The Effect of Burnout on Nurses’ Medication Errors

Topic: Nursing
Words: 2579 Pages: 9


Cases of medical errors have been occurring in recent years in patients’ medication in the healthcare systems of various nations. Several medical administration errors in healthcare facilities have different causes, among them the work fatigue that leads nurses to commit errors. The safety of patients and avoiding malfunctions and errors are among the vital goals of healthcare systems. Medication mistakes in nursing, especially from the deviance of doctors’ orders, have several sources, including errors in calculating, administering, and monitoring drugs.

Problem Statement

Nurses committing errors resulting from tension while administering medication and care to patients in the healthcare sector have increased. This study will evaluate how exhaustion among nurses leads them to make mistakes while rendering their services to the patients and come up with conclusions and recommendations that are important to the wellbeing of nurses. The examination will also discuss burnout’s effects and how nurses can prevent the incidence since it causes death among patients or permanent impairment.

Purpose and Significance of the Study

The study aims to investigate burnout among nurses in the healthcare department leads them to cause medication errors that end up causing the patients to develop permanent complications or even die. The study will discuss why nurses develop burnout, how these causes can be prevented, and establish conclusions and recommendations that are vital to nurses.

Research Questions

  1. What are the main reasons for burnout among nurses?
  2. What is the minimum number of responsibilities nurses must perform in a day?
  3. Who is responsible for assigning nurses roles of administering medication to patients?

Research Objectives

  1. To investigate the main causes of burnout among nurses in the healthcare department.
  2. To study the least number of tasks, nurses should be assigned daily while offering medication and care to patients in their respective duties.
  3. To understand individuals responsible for assigning nurses tasks in their respective duties.

Literature Review

Theoretical Literature

Medication inaccuracies are avoidable actions that may lead to or cause the wrong prescriptions, endangering patients’ lives in a healthcare facility. Researchers have established various theories to elucidate the effect of burnout and nurses’ medication errors (Dall’Ora et al., 2020). This study will use the Maslach Burnout Inventory and ‘Conservation of Resources’ (COR) theory to examine the connection between nurse burnout and medication administration mistakes.

Maslach Burnout Invention Theory

Maslach Burnout Invention theory (MBI) is the commonly used instrument to measure employee exhaustion. MBI captures three extents of burnout: personal achievement, depersonalization, and emotional collapse (Riethof & Bob, 2019). According to MBI, burnout results from excess work stress, which comprises emotionally weary moods and deficient expressive resources. Emotional exhaustion is caused by a negative and disconnected response to other individuals and a loss of optimism (Bakker & Sanz‐Vergel, 2020). Depersonalization is caused by a reduction in feelings of competency and work performance, while reduced personal achievement results from failure to positively evaluate an individual’s work, which lowers their self-esteem, hence poor professionalism (Yeh et al., 2021: Yuan & Xu, 2020). Burnout is a state that happens due to prolonged disparity between individuals and at least six scopes of work, including workload, reward, control, values, community, and fairness.

MBI proposes that a lack of employee control over the resources required to complete their tasks can drive them to burnout. Employers who do not motivate their employees lead them to experience work stresses since they feel unappreciated (Stehman et al., 2019). The scholar says that employees develop work-related stresses due to poor relations with their seniors and colleagues, resulting in frustrations and declining the likelihood of societal support (Farahat et al., 2021). According to the investigator, workplace fairness, including equity pay and workload, is a key factor in reducing employee burnout. Maslach emphasized the value aspect whereby he proposed that workers who are forced to work in an environment against their aspirations and values develop burnout-related issues in work (Stehman et al., 2019). These elements theorized by Maslach are the major causes of burnout among workers of an organization.

Conservation of Resources Model

The conservation of Resources model is a stress concept that defines the motivation behind preserving their present resources. The theory states that loss of the current resources leads people to specific stress levels (Hobfoll et al., 2018). This model covers two fundamental principles that involve safeguarding possessions from being lost. The first value is the Primary Resource Loss which states that it is dangerous for persons to lose resources than gain possessions, implying that a pay loss is more hurtful than a similar pay gain would have been useful (Coetzee & Laschinger, 2018). The second concept is Resource Investment, which upholds that individuals invest resources to defend against loss, heal from losses, and gain property (Singh et al., 2020). In coping, people capitalize on resources to evade future resources loss.

Insufficient resources constantly result in defensive efforts to individuals’ remaining possessions. COR assumes that people with many resources may be set up for advantages in resources. Correspondingly, personalities with minimal resources are probable to undergo resource loss in the future (Naseer et al., 2018). In addition, COR suggests that preliminary resource loss results in loss of resources in the future, while initial resource advantages lead to advantages in possessions. COR theory has been used in studying family or work stress, general stress, and burnout. In family and work stress, the theory’s studies have investigated how dispersing a person’s resources affects their lives (Zhu et al., 2017). COR research examines how resources impact mood and how emotional fatigue relates to depressive signs.

Empirical Literature

Common errors during medication administration in healthcare facilities result from minor mistakes conducted by nurses. SHoHani and Tavan (2018) conducted a study on factors impacting medication slipups from the viewpoint of nursing staff. The investigation was conducted in three domains. The findings were the most frequent factors leading to medication errors among nurses, including occupational fatigue, negligence, high patient-to-nurse ratio, and heavy workload inwards. The examiners concluded that based on the nursing domain, carelessness among individuals, work fatigue exhaustion, and inappropriate medication prescriptions were factors that mainly caused medication errors (SHoHani &Tavan, 2018). They recommended that adding more nursing staff in healthcare institutions can positively reduce work-related fatigue and negligence. Additionally, since heavy workloads and insufficient staffing were the major causes of medication errors, they proposed minimizing the factors by increasing the number of nurses in each shift.

Various medication blunders amongst nurses and medical professionals are linked to several causal agents. A study was conducted by Afshin et al. (2017) on Medication faults among nurses in teaching health facilities in West Iran to determine the causal agent of the mistakes. The sampling method was used to select participants in the examination. Afterward, a self-made questionnaire was used to collect the socio-demographic features data. Negative regression was applied in identifying the major determiners of the frequency of medication errors amongst nurses (Afshin et al., 2017). The research results showed that the major common mistakes were medical administration, giving patients medication at an inappropriate time, dosage errors, wrong-patient medication administration, and a heavy workload. They discovered that 45 percent of the nurses never reported medication faults. When nurses are assigned tasks beyond their ability, they develop fatigue, which drives them to commit medication faults.

The fear of being punished by the seniors in a workplace may lead to burnout in nurses, causing medication administration errors. An examination was conducted by Wilson et al. (2017) on quantifying burnout amongst medicine experts whereby the scientists performed a cross-sectional review among emergence medicine experts using a thirty-item standardized pilot testing questionnaire and the Maslach Burnout Inventory. One hundred and five professionals were interviewed, whereby 71.5 % were female and 51.4 % male medics. Prevalence of average to severe exhaustion in the three main components PA, DP, and EE, were 73.3 %, 71.4%, and 64.8%, respectively (Wilson et al., 2017). The extent of fatigue among nurses and doctors was averagely high in the three chief components. The prognosticators noted the fear of making mistakes, fear of seeing death, short-tempered character, and criticism as the main causes of medication blunders.

Medication faults amongst nurses can result from poor perceptions among nurses. Exploration was conducted by Salami et al. (2019) on medication administration mistakes and perceptions of nurses of Jordan. The valuation aimed to comprehend the Jordan nurses’ insights about medical administration faults. The investigation used a cross-sectional design with 470 nurses. According to the study results, the most errors in medication administration included wrong time and wrong patient, which contributed to 32,6% and 30.5 %, respectively (Salami et al., 2019). High workload during night shifts contributed to the medication administration faults among nurses in Jordan. The scholars concluded that night shifts were responsible for 42.9% of the medication administration errors. The researchers suggested that establishing quality assurance initiatives about medical administration would enhance patient safety.

The wellbeing of healthcare professionals may determine the possibility of the medical experts developing burnout, which leads to medication errors. A study was done by Hall et al. (2016) to determine the relationship between healthcare comfort, fatigue, and patient safety. The research used a systematic study review whereby quantitative empirical studies were used. The examination findings indicated a positive correlation between poor welfare and bad patient safety. Twenty-one of thirty studies that estimated burnout showed a significant relationship between fatigue and patient safety (Hall et al., 2016). The scholars concluded that poor security and high fatigue standards are linked to poor patient safety results like medical errors. Nevertheless, the lack of probable findings reduces the possibility of determining causality. Further research, studies in principal care piloted in the United Kingdom, and a precise description of healthcare workers’ safety are required.

Nurse fatigue is a prevalent phenomenon categorized by a reduction in nurses’ energy that expresses a lack of motivation, emotional tiredness, frustrations and feelings that result in reduced work efficacies among nurses. Burnout may occur due to work overload caused by insufficient resources, lack of justice and poor working environments (Maslach & Leiter, 2016; Assiri et al., 2018). Nurses have a crucial role in averting these errors by reporting them. Thus, standard protocols and knowledge are required for the safety of medication administration (Zarea et al., 2018; Bolandianbafgh et al., 2017). However, due to the fear of being victimized by their seniors, many nurses fear to report the medication administration errors that happen due to their carelessness that is often caused by work fatigue.

Even though researchers have conducted various researches relating to burnout issues among nurses, they have not yet concluded how the challenges are causing medication errors among patients. Thus, this study can be important to researchers in determining the major causes of nurse errors during medication administration (Ezenwaji et al., 2019; Basar, 2016; Nonnis et al., 2018). Additionally, the study results may be used by the global bodies concerned with healthcare, such as the World Health Organization, to make new guidelines and rules that can reduce the cases of nurse burnout mistakes (Fragoso et al., 2016; Mudallal et al., 2017; Kelly et al., 2019). Conversely, the outcomes of this assessment will be used nationally by healthcare practitioners to offer guidance and counseling to the affected nurses and educate them on how they should avoid burnout issues.

Workload factors nurses are subjected to may impact their appropriate administration of medicine to patients. Macphee et al. (2017) carried an investigation on the impact of many perceived nurse workloads on patient and nurse outcomes. Their study aimed to understand nurses’ workload needs at different levels, job units, and the kind of administrative measures required at particular workload needs. The scientists used cross-sectional research of 472 critical care professionals from Canada’s British Colombia. The labor load factors included nurse records of unit-level RN staffing levels and patient awareness and dependency, job-level nurse attitudes of many tasks, task-level disturbance workflow and nursing chores left compromised and undone. Workload results in nurses developing burnout, particularly in hospitals with a high patient-to-nurse ratio. Nurses are forced to accomplish many tasks under limited environments, leading to work fatigue, which results in medication blunders.

Patient results were nurse-recorded frequencies of medication faults, urinary tract infections, and patient falls, while nurse results were job satisfaction and emotional exhaustion. The investigation results showed that job-level attitudes of heavy assignments and task-level disturbances positively connect with patient and nurse outcomes (Macphee et al., 2017). The unfinished tasks intercede the link between nurse, patient results and heavy workloads. Compromised exert nursing levels mediated the association between nurse outcomes and loads; and nurse results and interruptions. MacPhee concluded that seniors in healthcare centers should collaborate with nurses to know environmental work strategies that better workload needs at different levels (Wei et al., 2020). Leaders in healthcare organizations have the core responsibility of ensuring their employees are well managed, and tasks are assigned equally to avoid burdening junior employees.

Corresponding with MacPhee’s conclusion, nurses with higher qualifications might feel that they do not deserve to be assigned too many tasks; instead, their counterparts with low qualifications deserve to perform most of the assignments. Such perceptions can make individuals with low qualifications feel unworthy, leading to burnout due to the many tasks they are left to accomplish (Chen & Chen, 2018; Hunt et al., 2019; Abellanoza et al., 2018). Extra workload makes nurses lose focus and concentration, causing unintended medication errors. Health organizations should ensure that workloads are equally shared among their nurses to end medication errors related to such incidents. Moreover, health institutions should instill the policy that no person is superior in the workplace for the smooth running of their operations.


Nurses’ burnout is a prevalent challenge that s common in the healthcare workplace. Nurse fatigue can be related to the theory of Maslach Burnout Invention, which is used as a tool for estimating employee exhaustion. This theory captures burnout to three extents: depersonalization, emotional collapse, and personal achievement. Maslach Burnout Invention stipulates that fatigue in employees is caused by work stress, which includes emotionally deprived moods and insufficient resources. Emotional exhaustion results from a lack of connectives with other employees in the workplace and loss of hope. Additionally, nurse burnout can be associated with the model of Conservation of Resources that pinpoints that when individuals lose their current resources, they stand on the verge of being stressed.

When employees of an organization are stressed, they may cause different errors considering the kind of tasks they are required to do. Apart from the Maslach Burnout Invention, the various empirical frameworks highlighted in this investigation indicate nurse burnout is among the several courses of medication administration errors that occur in various healthcare facilities globally. There is a strong relationship between nurses’ burnout and medical administration errors rendering to the studies conducted in the empirical literature. For instance, the study done by Afshin and his partners in 2017 on medication errors among the nurses in teaching hospitals in West Iran showed that workload among nurses results to work fatigue.

Effort tiredness leads to medical administration faults; from the empirical studies in this study, nurse workload is among the causal agents of nurses’ burnout that makes various health personnel commit medical administration errors. A general conclusion drawn from the empirical data in this research is that a larger number of medication administration errors among nurses is caused by work fatigue in many healthcare workers. For healthcare institutions to eradicate nurses’ burnout, they should recruit more staff to reduce workload in hospitals, clinics, teaching hospitals, and dispensaries. In addition, hospitals should develop quality assurance schemes to guarantee patient safety.


Abellanoza, A., Provenzano‐Hass, N., & Gatchel, R. J. (2018). Burnout in ER nurses: Review of the literature and interview themes. Journal of Applied Biobehavioral Research, 23(1), e12117.

Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101.

Bakker, A. B., & Sanz‐Vergel, A. I. (2020). Burnout. The Wiley Encyclopedia of Personality and Individual Differences: Clinical, Applied, and Cross‐Cultural Research, 411-415.

Basar, U., & Basim, N. (2016). A cross‐sectional survey on consequences of nurses’ burnout: moderating role of organizational politics. Journal of Advanced Nursing, 72(8), 1838-1850.

Bolandianbafghi, S., Salimi, T., Rassouli, M., Faraji, R., & Sarebanhassanabadi, M. (2017). Correlation between medication errors with job satisfaction and fatigue of nurses. Electronic physician, 9(8), 5142. DOI: 10.19082/5142

Chen, S. C., & Chen, C. F. (2018). Antecedents and consequences of nurses’ burnout: Leadership effectiveness and emotional intelligence as moderators. Management Decision

Coetzee, S. K., & Laschinger, H. K. (2018). Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review. Nursing & health sciences, 20(1), 4-15. DOI: 10.1111/nhs.12387

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18, 1-17.

Ezenwaji, I. O., Eseadi, C., Okide, C. C., Nwosu, N. C., Ugwoke, S. C., Ololo, K. O.,… & Oboegbulem, A. I. (2019). Work-related stress, burnout, and related socio-demographic factors among nurses: Implications for administrators, research, and policy. Medicine, 98(3).doi: 10.1097/MD.0000000000013889

Farahat, S. A., Amin, O. R., Hamdy, H. S., & Fouad, M. M. (2021). The impact of work-related stress on the cognition domain of executive functioning of health care workers during the COVID-19 pandemic. International Archives of Occupational and Environmental Health, 1-12. DOI: 10.1007/s00420-021-01814-8.

Fathi, A., Hajizadeh, M., Moradi, K., Zandian, H., Dezhkameh, M., Kazemzadeh, S., & Rezaei, S. (2017). Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiology and Health, 39. DOI: 10.4178/epih. e2017022

Fragoso, Z. L., Holcombe, K. J., McCluney, C. L., Fisher, G. G., McGonagle, A. K., & Friebe, S. J. (2016). Burnout and engagement: Relative importance of predictors and outcomes in two health care worker samples. Workplace Health & Safety, 64(10), 479-487.

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11(7), e0159015.

Hobfoll, S. E., Halbesleben, J., Neveu, J. P., & Westman, M. (2018). Conservation of resources in the organizational context: The reality of resources and their consequences. Annual Review of Organizational Psychology and Organizational Behavior, 5, 103-128.

Hunt, P. A., Denieffe, S., & Gooney, M. (2017). Burnout and its relationship to empathy in nursing: a review of the literature. Journal of Research in Nursing, 22(1-2), 7-22.

Jawaid, A. (2020). Protecting older adults during social distancing. Science, 368(6487), 145. DOI: 10.1126/science. abb7885

Kelly, L. A., Lefton, C., & Fischer, S. A. (2019). Nurse leader burnout, satisfaction, and work-life balance. JONA: The Journal of Nursing Administration, 49(9), 404-410. doi: 10.1097/NNA.0000000000000784

MacPhee, M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7.

Maslach, C., & Leiter, M. P. (2016). Burnout. In Stress: Concepts, Cognition, Emotion, and Behavior (pp. 351-357). Academic Press.

Mudallal, R. H., Othman, W. A. M., & Al Hassan, N. F. (2017). Nurses’ burnout: the influence of leader empowering behaviors, work conditions, and demographic traits. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 0046958017724944.

Naseer, S., Raja, U., Syed, F., & Bouckenooghe, D. (2018). Combined effects of workplace bullying and perceived organizational support on employee behaviors: does resource availability help? Anxiety, Stress, & Coping, 31(6), 654-668. DOI: 10.1080/10615806.2018.1521516.

Nonnis, M., Massidda, D., Cuccu, S., & Cortese, C. G. (2018). The impact of workaholism on nurses’ burnout and disillusion. The Open Psychology Journal, 11(1). doi: 10.2174/1874350101811010077

Rahman, M. S. (2020). The advantages and disadvantages of using qualitative and quantitative approaches and methods in language “testing and assessment” research: A literature review.

Riethof, N., & Bob, P. (2019). Burnout syndrome and logotherapy: logotherapy as a useful conceptual framework for explanation and prevention of burnout. Frontiers in Psychiatry, 10, 382.

Salami, I., Subih, M., Darwish, R., Al-Jbarat, M., Saleh, Z., Maharmeh, M.,… & Al-Amer, R. (2019). Medication administration errors: Perceptions of Jordanian nurses. Journal of nursing care quality, 34(2), E7-E12. DOI: 10.1097/NCQ.0000000000000340

SHoHani, M., & Tavan, H. (2018). Factors affecting medication errors from the perspective of nursing staff. J Clin Diagn Res, 12(3). DOI: 10.7860/JCDR/2018/28447.11336

Singh, B., Shaffer, M., & Selvarajan, T. T. R. (2020). Outcomes of organizational and community embeddedness: A conservation of resources perspective. Group & Organization Management, 1059601120963560.

Stehman, C. R., Testo, Z., Gershaw, R. S., & Kellogg, A. R. (2019). Burnout, drop out, suicide: physician loss in emergency medicine, part I. Western Journal of emergency medicine, 20(3), 485. DOI: 10.5811/westjem.2019.4.40970

Wee, L. E., Conceicao, E. P., Sim, X. Y. J., Aung, M. K., Tan, K. Y., Wong, H. M.,… & Venkatachalam, I. (2020). Minimizing intra-hospital transmission of COVID-19: the role of social distancing. Journal of Hospital Infection, 105(2), 113-115.

Wei, H., King, A., Jiang, Y., Sewell, K. A., & Lake, D. M. (2020). The Impact of Nurse Leadership Styles on Nurse Burnout:: A Systematic Literature Review. Nurse Leader, 18(5), 439-450.

Wilson, W., Raj, J. P., Narayan, G., Ghiya, M., Murty, S., & Joseph, B. (2017). Quantifying burnout among emergency medicine professionals. Journal of Emergencies, Trauma, and Shock, 10(4), 199. DOI: 10.4103/JETS.JETS_36_17

Yeh, T. F., Chang, Y. C., Hsu, Y. H., Huang, L. L., & Yang, C. C. (2021). Causes of nursing staff burnout: Exploring the effects of emotional exhaustion, work-family conflict, and supervisor support. Japan journal of nursing science, 18(2), e12392.

Yuan, C. M., & Xu, C. Y. (2020). Concept analysis of nurse burnout. Frontiers of Nursing, 7(3), 227-233. DOI: 10.2478/FON-2020-0034

Zarea, K., Mohammadi, A., Beiranvand, S., Hassani, F., & Baraz, S. (2018). Iranian nurses’ medication errors: A survey of the types, the causes, and the related factors. International Journal of Africa nursing sciences, 8, 112-116.

Zhu, H., Lyu, Y., Deng, X., & Ye, Y. (2017). Workplace ostracism and proactive customer service performance: A conservation of resources perspective. International Journal of Hospitality Management, 64, 62-72.

The ADDIE Model: Instruction Design and Frameworks
Vagueness, Ambiguity, and Generality in Nursing