Stress is not inherently dangerous or problematic. What can make stress challenging is an individual’s perspective. In other words, how you interpret the meaning of a stressful event can focus energy on the positive or the negative. Personality traits also have an influence over whether you think something is positive stress or negative stress.
Nevertheless, since the 1960s, stress has been identified as an occupational work hazard that creates health problems. The term “burnout” was not used until 1974 when American psychologist Herbert Freudenberger “borrowed” it from an everyday term used to describe the devastating effects of chronic drug use.
At nearly the same time in history, Dr. Christina Maslach, professor of psychology at the University of California-Berkeley, described similar symptoms in human services workers. Her team went on to create a self-reporting questionnaire, which is consistently used today to identify burnout.
Nursing burnout affects new nurses and seasoned nurses alike. In early research, Menzies identified four sources of stress for nurses. These included patient care, decision-making, responsibilities, and change.
Over the years these sources have changed with the growth of the nursing profession and added societal stresses. Healthcare professionals, like nurses and PAs, are at a heightened risk of burnout. Keep reading to learn more about nursing burnout, including symptoms, influences, prevention, and treatment.
Compassion Fatigue
Before discussing burnout, we need to address a similar condition called compassion fatigue. Healthcare professionals are also at risk of experiencing this syndrome. While it has similar symptoms, compassion fatigue is different from burnout.
Compassion fatigue used to only be seen in the helping professions, like healthcare. It is related to witnessing suffering and being exposed to emotional challenges. However, the instant communication of tragedy over the internet means this condition is no longer confined to healthcare professionals.
Like burnout, compassion fatigue affects the quality of life, and it requires awareness as the first step to recovery. Compassion fatigue is also called vicarious traumatization or secondary traumatization, reflecting the roots of the condition.
Symptoms of Compassion Fatigue
The Compassion Fatigue Awareness Project shares: “Denial is one of the most detrimental symptoms of Compassion Fatigue and life stress. It can easily hinder your ability to assess the level of fatigue and stress in your life as well as thwart your efforts to begin the healing process.”
Symptoms are similar to burnout and can include:
Physical Symptoms
Physical symptoms may increase your emotional and behavioral symptoms since exhaustion and poor sleep lead to reduced emotional resiliency.
- Insomnia
- Isolation
- Physical fatigue
- Exhaustion
- Irritability
Emotional Symptoms
Emotional symptoms are difficult to manage until the problem is under control. These feelings also seem to potentiate the problem. For instance, feelings of hopelessness increase the risk you’ll feel more hopeless.
- Poor self-care
- Nightmares
- Feeling burdened by others suffering
- Loss of pleasure
- Bottling up emotions
- Feeling hopeless or powerless
- Denial
- Feeling discouraged
- Intrusive imagery
Behavioral Symptoms
Behavioral symptoms may be observed by your close friends and family members. It’s easier for someone else to notice these symptoms than it is for you to see them yourself.
- Overeating
- High turnover
- Negative outcomes
- Drug and alcohol use
- Blaming people for their suffering
- Trouble concentrating
- Mental fatigue
- Frequent complaining about work or home life
Burnout
The differences between compassion fatigue and burnout are found in what triggers the condition.
A national nursing survey found 15.6% of nurses felt burned out in their professional capacity. Emergency room and critical care nurses have the highest risk This may be related to the high levels of stress in those departments and a shortage in nursing staff.
Unfortunately, it’s not only healthcare providers in the nursing field who experience symptoms but also their patients. Nursing burnout can lead to lower patient satisfaction and poor patient outcomes.
Definition of Burnout
In her book, ”Burnout: The Cost of Care,” Maslach describes burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur in individuals who do “people-work” of some kind.
It is a response to the chronic emotional strain of dealing extensively with other human beings, particularly when they are troubled or having problems.”
Another researcher believes burnout is at epidemic proportions among healthcare professionals, and it may continue to grow. It may also contribute to a growing physician shortage.
There are differences in healthcare professionals who experience stress and burnout. Stress results over engagement with a situation, while burnout leads to disengagement. This is the foundation of most symptoms of burnout.
Burnout Symptoms
Individuals who experience burnout have physical, emotional, and mental exhaustion that goes well beyond being tired or just having a bad day.
The World Health Organization lists burn out as a diagnosis in the ICD-11 describing it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The ICD-11 defines burnout in three areas including energy depletion, mental distance from the job, and reduced professional effectiveness.
Physical Symptoms
Physical symptoms of burnout may be visible to the healthcare professional and those in their immediate circle of friends and family. These symptoms adversely affect health in the short-term and long-term.
- Physical exhaustion
- Emotional exhaustion
- Anxiety/depression
- Frequent illness
- Change in appetite
- Change in sleep habits
- Change in eating habits
- Increased risk of accidents
Emotional Symptoms
Emotional symptoms related to burnout affect an individual’s ability to do their job and maintain their focus. It can also significantly impact their personal and professional relationships.
- Emotional exhaustion
- Leaves a sense of hopelessness
- Every day is a bad day
- Perceived inefficiency
- Depersonalization
- Lack of personal accomplishment
- Feelings of helplessness
- Sense of failure
- Cynicism
- Decreased career satisfaction
- Depression
- Communication breakdown
Behavioral Symptoms
Behavioral symptoms are visible to colleagues, as well as friends and family. They often results in challenges at work, poor decision-making, and potential job loss
- Withdrawn
- Poor judgement calls
- Procrastination
- Frustration
- Substance abuse
- Skipping work
- Suspicion
- Self-medication
- Sarcasm
- Self-doubt
- Lack of motivation
Recognizing Burnout
According to The Canada Life Assurance Company Workplace Strategies for Mental Health initiative there are common lies you may tell yourself if you are suffering from burnout. They include:
- I am fine
- It is your nagging at me that is stressful
- I love my job
- I am happy to take more on
- I am just tired
- You don’t understand; no one else can do this
- People are depending on me
- I really want to be helpful
- I will be fine once this is done
- This too will pass
- I need to get back to the top of my game
- I’ll take a vacation and then be okay
- If people just let me do my job, I would be fine
- It’s not me; it is everyone and everything else
Consequences
The consequences of burnout are not insignificant. In one literature review of physicians, researchers found healthcare professionals who were burned out retired sooner than others, took more sick leave, and were less productive. In other words, they had lower job satisfaction.
Healthcare professionals who were burned out had poor patient engagement, lower patient satisfaction, and organizations suffered a high staff turnover rate. Nurse practitioners had lower cognitive functioning when burned out.
What Influences Nursing Burnout?
Some of the same factors impact nursing burnout as other professions, such as a lack of perceived control, high workload, long hours, poor rewards, dysfunctional workplace, and a value mismatch in the workplace.
However, healthcare professionals are also exposed to unique stressors that increase the potential for burnout. Recognizing what might trigger the condition can help stop the trigger and reduce the symptoms.
Overachiever
The healthcare profession seems to attract individuals who are overachievers. If you’re an overachiever, you’re at a higher risk of developing burnout. The need for perfection, or near perfection, raises your personal level of expectation for performance.
By not consistently meeting your expectations, you can suffer from many of the symptoms of burnout, including perceived inefficiency and a lack of personal accomplishment.
Unrealistic Expectations
In the work environment, MDs, nurses, and PAs are faced with ethical decisions and end-of-life situations. The organizational and managerial beliefs and strategies may be at odds with your own ethical beliefs and standards, which adds stress.
These decisions also place an unrealistic expectation on healthcare providers to help patients and families manage situations that may require the help of a psychologist or therapist. Unrealistic expectations for an advanced practice provider increases the risk of burnout.
Heavy Workloads
Nearly every profession in healthcare has a heavy workload. Poor staffing, shortages, and a rising patient load lead to long work hours, fatigue, and burnout. Nurses who work 12-hour shifts must focus on getting enough rest and recovery between their shifts, as it affects their neurocognitive abilities.
Working double shifts, being on call, and higher patient load all contribute to a rising number of nurses experiencing burnout. Additional stresses include dealing with a variety of roles in the nursing profession as well as physical stresses from lifting and carrying heavy loads.
Tragedy
Although death and sickness are a part of the nursing profession, they continue to take an emotional toll on those who practice in healthcare. This factor more frequently leads to compassion fatigue from watching human suffering day in and day out, but it can also contribute to burnout.
Leadership
Poor leadership from the management or a supervising physician, and a lack of teamwork can increase the risk of nursing burnout. When leaders become part of the problem, it creates a greater challenge.
Strong leaders listen to their staff, express an interest in their health and well-being, and create a strong environment of teamwork and collaboration. On the other hand, ineffective leaders may increase the risk of burnout in their employees.
Special Circumstances – COVID-19
Healthcare professionals consistently work under a mantle of stress. Special circumstances can add even more stress, bringing some to the breaking point. A case in point is the pandemic triggered by SARS-CoV-2. In the early days, January 2020, The Joint Commission asked healthcare agencies to address burnout in order to improve retention and performance.
Added workloads, unbalanced patient distribution across hospital systems, and a lack of preparation for the epidemic have contributed to a rising number of prescriptions for antidepressants.
Prevent Nursing Burnout
An ounce of prevention is worth a pound of cure, especially with burnout. Using self-care strategies that you enjoy and feel good about helps reduce your risk. This may include journaling, yoga, reading, music, stretching, exercise, dancing, prayer, massage, meditation, or mindfulness. Identify your priorities at home and at work, and pare the list down to a manageable number.
Look for the stressful areas in your life so you can address them before they begin affecting you. Stay connected with people in your life who know you and who you trust. As you develop a strong social network of people, they can help you identify stressors and put strategies into place that reduce your risk of overload.
Battling Burnout (Treatment)
It’s important to remember that burnout is not terminal. There are treatments and people do recover. The first step is to always acknowledge the issue and move forward from there. If self-care is not successful, do not hesitate to seek professional help, as it will reduce the potential you experienced significant consequences.
Awareness and Warning Signs
Being aware of your situation and assessing your risk is the first step to recovery. Consider using the Professional Quality of Life Scale. This is a 30-question test that scores the potential you could be experiencing compassion fatigue or burnout.
It’s important to understand the issues, recognize the factors that increase your potential for burnout, and be aware of the signs and symptoms in your own life. It’s so much easier to recognize what’s happening in other people’s lives, which is why you need a strong network of friends and family who will be honest with you.
Treatment
Treatment begins with becoming aware of the problem. From there you can identify steps to reduce your symptoms and use strategies to prevent it from happening again. Consider finding an accountability partner you can trust and who will listen to your concerns. They can help validate what you’re feeling, as well as hold you accountable for the strategies you put in place.
Self-Care Strategies
By nature, nurses are caring individuals who spend their careers putting the needs of others above themselves. This characteristic makes for great nurses, but it is a challenge for self-care. It is important to care for yourself first so you have the fuel to care for others. Consider these strategies:
- Minimize or eliminate alcohol and caffeine
- Develop and follow a healthy eating plan
- Take time away from work (if the symptoms impair your ability to function)
- Develop a healthy approach to work
- Exercise
- Walk in a green space
- Find a creative outlet, such as painting
- Connect with friends and family
Change Your Thinking
Your thoughts create emotions and your emotions are often at the root of burnout. When you change your perception of the situation it doesn’t change the circumstances, but it does change the impact it has on you. Here are some strategies that can help:
- Focus daily on your accomplishments
- Keep a gratitude journal
- Avoid criticizing yourself
- Recognize and celebrate small improvements in yourself and your patients
- Stop multitasking!
- Stop working unnecessary overtime until you are well
- Work on positive projects and steer clear of the news
- Create a list of what you value, enjoy, or hold precious where you see these items each day
- Write down the reasons you became a healthcare professional
- Nurture your spirit using quiet reflection, meditation, or prayer
Avoid Nursing Burnout
In order to avoid getting burned out, you must first acknowledge that it’s possible. Consider taking your own burnout temperature every four to six months. This helps keep the possibility top-of-mind as you’re working in a high-stress, high-trauma environment.
Make a commitment to take steps today to prevent it, and to address it if it comes up. It is much easier to follow a plan you’ve outlined before burnout occurs, rather than waiting until you’re overwhelmed.
