreover, burnout also has a detrimental influence on the emotional well-being of professionals who start considering leaving their positions to find less stressful jobs. Thus, the PICO question is the following: how the implementation of burnout management strategies within healthcare organizations would impact turnover rates compared to the already existing retention tools?

Research Background

In their study, Liu et al. (2021) explored the ways in which the quality of care can be strengthened without undermining nurse job outcomes through creating safer healthcare systems. Specifically, the researchers had the objective to compare shifts in the care quality, nurse job outcomes, environments, non-professional tasks, and nursing tasks left unfinished. In their study, Zaheer et al. (2021) researched how organizational context impacts nurses’ perceptions of patient safety in connection to other factors. Specifically, the aim was to examine the influence of senior leaders on patient safety, teamwork effectiveness, and intentions of turnover.

In their research, Adams et al. (2019) aimed to identify the correlation between evidence-based strategies aimed at burnout management of nurses in emergency settings and professionals’ levels of performance. It was essential to determine how the burnout of staff can be significantly reduced in order to prevent the high rates of professionals’ turnover associated with increased stress and dissatisfaction with practice. With the help of the Cultural Change Toolkit, it could be possible to improve communication between nurses and their leaders to facilitate problem-solving. The aim of the research by Al Maqbali (2015) was to study the factors that predict the higher likelihood of nurses to get burnt out in their positions and leave them. There may be several factors ranging from personal issues to organizational problems, which, in combination, can reduce nurses’ satisfaction and cause them to quit.

How Research Articles Support the Nurse Practice Issue

The four articles help support the nurse practice issue as they provide various perspectives on the problem. While there are research articles that focus on the organizational factors that make nurses get burnt out and consider leaving their profession, others are focused on the nature of relationships within settings and their impact on the satisfaction and productivity of nurses. The current practice issue deals with the need to establish specific mechanisms for improving the environmental conditions that will help nurses become more satisfied and engaged in their profession. Therefore, it is essential to have knowledge of the various strategies that have already been studied to formulate recommendations for appropriate interventions. If there are studies that offer considerations of the modifiable factors that should be considered when developing effective interventions targeting nurses’ burnout, they will be used as both practical and theoretical frameworks for the practice issue.

Methods of Study

The methodology employed by Liu et al. (2021) was a quantitative longitudinal design to compare the changes in care quality as related to factors affecting nurses’ workloads. The method is beneficial for determining the patterns of variables over time as compared to the cross-sectional design that does not have such a capacity. Zaheer et al. (2021) implemented mixed-methods research and collected cross-sectional data from surveys relating to nurses and non-physician providers. The method’s main advantage is the possibility of reaping the benefits of both quantitative and qualitative data to provide comprehensive findings related to the search question.

In Adams et al. (2019), the researchers implemented a qualitative study intended to find a relationship between the levels of nurses’ burnout and the evidence-based tools and interventions aimed at addressing them. The research method is advantageous because it allows looking at the perspectives and experiences of nurses, providing a comprehensive analysis of the phenomenon of burnout. The design of Al Maqbali (2015) was also qualitative, representing a review of the available literature on the factors contributing to nurses’ satisfaction with their jobs. However, as compared to the methodology of Adams et al. (2019), the literature review design is limited to the evidence that is already available, without the possibility to involve participants.

Results of Study

The overall conclusion that all four studies made pertains to the fact that the environments in which nurses work significantly affect their performance, satisfaction, and, subsequently, turnover. Specifically, Zaheer et al. (2021) found a significant interactive effect of teamwork at healthcare facilities and nurses’ turnover intentions. Liu et al. (2020) also support these findings by showing that healthcare facilities require improved processes and environments for health care provision and its improved quality. Thus, when nurses work in overall positive environments, they are less likely to complain about being dissatisfied or get burnt out. In contrast, nurses who get overloaded with multiple assignments that are not associated with patient care are more likely to feel dissatisfied with their work positions and roles. Adams et al. (2019) found that with the implementation of the Cultural Change Toolkit at a healthcare facility contributed to the reduction of the expected turnover rates, the scores of burnout among nursing staff. These findings are supported by Al Maqbali (2015), who underlined the importance of various factors preventing nurses from being satisfied with their positions.

The implications of the four studies suggest that healthcare facilities should be highly attentive to the needs and expectations of nurses to ensure that they show the highest levels of performance when caring for patients. For the current practice problem, the studies offer an insight as to which factors nurses see as valuable to fostering positive environments. Importantly, changes in workflow that make the work easier and more productive, especially when it comes to non-nursing tasks and scheduling. Besides, the indicator of nursing care left unfinished is important to consider when it comes to burnout because too many tasks assigned to nurses is an improper practice that contributes to dissatisfaction, burnout, and retention.

Ethical Considerations

The two ethical considerations involved in conducting research on nurses’ burnout include anonymity and informed consent. Providing research anonymity entails either not collecting any identifying information from participants or not linking the identities of subjects to their individual responses. The aim of informed consent is to make sure that human participants involved in research possess complete information on what it entails to be involved in the study. By collecting informed consent, researchers are confident that their participants agree for their data to be collected and later analyzed.

For instance, both Adams et al. (2019) Al Maqbali et al. (2015) preserved the anonymity of subjects by not mentioning their names as referring to participants by numbers. By preserving anonymity, it was possible to mention such personal qualities as age, ethnicity, and education. In their research, Liu et al. (2020) obtained informed consent from subjects participating in the longitudinal study to make sure that they were aware of the implications of being involved. Both anonymity and informed consent were addressed by Zaheer et al. (2021) in the quantitative section of their study dealing with participants.

Outcomes Comparison

The main anticipated outcome of the PICO question is that burnout management strategies implemented at a healthcare organization would have a positive impact on turnover rates and help lower them. The burnout management strategies will represent consistent efforts to establish positive environments in which nurses will work. Whether it is an improvement in the relationships between nurses and their leaders or the reduction in non-nursing-related tasks, it will become possible to improve nursing care settings. If there are high levels of nurses’ turnover at a facility, it means that the leadership has been implementing ineffective burnout prevention practices and has been generally inattentive.

The outcomes of the four articles tend to align with the expected outcomes of the PICO question, as all of them point to the importance of establishing positive environments at nursing facilities to ensure that professionals do not get exhausted and burn out (Liu et al., 2020; Zaheer et al., 2021). In the environment of the COVID-19 pandemic, which continuously challenges the sphere of health care, it is imperative that nurses stay motivated and engaged in their work and receive support from their leaders.

Proposed Evidence-Based Practice Change

The research articles, the PICO question, and the nursing practice problem are all connected by the idea that the effectiveness of nursing practice depends on the nature of environments and the ways in which leadership tends to the needs of its employees. Specifically, it is imperative to implement strategies that facilitate shared decision-making and teamwork at facilities to ensure that nurses engage in their practice and are not preoccupied with unnecessary work. The issue of burnout in nursing has been viewed from different angles, but there is inconsistency in the way in which healthcare facilities have implemented prevention strategies. Therefore, it is important to draw from the findings of available research to implement targeted and effective tools.

Based on the information gathered from the studies, an evidence-based practice change can be recommended. Specifically, a burnout prevention strategy will entail the elimination of tasks that are not related to nursing, the establishment of shared decision-making and teamwork practices. In addition, the strategy should include the increased collaboration between nurses and their leaders to improve relationships and facilitate the improvement in the quality of care. Continuous collaboration and engagement can help nurses, and their leaders are on the same page in terms of health care provision, thus contributing to improved health outcomes of their patients. In a highly collaborative environment, more time and effort will be spent on problem-solving, which is essential for boosting care quality. Thus, while helping reduce the levels of nurses’ dissatisfaction with their work, the strategy will help improve the quality of health care.


Adams, A., Hollingsworth, A., & Osman, A. (2019). The implementation of a cultural change toolkit to reduce nursing burnout and mitigate nurse turnover in the emergency department. Journal of Emergency Nursing, 45(4), 452-456. Web.

Al Maqbali, M. A. (2015). Factors that influence nurses’ job satisfaction: A literature review. Nursing Management: Art & Science, 22(2), 30-37. Web.

Liu, X., Liu, J., Baggs, K., Wang, J. G., Zheng, J., & You, L. (2021). Association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care: A panel study. International Journal of Nursing Studies, 115. Web.

Zaheer, S., Ginsburg, L., Wong, H. J., Bain, L., & Wulffhart, Z. (2021). Acute care nurses perceptions of leadership, teamwork, turnover intention and patient safety-a mixed methods study. BMC Nursing, 20(1), 1-14. Web.

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