According to research conducted by Howard Weiss, PhD, associate professor of psychological services, Purdue University, Lafayette, IN, a caregiver’s unhappiness often spills over into the nurse-patient interactions and can impact patients on a large scale.

“Our studies have shown patients who come away from a positive encounter with a nurse are more likely to follow prescribed directions, take medications, and seek follow-up care,” says Weiss. The opposite appears to be true, too.

“If a patient encounters a healthcare worker who’s in a negative emotional state, it becomes a springboard into other negative behaviors,” says Weiss. “Down the road, their own outcomes suffer, and they just don’t fare as well.”

Although most people are quick to blame job dissatisfaction on nurses’ grumpiness, it’s not entirely to blame for their bad moods. Weiss says that the pulse of daily events drives nurses’ emotional states, like other workers. It is this waxing and waning of emotionally-charged events that directly affect nurses’ behavior.

Ignoring the Boiling Pot

“Too often hospitals assume that nurses’ feelings are constant," says Weiss. “Actually, the hospital floors are more like emotional cauldrons with daily circumstances influencing nurses’ feelings and their job performance.”

In some hospitals, the staffs’ emotional flux is reaching fever pitch. Patients, too, are under more stress. They are grappling with the usual mixed bag of stressors that accompany hospitalization, problems with managed care coverage, and loss of control. And they’re directing their frustration on those they trust most — their nurses.

“What’s happening in hospitals today is not unlike road rage,” says Linda Aiken, RN, PhD, director of the Center for Health Outcomes and Policy Research at University of Pennsylvania School of Nursing. She compares the irrational and often violent action that causes some motorists to lash out at fellow travelers with patients’ treatment of their nurses.

“Studies show that patients are verbally abusing nurses more than ever. Patients feel that there is no one accountable any more and no one within voice range — they’re scared and anxious and are yelling at their nurses,” she says.

The negative interactions can fan RNs’ existing emotional fires, perpetuate a domino effect of sour interplay with colleagues, and lead to nurse burnout.

Too Hot to Handle

“We used to think that burnout came from the constant caring for dying patients, working odd shifts and holidays,” says Weiss. “Burnout happens when nurses put on a happy face over and over again when inside they’re feeling truly frustrated and unhappy.”

Staffs’ frustrations are easy to identify. In Aiken’s latest research study, inadequate staffing, lack of control, and higher use of nonlicensed personnel at the bedside are three of the most popular reasons given for nurses’ anguish. “Patients hold nurses accountable for what happens in hospitals,” says Aiken. “Nurses feel the pain of not meeting those expectations. They feel bad.”

How to Turn Down the Heat

Managers are in perfect positions to help defuse negative situations as they happen. Weiss suggests supervisors become “events managers,” controlling to whatever extent possible the events that affect nurses. For example, a nurse who has been verbally abused by a patient may start a chain reaction of irritation as he or she interacts with others throughout the day. The manager can step in and derail that negative emotion before it escalates.

“It’s the manager’s place to keep the number of these negative events to a minimum,” says Weiss. “People need to be aware of their emotional state and the impact it has on patient care.” He suggests that managers offer open meetings that allow staff to learn how their emotional state affects patient outcome. “Try to make the work environment as fun as possible. Nurses deal with somber, stressful situations daily — if you see a staff member in a bad mood, jump in and try to derail it before it becomes contagious,” he says.

According to Aiken, nurses who work in hospitals that meet the criteria for prestigious American Academy of Nursing magnet hospital status appear to be happier. “In these hospitals, nurses’ morale has improved. Even if the institution doesn’t attain magnet hospital status, just knowing their institution is watching patient-nurse ratios and offering more autonomy to nurses is enough to boost their morale,” she says.

Other helpful strategies include giving nurses more control in their jobs. “Nurses prefer a decentralized management structure, where more decisions are made on the unit,” says Aiken. Allowing nurses to make more bedside decisions can actually be more cost-effective, according to Aiken. “My basic position is clinicians know best how to invest resources to get the best possible patient outcomes. They work most efficiently in a decentralized structure.”

Looking at the big picture, managers often think their staffs need big rewards — pay increases, time off, and more career opportunities in order to be happy in their work. Weiss disagrees: “Managers should be focusing on the daily experiences of the nurse, making each day as positive as possible. In the end, everyone on the hospital unit benefits.”