The U.S. Department of Labor notes that registered nurses comprise 2.3 million jobs in the healthcare field – the largest, by far. Furthermore, the Department projects that among all occupations in all fields, more nursing opportunities will be created over the next decade than any other. From a distance, things do indeed look quite good for the nursing profession. After all, we’re still living in an era of tremendous job uncertainty and labor market misalignment. It’s nice to know that, based on this promising statistical outlook, nursing is an wise career move for millions of people today, tomorrow, and for years to come.

Yet there is more to this story than rosy statistics; and the nurses reading this article would no doubt criticize any attempt to paint an incomplete picture of what’s really happening in the trenches. Despite the professional and personal satisfaction that comes from applying their considerable skills to help patients heal or face illnesses with dignity, more and more nurses are facing a situation that, by its very term, sends waves of dread through even the most battle-hardened health professional: burnout.

Why Does Burnout Occur?

Some of us may be accustomed to the word burnout. Yet before we look at this issue in and pose some solutions, it’s very valuable to take a step back and ask ourselves a question that is simply not being asked: why burnout?

The question doesn’t seem to make sense. Or, if it does (after reading it a few times), it implies that we want to know the causes of burnout; and yes, we do. But that’s not why we ask the question: why burnout? We ask it because there is an incredible amount of insight in simply understanding why this term is so appropriate.

Burnout: Real, Devastating, and Lasting

Author, counselor, and educator Elizabeth Ruth Skoglund, M.A., M.F.T notes in the write-up to her book Say No to Burnout, “At times the word burnout has become so overused that its meaning has become blurred”. This is no casual observation! Those who seek to deny nurse burnout as a serious problem have intentionally and perhaps at times, unintentionally, diminished the core meaning of this critically important word: burnout.

Indeed, other words have sometimes been used to soften the edges of this problem; words like exhaustion, or fatigue, or sometimes even stagnation. These are all relevant words (most of the time), and have their place in the discussion of nurse burnout. Yet they aren’t synonyms for the concept of burnout; they are merely adjectives that shed light on how burnout can manifest in hospitals, in the community, in long term care facilities: in anywhere that the skilled army of 2.3 million (with more needed!) nurses perform their skills.

When we look at the word burnout for what it is, literally, we can see that the concept points to three layers of meaning.

• Burnout is real. A flame that burns out, be it a candle, a torch, or an inferno, isn’t a matter of perspective or paradigm. A flame is tangible and exists in the objective world. Whether one cares about the flame or not is irrelevant. Whether one feels warmth by the heat or burned by it is beside the point. Attitudes towards the burnout may differ. Yet the burning out itself is not open to debate. It’s real, visible, and no political spin or use of soft adjectives is going to change this.

• Burnout is devastating. We're accustomed to hearing the word devastating crouched in emotional terms, such as a devastating loss of fame, fortune, property, or life. Yet probably due to overuse of the word burnout – particularly by those who aren’t nurses and don’t fully grasp the inner logic of what they’re talking about – we don’t tend to view nurse burnout as devastating. Yet it is! There’s no other way to approach this; not without fundamentally breaching the very definition of the word burnout; something that we can’t do, since burnout is real.
• Burnout is lasting. This is, by far, the most real and devastating aspect of the term: it is lasting. When a flame of any size is extinguished, it will not rekindle itself without external influence. A candle can only be lit by another flame. A burning ember can only be reignited by the intense rays of the sun, and a host of other supportive factors, such as wind speed and air temperature. Burnout is not a temporary measure. It lasts.

Please note that our focus here on the word burnout isn’t academic or remotely trivial. It’s certainly not speculative or interesting. It’s bottom-line, pragmatic fact. By breaking this term down and understanding its absolute suitability in describing what is really happening out there in the health care field, we can remind ourselves – if we need reminding – that there’s no soft edge politically polite way to grasp this problem. Only when we admit and accept that the problem of nurse burnout is real, devastating, and lasting can we begin to move forward with real solutions that respectfully serve the biggest component – by far -- of our essential health care system: nurses.

Remember, too: even if you aren’t a nurse and currently find yourself unaffected or even apathetic towards this problem, that unresolved issues in nursing have the potential to affect us all. As a study published Journal of the American Medical Association noted, burnout among hospital nurses can negatively influence patient care. Since the likelihood of everyone reading this right now coming into contact with a hospital or nursing care sooner or later is probably 100%, it’s time that we all realized that this isn’t a problem exclusive to nurses, or even to hospitals and administrators. This is a problem that affects us all, if not now, then eventually.

The Causes of Nurse Burnout

Driving the nurse burnout epidemic, or at least enhancing it to alarming levels, is the widespread shortage of nurses. This shortage creates an almost constant, and continuous, lack of resources: nurses are being asked – and often expected – to more than they physically, emotionally, and psychologically can achieve.

The impact of this relentless stress is enormous and immeasurable; it leads to everything from ineffective performance and, in some cases, outright withdrawal from the nursing profession. As Chief Nursing Officer Lillee Gelinas, RN, MSN regrettably notes, “after a while, [burned out nurses] become drained of that positive energy -- the very reason they went into nursing in the first place”.

The pressure and stress of shift work is also a key contributor to nurse burnout. Shift work can be long and extremely draining; especially when there is an almost continuous interface between delivering patient care, working with new (and sometimes very complex) technology, and ensuring that protocols and procedures are followed to the letter. Juggling these objectives – which often overlap and even seem to compete at times – can take a toll on even the most experienced nurses (let alone those new to the field!).

When you add all of this up, and then view it within the lens of a shortage of nurses, it’s not at all hard to hard to envision and comprehend the numerous causes of nurse burnout: it’s everything from lack of support, to expectations that can’t be met. Just because virtually all nurses enter the field because they’re motivated to help people, to give of themselves, and be a positive source of support to all that they come into contact with, doesn’t mean that they should be exploited for the very skills that made them such good nurses in the first place!

Solving Nurse Burnout

The UCLA Medical Center is offering an interesting and innovative way for nurses to restore some of their depleted reserves of spent energy and drained emotions. Through it’s “Teas for the Soul” weekly informal get together, the Center’s nurses have the opportunity to congregate with the Center’s Chaplain to share some of their war stories. There is no agenda, and the weekly session is proving to be quite an important strategy in the Center’s nurse de-stress efforts. Whether it’s simply empathizing with a colleagues plight, offering a shoulder to lean on, or getting away from the demands of a busy care center for an hour a week, it’s a therapeutic idea with ancient roots, and so far, modern benefits.

Cheryl L. Mee, RN,BC, MSN also offers some advice to nurses struggling with burnout, and in particular, new nurses who are encountering this issue for the first time on a very personal level. Mee’s advice doesn’t specifically point to a strategy or technique, but rather, to a mindset. She reminds nurses that “you hold the key to helping yourself and other nurses combat burnout. Take action now to revive your enthusiasm”. In practical terms, combating burnout and supporting colleagues can include ideas such as :

• Volunteering for workforce committee.
• Talking to colleagues about helping the hospital become recognized with quality designations such as “Magnet Recognition,” “Top 100 Best Places to Work” or “Employer of Choice”.
• Not giving “in” to the current situation, but doing something about it
• Keeping a sense of humor.
• Working in harmony with colleagues to diminish a sense of worry and anxiety.
• Learning to pace oneself.
• Stop denying that one feels pressure at work, or that one is overworked.

While, as Mee advises, nurses can escape the well of burnout through “action to revive their enthusiasm”, it’s clear that solving the problem must also come from outside the nurses themselves. As Lillee Gelinas (who we have referred to earlier) explains, hospitals and other employers must take a leadership role in helping and preventing nurse burnout. Steps that hospitals/employers should take include making a concerted effort to ensure that nurses feel that their job is meaningful and that the nurses themselves are valued and important. Part of this effort must include communicating with nurses and obtaining their input on everything from patient care to shift work details. Furthermore, and this is also essential, hospitals/employers must understand that nurses need to achieve a work life balance. Simply seeing that a nurse shows up to work on time, or seems to be smiling, is hardly a means to evaluate whether that nurse is really struggling with burnout. Hospitals/employers must reach out to nurses and discover if burnout is happening, and how it can be prevented on a managerial level.

Conclusion on Nursing Burnout

Conclusions are typically the places where issues are wrapped up, summarized, and if applicable, placed inside a larger issue or bigger picture. We can’t do any of this. The issue of nurse burnout will not tolerate being wrapped up and summarized; or least of all, being placed into a larger picture.
Nurse burnout is the larger picture. It is an issue – an epidemic – that is barely being understood at the moment, and largely because the problem is literally ripping health care at the seams. As the nursing sector desperately seeks new entrants and retention of its existing workforce, the reality of nurse burnout is a front and center issue. Perhaps, in a paradoxical way, it’s good that we’re faced with this problem in its stark magnitude and stressful clarity; because if we weren’t, we might not sense the urgency, the reality, and the necessity to solve it. Indeed, this is not merely a nursing crisis that must be addressed; it’s a social, economic, and political problem that must be tackled head on, at both the nurse level, and the hospital/employer level. Nursing burnout affects us all.

Sources

Source: US Department of Labor. http://www.bls.gov/oco/ocos083.htm

Source: Elizabeth Ruth Skoglund, M.A., M.F.T.. “Say No to Burnout”. http://www.hopeway.org/lifehelps/burnout.asp

Source: Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987-1993.

Source: Lillee Gelinas, RN, MSN. “Addressing Nurse Burnout. Changing the Culture is the Cure. http://www.endonurse.com/articles/3a1staffing.html

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Source: Valerie J. Nelson. “Nurses and Burnout: What You can Do to Prevent It”. http://www.nurseweek.com/features/97-2/burn.html

Source: Cheryl M. Yee, RN, BC, MSN. “Battling Burnout”. http://www.findarticles.com/p/articles/mi_qa3689/is_200208/ai_n9141607

Source: Lillee Gelinas, RN, MSN. “Addressing Nurse Burnout. Changing the Culture is the Cure. http://www.endonurse.com/articles/3a1staffing.html

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