Burnout of Nurses due to Workload and Long Working Hours during Shifts: Review Article

Objective This review is conducted to further understand the burnout experiences of nurses across different shifts and the implication of long working hours and workload. It has been understood that night shifts presents less workload for nurses while day shifts has more work engagement and loads. This clearly shows more nurses experience burnout during day shifts than night shifts. Some nurses may still experience high levels of burnout due to workload during night shifts when there is an emergency case during the night shifts.

nurture and nurse a patient back to health [3].Among the many different groups of trained professionals are the doctors, medical lab technicians, radiologist, nurses, etc.Among all these groups, the one most closest and which serves as the primary line of contact to the patients are the Nurses.This is in fact because they handle the general administration of drugs to the monitoring of a patients improvement back to health.This task as stressful as it is, is a round the clock over watch of the patient which makes it very demanding and engaging, which of course makes it un-logical for a particular nurse to handle all day long [4].
The demanding nature of the role and responsibilities of nurses thereby calls of the need for an extended period of break which is more than the usual one hour break at places of work.This extended period of break can be said to be regarded as "shift".This shift is crucial in managing the nurse's stress levels and or burnouts due to the demanding nature of the job.
This study therefore seeks to explain nurse's workload, long hours and burnout, from the review of related literatures.

Introduction
Health is undeniably one of the most important treasures of human existence, this is evident in the fact that an unhealthy individual is at the moment of his/ her ailment unable to engage in any form of activity, let alone participate in a productive career of any form.This shows how the value of good health cannot be over emphasized [1].Over the years, the human civilization has spent insane amount of resources, time and effort in establishing hospitals, clinics and different forms of medical care homes in order to tackle and manage the fragility of the human anatomy when in contact with harmful objects, viruses, bacteria's etc. [2].
With the establishment of those medical care houses and hospitals, it calls for the importance of having some groups of individuals who will be saddled with the responsibility of administering the said care in order to Workload in this case results into fatigue, lack of focus and concentration, de-motivation and frustration of the staff due to the overwhelming task which cannot be accomplished within the limited time and resources available [6].This situation often times makes the supervisors to increase the working hours of workers which results further into the increase in the stress level of the staff, physical and mental exhaustion, and in some extreme cases, employee tardiness, absenteeism and turnover [7].The physical and mental exhaustion of employees, in this case, Nurses, often times leads to lots of errors and mistakes at work which has dangerous consequences to the patients [8].
Workload and long hours for nurses always have negative repercussions due to the fact that keeping watch over patients is a tasking responsibility as lots of physical and mental effort is required in order to ensure proper care is given [9].In a situation where Nurses work consistently for long hours with lots of workloads, employee's insensitivity and burnout is inevitable [10].This insensitivity and burnout can increase the possibility of Nurses making a mistake which can be fatal to patients [6].
Long working hours has been associated to the nursing profession for centuries, mainly due to the fact that nursing is a profession that requires specialized skills in handling patients with different health needs [7].This results in always having an individual training for years in order to get a license of practice.Also the issue of fewer people who go for the profession in comparison to other professions like Business Administration, law, political science etc..This always leads to lower availability of the nurses as per the demand of patients.
This situation brings about the need for nurses to spend more time nursing patients under their care which always results in longer shifts that graduates into stress and ultimately burnout.

Nurses Burnout
Burnout is a term which largely refers to the total exhaustion where an individual reaches a point of total depletion of energy to the point of lacking the physical or mental strength to continue with his/her responsibility [11].This happens when an employee is constantly exposed to stressful situations and/or events in the process of carrying out his/her duties.It can manifest in different ways, but mostly in the employee losing interest at the work, loss of motivation and emotional exhaustion [12].
In recent times, nurses have been experiencing burnout across private and public practice especially during the COVID 19 outbreak across the globe, where health workers were tasked with mitigating and taken care of those affected [13].The pandemic brought with it lots of panic and uncertainty as measures were taken at first by professional guess work and not with absolute certainty due to the mysterious nature of the COVID 19 reaction to different treatments administered.
The nature of this pandemic exuberated the stress and burnout level of health workers, especially nurses, considering the fact that they are mostly at the front line of defense and the frontline care patients are counting on for help [13].They further opined that the burnout experienced by the nurses during the pandemic was due to the perceived threat it poses and also the fear of contracting it and infecting their loved ones.This was largely because of what the nurses witnessed on the patients that were infected and how dangerous it was.So worsening their fear and need for protection against the virus, thereby increasing their stressors which ends in burnout.

Nurses Shifts
It is a very common knowledge that medical health workers have shifts which is basically common with the profession.This of course is as a result of the importance of having a break time to recover considering the strenuous nature of medical care giving.The break in this case goes beyond a thirty minute or at most one hour break obtainable in other places of works [5].
This break is broken down to shifts, which is a time allocation for different sets of workers to work which at the expiration of the time; others replace them to continue with the same sets of responsibilities.These shifts are necessary as it allows for continuous care of patients and mitigating the rate of poor care given due to mistakes and errors that stress and fatigue can cause [5].
Shifts are very important because health is a delicate issue that must be addressed delicately.Most patients in the hospitals who are admitted, due to the nature of the care they need in respect to their diagnosis may require a round the clock watch and observation [5].This calls for the need for morning and night shifts for nurses in order to have someone always available to attend to the needs of patients.Thereby some nurses are placed on morning shifts and others on night shifts for proper watch over the patients.This helps in mitigating the stress levels of nurses to some level and enables them to administer the best care possible to their patients with minimum room for mistakes.

Methods
The study of [5] used a cross sectional study focusing on the wards that handle in-ward patients that are admitted.In the study, 347 beds with the population of 698 nurses for the study across maternity ward, intensive care, children's ward, emergency ward etc. the cross sectional study was very appropriate for this study because of its advantage of getting data from a large pool of subjects making it easier to compare This is evident especially when they are on night shifts, as in the morning, they can have time to rest and also engage in some family activities.The night shifts also has lower job demand, thereby giving them more resting periods even while on the job as they have lower contact and observation of patients.This can sometimes be a different story for those who may be having emergencies at the emergency unit during night shifts.But in general, most night shifts have lower nurse's engagement at work.The general idea of the shifts is to give more resting time for nurse so that they can have lower experience of burnout.As important as the shifts are, and also over the years, shifts have been instrumental in mitigating nurse's burnout, but yet it does not totally solve the issue of work stress and burnout among nurses.
Nurse continues to experience burnout in different ways, from depersonalization, loss of job satisfaction, emotional exhaustion and physical exhaustion.Even though the experience of burnout is still the cases among nurses, the importance of shifts which results in lower working hours and ultimately helps in reducing the levels of burnout cannot be over emphasized.
differences within the group.And considering the study focused on burnout of nurses across shifts due to job stress, the method adopted was very appropriate.
However, the researchers included subjects directly in contact with patients and have been working in the word or unit for more than a year.This is acceptable considering the nature of the work, and the fact that the focus was on the wards selected and the certain type of nurses.Other nurses who have worked for less than a year and also in ward not directly in contract with the patients but connected indirectly, experience job stress and burnout as well.Therefore the inclusion criteria weren't broad enough to accommodate other nurses facing job stress and burnout during shifts.
For the purpose of this study, secondary means of data collection was utilized.This combines different scholarly works across different indexed journals, including but not limited to articles indexed in Scopus, Pubmed, Crossreff, SSCI/SSCIE, google scholar and some few articles across other indexes.

Results of the Study
The study conducted by (Vidotti) [5] focused majorly on morning (day) shifts and night shifts, this focus limited the researcher to only two shifts.From the large number of articles gathered from other indexed journals, it was observed that there are three shifts obtainable across different health sectors to maintain an eight hour work time for health professionals, which includes nurses.
The scholarly studies showed that single nurses and those without children are very satisfied with working on day shifts, whiles the older nurses work mostly night shifts.There is an increase of emotional exhaustion among those who work on day shifts.This increases their dissatisfaction with sleep and also the feeling of lower control over their work.
The experience for those who work on night shifts, there's higher emotional exhaustion among those with kids and less of that among those without kids.There seems to be balance in this aspect as the night shifts have lower job demands than that of the day shifts.

Conclusion
It is evident that shifts and reduction in long working hours is of paramount importance especially when it has to do with nurses.This is so because of the fact that, nursing is a delicate profession that demands the worker to be at his/her best at all times considering health of patients and in some cases their lives are at stake.In this case, nurses always deserve a reduction in working hours as compared to other professions.As it has been observed the shifts helps not only in giving nurse opportunity to rest and recover from the stress of the work, but it also help them to have opportunity of building a leisure time and spend time with their families and friends.