As healthcare workers have been on the front lines of a global pandemic for more than a year, managing burnout and building resilience has never been more critical. This article can help understand what burnout is, what causes it, how to prevent it, as well as the significant impact burnout has on the nursing field, in particular.
Burnout is defined as a process of chronic disengagement that can impact lots of areas of your life, and is marked by three big dimensions: [1]
- Chronic exhaustion (wearing out; loss of energy; and fatigue);
- Cynicism (irritability; loss of idealism; and withdrawal; and
- Feeling increasingly ineffective on the job (reduced productivity and low morale).[2]
Causes of Burnout
Burnout is caused by a very specific formula of too many Job Demands, too few Job Resources, and too little Recovery.[3]
Job Demands are the aspects of your job that require sustained effort and energy; Job Resources are aspects of your job that (a) help you achieve job goals; (b) reduce the cost of Job Demands; and (c) stimulate growth and learning; and Recovery is the breaks you take at work, after work each night, on the weekends, and on vacation.[4]
This chart illustrates some of the different Job Demands and Job Resources that researchers have examined with some additional Job Demands specific to nursing:[5]
| JOB DEMANDS | JOB RESOURCES |
| High work pressure & workload | High-quality relationships with colleagues |
| Emotionally demanding interactions with colleagues and clients | Decision authority |
| Lack of autonomy | Feedback |
| Role conflict & role ambiguity | Time and job control (autonomy) |
| Lack of high-quality connections | Opportunities to learn new things |
| Values conflict | Leader support |
| Unfairness | |
| For Nurses, Add:[6] Patient aggression and violence Exposure to traumatic events |
Consequences of Nurse Burnout
Not surprisingly, intensive care and other critical care units are characterized by high-levels of work-related stress, and work-related stress is a factor known to increase the risk of burnout.[7] Burnout is linked to absenteeism and lower job performance,[8] and it has also been shown to partially explain turnover intention among nurses.[9] One study found a significant association between patient-to-nurse ratio and urinary tract and surgical site infections, and when the level of patient severity and nurse and hospital characteristics were controlled for, only nurse burnout remained significantly associated with urinary tract and surgical site infections.[10] That same study also found that, “Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million!”[11]
Burnout Prevention Strategies
While there is a burnout problem in healthcare, there is good news. There are clear, research-based strategies that nurses can learn to help alleviate and prevent burnout. These practices were instrumental in helping me recover when I burned out toward the end of my law practice. For over a year, I experienced countless illnesses, chronic exhaustion, three trips to the emergency room, and weekly panic attacks that made my life miserable. Thriving under stress is possible, and these three burnout prevention strategies will help:
Become more of an “otherish” giver
Every nurse I know has a strong tendency to put others first. My cousin, a critical care nurse, has completed entire 12-hour shifts without taking a bathroom break, and I know you have had similar experiences. In his book Give and Take, Adam Grant discusses the difference between givers, takers, and matchers and their success at work. He found different sub-sets of givers, two of which are “selfless” givers and “otherish” givers. Selfless givers give their time and energy without regard to their own needs (hey – it’s 3pm and I haven’t eaten yet today!).
Getting adequate Recovery is critical to preventing burnout, and selfless giving, in the absence of Recovery, drives burnout. The trick is to become more of an “otherish” giver. Otherish givers find a way to balance giving with their own self-interest and self-care. This might be difficult at first, and you may need to identify core beliefs standing in your way; such as, “Good nurses must always put the patient first,” or “I have to be a people pleaser.” You can determine how strong your giver tendencies are at Dr. Grant’s website, www.giveandtake.com.[12]
Incorporate resilience training
Psychological resilience has been associated with a lower prevalence of burnout in intensive care unit nurses,[13] and resilience has been shown to be both feasible and acceptable to ICU nurses.[14] One of the biggest adopters of resilience training in the U.S. has been the United States Army, through its Comprehensive Solider and Family Fitness program.[15] I had the privilege of teaching and training resilience skills to thousands of drill soldiers and non-commissioned officers during my time as part of the faculty for this program, and I have seen firsthand how resilience skills transform lives.
Let go of emotional labor
Pain, illness and the emotions that go along with those things don’t always bring out the best in people, and unfortunately, nurses are on the receiving end of some pretty awful behavior. Despite this, nurses need to make quick decisions, dispense treatment in an accurate way, and provide good “customer service.” Doing this often requires emotional labor, which involves suppressing your real emotions (frustration, anxiety, anger) in order to show interest, concern and sympathy toward your patients and their families. Emotional labor has been linked to job stress and burnout, yet in those units where nurses were able to express their emotions with their colleagues in an authentic way (i.e., they could appropriately “let it go” without any backlash or repercussion), burnout was buffered.[16]
Our healthcare system wouldn’t function without the time and talents of nurses. Know that there are skills you can learn to prevent burnout because healthcare needs more of you – talented professionals who are passionate about taking care of people when they need it most.
Please click here to order my book, Beating Burnout at Work: Why Teams Hold the Secret to Well-Being and Resilience.
References
[1] Monegain, B. (April 30, 2013). Burnout Rampant in Healthcare. Retrieved on January 26, 2015 at http://www.healthcareitnews.com/news/burnout-rampant-healthcare.
[2] Maslach, C., & Leiter, M.P. (2005). Stress and Burnout: The Critical Research in Handbook of Stress Medicine and Health 2nd Ed. Cary L. Cooper, Ed., 155-72.
[3] Arnold B. Bakker, Evangelia Demerouti, & Martin C. Euwema, Job Resources Buffer the Impact of Job Demands on Burnout, 10(2) J. Occ. Health Psychol., 170-180 (2005); see also Evangelia Demerouti, et al., Daily Recovery from Work-Related Effort during Non-Work Time, 7 Occ. Stress and Well-Being, 85-123 (2009).
[4] Id.
[5] Arnold B. Bakker, Evangelia Demerouti, & Ana Isabel Sanz-Vergel, Burnout and Work Engagement: The JD-R Approach, 1 Ann. Rev. of Org. Psychol. Org. Behav., 389-411 (2014); see also Michael P. Leiter & Christinan Maslach, Banishing Burnout: Six Strategies for Improving Your Relationship with Work 14-19(San Francisco, CA: Jossey-Bass, 2005)
[6] Wilkinson, S. (2014). How nurses can cope with stress and avoid burnout. Emergency Nurse, 22(7), 27-31.
[7] Bakker, A.B., Le Blanc, P.M., & Schaufeli, W.B. (2005). Burnout contagion among intensive care nurses. Journal of Advanced Nursing, 51, 276-287.
[8] Halbesleben, J.R.B., & Bolwer, W.M. (2007). Emotional exhaustion and job performance: The mediating role of motivation. Journal of Applied Psychology, 92, 93-106.
[9] Leiter, M.P., & Maslach, C. (2009). Nurse turnover: The mediating role of burnout. Journal of Nursing Management, 17, 331-339.
[10] Cimiotti, J.P., Aiken, L.H., Sloane, D.M., & Wu, E.S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486-490. Retrieved on December 12, 2014 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509207/.
[11] Ibid.
[12] Grant, A. (2013). Give and Take: A Revolutionary Approach to Success. New York: Viking.
[13] Mealer, M. et al. (2012). The presence of psychological resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. International Journal of Nursing Studies, 49(3), 292-299.
[14] Mealer, M. et al. (2014). Feasibility and acceptability of a resilience training program for intensive care unit nurses. American Journal of Critical Care, 23(6), 97-105.
[15] To learn more about the Army’s Comprehensive Soldier and Family Fitness program, please visit http://csf2.army.mil.
[16] Grandey, A., Foo, S.C., Groth, M., & Goodwin, R.E. (2012). Free to be you and me: A climate of authenticity alleviates burnout from emotional labor. Journal of Occupational Health Psychology, 17(1), 1-14.]]>
