Burnout has become a critical issue within nursing, particularly in specialties prone to emotional exhaustion such as oncology and end-of life-care. Models of oncology care are shifting to include palliative care, including primary palliative care, which emphasizes the role nurses have in supporting the physical, emotional, communication, and coordination needs of patients with advanced cancer. Rather than relying on palliative care delivered by specialists, primary palliative care is delivered by patients’ regular oncology team, including their oncology nurses. Advocates suggest that if oncology nurses are trained in palliative care, they may be protected against the emotional and structural causes of burnout and therefore be more likely to remain physically and emotionally healthy and satisfied in their work.
A team of researchers recently led a study to analyze if training oncology nurses to provide primary palliative care in addition to standard oncology nursing care would decrease their levels of burnout. Jessica Cohen, MD, the lead author, recently published the study results in the Clinical Journal of Oncology Nursing. The parent study, Care Management by Oncology Nurses to Address Supportive Care Needs (CONNECT), randomized seventeen oncology practices to implement primary palliative care in addition to standard oncology care or to provide standard oncology care alone.
Leaders at the oncology practices randomized to the CONNECT intervention selected infusion room oncology nurses (n = 21) to be trained in primary palliative care. These nurses received a three-day intensive training in primary palliative care, including symptom assessment and management, emotional support, engagement in advance care planning, and care coordination. Booster sessions were also provided biannually. These trained nurses were scheduled to have primary palliative care visits with patients before or after the patient’s regular oncology visits at least monthly for three months.
The 21 nurses trained in primary palliative care were compared to other (non-trained) nurses at the same oncology practice (n = 27) and nurses at oncology practices not implementing primary palliative care (n = 41). Nurses were about 46 years old, 99% female, had been working in oncology for an average of 13 years, and 88% worked full time.
At baseline, oncology nurses reported low to moderate levels of burnout using the Maslach Burnout Inventory. Specifically, they reported moderate emotional exhaustion, low depersonalization (e.g., negative feelings about work or feeling distant about their job), and high personal accomplishment at their job.
One year later, nurses did not report significant decreases in burnout. Nurses trained in primary palliative care did not report greater decreases in burnout compared to the other two groups. While nurses trained in primary palliative care reported lower emotional exhaustion than nurses in the same practice who were not trained in primary palliative care, those differences were not statistically significant. But the non-trained nurses at primary palliative care practices reported statistically higher emotional exhaustion compared to nurses at non-primary palliative care practices. Depersonalization remained low and personal accomplishment remained high across all three groups of nurses.
The researchers conclude the training in primary palliative care did not impact oncology nurses’ burnout levels. Nurses reported low burnout at the beginning of the intervention, and it mostly remained low for a year. Unlike their hypothesis, special training in communication and support for patients with advanced cancer did not act as a protective factor against burnout.
The researchers considered that the benefits of primary palliative care training may have been offset by the additional workload required of nurses providing both standard oncology care and primary palliative care. Infusion room nurses have an intensive, time-constrained workload and adding additional duties – even when valuable and impactful – can cause nurses additional stress that contributes to burnout. Additionally, the nurses who were not trained in palliative care likely had to take on additional tasks to make up for the work missed by nurses providing primary palliative care, possibly resulting in their relatively higher levels of burnout. More research is needed to ensure models of primary palliative care consider nurses’ workload and job satisfaction.
Oncology nurses are increasingly being asked to take on additional responsibilities, and this contributes to high levels of burnout, job dissatisfaction, and high turnover rates. While nurses have led and supported guidelines by the American Society of Clinical Oncology for providing early, integrated palliative care within the oncology setting, these models must be implemented in ways that promote nurses’ health and limits their stress and burnout.
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