Burnout in nursing is a growing problem because of ever-increasing stress. In this article, we’ll define what is burnout, symptoms of burnout, and what you can do to manage and prevent it.
High stress levels and burnout among nurses have been reported in numerous studies and its negative effect on the quality of patient care has also been well documented in research. Hospital nurses have the highest burnout scores and 1 out of 5 nurses indicated that they intended to leave their position within 1 year.
Nurses working in pediatrics, oncology, critical care are more vulnerable to burnout because of patients’ intense needs, uncertain outcomes, and the impact of ongoing witnessing of suffering and death.
A recent article described burnout among health care professionals as a public health epidemic. Once you know that you’re suffering from burnout it’s vital to take immediate action. However, knowing that we’re at risk, nurses should take steps to manage stress and practice self-care to prevent burnout.
What is nurse burnout?
Burnout has now been officially recognized as a syndrome by its inclusion in the World Health Organization’s newly released 11th Revision of the International Classification of Diseases (ICD-11). Classified under “factors influencing health status or contact with health services”, burnout is not a medical condition as such. The ICD-11 also emphasizes that burnout is only related to the workplace and is caused by extended workplace stress which is not managed effectively.
The syndrome has three dimensions including feelings of exhaustion, increasing distancing from the job and, as a result, reduced professional efficiency. In other words, one should distinguish between feeling stressed out and actual burnout – even though burnout is caused by ongoing and unrelieved stress.
Burnout is a recognized work-related syndrome which differs from stress. The very specific signs and symptoms of the condition develop gradually over a period of time and that is why burnout is often not identified before it’s too late. Being stressed out is usually short term. You can have periods of high stress and bad days, but recover once things ease up. You return to work refreshed after a few days off. In contrast, burnout creeps up over time and has long-term effects. There are many reasons for the high levels of burnout among nurses. Those who work in particularly high-stress environments, such as emergency departments and ICU’s, are particularly susceptible.
Nurses work long shifts in a fast-paced environment. Our role is continuously expanding while staffing levels are often inadequate. Electronic health records are also reported to have added to nurses’ stress, making them feel that they don’t get enough time to spend with their patients.
Nurses interact with and care for people all the time and are exposed to illness and death daily – all of which are emotionally draining. A further factor that contributes to burnout among nurses is tied to the reason why they chose nursing. In their desire to care for others, they tend to neglect self-care.
Let’s have a closer look at the signs and symptoms of burnout.
Symptoms of Burnout
In burnout, there’s a consistent feeling of exhaustion and a lack of energy – both physically and emotionally. The person feels tired when they wake up and drag themselves to work. This could be accompanied by insomnia or other sleeping problems.
Being fatigued causes irritability and anxiety. Concentration and attention are reduced, leading to forgetfulness. There might be physical symptoms such as dizziness, headaches and bowel problems. The immune system could be affected with increased susceptibility to colds, flu and other immune-related conditions.
In the working situation, the person who suffers from burnout becomes physically and emotionally detached. They no longer experience any enjoyment from their work and try to avoid it as far as possible. They might become irritable, angry and impatient with co-workers and patients. A further red flag for burnout is a negative and cynical attitude towards the workplace
They also tend to isolate themselves from their colleagues, avoiding any socialization and interaction. They’re no longer able to connect and empathize with their patients. Work becomes a matter of just going through the motions.
Obviously the person who is burnt out will become ineffective at work, with low productivity, poor performance and an increased risk of errors. They’re well aware of this, which eventually causes feelings of uselessness and hopelessness. Nothing matters any more on both a personal and a professional level.
If burnout is not recognized and managed it could have serious consequences. These include chronic diseases such as hypertension, heart disease, and type 2 diabetes. There’s also a high risk of alcohol or substance abuse, depression and suicide.
A widely accepted self-assessment tool, the Maslach Burnout Inventory, can be used to assess your burnout risk.
Managing nurse burnout
Once you recognize burnout symptoms in yourself, it’s critical that you take action to deal with it as soon as possible. Burnout can be turned around, but it will take time and effort. Because the condition develops over an extended period of time, you can’t expect a quick fix!
Your first thought might be to take a holiday for a week or two. This might give temporary relief but isn’t a long term solution. The stress will be back as soon as you return to work. You’ll need to find ways to improve the way you cope with daily stressors or to reduce the amount of stress you’re exposed to. Actions you can take include:
- Discuss your problem with your supervisor or the human resources department.
- Make use of employee assistance programs at your place of work if they’re available. This might include free counseling sessions or referral.
- Ask to change to a different position within the organization, or even consider changing jobs altogether.
- Consider professional counselling and therapies such as cognitive behavioral therapy which increases resilience.
- Focus on self-care at work. Are you skipping your breaks or working too much overtime, not taking your leave?
- Put new strategies in place to prioritise self-care and stress relief when you’re not at work. Learn to separate your personal and work life. Commit to a healthy lifestyle of a well-balanced diet, exercise, activities which help you to relax, and good sleeping habits.
The actions you decide on will depend on your personal circumstances. A good idea is to discuss your problem, and your various options, with a friend or family member that you trust and has your best interests at heart.
Preventing burnout
A high-stress job doesn’t necessarily lead to burnout – it all depends on your resilience and ability to manage the stress. Some people are more resilient than others, but anyone can build more resilience. Studies have shown that nurses practice fewer healthy lifestyle behaviors, and are less healthy, than the general population or than doctors. Nurses do tend to give to others and neglect themselves.
So to prevent burnout, make sure that you make time in your life for yourself. Eat healthy and get enough sleep. Exercise is as much a boost for mental health as for physical health. You can participate in a sport you enjoy, although even a brisk walk in nature is both relaxing and invigorating.
To counteract the effects of stress, add some activities to your life that you enjoy and that will help you to relax. Get out and socialize, play and laugh. Take up a creative pursuit. Use relaxation techniques like meditation, journaling or other mindfulness practices. Even the repetitive action of knitting or crochet has been shown to be similar in effect to meditation.
When at work, be sure to deal with stress and grief right away. Develop a support system at work – especially a good friend that you know you can trust and towards whom you can vent when things overwhelm you.
At the same time you can contribute towards building a culture of wellness at your organization. Call out undue criticism, rudeness and nurse bullying. Notice when a colleague is going through a rough time and offer a word of support or even a compliment that could make their day.
Fortunately, an increasing number of employers are introducing employee support and wellness programs because of mounting evidence that it saves money in the long run.
A future challenge
Nurse burnout is real. It is a syndrome characterized by exhaustion, detachment and reduced efficiency. The condition should be managed as soon as the symptoms are recognized, although ideally it should be prevented.
This will only be possible if all health care providers develop a greater awareness of the problem. The way people act when they’re burnt out might cause them to be shunned and criticized by their co-workers. But if their behavior is recognized as related to burnout they are to be helped and supported instead.