Nursing Burnout: Self-care in Healthcare
Working in the nursing field can be a rewarding but demanding profession. While nurses are focused on the goal of providing the best possible care for their patients, they may not always do the same for themselves. Working in a fast-paced environment, taking long shifts, and dealing with the emotional toll of being in a healthcare setting can lead to chronic stress and, eventually, burnout.
However, when the right support and resources are provided, nursing burnout can be prevented. It is important to recognize burnout symptoms, develop tools for nurses, and educate healthcare professionals on the topic so affected clinicians can seek help when they are experiencing burnout.
What Causes Nursing Burnout?
Workplace burnout can occur across all occupations due to a variety of factors. For nurses, being front line providers can weigh on these individuals physically, mentally, and emotionally.
According to a report on burnout prevention in the nursing field, “the nurse is expected to perform patient care with patience and empathy, all in a highly stressful environment, with few resources and an excessive workload, thereby requiring nurses to find a balance between these factors that interfere in their working life.”
These stressors can be more prevalent for institutions that are bearing the brunt of the nursing shortage. According to the Bureau of Labor Statistics, the employment rate of registered nurses will increase 12% between 2018 and 2028; additionally, jobs for nurse practitioners, nurse midwives, and nurse anesthetists will increase 26% between 2018 and 2028, much faster than the average occupation rate.
The American Nursing Association (ANA) has emphasized the need for more nurses, stating, “while the nursing shortage presents opportunities for nurses, there are potential negative implications, too. Nurses often need to work long hours under stressful conditions, which can result in fatigue, injury, and job dissatisfaction.”
What Are the Signs of Nurse Burnout?
Originally coined in 1981 as The Maslach Burnout Inventory, workplace burnout in the nursing field is often defined as a three-dimensional syndrome involving:
- Emotional exhaustion
- Low degree of personal accomplishment
When someone is passionate about what they do, “they tend to ignore the fact that they’re working exceptionally long hours, taking on exceedingly heavy workloads, and putting enormous pressure on themselves to excel—all of which make them ripe for burnout,” said Sherrie Bourg Carter, PsyD, in an article about burnout for Psychology Today.
How to Identify Burnout Symptoms
According to Dr. Bourg, symptoms of burnout can include:
Physical and emotional exhaustion
- Loss of appetite
- Anxiety and/or depression
- Loss of enjoyment
Ineffectiveness and lack of accomplishment
- Apathy and feelings of hopelessness
- Lack of productivity
What Are the Consequences of Nursing Burnout?
When not addressed properly, burnout can lead to poor mental health among nursing staff members. Stress, emotional exhaustion, and feelings of apathy can lead to more serious issues when experienced long term. According to one study, 30.7% of responding nurses had symptoms of depression.
In turn, when nurses become less engaged in their work, the quality of patient care may suffer. Research on nursing burnout has shown that nurses who are experiencing symptoms of burnout are more likely to have poor job performance.
How to Combat Burnout in Nursing
At the individual level, nurses who are experiencing burnout can address their symptoms through strategies such as mindfulness and self-care. For example, an article from ANA on nurse health highlighted the importance of eating healthily to combat chronic stress.
However, hospitals, physicians’ offices, and other healthcare settings also need to make changes at the administrative level to fully address nurse burnout prevention.
Recommendations for Addressing Nurse Burnout
Create positive work environments. When making decisions, institutions should consider how it will promote high-quality care, job satisfaction, and social support. For example, when deploying a new tool, considerations should be made for how it will affect nurses’ workload and what supports can be put in place.
Improve usability and relevance of health information technology (IT). Health IT, including electronic health records, should be as user-friendly and easy to operate as possible to reduce burnout. Healthcare organizations should deploy technologies to reduce documentation demands and automate non-essential tasks.
Reduce stigma and provide burnout recovery services. Many healthcare professionals do not report burnout because they fear the potential consequences. This can be addressed by providing access to services such as employee assistance programs, peer support programs, and mental health providers.
Support research on burnout. A report from the National Academy of Medicine has made a call for federal agencies to develop a coordinated research agenda on burnout among healthcare professionals by the end of 2020.
There is no universal measurement for burnout. Studies vary in how they quantify this information, and a consensus on how to classify burnout as a condition has not been reached within the industry. However, while burnout exists on a spectrum, signs can be observed in three areas—physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment.
The rate of burnout among nurses depends on how it is measured by research. According to a 2019 report on nursing engagement [PDF 888 KB], 14.4% of nurses were “unengaged” with their work, with 41% of those respondents reporting feelings of burnout. Another study found that 35.3% of nurse respondents had symptoms of burnout. Burnout rates can also vary by practice. A study focused on burnout in primary nurses addressed three aspects of burnout and found that 28% reported high emotional exhaustion prevalence, 15% reported high depersonalization, and 31% reported low personal accomplishment.
These variations reinforce the importance of viewing burnout on a spectrum, as well as providing tools and resources for nurses to address burnout symptoms.
Moral distress is the inability of a moral agent to act according to their core values and perceived obligations due to internal and external constraints. For nurses, this type of ethical dilemma can cause feelings of powerlessness and detachment, which can add to feelings of burnout.
Sometimes referred to as secondary traumatization, compassion fatigue occurs when an individual works with patients suffering from the consequences of traumatic events, which can leave the individual feeling emotionally drained. Burnout can be caused by many factors, whereas compassion fatigue is stress caused specifically by exposure to trauma. Compassion fatigue can be a contributing factor in burnout among nurses.