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[Comment on the article 2020 Eagles schedule: Picking wins and losses for all 16 games]. The Philadelphia Inquirer . https://rb.gy/iduabz If the author of the comment does not provide a real name, use the username without brackets. Simon. (2019, August 28). I've never read him, maybe I should? [Comment on the blog post H. P. Lovecraft. What am I doing wrong?]. Reader Witch . https://readerwitch.com/2019/08/26/lovecraft/ 18. WEBPAGE Author's Last Name, Initials. (Year, Month Day). Title of work . |
Title of Site. URL Pleasant, B. (n.d.). Annual bluegrass . The National Gardening Association. https://garden.org/learn/articles/view/2936/ If the author and the website name are the same, use the website name as the author. If the content of the webpage is likely to change and no archived version exists, use n.d. as the date and include a retrieval date. Centers for Disease Control and Prevention. (2019, December 2). When and how to wash your hands . |
https://www.cdc.gov/handwashing/when-how-handwashing.html Worldometer. (n.d.). World population . Retrieved February 2, 2020, from https://www.worldometers.info/world-population/ Documentation Map (APA) Webpage Lazette, M. P. (2015, February 24). A hurricane's hit to households . Federal Reserve Bank of Cleveland. https://www.clevelandfed.org/en/newsroom-and-events/publications/forefront /ff-v6n01/ff-20150224-v6n0107-a-hurricanes-hit-to -households.aspx Books, parts of books, and reports 19. |
BASIC ENTRY FOR A BOOK Author's Last Name, Initials. (Year of publication). Title. Publisher. DOI or URL PRINT BOOK Penny, L. (2008). A rule against murder . Minotaur Books. EBOOK Jemisin, N. K. (2017). The stone sky . Orbit. https://amzn.com/B01N7EQOFA AUDIOBOOK Obama, M. (2018). Becoming (M. Obama, Narr.) [Audiobook]. Random House Audio. http://amzn.com/B07B3JQZCL Include the word Audiobook in brackets and the name of the narrator only if you've mentioned the format and the narrator in what you've written. |
20. EDITION OTHER THAN THE FIRST Author's Last Name, Initials. (Year). Title (Name or number ed.). Publisher. DOI or URL Rowling, J. K. (2015). Harry Potter and the sorcerer's stone (Illustrated ed.). Arthur A. Levine Books. Burch, D. (2008). Emergency navigation: Find your position and shape your course at sea even if your instruments fail (2nd ed.). International Marine/McGraw-Hill. Documentation Map (APA) Book Stiglitz, J. E. (2015). The great divide: Unequal societies and what we can do about them. |
W. W. Norton. 21. EDITED COLLECTION OR ANTHOLOGY Editor's Last Name, Initials (Ed.). (Year). Title (Name or number ed., Vol. number). Publisher. DOI or URL Gilbert, S. M., &Gubar, S. (Eds.). (2003). The Norton anthology of literature by women: The traditions in English (3rd ed., Vol. 2). W. W. Norton. 22. WORK IN AN EDITED COLLECTION OR ANTHOLOGY Author's Last Name, Initials. (Year of edited edition). Title of work. In Editor's Initials Last Name (Ed. ), Title of collection (Name or number ed., Vol. |
number, pp. pages). Publisher. DOI or URL (Original work published Year) Choi, Y. (2018). The art of losing. In H. Pitlor &R. Gay (Eds. ), The best American short stories 2018 (pp. 38-61). Houghton Mifflin. (Original work published 2017) Baldwin, J. (2018). Notes of a native son. In M. Puchner, S. Akbari, W. Denecke, B. Fuchs, C. Levine, P. Lewis, &E. Wilson (Eds. ), The Norton anthology of world literature (4th ed., Vol. F, pp. 728-743). W. W. Norton. (Original work published 1955) 23. |
CHAPTER IN AN EDITED BOOK Author's Last Name, Initials. (Year). Title of chapter. In Editor's Initials Last Name (Ed. ), Title of book (pp. pages). Publisher. DOI or URL Amarnick, S. (2009). Trollope at fuller length: Lord Silverbridge and the manuscript of The duke's children . In M. Markwick, D. Denenholz Morse, &R. Gagnier (Eds. ), The politics of gender in Anthony Trollope's novels: New readings for the twenty-first century (pp. 193-206). Routledge. 24. |
ENTRY IN A REFERENCE WORK If the entry has no author, use the name of the publisher as the author. If the reference work has an editor, include their name after the title of the entry. If the entry is archived or is not likely to change, use the publication date and do not include a retrieval date. Author's Last Name, Initials. (Year). Title of entry. In Editor's Initials Last Name (Ed. ), Title of reference work (Name or number ed., Vol. number, pp. pages). Publisher. URL Merriam-Webster. (n.d.). Epoxy. |
In Merriam-Webster.com dictionary . Retrieved January 29, 2020, from https://www.merriam-webster.com/dictionary/epoxy 25. BOOK IN A LANGUAGE OTHER THAN ENGLISH Author's Last Name, Initials. (Year). Title of book [English translation of title]. Publisher. DOI or URL Ferrante, E. (2011). L ' amica geniale [My brilliant friend]. Edizione E/O. 26. ONE VOLUME OF A MULTIVOLUME WORK Author's Last Name, Initials. (Year). Title of entire work (Vol. number). Publisher. DOI or URL Spiegelman, A. (1986). Maus (Vol. 1). |
Random House. If the volume has a separate title, include the volume number and title in italics after the main title. 27. RELIGIOUS WORK If the date of the original publication is known, include it at the end. Title . (Year of publication). Publisher. URL (Original work published Year) New American Bible . (2002). United States Conference of Catholic Bishops. http://www.vatican.va/archive/ENG0839/_INDEX.HTM (Original work published 1970) 28. |
REPORT BY AN ORGANIZATION OR GOVERNMENT AGENCY Author's Last Name, Initials. (Year). Title (Report No. if there is one). Publisher. DOI or URL Centers for Disease Control and Prevention. (2009). Fourth national report on human exposure to environmental chemicals . US Department of Health and Human Services. https://www.cdc.gov/exposurereport/pdf/fourthreport.pdf Include the year, month, and day if the report you're documenting includes that information. |
If more than one government department is listed as the publisher, list the most specific department as the author and the larger department as the publisher. 29. DISSERTATION Author's Last Name, Initials. (Year). Title (Publication No. if there is one) [Doctoral dissertation, Name of School]. Database or Archive Name. URL Martin-Brualla, R. (2016). Exploring the world's visual history [Doctoral dissertation, University of Washington]. ResearchWorks. |
https://digital.lib.washington.edu/researchworks/handle/1773/37075 If the dissertation is in a database, do not include a URL. Solomon, M. (2016). Social media and self-examination: The examination of social media use on identity, social comparison, and self-esteem in young female adults (Publication No. 10188962) [Doctoral dissertation, William James College]. ProQuest Dissertations &Theses Global. 30. PAPER OR POSTER PRESENTED AT A CONFERENCE Presenter's Last Name, Initials. |
(Year, Month First Day-Last Day). Title [Paper or Poster presentation]. Name of Conference, City, State, Country. URL Dolatian, H., &Heinz, J. (2018, May 25-27). Reduplication and finite-state technology [Paper presentation]. The 53rd Annual Meeting of the Chicago Linguistic Society, Chicago, United States. |
http://chicagolinguisticsociety.org/public/CLS53_Booklet.pdf Audio, visual, and other sources If you are citing an entire website, do not include it in your reference list; simply mention the website's name in the body of your paper and include the URL in parentheses. Email, personal communication, or other unarchived discussions also do not need to be included in your list of references. 31. |
WIKIPEDIA ENTRY Wikipedia archives its pages so give the date when you accessed the page and the URL of the version you're citing. Title of entry. (Year, Month Day). In Wikipedia . URL List of sheep breeds. (2019, September 9). In Wikipedia . https://en.wikipedia.org/w/index.php?title=List_of_sheep_breeds &oldid=914884262 32. ONLINE FORUM POST Author's Last Name, Initials [username]. (Year, Month Day). Content of the post up to 20 words [Online forum post]. Name of Site. URL Hanzus, D. [DanHanzus]. |
(2019, October 23). GETCHA DAN HANZUS. ASK ME ANYTHING! [Online forum post]. Reddit. https://bit.ly/38WgmSF 33. BLOG POST Author's Last Name, Initials [username]. (Year, Month Day). Title of post. Name of Blog. URL gcrepps. (2017, March 28). Shania Sanders. Women@NASA . https://blogs.nasa.gov/womenatnasa/2017/03/28/shania-sanders/ If only the username is known, use it without brackets. 34. ONLINE STREAMING VIDEO Uploader's Last Name, Initials [username]. (Year, Month Day). Title [Video]. |
Name of Video Platform. URL CinemaSins. (2014, August 21). Everything wrong with National Treasure in 13 minutes or less [Video]. YouTube. https://www.youtube.com/watch?v=1ul-_ZWvXTs Whoever uploaded the video is considered the author, even if someone else created the content. If only a username is known, use it without brackets. 35. PODCAST Host's Last Name, Initials (Host). (First Year-Last Year). Podcast name [Audio podcast]. Production Company. URL Poor, N., Woods, E., &Thomas, R. (Hosts). |
(2017-present). Ear hustle [Audio podcast). PRX. https://www.earhustlesq.com/ 36. PODCAST EPISODE Host's Last Name, Initials (Host). (Year, Month Day). Episode title (No. episode number if any) [Audio podcast episode]. In Podcast name . Production Company. URL Tamposi, E., &Samocki, E. (Hosts). (2020, January 8). The year of the broads [Audio podcast episode]. In The broadcast podcast . Podcast One. https://podcastone.com/episode/the-year-of-the-broads 37. FILM Director's Last Name, Initials (Director). |
(Year). Title [Film]. Production Company. URL Cuarn, A. (Director). (2016). Harry Potter and the prisoner of Azkaban [Film; two-disc special ed. on DVD]. Warner Brothers. Jenkins, B. (Director). (2016). Moonlight [Film]. A24; Plan B; PASTEL. Indicate how you watched the film only if the format is relevant to what you've written. 38. TELEVISION SERIES Executive Producer's Last Name, Initials (Executive Producer). (First Year-Last Year). Title of series [TV series]. Production Company. |
URL Iungerich, L., Gonzalez, E., &Haft, J. (Executive Producers). (2018-present). On my block [TV series]. Crazy Cat Lady Productions. Indicate how you watched the TV series (2-disc DVD set, for example) only if the format is relevant to what you've written. 39. TELEVISION SERIES EPISODE Last Name, Initials (Writer), &Last Name, Initials (Director). (Year, Month Day). Title of episode (Season number, Episode number) [TV series episode]. In Initials Last Name (Executive Producer), Title of series . |
Production Company. URL Siegal, J. (Writer), Morgan, D. (Writer), &Sackett, M. (Director). (2018, December 6). Janet(s) (Season 3, Episode 10) [TV series episode]. In M. Schur, D. Miner, M. Sackett, &D. Goddard (Executive Producers), The good place . Fremulon; 3 Arts Entertainment; Universal Television. 40. MUSIC ALBUM Artist's Last Name, Initials. (Year). Title of album [Album]. Label. Lennox, A. (1995). Medusa [Album]. Arista. 41. SONG Artist's Last Name, Initials. (Year). Name of song [Song]. |
On Title of album . Label. Giddens, R. (2015). Shake sugaree [Song]. On Tomorrow is my turn . Nonesuch. 42. POWERPOINT SLIDES Author's Last Name, Initials. (Year, Month Day). Title of presentation [PowerPoint slides]. Publisher. URL Pavliscak, P. (2016, February 21). Finding our happy place in the internet of things [PowerPoint slides]. Slideshare. https://bit.ly/3aOcfs7 43. RECORDING OF A SPEECH OR WEBINAR Author's Last Name, Initials. (Year, Month Day). Title [Speech audio recording or Webinar]. Publisher. |
URL Kennedy, J. F. (1961, January 20). Inaugural address [Speech audio recording]. American Rhetoric. https://bit.ly/339Gc3e Rodrigo, S. (2020, March 19). Keep calm (and compassionate) &move everything online [Webinar]. W. W. Norton. https://seagull.wwnorton.com/CompositionTeachingOnline 44. MAP Mapmaker's Last Name, Initials. (Year). Title of map [Map]. Publisher. URL Daniels, M. (2018). Human terrain: Visualizing the world's population, in 3D [Map]. The Pudding. https://pudding.cool/2018/10/city_3d/ 45. |
SOCIAL MEDIA POSTS If only the username or organization is known, provide it without brackets. List any attachments (e.g., videos, images, or links) in brackets. Replicate any emoji or include a bracketed description. Do not change spelling or capitalization in a social media reference, even if it looks wrong. Author's Last Name, Initials [@username]. (Year, Month Day). Content of post up to 20 words [Description of any attachments] [Type of post]. Platform. URL TWEET Baron, D. [@DrGrammar]. |
(2019, November 11). Gender conceal: Did you know that pronouns can also hide someone's gender? [Thumbnail with link attached] [Tweet]. Twitter. https://bit.ly/2vaCcDc INSTAGRAM PHOTOGRAPH OR VIDEO Jamil, J. [@jameelajamilofficial]. (2018, July 18). Happy Birthday to our leader. I steal all my acting faces from you . @kristenanniebell [Face with smile and sunglasses emoji] [Photograph]. Instagram. https://www.instagram.com/p/BlYX5F9FuGL/ FACEBOOK POST Black Lives Matter. (2015, October 23). Rise and grind! |
Did you sign this petition yet? We now have a sign on for ORGANIZATIONS to lend their [Image attached]. Facebook. www.facebook.com/BlackLivesMatter/photos/a.294807204023865.1073741829.180212755483 311/504711973033386/?type=3 &theater 46. DATA SET Author's Last Name, Initials. (Year). Title of data set (Version number if there is one) [Data set]. Publisher. DOI or URL Pew Research Center. (2019). Core trends survey [Data set]. |
https://www.pewresearch.org/internet/dataset/core-trends-survey/ If the publisher is the author, no need to list it twice. 47. SUPREME COURT CASE Name of Case, volume US pages (year). URL Plessy v. Ferguson, 163 US 537 (1896). https://www.oyez.org/cases/1850-1900/163us537 Obergefell v. Hodges, 576 US ___ (2015). https://www.oyez.org/cases/2014/14-556 The source for most Supreme Court cases is United States Reports, which is abbreviated US in the reference list entry. |
If the case does not yet have a page number, use three underscores instead. Sources not covered by APA To document a source for which APA does not provide guidelines, look at models similar to the source you have cited. Give any information readers will need in order to find the source themselves-author; date of publication; title; and information about the source itself (including who published it; volume, issue, and page numbers; and a DOI or URL). |
You might want to check your reference note to be sure it will lead others to your source. Formatting a research essay Title page . APA generally requires a title page. The page number should go in the upper right-hand corner. Center the full title of the paper in bold in the top half of the page. Center your name, the name of your department and school, the course number and name, the instructor's name, and the due date on separate lines below the title. Leave one line between the title and your name. |
Page numbers . Place the page number in the upper right-hand corner. Number pages consecutively throughout. Fonts, spacing, margins, and indents . Use a legible font that will be accessible to everyone, either a serif font (such as Times New Roman or Bookman) or a sans serif font (such as Calibri or Verdana). Use a sans serif font within figure images. |
Double-space the entire paper, including any notes and your list of references; the only exception is footnotes at the bottom of a page, which should be single-spaced, and tables and images, where the spacing will vary. Leave one-inch margins at the top, bottom, and sides of your text; do not justify the text. The first line of each paragraph should be indented one-half inch (or five to seven spaces) from the left margin. APA recommends using one space after end-of-sentence punctuation. Headings . |
Though they are not required in APA style, headings can help readers follow your text. The first level of heading should be bold and centered; the second level should be bold and flush with the left margin; the third level should be bold, italicized, and flush left. Capitalize the first word and all other important words; do not capitalize a, an, the , or PREPOSITIONS . First Level Heading Second Level Heading Third Level Heading. Abstract . |
An abstract is a concise summary of your paper that introduces readers to your topic and main points. Most scholarly journals require an abstract; an abstract is not typically required for student papers, so check your instructor's preference. Put your abstract on the second page, with the word Abstract centered and in bold at the top. Unless your instructor specifies a length, limit your abstract to 250 words or fewer. Long quotations . |
Indent quotations of forty or more words one-half inch (or five to seven spaces) from the left margin. Do not use quotation marks, and place the page number(s) or documentation information in parentheses after the end punctuation. If there are paragraphs in the quotation, indent the first line of each paragraph another one-half inch. |
Kaplan (2000) captured ancient and contemporary Antioch: At the height of its glory in the Roman-Byzantine age, when it had an amphitheater, public baths, aqueducts, and sewage pipes, half a million people lived in Antioch. Today the population is only 125,000. With sour relations between Turkey and Syria, and unstable politics throughout the Middle East, Antioch is now a backwater-seedy and tumbledown, with relatively few tourists. |
(p. 123) Antioch's decline serves as a reminder that the fortunes of cities can change drastically over time. List of references . Start your list on a new page after the text but before any endnotes. Title the page References , centered and in bold, and double-space the entire list. Each entry should begin at the left margin, and subsequent lines should be indented one-half inch (or five to seven spaces). Alphabetize the list by authors' last names (or by editors' names, if appropriate). |
Alphabetize works that have no author or editor by title, disregarding a , an , and the . Be sure every source listed is cited in the text; do not include sources that you consulted but did not cite. Tables and figures . Above each table or figure (charts, diagrams, graphs, photos, and so on), write Table or Figure and a number, flush left and in bold (e.g., Table 1 ). On the following line, give a descriptive title, flush left and italicized. |
Below the table or figure, include a note with any necessary explanation and source information. Number tables and figures separately, and be sure to discuss them in your text so that readers know how they relate. Table 1 Hours of Instruction Delivered per Week American classrooms Japanese classrooms Chinese classrooms First grade Language arts 10.5 8.7 10.4 Mathematics 2.7 5.8 4.0 Fifth grade Language arts 7.9 8.0 11.1 Mathematics 3.4 7.8 11.7 Note. |
Adapted from Peeking Out from Under the Blinders: Some Factors We Shouldn't Forget in Studying Writing , by J. R. Hayes, 1991, National Center for the Study of Writing and Literacy (https://archive.nwp.org/cs/public/print/resource/720 ). Glossary PARAPHRASE, 284-85, 290-92 To reword a text in about the same number of words but without using the word order or sentence structure of the original. |
Paraphrasing is generally called for when you want to include the details of a passage but do not need to QUOTE it word for word. Paraphrasing a source in academic writing requires DOCUMENTATION . See also PATCHWRITING SUMMARIZE To use your own words and sentence structure to condense someone else's text into a version that gives the main ideas of the original. In academic writing, summarizing requires DOCUMENTATION . |
See PATCHWRITING QUOTE, 285-90 To cite someone else's words exactly as they were said or written. Quotation is most effective when the wording is worth repeating or makes a point so well that no rewording will do it justice or when you want to cite someone's exact words. Quotations in academic writing need to be acknowledged with DOCUMENTATION . SIGNAL PHRASES, 293-94 Words used to attribute QUOTED , SUMMARIZED , or PARAPHRASED material to a source, as in according to X or Z claims . |
DOI A digital object identifier, a stable number identifying the location of a source accessed through a database. PREPOSITION A word or group of words that tells about the relationship of a NOUN or a PRONOUN to another word in the sentence. Some common prepositions are after, at, before, behind, between, by, for, from, in, of, on, to, under, until, with , and without . PROPER NOUN A NOUN that names a specific person, place, or thing ( Steph Curry, Brazil, Google ). |
Student research essay, APA style Eli Vale is a student at Texas A &M University, San Antonio, where he is majoring in kinesiology. He wrote this essay for his Composition 2 course, one in which students spent the entire semester researching and writing about a topic of their choice. |
Vale wrote about the challenges that nurses in San Antonio face-and he then revised the essay for this book in order to address how a situation that did not exist when he first wrote it affected those nurses: the coronavirus pandemic. In addition to being a full-time student, Vale works as a rehab aide at a hospital in San Antonio, so his essay is based in part on his own firsthand observations and interviews. Student Research Essay, APA Style Page number appears in upper right corner. |
1 The Causes of Burnout in San Antonio Nurses- And Some Possible Solutions Name is centered below the title, with 1 double-spaced line in between. Eli Nicholas Vale Department of Language, Literature, and Arts Texas A &M University, San Antonio English 1302: Composition 2 Professor Sarah Dwyer May 22, 2020 Abstract begins a new page. Heading is bold and centered. Abstract text does not need a paragraph indent. |
2 Abstract The COVID-19 pandemic has led to widespread recognition of the heroic actions that nurses take every day. It has also shed light on the many stressors that nurses face even under the best circumstances-stressors that can lead to burnout. Nurses experience burnout due to problematic nurse-to-patient ratios, intense physical and mental demands, and a lack of necessary breaks. This paper explores these causes of burnout in nurses and suggests solutions based on leading research in the field. |
The demands of caring for many patients at one time affects the physical and emotional health of nurses, long shifts with few breaks even to sit and eat can cause other physical strain including musculoskeletal disorders, and the nature of the medical field can leave nurses in complicated and stressful legal situations without clear legal protection. Burnout can appear as exhaustion, depersonalization, and frequent illness. |
Once burnout is recognized and acknowledged, a crucial first step, hospitals can start to consider solutions. These solutions include mandatory breaks from work, better staffing regulation, discounted therapy, and an increase in physical and legal protection. A damaged healthcare system has created the burnout experienced routinely by nurses, which is harmful to the nurses themselves and to their patients, and contributes to high turnover rates. |
Implementing solutions to nurse burnout is key in providing the best possible care for both patients and hospital employees. 3 The Causes of Burnout in San Antonio Nurses- And Some Possible Solutions Hospitals today are facing challenges never seen prior to the COVID-19 outbreak. Of all medical personnel, nurses are at the forefront of the battle against this virus. Consider the experiences, for example, of one nurse working in the coronavirus unit at Methodist Hospital in San Antonio, Texas. |
Here's how this nurse (who wished to remain anonymous and will be referred to as Nurse A) described her work with COVID-19 patients: As a COVID nurse, you become everything the patient could possibly need. You are the phlebotomist, physical therapist, respiratory therapist, patient care tech, and housekeeper. But most importantly, you become their family in this time of need (personal communication, May 12, 2020) . |
This is because family members are not allowed to visit loved ones who are in isolation, even if they are dying; as a result, a nurse is their last comforter, holding their hand as they pass away. Such experiences take a large emotional toll on COVID nurses. In fact, Nurse A (personal communication, May 12, 2020) said that the mental stress is greater than the physical stress. |
Even the process of gowning up and making sure all personal protective equipment (PPE) is clean and worn securely can be nerve wracking. Changing out of her clothes and then putting on the gown, mask, face shield, and gloves takes time and mental energy, even before she enters the patient's room. And when she leaves the room, she has to make sure all PPE are taken off in a way that does not contaminate other surfaces. And then she must repeat this process each time she enters and exits a patient's room. |
Because of the increased responsibilities and stressful conditions, however, Nurse A (personal communication, May 12, 2020) reported that the nurses in her unit are being treated better than they were before the pandemic. COVID nurses have meals provided throughout the day and have ready access to bathrooms, both hard to come by in regular shifts. |
She pointed out that it took a global pandemic to recognize the need for safer nurse-to-patient ratios, lunch breaks, and bathroom breaks-and to finally recognize the heroic work being done by nurses, work they have always done every single day. 4 1 margins on all sides. |
These improved conditions have diminished since the virus surged, and in later communication Nurse A (personal communication, August 4, 2020) said the situation in the COVID unit was vastly different than it had been prior to the surge, with nurses responsible for as many as five patients at a time. A single nurse caring for so many patients in serious condition creates a dangerous amount of stress. However, stress is something these nurses are familiar with: they have dealt with exhaustion for a long time. |
In fact, while nurses are finally being recognized as heroes during this pandemic, they have always played an essential though often unappreciated role in the Bexar County healthcare system. According to the Texas Board of Nursing (2018) , there are 11,161 registered nurses employed at inpatient and outpatient facilities in Bexar County. Nurses who work in hospital settings are likely to deal with many more daily stressors than nurses at other facilities. |
Many of these nurses are employed at some of the most well-known healthcare systems in San Antonio, including Methodist Hospital, Baptist Medical Center, University Hospital, and Christus Santa Rosa Medical Center (Hernandez, 2018). Unfortunately, in spite of some improvements like those described by Nurse A, the working conditions at these well-known hospitals continue to undermine their nurses' ability to provide optimal care to patients. |
5 In San Antonio, a damaged healthcare system has created an epidemic of dangerous nursing conditions. In many cases, the ratio of nurses to patients is problematic, and nurses have to take on more patients than they should. This can affect patient care, and the demands of caring for too many patients at one time can also impact nurses' own physical, emotional, and mental health. Together, these conditions put nurses at risk of experiencing burnout. |
Signs of such burnout include exhaustion, a lack of interest in personal interaction with others, and frequent illness (Nursing.org, n.d.). In sum, problematic nurse-to-patient ratios, intense physical demands, insufficient breaks, and mental health issues create dangerous stress, which can lead to burnout. The city of San Antonio needs to recognize these issues and come up with solutions to prevent them. |
Potential solutions include a permanently lowered nurse-to-patient ratio, mandatory lunch breaks, increased security, and discounted physical and mental health therapy for nurses. For a closer look at how damaging such burnout can be, Nursing.org (n.d.) provided a succinct description of its signs and symptoms: Nurse burnout is caused by many different work-related issues. |
Nurses deal with death on a regular basis, and the emotional strain of losing patients and assisting grieving family members may become overwhelming. In addition, long shifts of 12 or more hours often lead to exhaustion and stress. (Causes of Nursing Burnout) Nursing.org (n.d.) went on to suggest the need to recognize those symptoms: The most important thing is to recognize symptoms as early as possible before they become overwhelming. |
No matter how minute warning signs may seem at the time, it's crucial to listen to your body and mind. All healthcare professionals should be familiar with potential burnout symptoms and should be prepared to deal with them as quickly as possible. (Warning Signs and Symptoms of Nursing Burnout) 6 Year follows authors' names, and page number follows direct quote. |
The first step toward solving the issue of nurse burnout, as Nursing.org (n.d.) pointed out, is to recognize the signs of burnout and start to combat their causes in the workplace. As Reineck and Furino (2005) concluded in a study on nursing careers: Not only does workload take a toll on the nurse, but also affects the quality of care (p. 30). Recognizing and reducing nurse burnout is crucial for the well-being of both the nurses and their patients. |
Insufficient Staffing Insufficient staffing is one of the primary causes of burnout, including shortages of registered nurses on overnight shifts and of supporting staff such as certified nursing assistants and patient care assistants in all shifts (Reineck &Furino, 2005) . To provide some context for the situation in San Antonio, consider how many nurses there are (20,972) relative to the overall population (1,988,364). Keep in mind that the entire population of nurses-20,972-is not employed at hospitals. |
This total includes nurses who work in schools, home health agencies, and other settings that are less strenuous than hospitals. Table 1 compares the nurse-to-patient ratio in Bexar County (all of it in San Antonio) with that in another county in Texas and calculates how many nurses there are per 100,000 people. Table 1 shows that nurses in Bexar County have to care for many more patients than those in Bastrop County. |
In other words, Bastrop County is more equipped to give patients the care they need; if 100,000 people were to become ill in Bastrop County, each nurse would need to care for 2.369% of those patients. On the other hand, if 100,000 people were to fall ill in Bexar County (San Antonio), each nurse would have to care for 10.54% of them, creating a dangerous ratio of nurses to population in San Antonio. |
7 Table 1 Ratio of Nurses to Population in Bastrop and Bexar Counties 2018 Population 2018 RN Total Ratio of RNs to 100,000 Population Bastrop 94,545 citizens 224 nurses 224 nurses caring for 94,545 citizens 224 nurses = 236.9 nurses = 2.369% 94,545 citizens Bastrop Ratio 100,000 citizens Comparison Ratio Based on the number of nurses in Bastrop County, each nurse would have to care for 2.369% of a population of 100,000. The higher the percentage, the more patients each nurse needs to care for. |
Therefore, as the percentage increases, there is a lower number of nurses available to sufficiently care for the population. 2018 Population 2018 RN Total Ratio of RNs to 100,000 Population Bexar 1,988,364 citizens 20,972 nurses 20,972 nurses caring for 1,988,364 citizens 20,972 nurses = 1,054 nurses = 10.54% 1,988,364 citizens Bexar Ratio 100,000 citizens Comparison Ratio Based on the number of nurses in Bastrop County, each nurse would have to care for 10.54% of a population of 100,000. |
These statistics indicate that Bexar County, which San Antonio encompasses, faces dangerous nurse-to-patient ratios due to a high population and a proportionately low number of nurses. Note . Data from the Texas Department of State Health Services (2018). 8 Potential staffing solutions could include a set nurse-to-patient ratio of 1:3. Hospitals could also have a staff of on-call nurses, which would help maintain the nurse-to-patient ratio even when patient admissions increase. Notes what others might think. |
When presented with evidence of insufficient staffing, people outside the nursing profession might argue that measuring the nursing population relative to the general population is misleading, given that not every person in Bexar County seeks treatment at the same time. Others might note that most nurses chose to pursue a career in a fast-paced work environment despite the risks and challenges. |
The shortage of nurses in San Antonio could also be attributed to factors outside of a hospital administration's control, such as a lack of younger nurses to take the place of the many older nurses in San Antonio who regularly go into retirement (Pelayo, 2013). We might address the need for more young nurses by encouraging students to go into hospital nursing as a way to gain hands-on experience, rather than going straight into non-clinical nursing roles. |
But many potential nurses may look at the job description and feel that the paycheck is not worth the intense work demands. And increasing the base pay might then impact the number of nurses hired, as the hospital would have to distribute costs. Another option is to promote bridge programs, in which student nurses take classes at a community college or university while completing their clinical work at an affiliated hospital, which then hires the nurses upon graduation. |
This would offer young nurses guaranteed employment once they graduate while also helping to solve the hospital's staffing shortage. 9 Intense Physical and Mental Demands Another major cause of burnout is the intense physical and mental demands of nursing. A significant part of a nurse's everyday regimen includes standing for prolonged periods, lifting patients, and pushing wheelchairs and gurneys, all of which can harm a nurse's physical health. |
The most common nursing injury is a strained back, but other physical stress points include sore shoulders from pushing wheelchairs and gurneys and injuries from falling while they work (Fohn, 2014). Nurses typically stand for most of their shift, leading to foot and knee complications and foot pain. Regardless of their fitness level, they are required to lift and transport immobile patients. |
As a result of this continuous lifting and bending, nurses are at a high risk of developing musculoskeletal disorders (Fohn, 2014). While hospitals cannot eliminate the heavy physical demands of the job, they can help nurses manage such complications by providing discounted physical therapy sessions. A physical therapist can treat the aches, strains, and injuries that accumulate over long shifts, helping alleviate the fatigue and pain and other physical symptoms of burnout. |
Providing this kind of help would increase nurses' productivity. Mental health issues also contribute to burnout. While many nurses in San Antonio are passionate about the care they provide to patients, that care sometimes presents life-and-death choices. As a result, nurses can become excessively worried and anxious about their work. Across the country, the nursing profession has been shown to be incredibly taxing on the mental well-being of employees. |
In a study conducted on 332 hospital nurses in Colorado, 86% showed symptoms of burnout (Mealer et al., 2009). And burnout was not the only mental health concern found; other psychological conditions included PTSD, depression, and anxiety (Mealer et al., 2009). 10 Hospital administrators also need to respond to the psychological effects this profession can have. To ensure the mental health of nursing staff, hospitals should offer a healthcare-worker hotline. |
Nurses struggling with the death of a patient would be able to call this hotline for support. As with physical therapy, nurses should be offered discounted psychiatric therapy sessions. Helping nurses take care of their mental health would help prevent psychological symptoms of burnout such as irritability, dissociation, or depression. Some of the most stressful situations are when patients become violent. |
And nurses who are threatened or assaulted by a patient cannot engage in self-defense without risk of losing their licenses. It wasn't until 2013 that a nurse assaulted by a patient could expect any legal defense at all. In that year, Governor Rick Perry signed a bill stating that assaulting a nurse will result in punishment ranging from a Class A misdemeanor to a third-degree felony (Emergency Nurses Association, 2013) -a welcome, if somewhat late, protection for nurses. |
Especially when life-and-death choices are on the line, emotions take over, leading to a patient confronting the caregiver or the patient's family expressing anger toward hospital staff. Some of those observing such confrontations may point out that it is reasonable for people to become aggressive when there are serious choices to be made. Families might feel worried or scared for their loved one. Or the patient might be very frightened and exhausted from treatment. |
However, not every such confrontation is fueled by legitimate emotions, and sometimes nurses are confronted by irrational verbal and even physical violence. 11 Preventing such dangerous confrontations calls for increased security in hospital units, which should be based on patient capacity. Using the same strategy as for nurse-to-patient ratios to maintain optimum patient care, hospitals should adopt a reasonable security-to-patient ratio in each hospital unit of 1:50. |
Having one officer present for every 50 patients in a hospital unit would provide nurses with increased safety in the event of an assault. Additional officers should also be present in any unit housing hostile patients. For example, once any patients have threatened to harm themselves or others, an officer should remain in their rooms so that nurses can continue providing care without risking their own safety. Hospitals also need to regulate visitors. First, patients must approve all visitors. |
This requirement will help prevent abusive family members from assaulting patients or staff. In addition, no one with a record of violence, assault, or abuse should be allowed to visit. Not admitting visitors who have a history of confrontation and aggression will help decrease the frequency of violence in hospitals. Nurses in San Antonio will then be able to trust that they are safe and can put all their focus on patient care. |
Skipping Necessary Breaks Skipping meals and even bathroom breaks is a third cause of burnout among nurses. To alleviate the stress of long shifts, hospitals should require nurses to take a lunch break. An uninterrupted lunch break would not only enable nurses to take care of their own basic needs, but would also help prevent fatigue and low blood sugar levels by allowing them to rehydrate. Depending on the patient load, a nurse should have a minimum break of 30 minutes and a maximum of one hour. |
Nurses working 12-hour shifts should have an hour break. Unfortunately, nurses in Texas are not legally entitled to take lunch breaks (Texas Workforce Commission, n.d.). Medical employers take advantage of the fine print, which is why many nurses go without any breaks at all and administrators face few if any penalties. 12 We all know that in this time of pandemic, COVID nurses in San Antonio (and everywhere) are working heroically in unbelievably stressful conditions. |
But all nurses, even those working in non-COVID units, are experiencing burnout due to problematic nurse-to-patient ratios, intense physical and mental demands, and the lack of necessary breaks. To help prevent nurse burnout, hospital administrators need to consider more staffing, discounted therapy sessions, and mandatory lunch breaks. San Antonio's nurses are taking on more patients than they can handle, which affects the quality of care they can provide. |
In order to deliver the best care to patients in the Bexar County area, we need to deliver the best care to those who look after them-remembering that they are our lifelines, the heroes we cannot do without. 13 References List of references begins a new page. Entries are arranged alphabetically by author's last name. Entries flush left; subsequent lines indent or 5 spaces. Emergency Nurses Association. (2013). |
Emergency Nurses Association applauds Texas legislation that raises assaults against emergency department personnel to third degree felony . https://prnewswire.com/news-releases/emergency-nurses-association-applauds-texas-legislatio n-that-raises-assaults-against-emergency-department-personnel-to-third-degree-felony-212198 351.html Fohn, R. (2014, December 4). Stress test: Researchers studying soaring stress levels among nurses. Mission . |
uthscsa.edu/mission/stress-test-researchers-studying-soaring-stress-levels-among-nurses/ Hernandez, K. (2018, July 27). Largest San Antonio hospitals by beds. San Antonio Business Journal . https://www.bizjournals.com/sanantonio/subscriber-only/2018/07/27/hospitals-by-beds.html Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., &Moss, M. (2009). The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. |
Depression &Anxiety, 26 (12), 1118-1126. http://doi.org.10.1002/da.20631 Nursing.org. (n.d.). Nurse burnout . Retrieved April 18, 2019, from https://www.nursing.org/resources/nurse-burnout/ Pelayo, L. W. (2013). Responding to the nursing shortage: Collaborations in an innovative paradigm for nursing education. Nursing Education Perspectives, 34 (5), 351-352. Reineck, C., &Furino, A. (2005, January-February). Nursing career fulfillment: Statistics and statements from registered nurses. |
Nursing Economic$, 23 (1). Texas Board of Nursing. (2018). Practice-Peer review: Incident-based or safe harbor . Retrieved January 24, 2019, from https://www.bon.texas.gov/practice_peer_review.asp 14 Texas Department of State Health Services. (2018, November 29). Registered nurses, 2018 . Texas Health and Human Services. https://www.dshs.texas.gov/chs/hprc/tables/2018/RN18.aspx Texas Workforce Commission. (n.d.). Fair Labor Standards Act-What it does and does not do . |
Retrieved April 18, 2019, from https://twc.texas.gov/news/efte/flsa_does_and_ doesnt_do.html Endnotes Title is bold and centered. Return to text Title is bold and centered. Return to text Personal communications are documented in-text but are not included on the references list. Return to text In-text documentation that includes only the date goes right after the author. Return to text Signal phrases are in past tense. |
Return to text Parenthetical documentation follows the punctuation in a block quote. Return to text 2 authors in parenthetical documentation are linked with ampersand. Return to text Table number is bold and left justified. Descriptive title is italicized and appears below table number. Return to text Source information is given in table note. Return to text Headings help organize the essay. Return to text Past tense is used to discuss the results of a study. |
Return to text Parenthetical documentation goes right after the information cited, so it is not always at the end of a sentence. Return to text DOI is provided when one is available. Return to text Retrieval date is included when the content of an online source may change. Return to text PART 5 LANGUAGE &STYLE / GET ATTENTION Chapter 22 Getting &Keeping Attention GOOD WRITING IS . . . STILL ONE OF THE BEST TOOLS WE HAVE TO GET AND CAPTURE PEOPLE'S ATTENTION. |
-ROBIN SLOAN Once upon a time-and for a very long time, too-style in writing meant ornamentation, dressing up your language the way you might dress up for a fancy party. In fact, ancient images often show rhetoric as a woman, Dame Rhetorica, in a gaudy, flowing gown covered with figures of speech-metaphors, similes, alliteration, hyperbole, and so on: her stylish ornaments. This view eventually led many writers to view style as mere decoration. But not today. |
Not in a time of instantaneous communication, of being inundated with messages of all kinds-news, posts, notifications, ads-all of them coming at us with the force of a fire hose. In such a time, how can we get others to pay attention to what we say or write? I believe the best answer to this question is by attending carefully to our use of language and style. And by style I mean how a message is presented, not simply what it says. In this view, style isn't just the use of pretty language. |
Rather, it is a crucial element in making a message effective, memorable, compelling-and heard. Dame Rhetorica, from Gregor Reisch's Margarita Philosophica (1504). Today, then, style and substance are inseparable, and style is more important than ever before for getting and holding an audience's attention. |
Rhetorician Richard Lanham argues that the most important task facing writers and speakers today is not learning as much as possible about a subject or presenting the most convincing evidence to support a claim about that subject. Rather, the most important task today is getting the attention of those we want to address! |