No job is stress-free. But because clinical nurses work in an environment that is high-stress by nature—making decisions that can impact patients’ lives—they need to take extra care to avoid the mental and physical condition known as “burnout.” This piece outlines what nurse burnout is, the dangers it poses, how to prevent it, and how to address it if it’s happening to you.
What Is Nurse Burnout?
Nurse burnout is the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes. As you face these compounding factors, you may start feeling disengaged and detached, the first warning signs of burnout. If you don’t address this situation with good self-care, burnout can lead to feelings of cynicism, hopelessness, and even depression.
Causes of Nurse Burnout in Nurses
According to the World Health Organization, burnout is an occupational phenomenon. ((World Health Organization. “Burn-out an ‘occupational phenomenon’: International Classification of Diseases.” May 28, 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases. Accessed: January 25, 2022)) It is not specific to nursing: Professionals in any industry, from teaching to engineering, can suffer from this type of exhaustion caused by unrealistic expectations, lack of sleep, and other work-related stressors. However, due to their high-stress work environment, nurses and other medical professionals face a greater risk of burnout.
Another contributing factor is the growing demand for nurses as the Baby Boomer generation ages and the prevalence of chronic disease increases. The U.S. Bureau of Labor Statistics projects that employment for registered nurses will grow by 12% between 2018 and 2028. ((U.S. Bureau of Labor Statistics. “Registered Nurses.” Last modified September 8, 2021. https://https://www.bls.gov/OOH/healthcare/registered-nurses.htm. Accessed: January 25, 2022)) That’s good news if you are looking for a nursing job. However, the pace of this increase has led to growing pains: understaffed hospitals, overworked nurses, and nurse burnout.
Another contributing factor is the growing demand for nurses as the Baby Boomer generation ages and the prevalence of chronic disease increases. The U.S. Bureau of Labor Statistics projects that employment for registered nurses will grow by 12% between 2018 and 2028. ((U.S. Bureau of Labor Statistics. “Registered Nurses.” Last modified September 8, 2021. https://www.bls.gov/OOH/healthcare/registered-nurses.htm. Accessed: January 25, 2022)) That’s good news if you are looking for a nursing job. However, the pace of this increase has led to growing pains: understaffed hospitals, overworked nurses, and nurse burnout.
Lack of Sleep
One of the largest burnout risks for professionals in any industry is chronic lack of sleep. This is particularly common for nurses who work long hours and consecutive shifts. In a survey conducted by Kronos Inc., 25% of nurses reported that they were unable to get enough sleep between shifts. ((Kronos. “Wake Up to the Facts About Fatigue.” 2018. https://www.kronos.com/resource/download/24266. Accessed: January 25, 2022))
Every nursing specialty brings its own challenges, but some specialties are naturally more stressful than others. If you work in the emergency department with telemetry or intensive care, you may have to deal with combative patients, traumatic injuries, ethical dilemmas, and a high mortality rate, all of which are linked to high stress levels and an increased risk of burnout. In a study in Psychooncology, 30% of oncology nurses reported emotional exhaustion, while 35% reported feelings of low personal performance—both symptoms of burnout syndrome. ((Cañadas-De la Fuente, Guillermo A., Jose L. Gomez-Urquiza, Elena M. Ortega-Campos, Gustavo R. Cañadas, Luis Alberndín-García, and Emilia I. De la Fuente-Solana. “Prevalence of burnout syndrome in oncology nursing: A meta-analytic study.” Psychooncology 27, no. 5 (May 2018): 1426–1433. doi: 10.1002/pon.4632. ))
Lack of Support
If your workplace lacks a culture of good teamwork and collaboration practices, burnout may be more prevalent there. ((DeKerel, Alan. “The Biggest Causes of Nurse Burnout and What You Can Do.” Well-Being Index Team. February 24, 2021. https://www.mywellbeingindex.org/blog/the-biggest-causes-of-nurse-burnout-and-what-you-can-do. Accessed: January 25, 2022)) While collaboration is important in most professions, in nursing, it can actually save lives. Poor teamwork—which is characterized by conflict, sub-par communication, lack of cooperation, and even peer bullying—makes for an unpleasant work environment and can lead to medical errors.
Emotional Strain from Patient Care
Patient care is one of the most rewarding aspects of nursing, as you make connections with patients and feel the satisfaction of helping them get better. But if you work in critical or end-of-life care, the emotional letdowns of dealing with lower recovery and higher mortality rates can lead to compassion fatigue and increased rates of burnout. ((LeVeck, Danielle, DNP, ACNPC-AG, CCNS, CCRN. “Nurse Burnout Is Real: 7 Risk Factors and the Top 3 Symptoms.” Nurse.org. October 2, 2018. https://nurse.org/articles/risks-for-nurse-burnout-symptoms/. Accessed: January 25, 2022)) The number of patients you care for is another factor. Nurses with greater than a 1:4 nurse-to-patient ratio have a higher risk of burnout, with each additional patient raising the risk by 23%. ((Gutsan, Ekaterina, Jami Patton, William K. Willis, and Alberto Coustasse, Dr.PH. MD, MBA, MPH. “Burnout syndrome and nurse-to-patient ratio in the workplace.” Marshall University. April 2018. https://mds.marshall.edu/cgi/viewcontent.cgi?article=1196&context=mgmt_faculty. Accessed: January 25, 2022))
Dangers of Nurse Burnout
Nurse burnout is a substantial concern for all concerned: nurses, employers, and patients. Nurses themselves are at risk for developing depressive disorders and other mental health conditions and for quitting their job. For institutions, a decrease in the quality of patient care can affect their reputation and bottom line. For patients, nurse burnout can directly impact their health.
In a study in the International Journal of Environmental Research and Public Health, ((Van der Heijden, Beatrice, Christine Brown Mahoney, and Yingzi Xu. “Impact of Job Demands and Resources on Nurses’ Burnout and Occupational Turnover Intention Towards an Age-Moderated Mediation Model for the Nursing Profession.” International Journal of Environmental Research and Public Health 16, no. 11 (June 2019). https://www.mdpi.com/1660-4601/16/11/2011. Accessed: January 25, 2022)) researchers found a correlation between higher rates of burnout syndrome and nurses’ intention to leave. This increased turnover puts more stress on an already overworked environment.
Lower Quality of Care
The most dangerous risk associated with burnout is a decrease in the quality of patient care. Mistakes due to exhaustion can lead to patient discomfort, infection, and even (in extreme cases) death. One study found that the patients of nurses experiencing burnout had an increased incidence of urinary tract and surgical site infections. ((Jeanne P. Cimiotti, et al., “Nurse staffing, burnout, and health care-associated infection,” American Journal of Infection Control,” Aug. 1, 2012: https://doi.org/10.1016/j.ajic.2012.02.029))
In a study by Marshall University, nurse-to-patient ratios greater than 1:4 were not only correlated with higher percentages of burnout—but for each patient added to that ratio, there was a 7% increase in hospital mortality. ((Ekaterina Gutsan et al., “Burnout syndrome and nurse-to-patient ratio in the workplace.” April 2018: https://mds.marshall.edu/cgi/viewcontent.cgi?article=1196&context=mgmt_faculty))
How Nurses Can Prevent Burnout
Fortunately, it’s possible to prevent nurse burnout before it occurs—and to treat it immediately when it happens. For medical institutions, preventing burnout protects their employees, patients, and their bottom line. Nurse managers and nurse leaders can help lower the risk in their workplace. And nurses themselves can take preventive and therapeutic measures for self-care.
Whenever possible, nurse managers should create humane schedules for their staff, with shift lengths of 9 hours maximum. If you’re a nurse, try to work in a facility that treats its workers well. Avoid working overtime, and advocate for a schedule that lets you live a balanced and healthy life, leaving time and energy for loved ones and your favorite activities.
Be sure to take your vacation days so you can deeply relax and get a change of scenery. To encourage this, institutions can introduce a mandatory vacation day policy with a quarterly check to make sure their staff are taking the time they need. This helps to increase job satisfaction and decrease the turnover rate.
Seek Out Support
Support groups and work buddy systems can give you an outlet to vent frustrations and discuss conflicts and challenges so that when you go home or on vacation, you can truly relax. When you and your peers feel heard, this can also improve teamwork and collaboration. If you are feeling hopeless or depressed, be sure to seek out the help of a therapist or counselor.
Learn Coping Methods
One of the best ways to manage your work stressors is to learn coping skills. Methods such as breathing techniques, restorative exercise, journaling, and a post-work relaxation routine can make a big difference in your physical and mental health and well-being.
Change Specialties or Focus
Finally, if your current specialty is too stressful, consider making a change. Earning your graduate nursing degree, such as your Master of Science in Nursing or Doctor of Nursing Practice, can enable you to switch to a specialty that’s a better fit. Becoming a family nurse practitioner could give you more autonomy in your practice, or you might consider mentoring the next generation of clinicians as a nurse educator.
If you’re a nurse who is noticing signs of burnout, be sure to up your self-care game. It’s important for you, your employer—and your patients.
The University of St. Augustine for Health Sciences (USAHS) offers Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions ((Cimiotti, Jeannie P., DNSc, RN, Linda H. Aiken, PhD, Douglas M. Sloane, PhD, and Evan S. Wu, BS. “Nurse staffing, burnout, and health care—associated infection.” American Journal of Infection Control 40, no. 7 (September 2012): 486–490. https://doi.org/10.1016/j.ajic.2012.02.029. Accessed: January 25, 2022)) and an annual interprofessional trip abroad. Role specialties include Family Nurse Practitioner (FNP), Nurse Educator, ((Gutsan, Ekaterina, Jami Patton, William K. Willis, and Alberto Coustasse, Dr.PH. MD, MBA, MPH. “Burnout syndrome and nurse-to-patient ratio in the workplace.” Marshall University. April 2018. https://mds.marshall.edu/cgi/viewcontent.cgi?article=1196&context=mgmt_faculty. Accessed: January 25, 2022)) and Nurse Executive. The MSN has several options to accelerate your time to degree completion. Complete coursework when and where you want—and earn your advanced nursing degree while keeping your work and life in balance.