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The following scenario, particularly given the current COVID surge, is all too common for nurse managers and supervisors:

A staff nurse has been more absent-minded and withdrawn recently. He’s an experienced nurse of 5 years and has always been personable, conscientious, and capable. However, the everyday stresses of working in a fast-paced, stressful environment with less staff and higher patient loads have started to affect his performance. In addition, several highly competent nurses have resigned after almost two years of pandemic care, and now many of our remaining nurses have less than a year or two of experience.

Nurse Burnout

Managing burnout is a high priority for all nurse managers. Stressful work environments combined with the high cognitive load create challenges for nursing staff that affect workflow and direct patient care.¹ Multiple studies have documented up to one-third of critical care nurses experiencing severe burnout syndrome and over 80% exhibiting at least one of the three classic symptoms (exhaustion, depersonalization, and reduced personal accomplishment).^2-7 Furthermore, critical care nurses exhibit higher rates of burnout compared to other nursing disciplines.⁸ Burnout negatively affects the caregiver, patient care, and the hospital environment. Studies indicate that burnout is correlated with staff turnover,⁹ which may increase healthcare cost¹⁰ and decrease productivity, unit morale, and overall quality of care.¹¹

Common Stressors

Of all the stressful situations experienced by ED & ICU nurses, perhaps the most physically and mentally demanding is the resuscitation of hypotensive or cardiac arrest patients. In an evaluation of most common stressors among critical care nurses, managing unstable patients was ranked as most and moderately stressful in 24.4% and 47.4%, respectively.¹² Early, rapid fluid resuscitation is foundational to the management of hypotensive, unstable patients. However, while many studies have evaluated the type, amount, and the expeditious use of fluids in the resuscitation of patients, little effort has been devoted to evaluating the impact of the method of fluid administration on stress. In a recent survey of nurses at the Emergency Nurses Association Annual Conference, nearly all nurses (52 of 53) agreed that a fluid bolus device that could reduce the complexity and stress in emergency situations would be very beneficial.

Reducing Mental Demand

In a simulated fluid resuscitation study at Yale New Haven, LifeFlow®, a novel device for fluid resuscitation, was compared to two traditional fluid resuscitation methods: push-pull and pressure bag. The study simulated a standardized crystalloid infusion to a 10 kg patient in decompensated shock through a 22-gauge catheter.¹³ Twenty-seven teams of providers were randomly assigned to one of the resuscitation methods and instructed to provide three 20 ml/kg fluid boluses to a simulated infant based on vital signs and history. The primary outcome of the study was mean rate of fluid administration, which was fastest with LifeFlow (65.3 ml/min), followed by push-pull (46.2 ml/min), and lastly by pressure bag (42.2 ml/min), p<0.001. Workload was evaluated using the composite National Aeronautical and Space Administration Task Load Index (NASA-TLX). This tool measures the mental, physical, and temporal demands, as well as performance, effort, and frustrations associated with the task. Across all domains, LifeFlow was perceived to have a lower workload, evidenced by numerically lower NASA-TLX score in all categories. The composite NASA-TLX score was also significantly lower compared to pressure bag. Similarly, significant differences were observed in mental demands in favor of LifeFlow versus the other two methods.

Effective Tools to Reduce Stress

Management of unstable emergent or critically ill patients is stressful at any time. COVID has amplified the stress 10-fold. Empowering nurses with easier-to-use, more effective tools may help reduce stress and burnout, which is a win for nurses, nurse managers, and most importantly, patients.

LifeFlow is an easy-to-use handheld infuser that delivers a unit of blood or 500mL of fluid in less than 2 minutes.  Schedule a virtual demo here.