Canadian Nurse

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2019/10/28/epuisement-professionnel-du-personnel-infirmier-no

Oct 28, 2019, By: Crystal McLeod

Scrolling through social media, I see the faces of nursing classmates and past colleagues enjoying time with family and adventurous travels. Many of these people bring a smile to my face as I remember the lessons I learned with them and the shifts we worked together. However, I feel a pang of sadness as I view some of these posts.

The posts that bring sadness have been made by nursing classmates and colleagues who are no longer nursing; they have either permanently or temporarily stepped back from the profession. Though I am glad that these people are pursuing new dreams, I remember what excellent nurses they were, and how much joy their care brought to patients. I perceive the great loss of their vitality and energy in the profession.

I cannot say with certainty that these acquaintances have left nursing because of burnout, but I can’t rule out the possibility either. I reflect on the time I spent with them, and wonder if the concerns of nursing workload and personal fatigue voiced to me were early signs of burnout. Did this stress eventually become too much?

Understanding nursing burnout

Burnout is not unique to the nursing profession, but it is a clinical phenomenon felt across all fields of nursing. Characterized by emotional exhaustion, depersonalization, and low sense of personal achievement, burnout is brought on by prolonged involvement in emotionally demanding and stressful situations (Cañadas-De la Fuente et al., 2015; Wei, Ji, Li, & Zhang, 2017). Studies estimate that the majority (25–65%) of nurses experience burnout, but the prevalence and gradual onset of burnout can vary greatly among nursing fields (Rushton, Batcheller, Schroeder, & Donohue, 2015; Tawfik et al., 2017; Wei et al., 2017). The pressure to perform at high levels from both patients and colleagues, exacerbated by poor sleep from shift work, changes in technology, and lack of knowledge regarding emotional exhaustion, are all suspected causes for elevated rates of burnout in modern health care settings (Cañadas-De la Fuente et al., 2015; Tawfik et al., 2017; Wei et al., 2017). For nurses specifically, burnout has been shown to have strong causative relationships with mental health disorders, substance abuse, changes in workload, moral distress, and harassment from patients or colleagues (Cañadas-De la Fuente et al., 2015; Henry, 2013; Rushton et al., 2015; Tawfik et al., 2017; Wei et al., 2017).

First identified in health care literature in 1974, burnout is neither a newly identified problem nor a problem with no conceivable solutions (Walton, 2018). In fact, quite the opposite is true, as researchers have worked over several decades to validate numerous interventions effective at reducing nursing burnout. Developing resilience, or adapting coping strategies to diminish stress and produce positive learning experiences, is considered the core element to prevent and treat nursing burnout (Rushton et al., 2015). Resilience requires the external pursuit of engaging and meaningful activities to cultivate an internal means of thinking that allows one to cope with the realities of nursing (Rushton et al., 2015). Nurses may also have strong innate internal characteristics, without external activity, that allow them to achieve resilience, such as hope, humour, self-efficacy, and adaptability (Rushton et al., 2015). So why is nursing burnout still a problem? Why are so many fellow nurses burning out in this career? Perhaps, having experienced burnout myself, and having nearly left the nursing profession early in my career, has given me some perspective on this conundrum: we are not doing enough.

My experience

I first began to experience nursing burnout around the two-year mark in my career, while working at a small community hospital. I was increasingly irritable, had a negative outlook, and felt tremendously tired after each shift. I did not know I was experiencing burnout, but I turned to hospital administration looking to address what I felt was causing my symptoms: a poor staffing model.

From my concerns, administration and I created a staff satisfaction survey, which I provided to each nurse and analyzed the data. Conducting this survey eased my burnout symptoms initially, because I felt supported by colleagues and the survey was a success. I had hope that my workplace issues would be resolved. Yet, after administration reviewed the results, no changes were made to the hospital’s staffing model.

Gradually my symptoms of burnout returned, and I began openly showing frustration with charge nurses and managers. I disagreed with orders from charge nursing staff when I felt these jeopardized patient care, and pushed back verbally with a manager during a debriefing of an adverse event, when I felt accused of providing poor care. Looking back, I see the lack of professionalism in my actions, but I also see that I was hurting and had no idea why. Actually, I don’t think anyone in my workplace had much knowledge of nursing burnout, let alone suspected me of experiencing it.

Years of reflection have helped me understand that I was experiencing intense burnout at this time from the stress, fast pace, and long hours of my work. Connecting the dots between what nursing burnout is and how I felt was a difficult process because I didn’t want to feel the stigma. I did not want to be seen as the nurse who couldn’t cope, was too sensitive, or worse, to be seen as a “bad nurse” by my colleagues, friends, and family.

Fortunately, time has also allowed me to understand that these perceptions of nursing burnout are incorrect, and helped me come to better terms with my experiences of burnout (Walton, 2018).

I have long since left the hospital where I first experienced nursing burnout, but nursing burnout has not left me. Struggling to resolve burnout over several years, with mistakes made along the way, creates painful memories, regrets, and questions of “What if?” Viewing my experiences with hope and optimism has only recently allowed me to see the value of nursing burnout as a topic for study and discussion. Leaning into the future, I share what I have ultimately learned from my trials: everyone in health care has a role in preventing, recognizing, and treating nursing burnout. Whether you’re a nurse trying to help yourself, an administrator trying to help your staff, or a nurse leader trying to brighten the future of our profession, we all have work to do.

Doing more

The potential to do more for nurses who are at risk for or are actively experiencing nursing burnout is vast. As individuals in our workplaces, and as a profession, nurses have not presented a united front that is committed to resolving nursing burnout. Though I do not want to discount the work of nursing burnout champions, who have committed their lives to improving the mental health of nurses, more action can still be realized. To highlight this point further, consider the high prevalence of physician burnout in the popular media, academic literature, and institutional programming (for example, Stanford Medicine WellMD Center and the Mayo Clinic Program on Physician Well-Being), whereas little exists, in contrast, for nurses (Tawfik et al., 2017; Walton, 2018). To resolve this discrepancy, nursing burnout should become a priority for all nurses, who can each make a unique contribution to ending nursing burnout.

At the individual level, nurses can begin by educating themselves and learning to recognize the symptoms of burnout. Then, turning this knowledge into action, every nurse can personally foster healthy mental habits, such as practising good sleep hygiene, journaling, exercising, healthy eating, and mindfulness, to prevent or treat burnout (Henry, 2013; Rushton et al., 2015). If personal change is not enough or work environments remain toxic, individuals should lobby employers for improved working conditions (Walton, 2018). Additionally, transferring to another clinical setting may assist with reducing burnout, as the experience varies greatly among settings (Cañadas-De la Fuente et al., 2015; Henry, 2013; Rushton et al., 2015; Tawfik et al., 2017; Wei et al., 2017). However, based on my experience, I caution that changing clinical settings alone is not enough. Every nurse must take steps outside of work to develop resilience by fostering good mental health habits (Rushton et al., 2015).

In the workplace, nursing administrators must remain vigilant of their staff’s emotional and psychological status to identify burnout (Cañadas-De la Fuente et al., 2015; Henry, 2013; Wei et al., 2017). As evidenced by my own experience, nurses suffering from burnout can present to administrators with workplace concerns and in varying mental states. New nursing staff, who often lack professional awareness, must be given the support they require to fulfill their new duties and not be shamed (Tawfik et al., 2017; Wei et al., 2017). Experienced nursing staff, who tend to develop moral distress, could benefit from administration providing leadership coaching and counselling (Rushton et al., 2015). When burnout is suspected in a workplace, administrators are encouraged to intervene, such as offering staff training in communication skills, conflict resolution, emotional control, and practical skills (Henry, 2013; Rushton et al., 2015; Wei et al., 2017). Less traditional activities, such as nonclinical retreats, crafting sessions, yoga classes, writing workshops, newsletters recognizing staff, and reward programs, should also be considered and may be financed with external grants and nursing society funds (Henry, 2013; Rushton et al., 2015). The benefits for facilities offering support and intervention for nurses experiencing burnout can include higher patient and staff satisfaction rankings, improved patient care, and lower rates of staff turnover (Henry, 2013; Wei et al., 2017).

Finally, nursing leaders must embed education and policy on nursing burnout into the foundation of our profession through activism and academic writing. To remove stigma, leaders can create forums for nurses to share their narratives of burnout and empower one another. And perhaps most importantly, nursing leaders hold the power to resolve nursing burnout by leading through example, showing us all how to have successful, and healthy, nursing careers.

References

Cañadas-De la Fuente, D. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240–249.

Henry, B. J. (2013). Nursing burnout interventions: What is being done? Clinical Journal of Oncology Nursing, 18(2), 211–214.

Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412–420.

Tawfik, D. S., Phibbs, C. S., Sexton, J. B., Kan, P., Sharek, P. J., Nisbet, C. C., … Profit, J. (2017). Factors associated with provider burnout in the NICU. Pediatrics, 139(5).

Walton, A. (2018). The cost of caring: Emergency department nurses, compassion fatigue, and the need for resilience training. Educational Specialist, 125.

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal of Emergency Nursing, 43, 145–149.

Additional Resources

Canadian Nurses Association. 2010. Nurse Fatigue and Patient Safety.

Cleveland Clinic. 2016. Nine Strategies for Alleviating Nurse Burnout.

Mayo Clinic. 2018.  Job burnout: How to spot it and take action.

Norwich University. 2017. How Nurse Leaders Combat Burnout.

Crystal McLeod is a MScN graduate student at Western University, Ontario.