Change fatigue in nursing: An integrative review

Abstract

Aims To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. Background Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing. Design Integrative review following Toronto and Remington and Whittemore and Knafl methodology. Data Sources Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022. Review Methods A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed. Results Twenty‐six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue. Conclusion This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives. Impact Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management. Patient or Public Contribution This project was an integrative review of the literature therefore no patient or public contribution was necessary.

Experiences of Burnout among Health Systems’ Employees: A Mixed-Methods Study

“…Volatility increased stress and burnout, especially in leadership. Health systems who show poor change management by not communicating well with employees or being transparent may have contributed to employees' burnout (Beaulieu et al, 2023;Gwon et al, 2023;Sengul et al, 2021). Interviewees may have been afflicted with "change fatigue", in which employees feel exhausted, stressed, and burned out from frequent change (Brown et al, 2018).…”

Practice and process improvement: An integrated evidence‐based quality model

“…The decreased experience and bandwidth of the current healthcare workforce leave no buffer to readily adapt to change, especially when changes are constant, opinion-based, and ineffective. This cycle leads to change fatigue, which is the primary cause of exhaustion, burnout, and the "great resignation" (Beaulieu et al, 2023;McMillan & Perron, 2020).…”

Development, validation, and accuracy of ORCHESTRA emotional exhaustion screening questionnaire among healthcare workers during COVID‐19 Pandemic

“…Apart from being the backbone of the global effort to overcome the COVID‐19 pandemic, the prolonged struggles exposed the healthcare worker to burnout, change fatigue, and compassion fatigue (Beaulieu et al., 2022; Camilleri et al., 2019; Leo et al., 2021; Nishihara et al., 2022; Oţelea et al., 2022; Sexton et al., 2022; Stefanatou et al., 2022; Ulfa et al., 2022). Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal efficacy (Edú‐valsania et al., 2022; Maslach & Jackson, 1981).…”

“…Change fatigue is positively associated with emotional exhaustion (Bernerth et al., 2011). Therefore, emotional exhaustion items can also be seen in the questionnaire measuring change fatigue observed among healthcare workers (Beaulieu et al., 2022; Camilleri et al., 2019; Cavanagh et al., 2019; Gustafsson & Hemberg, 2022; Thapa et al., 2021) in different circumstances of psychological strain, especially after Covid‐19 pandemic.…”

“…Moreover, there is an overlap between the emotional exhaustion construct and the above‐mentioned constructs for the work‐related psychological effects of a public health crisis in healthcare workers (Beaulieu et al., 2022; Camilleri et al., 2019; Cavanagh et al., 2019; Gustafsson & Hemberg, 2022; Thapa et al., 2021; Werner et al., 2022). Public health crisis caused by the COVID‐19 pandemic was characterized by rapid changes in the organizational design and procedures, with most of the guidelines for practice defined as “interim”, with repeated exposure to others' suffering and fear of COVID‐19 impact on the personal and family level.…”