By Susan VanBeuge, DNP, APRN, FNP-BC, FAANP (UNLV School of Nursing Associate Professor in Residence)
What is burnout? It’s a term that’s thrown out quite often, especially during the last year and a half, but it’s far from new, especially in healthcare. Chances are we’ve all seen it and possibly experienced it without knowing what to call it.
Burnout is defined as “a long-term stress reaction marked by emotional exhaustion, depersonalization, and lack of sense of personal accomplishment” (AHRQ, 2017). The concept of provider burnout has received more attention in the past year related to the impact of Sars-CoV-2 “COVID-19” on those providing care. These types of feelings became more publicized and the sights and sounds became more common: tired expressions; weary voices; lack of energy and purpose.
Even though we are moving back into routines that closely resemble pre-pandemic times, burnout still exists across all professions, particularly in high-stress fields like nursing. This is why it’s critical to understand burnout, how to spot it, and how to manage it.
Identifying Red Flags and Contributing Factors
The COVID-19 pandemic provided the template for increased reports of burnout in health care providers. Intense pressure on the healthcare system, overburdened workers, complex multi-system conditions, and long hours are some of the contributing factors to burnout in the acute care setting. Over time, this burnout has been seen in all areas of healthcare from acute to outpatient community care. In focusing on strategies to prevent and mitigate burnout, there are many individual focused interventions that may be employed (Howell, 2021).
Nurses in every stage of practice may experience burnout. In recent years, this has been studied as its rising prevalence has been noted by all types of health care providers. The etiology is multi-faceted and can be linked to work conditions such as time pressures, chaotic environments, poor organizational culture, feelings of dissatisfaction, stress, and outside responsibilities related to family and life pressures (AHRQ, 2017). Watch for some of the warning signs of declining efficiency and/or performance, loss of confidence to achieve goals, avoiding work-related tasks, feeling exhausted and overwhelmed, and loss of interest in your work. One of the most important aspects for nurses at any point in their career is to not put off dealing with burnout. If you see some of the signs in yourself or others, seek help and care yourself. These stressors will take a toll over time in your physical well-being and those around you.
What the Literature Says
A 2018 study of advanced practice nurses (APNs) and physician assistants (PAs) at Vanderbilt University Medical Center, 433 participants reported this experience of burnout in one of three groups: never experiencing burnout (40.4%), formerly experienced burnout (33.3%), and currently experiencing burnout (26.3%). The largest group, never experiencing burnout, reported low levels of emotional exhaustion and depersonalization and high personal accomplishment. The group currently experiencing burnout demonstrated high levels of emotional exhaustion, moderate depersonalization, and moderate personal accomplishment. This group reported fewer opportunities for advancement and lesser work appreciation (Kapu, et. al, 2021). This study found that most advanced practitioners (59%) had experienced or were experiencing burnout and 41% had not identified as experiencing burnout.
Additionally, a study on the burnout of nurses during COVID-19 in 2020 demonstrated those who had increased anxiety and less experience had a higher level of burnout (Guixia, & Hui, 2020). This study showed during the early days of COVID-19 there was high morale and work enthusiasm. As the burden of long hours, sick patients, lack of specific drug treatments, and a feeling of limited impact nurses could make, an increase of emotional exhaustion, depersonalization, and lack of personal accomplishment became more prevalent leading to burnout. An interesting observation about this study was nurses who had experience with previous SARS/Influenza A/Avian Influenza had less reported burnout with COVID-19. This study demonstrated that having more clinical experience gave them greater skills to deal with the negative emotions to protect themselves from emotional exhaustion and depersonalization, thus protecting themselves from burnout.
Incorporating Self-Care and Ways to Prevent/Mitigate Burnout
Self-care is important for all health care providers. In a case-control design study on sleep, COVID-19, and burnout, research authors reported less sleep and high levels of burnout were associated with an increased risk for COVID-19 among healthcare workers (Kim, Hedge, & LaFiura, 2021). They found that every 1-hour increase in sleep duration was associated with 12% lower odds of contracting COVID-19.
Incorporating individual focused care along with strong support of others such as family, spiritual, social connections and other positive collaborative relationships are ways to promote care. Taking time to prioritize you as an individual can mitigate burnout over time. It is important for advanced practice nurses to deliberately prioritize self-care to promote well-being as an individual. This self-care can be modeling for our colleagues and those new to the profession as well as the organizations we may belong.
Proper nutrition, adequate rest, and physical exercise should be the foundation of care. Finding work-life balance measures are important to find stability. These include being with family, participating in social activities, taking vacations or taking time off work, and being engaged in fun activities outside work. In this time of COVID-19, the struggle with social distancing can make some balancing activities challenging, but not impossible. Other interventions include activities to build resistance like stress-reduction techniques (yoga, meditation, mindfulness, focused breathing), developing flexibility and coping skills. Furthermore, seek out help or assistance as needed in the form of therapy, debriefing, or counseling sessions (Howell, 2021).
At the time of this writing, the COVID-19 pandemic continues in our community and around the world. Each day brings new numbers, more statistics, and more patients who need care as the virus evolves. As we continue to navigate our roles in nursing, take time to do a self-check and take care of you, deliberately and kindly. Being aware of the signs can help nurses engage in activities to improve their own well-being and seek assistance when needed.
- Agency for Healthcare Research and Quality, (2017). Physician Burnout. Downloaded from https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html
- Howell B. (2021). Battling Burnout at the Frontlines of Health Care Amid COVID-19. AACN advanced critical care, e1–e9. Advance online publication. https://doi.org/10.4037/aacnacc2021454
- Kapu, A. N., Borg Card, E., Jackson, H., Kleinpell, R., Kendall, J., Lupear, B. K., LeBar, K., Dietrich, M. S., Araya, W. A., Delle, J., Payne, K., Ford, J., & Dubree, M. (2019). Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study. Journal of the American Association of Nurse Practitioners, 33(1), 38–48. https://doi.org/10.1097/JXX.0000000000000324
- Kim H, Hegde S, LaFiura C, et al COVID-19 illness in relation to sleep and burnout BMJ Nutrition, Prevention & Health 2021;bmjnph-2021 000228. doi: 10.1136/bmjnph-2021-000228
- Liu Guixia, Zhang Hui, A Study on Burnout of Nurses in the Period of COVID-19, Psychology and Behavioral Sciences. Vol. 9, No. 3, 2020, pp. 31-36. doi: 10.11648/j.pbs.20200903.12
- University of South Florida (2021). Nurse Burnout: Early Signs and Remedies. https://www.usfhealthonline.com/resources/career/signs-you-are-experiencing-nurse-burnout/
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