The Fight to Prevent Burnout in Nursing

Bree Doran

Youngstown State University

NURS 6900 Professional Issues

Dr. Valerie O’Dell

June 17, 2020

 Abstract

Nurse burnout is a known significant issue in nursing that continues to occur at an alarming rate.
Nurses are either leaving the profession all together or constantly changing jobs to find a better
alternative. This paper explores the history of burnout in nursing, the causes of burnout and ways
to battle this widespread problem. Propositions to help resolve the issue can be done by
implementing activities to help promote self-care and provide education on healthy
communication amongst healthcare providers. By achieving these, great improvements in nurse
satisfaction and retention will be observed. Moreover, patient care will significantly benefit due
to a decrease in medication errors, patient safety issues and lack of compassion that can often be
related to the burnout of nurses. The fight to prevent burnout is incredibly important for the sake
of healthcare stability and expenses.
 The Fight to Prevent Burnout in Nursing

When an individual chooses a nursing career, no matter which nursing path is taken, there

is one mission in mind; to help others in a time of great need. Nurses are known to be dedicated,

selfless, caring and nurturing. Fighting the battle against diseases and pushing for patients to

build a healthy lifestyle for their future are the ultimate goals for nurses but these goals are often

neglected when caring for themselves on a day-to-day basis. The needs of individuals dedicated

to the career are often placed on the “back burner”, always making their patients’ needs the

greater priority (Halm, 2017). Willingness to care for patients is not what puts nurses’ mental

and physical health at risk; the ins and outs of the environment where they work is what is

detrimental. Pressure from upper management, leadership, inadequate staffing with forced

overtime, customer satisfaction and industry expectations all greatly contribute to burnout and a

decrease in self-care across the nursing profession. It is not uncommon that the situations that

nurses face on a day to day basis at work; life, death and all the seemingly mundane tasks in

between, is entirely inconceivable to others (Waddill-Goad & Sigma Theta Tau International,

2016). To continue to excel and carry the burden in many aspects of healthcare, the promotion of

self-care, healthy lifestyles and work environment alongside stress management to prevent

burnout and job dissatisfaction needs to be a top priority.

Background

The nursing profession and nursing environment has never been one that was stress-free.

Historically, the working conditions for nurses were far worse than those in the modern day but

other aspects have become more difficult over the years. Stress was first documented as a

workplace hazard in the mid-1950’s but work stress related to nursing was first analyzed when

Menzies worked to addressed sources of anxiety for nurses in 1960. Four major items were
identified as sources of anxiety: patient care, decision making, taking responsibility and change

(Menzies, 1960). However, as ever-changing technology use and turbulence in the working

environment continues to effect nurses and their workday, stress continues to escalate.

The term “burnout” was first coined by Herbert Freudenberger in 1974. He began

investigating what burn out truly was and how it affected people differently when he himself

started to feel burnt out at his current job. He states, “The dictionary defines the verb ‘burn-out’

as ‘to fail, wear out, or become exhausted by making excessive demands on energy, strength, or

resources” (Freudenberger, 1974, p. 159-160). In Chapter 26 of Patient Safety and Quality: An

Evidence-Based Handbook for Nurses by Bonnie Jennings, it is defined that burnout is typically

conceptualized as a syndrome characterized by emotional exhaustion, depersonalization, and

reduced personal accomplishment. In order to survive, nurses must learn to effectively cope with

the inherent stress of everyday work as well as learn to deflect and defuse to preserve one’s

mental health and physical well-being. A very important component to dealing with stress to

prevent an adverse effect on work production is to learn about self-care.

In the words of Dalai Lama, “if you feel ‘burnout’ setting in, if you feel demoralized and

exhausted, it is best, for the sake of everyone, to withdraw and restore yourself.” Originating in

the 1950s, the term “self-care” was one with medical roots that was used to describe activities

that helped institutionalized patients maintain some amount of physical independence. These

activities were meant to help cultivate a sense of self-worth, which was studied when the

working class was showing high levels of stress with a decrease in care for oneself. The World

Health Organization (WHO) defines self-care as “the ability of individuals, families and

communities to promote health, prevent disease, maintain health, and to cope with illness and

disability with or without the support of a healthcare provider.” It is important to for the
individual to understand how they react or do not react to promote self-preservation when

extremely stressful situations present or when a person is exposed to a chronic stressful

environment (World Health Organization, 2019).

Significance in Nursing

Stress and burnout in nursing is a well-known issue with studies completed to show how

both can negatively effect work, patient care and outcomes, threatening patient safety, as well as

personal health. Factors that negatively impact the care of patients and ultimately their outcomes

present as an unnecessary expense to healthcare facilities and insurance companies. Nurses are

flagged as being at a significant risk for burnout due to the common mindset of “carrying on”

despite the many challenging scenarios they frequently experience in their profession (Waddill-

Goad & Sigma Theta Tau International, 2016). The Maslach Burnout Inventory recognized as

the leading measure to calculate nurse burnout internationally.

A study conducted in Thailand involving 2,084 registered nurses evaluated adverse

patient events related to nurse stress and burnout. It was determined that approximately 32% of

nurses had high emotional exhaustion, 18% experienced high depersonalization, and 35% felt

low personal accomplishment, all of which contributed to adverse patient events. Events

examined were patient falls, medication errors and infection rates. When high levels of

emotional exhaustion were reported, the nurses reported that they felt their quality of care to

patients was fair to poor which resulted in increased odds of medication errors and infection rates

by 1.47 and 1.32 times, respectively, than those who had less emotional exhaustion. In addition

to decreased reported quality of care amongst those nurses, they also reported feeling high levels

of depersonalization which further increased the odds of medication errors and infections by 1.83

and 1.74, respectively. With the addition of depersonalization, an increased odd of falls was also
reported (Nantsupawat, A, et al., 2016). Overall, as stress and ultimately burnout presents itself

in nursing, patient safety and mortality are affected; but what about the effect it has on the

wellbeing of the nurse?

Through research by Jennings in 2008, she revealed that “regardless of whether stress is

perceived positively or negatively, the neuroendocrine response yields physiologic reactions that

may ultimately contribute to illness”. While it is known that nurses are working to promote

health and wellbeing of patients, the incidence of obesity among nurses is quite high. In the

United States, the obesity rate among nurses’ ranges from 23% to 61.4% across the nation with

England and Britain being comparable at 25.1% and 27%, respectively. Stress, exhaustion and

ultimately burnout contribute to poor weight control in nurses due to poor diet choices related to

stress eating and lack of adequate physical activity. When nurses were interviewed in 13 large-

scale studies regarding their diet and exercise habits in hospitals across the United States, 53%-

61% of nurses reported poor quality diets with 60%-74% reporting insufficient levels of physical

activity. Obesity resulting from bad eating habits and lack of exercise puts nurses at a higher risk

of chronic illnesses such as diabetes and cardiovascular disease. When nurses suffer from

obesity, with the combination of stress or burnout, will also have potential to negatively impact

patient care. Nurses who are overweight are shown to be less likely to promote weight loss and

exercise regimens to patients when providing patient education. In addition to excess weight

contributing to decreased work performance and increased risk for chronic illnesses, excess

weight and lack of exercise increases the risk of nurses to report or suffer from low back pain.

(Ross et al., 2019)

Proposal to Resolve the Issue

 To help fight to prevent the overwhelming numbers of burnout in nursing, which also

contributes to staffing and nurse turnover issues, is to promote self-care and to transform work

environments to better support nurses. Halm (2017) excellently explained why self-care is so

important, stating that it “…remains vital for nurses to ease the detrimental effects of stress in the

constantly and rapidly changing healthcare environment and to prevent progression of those

effects to burnout, which can have devastating consequences for nurses and those under their

care” (p. 344). One approach that helps in nurses battle burnout is learning the art of

mindfulness. Mindfulness is described as a mental state achieved by focusing on one’s awareness

to a situation or present moment, while calmly acknowledging feelings, thoughts and body

sensations. When applying this to the nursing career, it allows the nurse to manage stressful

situations as they arise in an effective and healthy manner. When this is done effectively, it

prevents stress and anxieties from piling up and thus preventing burnout (Halm, 2017). It is also

very important for the nurse to have an excellent support group, including those who are in the

same workplace. Support allows the worker who is suffering from burnout or excessive stress

and exhaustion to feel understood and receive sympathy from others (Freudenberger, 1974).

The implementation of yoga or mediation programs within the healthcare setting has been

shown to have an excellent impact on the well-being of nurses and improve patient care. In a

study done by Margo Halm in 2017, she reviewed eleven studies and how therapeutic

interventions such as yoga and meditation effected the nurses’ attitudes over 8 weeks. Nurses

where asked about physiological states and symptoms, psychological symptoms, burnout, work

or life satisfaction, mindfulness awareness, and sense of coherence after participating in yoga

and meditation activities and overall, there was an increase in physical and psychological well-

being. Nurses also self-reported decreased negative emotional reactivity to stress, anxiety or
depression (Halm, 2017). “By learning to quiet one’s inner voice, mindfulness can increase

resiliency that not only benefits nurses personally but also improves their effectiveness and

safety in clinical practice. In one study, clinicians with higher mindfulness were more likely to

use patient-centered patterns of communication such as building rapport, positive emotional

tone, and discussion of psychosocial issues” (Halm, 2017, p. 348). Altering the nurses’

workplace can also help decrease the rate of burnout.

By transforming noxious workplaces into healthy and supportive work environments, the

benefits can be seen in retention as well as recruitment of nurses and job satisfactions thus

improving patient outcomes, especially when referring to patient safety (Jennings, 2008).

Studies have shown that administrators and peers within the workplace can also be motivating

for nurses to strive for healthy living by either providing support and/or being role models. Some

nurses have stated that when being surrounded by or working alongside peers or nurses in

leadership positions who demonstrated healthy work-life balance and coping strategies, they

were also motivated to follow the same lifestyle (Ross et al., 2019). Leaders at all levels of

healthcare must be able to step back and evaluate the current moral within the healthcare system

they are governing. Monitor the level of stress and exhaustion amongst the team and adjust

operations accordingly to prevent burnout. Leaders themselves must work to adopt positive

strategies to cope with stressors and once mastered, convey those abilities onto those within the

workplace (Waddill-Goad & Sigma Theta Tau International, 2016). The encouragement of

healthy doctor-nurse communication is another aspect that can greatly influence stressors in the

nursing workforce. By educating all healthcare providers on appropriate communication within

the profession, there would be an improved rapport between providers resulting in better

relationships and improved communication about patients. When communication can be

improved, stress related to calling physicians on patient health concerns, abnormal lab values or

decline in patient status would become less nerve wrecking. Changing workplace environment

and promoting self-care can drastically decrease the rate of burnout amongst nurses.

Conclusion

It is pertinent that nurses begin to care for themselves, just as they do for others, by

making time to place their own health and illness prevention as a top priority. Improving self-

care amongst nurses not only has a positive influence on the care that nurses provide to patients

due to reduced stress and exhaustion, it also decreases the risk for illness and injury for the

nurses. Introducing activities like yoga and meditation are proven to be beneficial in reducing

stress and anxiety to help introduce healthy coping strategies. Improving the healthcare

environment to support healthy relationships among healthcare providers and nurses can also

help the fight against burnout in nursing. In a perfect world, stress and burnout would be a rare

occurrence so the rate of turnover in nurses would decrease, the frequency of adverse patient

events would decline, and nurse satisfaction would skyrocket. While this is always a work in

progress, nurses need to continue to fight to take care of themselves, for a healthy and supportive

work environment and fair patient workload.

 References

Freudenberger, H. J. (1974). Staff Burn-Out. Journal of Social Issues. 30(1).

Halm, Margo. (2017). The Role of Mindfulness in Enhancing Self-Care for Nurses: Clinical Evidence

Review. American Journal of Critical Care. 26(4), 344–349.

https://doi.org/10.4037/ajcc2017589

Jennings, B. (2008). Chapter 26: Work Stress and Burnout Among Nurses: Role of the Work

Environment and Working Conditions. RG Hughes (Ed.), Patient Safety and Quality: An

Evidence-Based Handbook for Nurses. Rockville, MD 2008: Agency for Healthcare Research

and Quality.

Menzies, I.E.P. (1960) Nurses under Stress. International Nursing Review. 7, 9-16.

Nantsupawat, A., Nantsupawat, R., Kunaviktikul, W., Turale, S., & Poghosyan, L. (2016). Nurse

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That Influence Health-Promoting Self-care in Registered Nurses: Barriers and Facilitators.

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