Reasons for Work Stress & Burnout Among Nurses

 Reasons for Work Stress & Burnout Among Nurses

The field of nursing has seen an increasing need for bright-eyed, compassionate, wet-footed nurses. While there are many reasons as to why the gap is constantly growing, there are two main reasons as to why it is growing at such an exponential rate. One of the reasons is that nurses belonging to the Baby Boomer era are getting ready for retirement. On the other hand, there is an increasingly competitive nature of nursing programs which calls for a shortage of spots in every cohort. This stunts the amount of nurses graduating every year to fill the spots of those leaving the field. 

On top of that, the nursing field requires that professionals have the skills and knowledge to take on the everyday challenges that come with patients who rely on the medical team for restorative or preventative health care. 

However, what isn't accounted for, are the skills and knowledge needed to heal from the emotional, physical, and mental overload that come from chronic feelings of being overworked or lack of fulfilment from one's job. 

This is what we call burnout. 

What is Burnout?

In 1960, Isabel Menzies, a British psychoanalyst, began to assess the work stressors involved specifically to the nursing profession. Her studies showed that nurses were overwhelmed by the anxiety that stemmed from four sources: "patient care, decisionmaking, taking responsibility, and change." (Jennings, 2008). 

It wasn't until 1974, that the feelings of "emotional exhaustion, depersonalization, and reduced personal accomplishment." (Jennings, 2008) were given a name by Herbert Freudenberger, a German-born American psychologist. He termed it: burnout. 

However, burnout is not isolated to just work-related issues. It encompasses nonwork stressors as well. Juggling the responsibilities of work, marriage, and children only further added to the feelings of being overworked and overwhelmed. 

Nursing is predominantly a female profession--that is without a doubt. 

For this, we see an inevitable outcome of women juggling multiple roles in their everyday lives: being a healthcare provider who must provide the best possible care for her patient, while also struggling to be a mother, wife, or daughter—for which she may hold sole or major responsibility for. 

However, this is not to say that male nurses do not also face these same particular set of problems. 

A research study conducted by RNnetwork showed that while only 27% of nurses reported an increase in their work-hours compared to two years ago in 2017, 46% reported an increase in their workload (Sutherland, 2017). 

It is presumed that the increase in workload topped with an increase in work-hours has led to 43% of nurses feeling that their respective workplaces do not allow for a healthy work and life balance (Sutherland, 2017). 

And while some nurses are considering leaving the field, it shouldn't be ignored that the nation is currently facing a shortage of skilled nurses who can take their place. With over 3 million nurses working nationwide, the nursing profession takes up the largest portion of healthcare workers within the United States (Sutherland, 2017). 

Furthermore, the Bureau of Labor Statistics expects to see a surge of 1.2 million vacancies for registered nurses positions between 2014 and 2022 (Sutherland, 2017). 

Causes of Burnout

As mentioned previously, burnout stems from both work and nonwork-related stressors. During work, nurses are faced with the challenges that come with:

• The physical tolls that accumulate overtime (i.e. lower back pain, foot pain, long 12-hour shifts, needlestick injuries, etc.)
• Ensuring that all medical information is charted properly and correctly
• Dealing with family members who may be emotionally overwhelmed
• Caring for patients that greatly rely on the nurse for healthcare
• Making sure that medications are at proper dosage and administered on time
• Waiting on other other health professionals in order to proceed onto the next step of care for a patient (i.e. respiratory therapist, lab results, x-rays and EKGs from radiology, physician orders for a new medication or intervention, etc.)
• Dealing with the loss of a patient during shift
• Making time or remembering to take meal and bathroom breaks—yes, this really is a problem for all healthcare professionals. 

These are just some of the many varying issues that nurses face on a day-to-day basis.  Add these on top of coming home from a 12-hour shift and then having to deal with nonwork-related stressors that might stem from marriage, children, school, etc. and you'll classic recipe brewing for burnout. 

Nonwork-related stressors might look like:

• Having to find someone to pick your kids up from school because you don't get off work till 6 PM
• Not being able to spend time with your partner or kids because you work nightshift and you come home when they're just getting ready to leave for work/school 
• Struggling to juggle 12-hour work shifts with a full-time school schedule
• Having issues sleeping due to built up adrenaline from work—leaving you with less than 8 hours of the recommended sleep time

For anyone—not just nurses, this is a lot to handle. 

Signs & Symptoms of Burnout

As with anything, people experience things differently and there is no set list of definitive signs or symptoms that come with burnout. It is important to note that because we, as humans, manifest signs and symptoms differently, it may be difficult to recognize burnout in ourselves or in our coworkers. One person may only present with one symptom of burnout, while others may manifest a variety of symptoms in varying degrees of intensity. 

What is most important is to recognize these signs as early as possible and seek proper help before it becomes too overbearing. 

Some commonly reported signs and symptoms of burnout include: irritability, frequently calling in sick, intolerance to change, exhaustion, and a "checked out" mentality (Avoiding Burnout as a Nurse, 2019). 

As mentioned previously, burnout can happen to anyone and everyone. Likewise, burnout can manifest in any nurse. However, there are some areas of nursing in which burnout is found to be more prevalent. It has been found that nurses who specialize in oncology and emergency response encounter the largest number of burnout cases (Avoiding Burnout as a Nurse, 2019). 

Nurses who work in oncology handle patients who are diagnosed with cancer. As one can imagine, the patients on this particular unit face challenges that are emotionally, physically, and mentally draining over a long-period of time. However, not every battle is a fought won. Due to this, nurses are often faced with acute feelings of loss as facing death is a common stressor on this floor (Avoiding Burnout as a Nurse, 2019). 

Meanwhile, working on the emergency response (ER) team, nurses are faced with a different kind of stressor. While the typical nurse can usually expect to care for 4 patients during their shift, the ER nurse will typically see at least 50 patients during their 12-hour shift. This creates a environment susceptible to burnout as nurses working in the ER are placed in high-pressure situations that require fast action and quick thinking coupled with a frequent turn-over rate of patients. 

When signs and symptoms of burnout are recognized, it is important for the nurse to seek out help immediately. An increase in employee assistant programs that cater to emotional support are being seen in hospitals nationwide. Help can be found in the form of free phone counseling sessions, professional and pastoral counseling, support groups, and therapy (Avoiding Burnout as a Nurse, 2019).

However, the best care for burnout begins once the nurse is off the clock. Nurses should take time to establish healthy and effective stress-reducing habits outside of work. It is important to separate one's professional life from home life. Self-care habits such as engaging in activities/hobbies that are found enjoyable, relaxation techniques such as meditation or journaling, incorporating a well-balanced diet, exercise, and getting an adequate amount of rest are all great starters. 

Personal Reflection

The topic of burnout in nurses is an important issue I wanted to bring to light as it does hit close to home for me. I am currently a 2nd year nursing student attending CSULA's Patricia A. Chin School of Nursing. As a student nurse, I have been privileged to work with a variety of nurses with a varying degree of experience on the floors that they work on. Even as a student, I find myself feeling just the most miniscule flicker of burnout in my studies. I can only imagine the intensity that some nurses might feel as they are hit with feelings of burnout working on the floor. 

As nurses, we have an inclination towards becoming emotionally invested in our patients. Rightfully so, this feeling is called compassion fatigue. We seek to provide the best plan of care for our patients. This entails advocating for their rights, ensuring that their family members are also being taken care of, making sure that our patients feel that they are safe and have a person to rely on, etc. 

And while this is all fantastic and what some may say as "just a part of the job", it is incredibly tolling on the body. As discussed above, nurses face stressors in both the work and nonwork environment. Having to work three 12-hour shifts a week where there is an extremely high-pressure to care for a variety of patients with varying degrees of illness is a lot. When nurses walk onto the floor for their shift, they don't exactly know what to expect for the shift. Every shift is different. 

Every shift comes with a new set of complications that can't be predicted. 

Now, add on the nonwork stressors that come with home life. Some nurses may find it even more difficult to find support from their parents, children, or partners due to their jobs. 

As a bedside nurse, you are expected to work an average of 12 hours per shift. These shifts are typically from 6 AM to 6 PM (dayshift) or 6 PM to 6 AM (nightshift). Imagine having to find someone to take your kids to school or pick them up because the times that you are driving to work are incompatible with school schedules. Furthermore, imagine not being able to spend time with your kids or partner because you come home from a nightshift when they're still sleeping. 

Even if family was not an issue, some nurses may feel inadequate or underappreciated for the amount of work that they do. Perhaps a patient is unsatisfied with the nurse's care, despite the nurse trying their very hardest to cater to this patient. Or maybe this nurse feels that their work environment does not stimulate or encourage a support work-flow where nurses help nurses. This only adds to the emotional stress that nurses face on a day-to-day basis. There are physical stressors such as lower back pain caused by constantly lifting and transporting patients or bending down, foot pain from standing, eye-strain from staring at computer screens, risk for needle sticks from syringes, etc. 

But why is this all important? If it isn't obvious yet, burnout has been deemed a significant health problem. Not only can it lead to mental disorders, in increased and constant amounts of stress, burnout can lead to health problems, diabetes, high blood pressure, and other life-threatening illnesses. 

Furthermore, burnout poses a detrimental risk to the wellbeing of patients as well. When nurses face the turmoil of burnout, their patients suffer. Burnout can lead to inadequate care of patients which may lead to increased mortality rates, failure to rescue, and overall dissatisfaction of patients and their family members. 

Burnout is a topic that we, as a community, should be concerned about. Nurses are just one of the healthcare providers that take care of us when we are faced with life-threatening illnesses or when we're at our lowest selves. For that, we should understand that their jobs are no easy feat—not just anybody can be an excellent nurse. 

It is important for us to promote change within the healthcare community as well. This can include encouraging hospitals to provide and advertise support programs within the workplace that cater to healthcare professionals who may be going through emotional, physical, and mental stressors. It could also entail lowering the cost of nursing programs or training more nursing school instructors so that there are more skilled nurses being placed into the field. 

It could also mean taking the time to thank your nurse for whatever care they have provided you. Give them a compliment on something they did that day or take the time to ask how their day is going. 

It's about time we took care of those who take care of us. 

References

Avoiding Burnout as a Nurse: Dealing With Work Stress. (2019, June 11). Retrieved October 22, 2020,
                     from https://www.nursing.org/resources/nurse-burnout/

Jennings, B. M. (2008). Work Stress and Burnout Among Nurses: Role of the Work Environment

                     and Working Conditions. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-

                     Based Handbook for Nurses. Agency for Healthcare Research and Quality (US).

Sutherland, S. (2017, March 01). Survey Finds Half of Nurses Consider Quitting. Retrieved October 

                     21, 2020, from https://rnnetwork.com/blog/rnnetwork-nurse-survey/