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Understanding Nurse Burnout: An Overview
Burnout is a problem that is very significant in the nursing world. This contributes to many factors such as psychological distress, job dissatisfaction, high employee turn-over rate, care is drastically reduced, and there is an increase in healthcare costs. Not only are the effects on nurses in the professional world, but it also starts out with nursing students. Many of the same stressors that the nursing professionals encounter, so do nursing students. Studies have shown evidence towards providing ways of incorporating organizations in support of burnout with these nurses. Further research is required to determine what specific programs and tools will prohibit healthy happy nurses.
The Vulnerability of Novice Nurses to Burnout
As many nurses have become familiar with the negative effects of burnout, novice nurses are more susceptible to it. It is unfortunate that many workers and nurses experience professional burnout. Kutluturkan (as cited in Brown, 2018) says that burnout is when a person can no longer manage the effects of stress. Many people experience burnout whether it may be through their co workers, or from personal experience, all in all the people understand the negative effects it brings forth. Since burnout can affect nurses throughout their career at any time, it is important to value the nurses that are out there now. Nurses have many tasks, some more difficult than the other, and go through experiences on a daily basis that include emotional distress, which can make it difficult for a nurse to be as involved with their patients as they would like to be. Thus, this then creates an imbalance in the work environment contributing to not adhering to their patients feelings and how they apply themselves at work. Not only that, as a nursing professional, this is one of many things that contribute to nurse burnout along with, the toll of overworking themselves, lack of resources, and facilities with poor management.
A nurses job is very critical and very important in a healthcare setting, that shouldnt be taken for granted. The strain and pressure of a new work environment, and lacking certain abilities in their field can also further lead to professional burnout while they are still becoming acclimated to the job. Since nursing professionals are not the only ones who experience nurse burnout, nursing students do as well and this creates a strain in their learning. The strain put on the nursing students to gain all of this clinical knowledge while trying not to lack confidence in their abilities also leads to signs of burnout while training. Needless to say, this burnout can happen at any stage in a nurses career. It is essential to understand the concepts behind nurse burnout, then there can be preventive measures put in place, or available programs for nurses facing this kind of problem.
Defining and Measuring Burnout in Nursing
Defining burnout can mean a multitude of things. Some words associated with burnout are words like, compassion fatigue, emotional exhaustion, and occupational burnout. Characteristics and associations that help define the word burnout will help clarify and promote a good understanding of the topic. Compassion fatigue (CF), is considered to be the negative aspects of care provision that results from the demands of the work environment and caregiving to distressed individual (Craige, and et. al, 2016). Some words that may be used interchangeably thought this paper are burnout, compassion fatigue, and occupational burnout. Emotional exhaustion (EE) is another component of burnout. As stated by Maslach, Jackson, & Leiter (as cited in Martinez-Inigo, Bermejo-Pablos, & Totterdell, 2018) EE is a state of physical and emotional depletion that usually arises from excessive personal demands and is one of the components of burnout. Lastly, stated in an article by Maslach & Jackson (as cited in Jaracz, Rosiak, Bertrand-BuciDska, Jaskulski, Nie|urawska, & Borkowska, 2017) occupational burnout (OB) is defined as a syndrome of exhaustion, depersonalization, and inefficacy, in reaction to chronic stress at workplace.
Root Causes of Nurse Burnout
Why does nurse burnout happen? Nurse burnout has various factors that play into a nurses life. People may develop issues due to the constant exposure to unpleasant, traumatic and stressful events ( Mohsin, Shahed, & Sohail, 2017). As stated by (Mohsin et al., 2017) nurses are burdened with workload and have to attend to many patients during their duty hours. Dealing with the emotional stress of seeing patients dying, dealing with patients, families and doctors, not being appreciated, and figuring out solutions repetitively each day gets exhausting. The weight of all of that certainly gets to the nurses overtime, especially when there are patients who use and abuse the system. This leaves the nurse feeling useless and having the nurse at the end of the day leave their patients with the lasting effects of emotional exhaustion.
Emotional exhaustion can stem into negative feelings for oneself and their job. With having emotional exhaustion, this will start showing in the quality of care the nurse gives and what the patient receives. Although the patients will be affected by this tremendously, so will the people working in that environment with the nurse. This newly developed attitude will negatively impact the work environment and how the nurse proceeds with her day to day activities. These maladaptations include a lack of emotional abilities such as awareness and emotional clarity, rejecting responses, high emotional interference of negative emotions in the performance of goal- oriented behaviors, and the inability to control behaviors in the face of emotional distress (Blanco-Donoso, Garrosa, Demerouti, & Moreno- Jimenez, 2017). Along with emotional exhaustion, a characteristic flaw that will start to develop is depersonalization. Depersonalization is what happens when a nurse becomes numb to a situation. They will eventually start to work like robots, essentially. These people will work to work and not work to provide quality care to their patients. They also fail to recognize the humanness aspect of the job. Since depersonalization causes low self worth and low personal achievement, these types of situations may arise as another component that may lead up to emotional exhaustion in a nurse while working.
A way that burnout can be measured is buy MBI which stands for Maslach Burnout Inventory. What MBI does is measure three components which are: EE, CF, & OB. If the score was higher on the subjects of EE and CF, then that would mean it correlated with higher degrees of burnout (Molavynejad, Babazadeh, Bereihi, & Cheraghian, 2019). Also, the lower scores related to burnout was OB (Molavynejad, Babazadeh, Bereihi, & Cheraghian, 2019). The MBI is very useful because it serves a good purpose of showing good measurement of burnout for many years, as well as reliability and validity (Ilic, Todorovic, Jovanovic, & Ilic, (2017).
The Impact of Burnout on Nursing Students
However the stress doesnt start from just working as a nurse in the medical field, but it also starts out in school. Nursing students have to cope with some of the same stressors as other nurses do who are already working in the field. They have a commitment to doing well academically, while committing to a lack of a social life (Nechita, et. al, 2014). The demands from nursing school are physically generative, exhausting emotionally, and a hindrance on their relationships (Nechita, et. al, 2014). Additionally, nursing students have to be home for long periods of times, be financially worried, assessments done at clinical and in the classroom, and the ever changing environmental situations (Nechita, et. al, 2014). A lot of nursing students suffer from self confidence. They have insecurities about their clinical skill experience, as well as their lack of experience in the medical setting, which is very important in the nursing field. Not only do the students have all of the stress mentioned above, but nursing schools also have an increase in nontraditional students, which also adds to the levels of stress that they experience (Lott, & Davis, 2018). For many reasons, nursing students are more prone to experiencing burnout while attending their nursing program.
Strategies and Interventions to Combat Nurse Burnout
Some ways to combat burnout for nurses include many different things. One topic that can be addressed is nurses workload. In the state of California, a law states that a nurse must have a patient to nurse ratio of 1:5 for medical surge units (TS, 2015). Another suggestion for reducing nursing burnout is to have an increase in clinical supervision, which was proven to reduce stress psychologically (Hyrkas, 2005). Problem Based Learning has been shown to be effective in enhancing student success and empowerment ( Young-Hee, Kyung-Hye, & Ok-Hee, (2018) thus would be beneficial for the nursing population.
Meditating has also been proven to be effective in reducing stress for nursing professionals. However, there are some issues around that because there needs to be an intervention done to help guide these nurses in the correct way to make sure that they are getting professional help and guidance. ( Noble, and et. al, 2019). Other ways that can reduce stress for nurses is by increasing the support from coworkers and providing a plethora of opportunities for nurses in the professional world. There is always room for improvement that can improve the quality of life for nurses. The current management of nursing burnout has yet to be tackled, and there is so much room for improvement for this situation.
Burnout in the nursing profession is definitely a problem that cost a lot. Even though there are detrimental effects while examining the reasoning behind nurse burnout, however there are other problems that is worth looking into. Financially, a study done around 2007-2008 showed that the nurse turnover rate resulted in at least over $80,000 dollars for the cost of the hospital per registered nurse, and most likely this number has risen since these numbers were during inflation (Jones, 2008). Since there are multiple factors affecting nurse burnout, one of the contributing factors to it is job dissatisfaction. According to (Snavely, 2016), many of the nurses believe that there is a shortage of nurses, which present problems such as the quality care of the patients, their work life, and how much time the nurses can spend with their patients.
Hospital acquired infections and burnout have been linked to show a major contribution to high readmission rates. The hospital loses at least several millions of dollars annually do to infections (Snavely, 2016). On the subject of costs, some positive conditions for working nurses unfortunately do not increase the nurses salary. Conditions like the autonomy of their work, decision making skills, and their workforce resiliency do not contribute to increased salary. Nurse burnout can be seen not only from a business perspective but a perspective of morality. With a study shown on nurse burnout and patient mortality, these nurses felt emotionally exhausted, and cynical towards the people who were in need in help, resulting in inefficient performance tasks and always expressing the want to quit or leave (Lee, & King, (2014). Unfortunately, this study shows how important burnout can be and how it can end up affecting human lives in the end.
Upon considering the facts above and the interventions suggested, burnout should not only be directed towards nurses in the professional world, but also towards students as well, because it starts from there. Nursing students are the foundation of future nurses, and the problems occurring with nurses of today will only prohibit the same unforeseen circumstances with the developing nursing students. Nursing students go through rigorous training that can really break the students down. These habits will start to develop now, and how they cope with the stress of nursing school will only follow them throughout their professional career. It is already known that their empathy decreases as they advance while being in the nursing program (REFERENCE). In regards to how the nurses feel during their nursing program, and their attitudes and behaviors that develop with them into their professional career is very concerning. It is concerning because this relates to the EF component of burnout. Although, nursing schools want their students to be equipped with the best practice of care, and safety, it would be helpful for these students to be armed with proper training against burnout. Nurses should have a successful long fulfilling career.
Research that has been done shows that there is a significant problem with nurse burnout. There have been multiple studies showing that various stressors that contribute to nurse burnout can decrease the quality of life for a nurse. Furthermore, there have been more studies that contribute to individual behaviors that factor into nurse burnout. While there are still more studies to be done in regards to nurse burnout, there are still some strategies that are not known to be as effective to reduce the incidence elf nurse burnout.
There also have been to positive coping methods which have shown great success within the nursing profession. One positive method was to walk. The benefits of walking include having a therapeutic advantage while the nurses have high levels of stress. In addition to that, this is cost effective and easily accessible for everyone to incorporate into their daily lives. Walking, and exercise in general promotes lower levels of stress as well as a happier well being. With walking, this induces such positive effects, however walking, along with practicing mindfulness, engaging in strategies that involve positive engagement, and mentoring in proximity to a green place enhances its benefits.
As stated by (Duvall, 2011), found that there was a significant increase in self- esteem while walking in this type of environment. While this coping method is a positive one, burnout does affect people’s participation levels. Not many people who suffer from burnout are going to want to participate in any kind of activity, especially if the demands at work are increased. However, it all depends on the person’s personality and how driven they are to even want to do anything that promotes a better well-being. There needs to be more research done to confirm the effects of walking and nurse burnout in nurses. Integrating research from the real world as well as including the values, concerns, and the critical choices the nurses makes is crucial in reaching the burnout for this population.
While burnout is detrimental for nurses in their profession, it also contributes to the quality of care given to their patients, being dissatisfied with their jobs, and an increase in mortality and morbidity, and higher costs for healthcare. Burnout doesnt only affect nurses and nursing students as well. Starting from the nursing program, these students can start to attain burnout right from the very beginning. Since the demand for nurses is high, it would be helpful to invest in the social, psychological, and emotional well being of the students and nurses.
References
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- Brown, S. (2018). The Impact of Resiliency on Nurse Burnout: An Integrative Literature Review. MEDSURG Nursing, 27(6), 349378. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=aph&AN=133645959&site=ehost-live&scope=site
- Craigie, M., Osseiran-Moisson, R., Hemsworth, D., Aoun, S., Francis, K., Brown, J., & Rees, C. (2016). The influence of trait-negative affect and compassion satisfaction on compassion fatigue in Australian nurses. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 8897. https://doi.org/10.1037/tra0000050.supp (Supplemental)
- Duvall, J. (2011). Enhancing the benefits of outdoor walking with cognitive engagement strategies. Journal of Environmental Psychology, 31, 27-35. doi:10.1016/j.jenvp .2010.09.003
- Hyrkas, K. (2005). Clinical supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland. Issues in Mental Health Nursing, 26(5), 531556. doi: 10.1080/01612840590931975
- Ilic, M., Todorovic, Z., Jovanovic, M., & Ilic, I. (2017). Burnout Syndrome Among Medical Students at One University in Serbia: Validity and Reliability of the Maslach Burnout InventoryStudent Survey. Behavioral Medicine, 43(4), 323328. https://doi.org/10.1080/08964289.2016.1170662
- Jaracz, M., Rosiak, I., Bertrand-BuciDska, A., Jaskulski, M., Nie|urawska, J., & Borkowska, A. (2017). Affective temperament, job stress and professional burnout in nurses and civil servants. PLoS ONE, 12(6), 111. https://doi.org/10.1371/journal.pone.0176698
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- Molavynejad, S., Babazadeh, M., Bereihi, F., & Cheraghian, B. (2019). Relationship between personality traits and burnout in oncology nurses. Journal of Family Medicine & Primary Care, 8(9), 28982902. https://doi.org/10.4103/jfmpc.jfmpc_423_19
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- Young-Hee Kim, Kyung-Hye Hwang, & Ok-Hee Cho. (2018). Simulation Education with Problem-Based Learning: Effect on Nursing Students Communication Apprehension. Social Behavior & Personality: An International Journal, 46(1), 151160. https://doi.org/10.2224/sbp.6906
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