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February 5, 2003

Nursing Burnout and Patient SafetyNursing Burnout and Patient Safety

JAMA. 2003;289(5):549. doi:10.1001/jama.289.5.549-a

To the Editor: As Dr Aiken and colleagues report,1 all caregivers need to be aware of the the daily demands of nurses and nursing leaders as key sources of burnout and unsafe staffing levels in hospitals.

Burnout seeps into hospital nursing in the form of aggressive behaviors of leaders toward staff nurses, charge nurses, and others involved in providing nursing services. It may also make nursing leaders more willing to hire nurses with less education and experience than registered nurses. In my experience, many hospital nursing leaders pressure staff nurses to take an unsafe load of patients on an ongoing basis, resulting in ethical dilemmas for many nurses, and even for nursing students.2 Common strategies include hiring fewer registered nurses, shortening nursing orientation programs, offering fewer continuing education programs, and requiring more 12-hour shifts. All these short-term budget fixes can interfere with experiential learning, which helps nurses to develop expertise.3,4 Flexible scheduling, effective orientation programs, and continuing education are but a few of the solutions that have been offered to entice expert nurses back to the bedside. Per diem arrangements may improve nursing staffing ratios by providing experienced, competent nurses willing to work per diem.

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