Nurse Burnout: An Occupational Hazard

Poll: Has Burnout Affected Your Career?

Troy Brown, RN

Disclosures

November 27, 2018

Interested in taking a poll about nurse burnout? Start here.

Burnout—A Life-altering Emotion

Burnout—a phenomenon affecting those in the helping professions—was first described by psychologist Herbert J. Freudenberger in the 1970s.[1] It refers to a response to long-term work-related stress in which a person experiences emotional exhaustion, depersonalization, and reduced personal accomplishment.

The term is widely used today in a variety of contexts, its meaning largely diluted; however, it is life-altering for those who experience it and causes many nurses to leave the profession.

But nurses who actively care for their own physical and mental well-being may be able to avoid burnout, and healthcare organizations can take steps to reduce burnout among their nurse employees, as well, according to Raphaela F. O'Day, PhD, a senior manager at Johnson & Johnson Health and Wellness Solutions.

Burnout is largely characterized by emotional exhaustion—physical and emotional overload experienced by nurses as a result of interactions with coworkers and patients.[2] In fact, in one study, emotional exhaustion was the most reliable predictor of burnout.[3] Depersonalization refers to cynicism toward coworkers and healthcare users and reduced personal accomplishment occurs when a nurse develops a negative self-concept as a result of unrewarding situations.[2]

Nurses suffering from burnout typically experience such psychosomatic problems as weakness and insomnia; emotional problems including anxiety and depression; attitude changes such as hostility, apathy, and mistrust; and behavioral problems including aggressiveness, irritability, and isolation.[2]

Patient care,[2] patient outcomes,[3] and patient satisfaction[2,3] all are negatively affected when nurses are burned out.

Nurses' workplaces pay a price for nurse burnout as well, typically experiencing spikes in sick leave use, absenteeism, and nurse turnover,[3] and declines in work effectiveness.[2] Costs.....human and monetary.

Risk Factors for Burnout

Burnout, of course, is not unique to the nursing profession and may be most closely related to the healthcare professional's clinical work setting. Nurses who specialize in certain areas are more prone to burnout. In burn units,[4] emergency departments,[5] critical care, pediatrics, and oncology—where e patients have intense needs for care as well as unpredictable outcomes—nurses are continually exposed to suffering and death, increasing their susceptibility to burnout.[3]

Moral distress, excessive workload in terms of physical and emotional demands, and psychological stressors of the work environment all contribute to the development of burnout. Moral distress is associated with exposure to death and dying, being inadequately prepared to meet the emotional and spiritual needs of patients and their families, too little staff support, and uncertainty related to patient care and treatment.[3]

In one study, moral distress levels were higher in nurses with 10 or more years of experience than in less-experienced nurses.[3] In other research, older and more experienced nurses were less likely to develop burnout when compared with younger nurses.[5]

"Sustained exposure to clinical situations in which conflicts arise about treatment goals for critically ill patients may lead nurses to act contrary to their values; the resulting moral distress and generalized stress lead to emotional and spiritual exhaustion, burnout, and suffering. These sources of suffering threaten the nurses' authenticity and integrity and their sense of meaning, commitment, and hope," Cynda Hylton Rushton, RN, PhD, and colleagues wrote.[3]

Spiritual well-being, hope, resilience (the ability to develop ways to cope with and minimize distress), and believing their patient care is meaningful all serve to protect nurses against burnout. Hope and meaning in patient care have been found to be independent predictors of burnout.[3]

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