Burnout Syndrome in Different Nursing Specialties

Occupations that involve personal interactions offer a sense of satisfaction and fulfillment to some people. However, excess contact with other humans in the line of duty may have adverse effects on an individual’s mental and physical well-being, which manifests as burnout. Burnout syndrome can be described as a longstanding state of mental, physical, and emotional stress that occurs due to constant pressure that is linked to extreme personal involvement for protracted periods. Common indications of burnout syndrome include emotional fatigue, pessimistic attitudes, rebellion against work-related activities, and diminished work performance.

Negative outlooks and affections towards coworkers and their professional achievement may also develop. Burnout syndrome is observed in professionals from different areas. However, the prevalence of this condition is high in service and care personnel, particularly in the healthcare arena (Eelen et al., 2014). Nurses are susceptible to work-related stress because of work overcharge. Nurses undergoing burnout may display emotional exhaustion and feel worn-out, overworked, and sluggish. Nurses work closely with patients of varying socioeconomic standing. These patients have diverse levels of suffering and expectations of the healthcare system. As a result, nurses are likely to go through recurrent stressful labor situations. Burnout syndrome in nursing is associated with adverse health outcomes and increased healthcare costs (Harkin & Melby, 2014).

The purpose of this proposal is to identify the prevalence of burnout syndrome in various nursing specialties and establish the risk of developing the condition in distinct areas of nursing. This paper also compares the incidence of burnout syndrome in various nursing specialties and includes a description of the significance of the practice problem, PICOT question, theoretical framework, and synthesis of the literature. Thereafter, descriptions of the practice recommendations, project, evaluation outcomes, and implications for nursing practice are provided.

Significance of the Practice Problem

Nurses in most hospitals are subjected to increased workloads because of a national shortage of nursing staff, which is allegedly caused by nurses exiting the profession due to experiencing burnout (Harkin & Melby, 2014). A high nurse workload, which may be defined as a ratio of one nurse to eight or more patients, is linked to burnout syndrome (Pradas-Hernández, et al., 2018). About half of hospital staff nurses suffer from job-related burnout, with more than 20% stating that they plan to leave their hospital jobs within one year (Moss, Good, Gozal, Kleinpell, & Sessler, 2016). Investigations on burnout syndrome in nurses show that the presence of stress in the work environment is to blame for the high incidence of the condition, which has worsened the shortage of nurses by prompting many nursing staff to leave their jobs willingly (Cañadas-De la Fuente et al., 2015; Moss et al., 2016).

The incidence of burnout syndrome has escalated over time due to a number of factors, including socio-demographic physiognomies, work responsibilities, social and personal lives, extra work involvements, leisure and physical activities, and work-related health complications (Cañadas-De la Fuente et al., 2015). Studies show that burnout syndrome increases by approximately 23% for each extra patient included in the shift workload of nurses (Holdren, Paul III, & Coustasse, 2015). The scarcity of nursing staff has also compelled many nurses to work mandatory overtime (Pradas-Hernández et al., 2018). It was approximated that about half a million registered nurses in the U.S. did not practice in their profession due to difficult working conditions attributed to prolonged working hours and understaffing (Akman, Ozturk, Bektas, Ayar, & Armstrong, 2016). Additionally, burnout syndrome has affected about 49 % of registered nurses aged 30 and younger and 40 % of nurses aged 30 and older (Khamisa, Peltzer, Ilic, & Oldenburg, 2016). The symptoms associated with burnout syndrome lead to undesired upshots on patient care, work environments, and staffing inadequacies (Harkin & Melby, 2014). Nurse burnout has adverse effects on the patient, including high rates of medical errors that may have negative health effects, prolonged hospital stays, and poor patient satisfaction (Khamisa et al., 2016).

Nurse burnout has deleterious consequences on the healthcare system. Some of the effects of burnout on patients and their families also have negative repercussions for health facilities. For example, medical errors attributed to burnout may have legal ramifications for health organizations in instances where the aggrieved patients decide to pursue justice through legal channels. Additionally, prolonged hospital stays and high rates of readmission reflect badly on a healthcare facility and may have financial implications. For instance, the passing of the Affordable Care Act, as well as the introduction of financial disincentives by the Centers for Medicare and Medicaid Services (CMS), strive to reduce the rates of hospital readmissions (Zuckerman, Sheingold, Orav, Ruhter, & Epstein, 2016). As a result, practice settings that record high rates of hospital readmissions incur financial penalties (Gilman et al., 2015). Breakdown affects the health of nurses and leads to absenteeism from work, which in turn affects the quality of services provided by healthcare institutions (Adriaenssens, De Gucht, & Maes, 2015).

The ethical implications of burnout syndrome are associated with the negative effects on patients’ health, for example, medical errors and poor patient outcomes. These effects contravene the ethical principle of beneficence and non-maleficence (Winland-Brown, Lachman, & Swanson, 2015). Nurses should ensure that their actions do not cause harm to their patients or themselves. Burnout syndrome affects the quality of nursing care, which may cause unintended harm to patients.

Hospitals should lay emphasis on developing healthy work environments where nurses perceive the backing of the administration and their colleagues. Hospitals should also create stress management plans that deal with the signs of burnout and guarantee that safe nurse staffing patterns are implemented. A reduction in nurse professed burnout could help to lower the national nursing shortage and benefit hospitals by eliminating high expenses incurred in employing nursing staff. Promoting lower nurse to patient ratios, creating better work environments through improved management, offering higher remuneration rates and shorter working shifts are some of the strategies that can enhance the desirability of the nursing profession and appeal to more people to join the vocation (Cañadas-De la Fuente et al., 2015). However, for caregivers and administrators in clinical settings to implement these measures effectively and alleviate burnout syndrome, there is a need to understand the prevalence of the condition in various departments. Therefore, for these reasons, this project aims at determining the prevalence of burnout syndrome in different nursing specialties.

PICOT Question

The research question for the project is “what is the incidence of burnout syndrome within the nursing area depending on the specialty?” This question can be developed into a PICOT to reflect the population, intervention, comparison intervention, and outcome. The population is the nursing arena, which includes all nursing specialties, for example, pediatric nursing, public health nursing, gastroenterology nursing, oncology nursing, geriatric nursing, oncology nursing, medical-surgical nursing, orthopedic nursing among others. Increasing nursing staff levels is associated with reduced workloads and burnout levels (Pradas-Hernández et al., 2018). However, given that working in specific specialties predisposes an individual to exhaustion, it is unclear whether this intervention would reduce the incidence of the burnout syndrome in all nursing departments. Cancer is a leading cause of mortality globally (Eelen et al., 2014). Caring for cancer patients is a complex process, which has sparked research interest in the professional quality of life of oncology nurses. Therefore, the PICOT question is: In the oncology nursing specialty, what is the impact of increased staffing levels on the incidence of burnout syndrome compared to other nursing specialties?

Population: Oncology nursing specialty.

Intervention: Increased staffing levels.

Comparison: Other nursing domains.

Outcome: Prevalence of burnout syndrome.

Theoretical Framework

The Neuman’s System Model (NSM) is the theoretical framework that will guide this project. NSM is a rational principle used by caregivers and administrators in health settings to elicit positive client upshots. This theory was developed based on the author’s educational and professional experiences. NSM describes the wellness of the client or the client system in relation to environmental stress and reaction to pressure (Butts & Rich, 2017). According to Neuman, each client system is distinctive and consists of a combination of factors, traits, and a range of responses within a fundamental structure. There exist many documented, unidentified, and universal stressors, each differing in its potential capacity to upset the client’s standard levels of stability (normal LOD or Line of Defense). Specific interactions between client variables at particular times may influence the extent to which the adaptable LOD shields the patient from potential reactions to stressors. Every client system has developed a typical range of rejoinders to the surroundings, which is known as a normal LOD. The normal LOD is a yardstick for estimating health unconventionality. Failure of the flexible LOD to protect the client against environmental stresses allows the stressors to traverse the normal LOD.

Therefore, the stated variables exhibit dynamic interrelationships in a client during states of wellness or illness. Wellness may be defined as the availability of continuous energy to maintain the system in an ideal state of system stability. Each client has internal resistance factors referred to as Lines of Resistance (LOR) whose role is to steady and restore the client to the normal wellness state. Primary prevention is related to measures that are applied in client evaluation and intervention, as well as the recognition and elimination of potential risk factors. Conversely, secondary prevention refers to the symptoms that occur after reacting to a stressor and the prioritization of intervention strategies to abolish or minimize adverse effects. Tertiary prevention denotes the restorative processes involved during the rebuilding and maintenance stages towards primary prevention. Overall, the client behaves like a system, which is in an active, continuous energy interchange with the surrounding.

The NSM provides a detailed account of a person’s acclimatization to environmental stressors. Neuman underscores the role of spirit, mind, and body in adjusting to the surroundings to preserve, achieve, and maintain wellness. Five variables are known to affect the performance of nurses: psychological, physiological, developmental, sociocultural, and spiritual (Butts & Rich, 2017). The NSM is a working framework meant to direct caregivers and administrators in assisting those in their custody to handle stressors. Nurse practitioners recognize the theory as an effective method to produce positive patient outcomes. Different institutions, including academic, business, and health organizations apply the NSM to set best practices to deal with stressors efficiently. Neuman argues that physiological, mental, sociocultural, age-related, and spiritual variables influence the extent of the protection conferred by the LOD and LOR (Butts & Rich, 2017). Consequently, considering the association between burnout and the capacity to provide reliable care, an individual can depend on these five variables to reinforce the flexible and normal LODs. Doing so will preclude the infiltration of both lines of defense and shield the basic core. Additionally, the interaction between these five variables can affect the caring behavior of nurses.

Kaur, Sambasivan, and Kumar (2013) examined the impact of spiritual and emotional intelligence as well as the psychological ownership and burnout on the caring behavior of nurses. Kaur et al. (2013) used the NSM to explain the effect of spiritual, psychological, physiological, and psychological well-being on the caring behavior of nurses. The findings of this study emphasize the need for professional healthcare workers and managers to pay attention to the relationships between the spiritual, psychological, physiological, and psychological aspects that influence the quality of health care provided by nurses. The NSM has also been used in interdisciplinary investigations in health care. The systems approach described in the model is relevant to the evolving health care delivery system. Hence, its application to interdisciplinary issues in health care is multidimensional (Witteman & Stahl, 2013).

In this project, the nurse will be the client system. The role of the client system is to care for other people. Hence, a caring behavior is the most important aspect of the client. Nurses should be able to provide quality care to their patients while handling stress. Day-to-day nursing roles are constantly attacked by stressors at work and the surroundings. These stressors attempt to cross the lines of defense and resistance and destroy the core, which is nurses’ caring behaviors. In this context, the term ‘defense’ encompasses the well-being of nurses and outside security from individuals, families, groups or the community. The phrase ‘resistance’ denotes protective mechanisms that promote the restoration of wellness in nurses. The LOD and LOR provide nurses with protection. Hence, the features of nurses’ caring behavior will be determined by the integrity of the LOD and LOR. For example, inadequate LORs cause burnout, which interferes with the core and reduces the degree of caring behaviors among nurses.

Synthesis of the Literature

The term “burnout” was made up by Herbert Freudenberger in the 1970s to illustrate the outcomes of severe stress faced by personnel in “helping” professions (Aronsson et al., 2017). Burnout is common in the healthcare field and is associated with numerous adverse effects. In the nursing field, different nursing specialties face diverse challenges that are linked to various stress levels and burnout. This literature review addresses the similarities, differences, and controversies in the body of evidence about burnout syndrome in various nursing specialties.

Burnout syndrome occurs in most healthcare professionals. However, its incidence is higher in people who care for seriously ill patients. The development of burnout syndrome is often linked to an imbalance in the personal traits of an individual and work-related problems or administrative factors (Moss et al., 2016). Khatiban, Oshvandi, Borzou, and Moayed (2016) examined the effect of applying the NSM in intensive care units (ICUs). The specialty and subspecialty treatments required in ICUs cause stress for nurses and patients. Neuman asserts that prevention is a valuable strategy of safeguarding the client from stress. Khatiban et al. (2016) reported that applying the NSM enhanced nurses’ support by developing a social network within the place of work. Consequently, post-traumatic disorder was prevented using the three prevention levels reported in the NSM (Khatiban et al., 2016).

Global research shows that oncology staff experience more burnout compared to other healthcare professionals (Aronsson et al., 2017). Several studies reported high prevalence rates of burnout syndrome in oncology nurses (Eelen et al., 2014; Yu, Jiang, & Shen, 2016; Gomez-Urquiza et al., 2016). Yu et al. (2016) reported that higher levels of compassion fatigue and burnout were recorded in oncology nurses who had worked as nurses for longer periods, obtained significant working experience in secondary hospitals, and nurses who embraced passive survival styles. Important protectors against compassion fatigue and burnout included intellectual understanding, guidance, and backing from organizations.

Character traits such as frankness and diligence had a positive correlation with compassion fulfillment. On the other hand, neuroticism led to low compassion fulfillment and was responsible for 24.2% and 19.8% of the difference in compassion exhaustion and burnout respectively (Yu et al., 2016). Eelen et al. (2014) reported a significantly higher level of emotional fatigue and depersonalization in oncologists as opposed to other professionals. Gomez-Urquiza et al. (2016) also investigated the average levels of emotional overtiredness, depersonalization, and personal achievement among oncology nurses as well as the risk factors of these factors. It was noted that oncology nurses felt a low sense of personal achievement and experienced emotional enervation. However, Gomez-Urquiza et al. (2016) noted very few indications of depersonalization.

Similarly, Adriaenssens et al. (2015) reported a high frequency of burnout syndrome in emergency nurses. Personal factors such as demographic variables, character traits, and coping mechanisms predicted the incidence of burnout. Work-related dynamics such as experiencing disturbing occurrences, job physiognomies, and organizational variables also caused weariness in this group of nurses. Overall, it was concluded that job requirements, social support, organizational variables, and contact with traumatic events caused burnout. As a result, hospital management should formulate specific interventions to lower staff resignation rates and burnout in emergency nurses.

Iglesias and de Bengoa Vallejo (2013) sought to determine the occurrence of burnout syndrome, job fulfillment, work pressure, and clinical indicators of stress in critical care nurses. The findings revealed a moderate occurrence of nursing stress, high incidence of emotional tiredness, and modest development of unenthusiastic attitudes towards patients. Tay, Earnest, Tan, and Ng (2014) found that nurses working in rehabilitation wards were more likely to have burnout syndrome than other nurses. However, when Harkin and Melby (2014) compared the prevalence of burnout in emergency and medical nurses, there was no significant difference in emotional fatigue, depersonalization or personal achievement extents between these two groups of nurses. Work-related and individual factors such as gender, age, marital status, and weekly working hours were associated with burnout.

Heeb and Haberey-Knuessi (2014) investigated the prevalence of burnout syndrome among nurse managers. Contrary to the expectations, nursing managers demonstrated a low degree of burnout. This trend was also replicated in the medical managers. Low levels of emotional fatigue and depersonalization were observed in both personnel, whereas the extent of personal accomplishment differed between the two groups. Only 2.3% of the nurse managers reported high levels of burnout (Heeb & Haberey-Knuessi, 2014). These findings go against the supposition that high levels of stress are linked with high burnout levels because nursing managers are assumed to hold very demanding positions due to their position within the hospital chain of command. This observation could be explained by the fact that managerial roles do not involve direct contact with critically ill patients, which reduces the type of work stress that is associated with burnout syndrome. However, it was clear that unequal distribution of resources played a crucial role in exhaustion (Heeb & Haberey-Knuessi, 2014). Misiołek, Gil-Monte, and Misiołek (2017) looked into the prevalence of burnout in nurse anesthetists. It was observed that the prevalence of burnout levels in nurses was 18.63 % as opposed to 12.06 % in anesthesiologists. Furthermore, critical levels of burnout were recorded in 3.74 % of the nurses and 5.90 % of the anesthetists (Misiołek et al., 2017).

Understaffing is the main cause of work-related stress (Abdo, El-Sallamy, El-Sherbiny, & Kabbash, 2015). Other factors that prompt the progress of burnout syndrome comprise compassion lassitude, sympathy satisfaction, secondary traumatic stress to individual or environmental features, insufficient coping machinery, and experiencing distressing events (Hinderer et al., 2014). Tay et al. (2014) showed that many years of working experience as a nurse and the interference of work responsibilities with family commitments played a major role in the development of burnout. Age, workload, and communication skills also influenced the development of the burnout syndrome (Tay et al., 2014).

Practice Recommendations

Various factors can affect the professional quality of life of healthcare workers. One factor that is evident in the review of the literature is that nursing specialties that involve caring for patients in critical conditions are associated with a high prevalence of burnout syndrome. For example, oncology care has distinct features and requirements, which may cause oncology nurses to undergo more work-related stress than other types of nursing fields. Therefore, the pervasiveness of emotional fatigue, depersonalization, and low individual achievement appears to be considerably higher among oncology nurses than other nursing specialties. Harkin and Melby (2014) confirmed that burnout was also widespread in emergency and medical nurses. In addition, caring for trauma patients could cause burnout, sympathy fatigue, and secondary traumatic stress. The prompt recognition of the predictors of these effects can direct the advancement of intermediations to alleviate burnout.

The findings of this literature review serve as clues to help nurse administrators to recognize the predisposition of oncology nurses to compassion fatigue and burnout and create all-inclusive stratagems to enhance their professional quality of life. Detecting burnout is crucial because it has a significant effect on the individual well‐being and the quality of life of the healthcare specialist, which in turn affects the quality of care offered to patients. Interventions that could be useful in alleviating burnout syndrome among nurses include adequate staffing levels, providing emotional and physical support to nurses, encouraging active involvement in regular physical exercise, meditation, and forging positive coworker relationships (Gomez-Urquiza et al., 2016). Clinical settings should strive to implement some of these interventions.

Further studies are required to determine the prevalence of fatigue in other nursing specialties and recognize factors linked with burnout syndrome in nurses in these areas. Additionally, there is a need for the formulation of studies to identify interventions that can minimize emotional exhaustion and augment feelings of personal achievement. Risk factors for burnout syndrome and protective measures should be studied more expansively. However, based on the available evidence, the most practical intervention would be to alleviate the workload of nurses as a first step towards preventing burnout. This intervention would mean employing more nurses to reduce the nurse to patient ratio, which is the proposed intervention in the PICOT question.

Project Description

Organizational need for the change can be established by reviewing a health organization’s performance over the last 6 months with respect to various nursing specialties. Measures such as patient satisfaction, readmission rates, and nurse absenteeism need to be reviewed. Any significant decline in performance that can be linked to understaffing problems should be identified. Some of the facilitators of the project include the availability of adequate amenities to develop and execute evidence-based projects, for example, a reliable Internet connection and access to various online databases. On the other hand, the anticipated barriers include time constraints, which may leave inadequate time to focus on the development and implementation of change projects and other evidence-based initiatives that could improve patient outcomes.

The chosen change model for the project is Kotter’s eight-step change model. This model was put forth by John Kotter in 1996 to guide organizations that were undergoing change (Chappell et al., 2016). The change model has been used successfully to implement change projects in business settings as well as healthcare institutions. The eight steps of the model and their application in the implementation of a change project are described as follows.

Creating a Sense of Urgency

To establish a sense of urgency, it is necessary to hold a meeting with other members of staff to discuss the prevailing work situation at practice site where the proposed change should take place. The researcher should inform other nurses that the performance of the nursing department is not satisfactory due to burnout syndrome among the nurses. Symptoms of demotivation and fatigue can be attributed to a shortage of nursing staff. The effect of the increased workload can be evident in the current mood of the employees. The researcher should explain that there is a need to inform the administration about the need to recruit more nurses to address the understaffing issue.

Creating a sense of urgency makes it possible to bring the right people together by recognizing and emphasizing the possible dangers and consequences of failing to address the problem (Tan et al., 2016). It is important to initiate discussions to make other staff members realize the gravity of the problem to be addressed. A crucial part of this phase is to request the involvement and support of other stakeholders in the change project.

Forming Powerful Guiding Coalitions

After the staff members have understood the gravity of the problem, it is necessary to have a team of people who will ensure that the proposed change is implemented. The researcher should choose a team of staff members to help with the project. An appropriate team should include the nurse manager to convey the team’s request to the administration and the leaders of all other nursing specialties to act as a link between the nursing specialties and nurse leadership. The specialty leaders will be expected to identify potential issues in their areas and report to the nursing manager.

Developing a Vision and Strategy

The team should agree that there is a need to communicate the proposed change to other nurses and the administration. Thereafter, the change leaders should describe the vision effectively to avoid misunderstandings. This step can be achieved by determining the core values, outlining the ultimate vision, and clarifying the proposed approaches for realizing the change.

Communicating the Vision

There is a need to communicate the vision to the entire organization. For example, it can be agreed that nurses who wish to quit their jobs or relocate can provide the administration with a three-month notice to allow enough time to organize for replacements. This move would ensure a smooth transition for other nurses and minimize the likelihood of burnout syndrome and adverse patient outcomes. Concerns raised by the staff members should also be addressed accordingly.

Removing Hindrances and Empowering Employees for Action

It is necessary to get rid of obstacles to ensure that the project runs smoothly. This step entails instituting organizational processes that match the overall vision of the organization. Additionally, barriers to change should be checked. Reward strategies can also be put in place for people who support change.

Creating Short-Term Wins

Creating short-term wins in the initial stages of the change project provides a sense of victory and boosts the morale of the workers (Issah & Zimmerman, 2016). Several short-term goals are more encouraging than one long-term goal. Even though the major goal of the intervention is to prevent and lower the incidence of burnout syndrome, a number of short-term goals can be created. They include creating shorter work shifts and reducing the nurse to patient ratio.

Consolidating Gains to Yield More Change

This step involves the putting together the observed gains to achieve continuous improvement. Success stories provide lessons that direct future improvements. This step will be an ongoing process throughout the lifetime of the project.

Anchoring Change in the Organizational Culture

The last step involves securing the change in the organizational culture. Strategies that can be used to achieve this goal include using every opportunity to discuss the success stories related to change programs. It is also necessary to ensure that current leaders, as well as new leaders, continue to support the change initiative. It may be necessary to make the change project part of the company policy. For example, a health facility can make a rule concerning the maximum nurse to patient ratio that is permitted in the hospital. Such a policy will ensure that incoming leaders continue to support the change.

The Researcher’s Role

My role in the project is to conduct a thorough review of the literature to find reliable evidence to answer the research question. I am also tasked with synthesizing and appraising evidence from the research findings to answer the research question and make meaningful conclusions. Thereafter, I am expected to evaluate the effectiveness of the literature review and disseminate the findings of my project to other members of the scientific and healthcare community. I am also expected to discuss the implications of these results on nursing and health care. Useful leadership qualities that will facilitate my role in the project include evidence-based leadership, being a change agent, effective conflict management skills, and team leadership. As an individual, it will also be necessary to have competent research skills to search the literature effectively and obtain valid evidence.


The project will involve an analysis and synthesis of research evidence. Research articles will be retrieved from different databases using a specific search criterion. Data from the publications will be recorded in tables and analyzed to make meaningful conclusions.


The independent variable will be different nursing specialties. On the other hand, the dependent variable will be the prevalence of burnout syndrome in each specialty. Three main scales will be used to determine burnout syndrome. They include emotional exhaustion, depersonalization measures, and personal accomplishment measures.

Reliability and Validity of the Instrument

The Maslach Burnout Inventory (MBI) will be used to assess burnout syndrome among nurses in various specialties. This questionnaire was not originally developed for clinical practice but for scientific investigations on burnout. However, since its initial publication, several versions have been developed to match various settings. MBI has been used in most publications investigating burnout among nurses. Three main scales of emotional exhaustion, depersonalization, and personal accomplishment are measured by this instrument (Loera, Converso, & Viotti, 2014).

The first scale evaluates feelings of being emotionally overstretched and fatigued by one’s work, whereas the second scale assesses the lack of feeling and unfriendly responses towards the recipients of an individual’s service. The third scale measures outlooks of proficiency and successful accomplishment in one’s work. The validity and reliability of this tool have been determined in various studies where the instrument has been used to investigate burnout in healthcare settings (Lee, Chien, & Yen, 2013; Pisanti, Lombardo, Lucidi, Violani, & Lazzari, 2013; Loera et al., 2014). The reliability of the various items included in the instrument has been ascertained using the Cronbach’s alpha index and found to be satisfactory (Loera et al., 2014).

Protection of Human Subjects According to IRB Criteria

The project will involve an analysis and synthesis of already published research articles. As a result, there will be no direct involvement of human subjects in the collection of data. Therefore, no specific steps will be required to protect human subjects in this part.

Procedure to Complete the Study

Various nursing databases will be searched to find information related to the research question. These databases include CINAHL, Medline, EBSCO Host, and Google Scholar. Specific search terms will be used to find and retrieve relevant magazines, articles, and authorized and updated sources. The search terms will include prevalence of burnout, burnout syndrome, and nursing specialties. The search will be restricted to articles published within the last 5 years (from 2013 to 2018). Another useful filter that will be used is confining the findings to original research and systematic reviews of the literature. Relevant articles will be identified by skimming through the titles and abstracts after which full-text articles will be retrieved for further analysis. Specific details concerning the articles will be noted down in summary of evidence tables (Appendices A and B). Evaluation of the collected evidence will enable the identification of nursing specialty areas with a high prevalence of the burnout syndrome. The gathered evidence will inform the implementation of the intervention to answer the PICOT question. Collection of evidence will only proceed following IRB approval of the proposal.

Project Evaluation Results

The planned change project will be evaluated using tables from appendixes A and B. Appendix A will be a summary of primary research evidence. These details will include the citation information, question or hypothesis, theoretical foundation, research design, sample size, key findings, recommendations or implications for nursing practice, and the level of evidence. On the other hand, Appendix B will be a summary of systematic reviews. Appendix B will include citation information, research question, search strategy, inclusion and exclusion, data extraction procedure, key findings, recommendations or implications for nursing practice, and the level of evidence.

A formative evaluation is a technique used to ascertain the worth of a program while the program is in progress. This evaluation focuses on the process and can be done at any stage of the project. The benefit of this assessment is that it allows managers to keep an eye on the instructional goals and objectives and note any deficiencies in the early stages to facilitate the timely mounting of additional interventions. Formative evaluation of the project will involve checking the integrity of the articles included in the review by examining their limitations and strengths.

A summative evaluation is used to determine the value of a program at the end of all activities. The focus of this assessment is on the outcome of the project. Instruments such as questionnaires, interviews, surveys, and observations can be used for this evaluation. Summative assessment of this project will entail scrutinizing the findings of the review for strengths and weaknesses of the entire methodology.

The MBI uses a 7-point Likert scale (ranging from never to daily) to assess the three constituents of burnout syndrome. Therefore, the type of data that will be collected will be ordinal data (McCormick & Salcedo, 2017). Consequently, nonparametric methods of data analysis will be used.

Extraneous variables will be controlled by establishing specific inclusion and exclusion criteria for the review. For example, articles published before 2013 will be excluded from the study. Additionally, only original research articles or systematic reviews will be used for the literature review and synthesis of evidence.

Data will be analyzed using Statistical Package for the Social Sciences (SPSS) Version 20. Descriptive statistics such as frequencies and means will be used to simplify and interpret the collected data. The Kruskal-Wallis Test (One Way ANOVA on ranks) will be used to compare the scores on the burnout subscales for different nursing specialties. Spearman’s Rank Order Correlation will be used to describe the strength and direction of the relationship between burnout syndrome and improved staffing levels.

Discussion and Implications for Nursing and Healthcare

The project evaluation results will highlight the impact of enhanced staffing levels on the prevalence of burnout syndrome in oncology nursing compared to other nursing specialties. The internal validity of the project evaluation is confirmed by the reliability of the MBI instrument used in data collection. One possible limitation of the project evaluation is that the conclusions of the project may be inaccurate due to dependence on published and readily available studies. Published studies do not include outcomes from all existing research. Adverse outcomes are unlikely to be published due to the fear of negative publicity (Alonso-Coello et al., 2016). Therefore, the entire review may have publication bias, which may be attributed to the researchers or journal editors and peer reviewers. Additionally, a comprehensive literature review requires access to numerous databases, which is an expensive and labor-intensive process. Different databases have varying search functions, which challenges the objectivity of the search and retrieval process. For example, it may be necessary to modify or reject certain search strings, which may cause the researcher to miss important studies.

The researcher’s clinical experiences may lead to a form of researcher bias known as confirmation bias. Confirmation bias occurs when a researcher forms an assumption and uses respondents’ data to validate the belief (Baack, Dow, Parente, & Bacon, 2015). Judging responses that substantiate the researcher’s suppositions as relevant and dependable while ignoring evidence that does not match my expectations could also lead to this bias (Baack et al., 2015). As a result, there will be a need to enlist the help of someone else who does not have an interest in the project. For example, it may be necessary to seek the opinion of my instructor or a colleague to check the work for evidence of researcher bias.

This project will highlight the impact of adequate staffing levels on positive nurse and patient outcomes. These findings will inform managerial office and human resource departments of healthcare institutions about the value of proper staffing on hospital performance. It is recommended that additional measures should be taken to address other identified causes of burnout syndrome among nurses. These measures include providing emotional and physical support to nurses, encouraging active involvement in regular physical exercise, meditation, and forging positive coworker relationships. A replication of this project and project evaluation could also look into other factors that are linked to high incidences of burnout syndrome and determine their association with the three subscales of the condition in the study population. These include factors such as contact with traumatic events, age, work experience, and unequal distribution of resources. Such a study will also guide initiatives to address the issue of burnout syndrome.

Plans for Dissemination

The findings of the project will be disseminated to the researcher’s colleagues using a PowerPoint presentation. The outcomes will also be drafted into a manuscript for publication in a peer-reviewed journal. The proposed journal is the Journal of Nursing Management. This journal was chosen because it is an international forum that updates and develops the field of nursing management and leadership. The journal provides evidence that supports and elucidates the practice of management, improvement, and governance in nursing and health care. An oral presentation will be given in a nurses and physicians conference to target other members of the professional healthcare community.

Summary and Conclusion

The purpose of this paper was to identify the prevalence of burnout syndrome in different nursing specialties, establish the various risk factors for the development of the condition in diverse areas of nursing, and compare the incidence of burnout in various nursing fields. This paper included an explanation of the significance of the problem, the PICOT question, theoretical framework, and a synthesis of the literature. From the available body of evidence, it was clear that nursing specialties that dealt with critically ill patients had a high prevalence of burnout syndrome. These included oncology, emergency, and critical care nursing areas. Conversely, the prevalence of burnout syndrome in nurse managers was low. The risk factors for the development of burnout syndrome included exposure to traumatic events, age, work experience, coping mechanisms, and unequal distribution of resources. Implications for nursing practice and practice recommendations based on the available evidence were provided in addition to a project description and proposed evaluation of outcomes.


Abdo, S. A. M., El-Sallamy, R. M., El-Sherbiny, A. A. M., & Kabbash, I. A. (2015). Burnout among physicians and nursing staff working in the emergency hospital of Tanta University, Egypt. Eastern Mediterranean Health Journal, 21(12), 906-915.

Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies, 52(2), 649-661.

Akman, O., Ozturk, C., Bektas, M., Ayar, D., & Armstrong, M. A. (2016). Job satisfaction and burnout among paediatric nurses. Journal of Nursing Management, 24(7), 923-933.

Alonso-Coello, P., Carrasco-Labra, A., Brignardello-Petersen, R., Neumann, I., Akl, E. A., Vernooij, R. W.,… Ebrahim, S. (2016). Systematic reviews experience major limitations in reporting absolute effects. Journal of Clinical Epidemiology, 72, 16-26.

Aronsson, G., Theorell, T., Grape, T., Hammarström, A., Hogstedt, C., Marteinsdottir, I.,… Hall, C. (2017). A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health, 17(264), 1-13. doi:10.1186/s12889-017-4153-7

Baack, D. W., Dow, D., Parente, R., & Bacon, D. R. (2015). Confirmation bias in individual-level perceptions of psychic distance: An experimental investigation. Journal of International Business Studies, 46(8), 938-959. doi:10.1057/jibs.2015.19

Butts, J. B., & Rich, K. L. (2017). Philosophies and theories for advanced nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & Emilia, I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240-249.

Chappell, S., Pescud, M., Waterworth, P., Shilton, T., Roche, D., Ledger, M.,… Rosenberg, M. (2016). Exploring the process of implementing healthy workplace initiatives: Mapping to Kotter’s leading change model. Journal of Occupational and Environmental Medicine, 58(10), e341-e348.

Eelen, S., Bauwens, S., Baillon, C., Distelmans, W., Jacobs, E., & Verzelen, A. (2014). The prevalence of burnout among oncology professionals: Oncologists are at risk of developing burnout. Psycho‐Oncology, 23(12), 1415-1422.

Gilman, M., Hockenberry, J. M., Adams, E. K., Milstein, A. S., Wilson, I. B., & Becker, E. R. (2015). The financial effect of value-based purchasing and the hospital readmissions reduction program on safety-net hospitals in 2014: A cohort study. Annals of Internal Medicine, 163(6), 427-436.

Gomez-Urquiza, J. L., Aneas-López, A. B., la Fuente-Solana, D., Emilia, I., Albendín-García, L., & Díaz-Rodríguez, L. (2016). Prevalence, risk factors, and levels of burnout among oncology nurses: A systematic review. Oncology Nursing Forum, 43(3), E104-E120.

Harkin, M., & Melby, V. (2014). Comparing burnout in emergency nurses and medical nurses. Clinical Nursing Studies, 2(3), 152-163.

Heeb, J. L., & Haberey-Knuessi, V. (2014). Health professionals facing burnout: What do we know about nursing managers? Nursing Research and Practice, 2014, 681814. Web.

Hinderer, K. A., VonRueden, K. T., Friedmann, E., McQuillan, K. A., Gilmore, R., Kramer, B., & Murray, M. (2014). Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. Journal of Trauma Nursing, 21(4), 160-169.

Holdren, P., Paul III, D. P., & Coustasse, A. (2015). Burnout syndrome in hospital nurses. Web.

Iglesias, M. E. L., & de Bengoa Vallejo, R. B. (2013). Prevalence and relationship between burnout, job satisfaction, stress, and clinical manifestations in Spanish critical care nurses. Dimensions of Critical Care Nursing, 32(3), 130-137.

Issah, M., & Zimmerman, J. A. (2016). A change model for 21st century leaders: The essentials. International Journal of Pedagogical Innovations, 4(1), 23-29.

Kaur, D., Sambasivan, M., & Kumar, N. (2013). Effect of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behaviour of nurses: A cross‐sectional study. Journal of Clinical Nursing, 22(21-22), 3192-3202.

Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B. (2016). Work related stress, burnout, job satisfaction and general health of nurses: A follow‐up study. International Journal of Nursing Practice, 22(6), 538-545.

Khatiban, M., Oshvandi, K., Borzou, S. R., & Moayed, M. S. (2016). Outcomes of applying Neuman system theory in intensive care units: A systematic review. Journal of Critical Care Nursing, 9(4), 1-7. Web.

Lee, H. F., Chien, T. W., & Yen, M. (2013). Examining factor structure of Maslach Burnout Inventory among nurses in Taiwan. Journal of Nursing Management, 21(4), 648-656.

Loera, B., Converso, D., & Viotti, S. (2014). Evaluating the psychometric properties of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) among Italian nurses: How many factors must a researcher consider? PLoS One, 9(12), e114987. Web.

McCormick, K., & Salcedo, J. (2017). SPSS Statistics for data analysis and visualization. Indianapolis, IN: John Wiley & Sons.

Misiołek, A., Gil-Monte, P. R., & Misiołek, H. (2017). Prevalence of burnout in Polish anesthesiologists and anesthetist nursing professionals: A comparative non-randomized cross-sectional study. Journal of Health Psychology, 22(4), 465-474.

Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). An official critical care societies collaborative statement: Burnout syndrome in critical care health care professionals: A call for action. American Journal of Critical Care, 25(4), 368-376.

Pisanti, R., Lombardo, C., Lucidi, F., Violani, C., & Lazzari, D. (2013). Psychometric properties of the Maslach Burnout Inventory for Human Services among Italian nurses: A test of alternative models. Journal of Advanced Nursing, 69(3), 697-707.

Pradas-Hernández, L., Ariza, T., Gómez-Urquiza, J. L., Albendín-García, L., Emilia, I., & Cañadas-De la Fuente, G. A. (2018). Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis. PloS One, 13(4), e0195039. Web.

Tan, S. Q., Lim, W. W., Liu, S. L., Phoon, W. L. J., Tan, T. Y., Viardot, V.,… Tan, H. H. (2016). Kotter’s eight-step change model: One centre’s experience for transition to the GnRH antagonist protocol. Journal of Women’s Health, Issues and Care, 5(5). Web.

Tay, W. Y., Earnest, A., Tan, S. Y., & Ng, M. J. M. (2014). Prevalence of burnout among nurses in a community hospital in Singapore: A cross-sectional study. Proceedings of Singapore Healthcare, 23(2), 93-99.

Winland-Brown, J., Lachman, V. D., & Swanson, E. O. C. (2015). The new code of ethics for nurses with interpretive statements. 2015: Practical clinical application, Part I. Medsurg Nursing, 24(4), 268-71.

Witteman, H. O., & Stahl, J. E. (2013). Facilitating interdisciplinary collaboration to tackle complex problems in health care: Report from an exploratory workshop. Health Systems, 2(3), 162-170.

Yu, H., Jiang, A., & Shen, J. (2016). Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: A cross-sectional survey. International Journal of Nursing Studies, 57, 28-38.

Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374(16), 1543-1551.