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Preventing Nurse Burnout

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Contact Hours: 1

This educational activity is credited for 1 contact hours at completion of the activity.

Course Purpose   

To provide nurses with knowledge and tips to identify stressors that can lead to nurse burnout and strategies to reduce the risks of burnout from occurring. 

Continuing Education Credit Designation   

This educational activity is credited for 1 hour at completion of the activity.  

Overview 

Nurse burnout is described as a state of mental, physical, and emotional exhaustion that often stems from sustained work-related stressors, including long work hours, the pressure of quick decision-making, job-related dissociation, low sense of accomplishment, and the strain of caring for patients who may have poor outcomes. At some point during their careers, approximately 70% of nurses will report feeling exhausted and burned out. Nurse burnout does not solely affect the nurse’s emotions and health. It also affects the patients’ well-being and the quality of care that they receive. This course provides an overview of nurse burnout, and strategies to assist the nurse in managing stressors to reduce the risks of nurse burnout from occurring.

Objectives

Upon completion of the independent study, the healthcare professional will be able to:  

  • Identify causes of nurse burnout
  • Understand the stages of nurse burnout
  • Apply effective strategies to reduce the risks of burnout
  • Analyze the differences of compassion fatigue and nurse burnout

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Fast CE For Less, Inc. and its authors have no disclosures. There is no commercial support.  

Fast Facts: Preventing Nurse Burnout

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Preventing Nurse Burnout Pretest

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Definition

Nurse burnout: A state of mental, physical, and emotional exhaustion that often stems from sustained work-related stressors.

Compassion fatigue: Describes the physical, emotional, and psychological impact of helping others, often through experiences of stress or trauma.

Introduction

Nurse burnout is a common problem. In fact, at some point during their careers, approximately 70% of nurses will report feeling exhausted and burned out. ¹ Nurse burnout does not solely affect the nurse’s emotions and health. It also affects the patients’ well-being and the quality of care that they receive. ³ In addition, nurse burnout can be costly with an expense of $14 billion dollars every year to the healthcare industry. ¹ Although nurse burnout is prevalent and costly, it can be improved by having the nurse set boundaries and prioritize self-care.

Burnout

The term burnout was first used in the 1970s to describe the emotional and physical stress experienced by those who worked in helping professions, such as nursing. Today, nurse burnout is described as a state of mental, physical, and emotional exhaustion that often stems from sustained work-related stressors, including long work hours, the pressure of quick decision-making, job-related dissociation, low sense of accomplishment, and the strain of caring for patients who may have poor outcomes. ⁵ This is especially relevant for nurses who are working during the Covid-19 pandemic. They are under an unprecedented amount of work strain and pressure while caring for sick patients. In addition, the baby boomer generation is aging and retiring, leading to an increased shortage of nurses. In fact, the U.S. Bureau of Labor Statistics projects that employment needs for registered nurses will grow by 12% between 2018 and 2028, which can exacerbate the nursing shortage, leading to overworked nurses and nurse burnout. There are several symptoms for nurse burnout, including ³:

Behavioral:

  • Abuse of substances
  • Increased risk-taking behaviors
  • Reduced ability to be a productive member of the healthcare team

Cognitive: 

  • Difficulty with remembering details or conversations
  • Inability to focus or think clearly
  • Inability to make decisions or solve problems

Emotional:

  • Apathy
  • Depersonalization (start seeing patients as tasks instead of individuals)
  • Feeling emotionally numb
  • Increased irritability or frustration
  • Sadness

Physical:

  • Difficulty with sleeping
  • Gastrointestinal issues 

Five Stages of Burnout

Burnout can affect anyone, at any time in their lives. Symptoms of burnout can vary, and below is a list of common stages ¹˒³:

1. Honeymoon Phase

In the first stage, the nurse experiences high job satisfaction, commitment, energy, and creativity. This often occurs with a new job, or at the beginning of a business venture. In this phase, stress is predictive. As such, it is important to develop good coping strategies to stress. If good coping skills are created and practiced in this phase, the nurse theoretically can remain in the honeymoon stage indefinitely and never experience burnout.

Symptoms of the honeymoon phase include:

  • Compulsion to prove oneself
  • Free-flowing creativity
  • High productivity levels
  • Job commitment
  • Job satisfaction
  • Optimistic
  • Readily accepting responsibility
  • Sustained energy levels

2. Onset of Stress

The second stage of burnout arises when the nurse realizes that some workdays are more difficult than others. Optimism may begin to wane, and stress may begin to affect the nurse physically, mentally, or emotionally.

Symptoms of onset of stress include:

  • Anxiety
  • Avoidance of decision making
  • Change in appetite or diet
  • Fatigue
  • Forgetfulness 
  • General neglect of personal needs
  • Grinding your teeth at night 
  • Headaches 
  • Heart palpitations 
  • High blood pressure 
  • Inability to focus 
  • Irritability
  • Job dissatisfaction
  • Lack of sleep or reduced sleep quality
  • Lack of social interaction
  • Lower productivity
  • Unusual heart rhythms

3. Chronic Stress

The third stage of burnout is chronic stress. In this stage there is a notable change in stress levels, fluctuating from motivation to an increased frequency of experiencing stress. 

Symptoms of chronic stress include:

  • Anger or aggressive behavior
  • Apathy
  • Arriving late to work repeatedly 
  • Chronic exhaustion
  • Cynical attitude
  • Decreased sexual desire 
  • Denial of problems 
  • Feeling pressured 
  • Feeling threatened
  • Increased alcohol/drug consumption 
  • Increased caffeine consumption 
  • Lack of hobbies
  • Missed work deadlines 
  • Persistent tiredness in the mornings
  • Physical illness
  • Procrastination 
  • Resentfulness
  • Social withdrawal 
  • Uptake of escapist activities

4. Burnout

Burnout occurs in stage four. In this stage, symptoms become critical and are exhibited by an inability to cope. 

Symptoms of burnout include:

  • Behavioral changes
  • Chronic headaches 
  • Continuation or increase in escapist activities
  • Desire to move away from work or friends and family
  • Feeling empty inside
  • Gastrointestinal problems 
  • Neglect of personal needs
  • Obsession over problems at work or in personal life
  • Pessimistic outlook on work and life
  • Physical symptoms intensify 
  • Self-doubt
  • Social isolation

5. Habitual Burnout

The final stage of burnout is habitual burnout. In this stage, the symptoms of burnout are so embedded in daily living that the nurse may experience ongoing mental, physical or emotional problems. 

Symptoms of habitual burnout include:

  • Burnout syndrome
  • Chronic mental fatigue 
  • Chronic physical fatigue 
  • Chronic sadness 
  • Depression

Causes of Burnout

Some of the greatest causes for burnout amongst nurses are chronic lack of sleep and chronically being overworked. ⁵ These are caused by physical and emotional exhaustion and are particularly common for nurses who work long hours (usually 12 hours or more) and consecutive shifts. Shift rotations (working day and night shifts) as well as planned and unplanned overtime can increase burnout by triggering fatigue and the inability to plan for activities outside of work.  Even when personal time is available, many nurses feel compelled to take care of others before they take care of themselves. This includes children, significant others, parents, in-laws, etc. This in combination with any pursuits of academic growth can lead to fatigue and burnout. 

Every nursing specialty brings its own challenges, but some specialties are naturally more stressful than others.  For instance, working in the emergency department, intensive care unit, or in end-of-life care can be stressful, especially when working with patients with traumatic injuries, ethical dilemmas, or low recovery and high mortality rates. Daily exposure to illness and death, as well as the physical and emotional toll that it takes, can be overwhelming, and physically and emotionally exhausting. Additionally, nurses may not have time to decompress, debrief a stressful situation, or grieve the loss of a patient.

Signs of Burnout

It is important to recognize the signs of burnout. If nurses are experiencing any of the following symptoms, it may be time to make some changes to reduce stress levels and avoid burnout ¹˒³˒:

Dreading work

Nursing is often a thankless profession, and it is easy to feel underappreciated, especially when dealing with an angry or emotional patient or their family members. It’s normal for a nurse to have sporadic feelings of not wanting to be at work, but if the feelings occur on a regular basis, the nurse may be experiencing burnout.

Fatigue

Nurses are often tired when working long, rotating shifts, however, there is a difference between feeling tired and chronic fatigue. Symptoms of chronic fatigue include struggling to wake up in the morning, falling asleep throughout the day, or never feeling like you’ve had enough sleep. A nurse who has chronic fatigue is at risk for burnout.

Illness

Continuously elevated levels of stress can weaken the immune system, causing illnesses such as gastrointestinal issues, chronic pain, and heart problems. If a nurse is experiencing illness on a regular basis, they may be experiencing stress-related burnout.

Indifference

Nurses who have an emotional disconnect by insensitivity and detachment towards their patients may be experiencing burnout and are also posing a health and safety risk to the patient.

Severe anxiety

The occasional feeling of nervousness while at work is normal, especially for a nurse who is working (floating) in an unfamiliar environment. They may worry about the health of their patients, making a mistake, or the anticipated death of a terminal patient. Anxiety occurs when these feelings become overwhelming and start consuming their life outside of work.

Dangers of Burnout

Nurse burnout is a big concern for nurses, employers, and patients. Nurses themselves are at risk for developing depressive disorders and other mental health conditions, and for quitting their job. For employers, a decrease in the quality of patient care can affect their reputation and finances. For patients, nurse burnout can directly affect their health and safety. ⁵

In a recent study, researchers found a positive correlation between higher rates of nurse burnout and nurses’ intention to leave employment. This correlation causes increased turnover, increased staffing shortages, increased expenses for training of newly hired nurses, increased nurse burnout, and a cycle that repeats itself, which causes more stress on an already overworked environment.

The most dangerous risk associated with burnout is a decrease in the quality of patient care. Mistakes due to exhaustion and job dissociation can lead to patient discomfort, infection, and death in extreme cases. 

Compassion Fatigue vs Burnout

Compassion fatigue is also called “vicarious traumatization” or secondary traumatization, and describes the physical, emotional, and psychological impact of helping others, often through experiences of stress or trauma. ² It occurs most commonly among professionals who work in healing or helping capacity and happens when triggers and experiences start to affect one’s thoughts, moods, and well-being outside of work. ⁴ Compassion fatigue is often mistaken for burnout, which is a cumulative sense of fatigue or dissatisfaction. Although compassion fatigue is different from burnout, the two can co-exist.

Solutions

Fortunately, it is possible to prevent nurse burnout before it occurs and to remedy it when it happens. ⁵ A nurse should request a schedule that allows them enough personal time to create a work/life balance. An employer should support the nurse by providing adequate breaks while working and promoting self-scheduling when feasible.

A nurse should also consider using earned vacation time to decompress, relax, and take a break from their work environment. To encourage this, employers can consider a vacation day policy to monitor vacation days that nurses take on a quarterly basis and ensure that nurses’ have an opportunity to take an available vacation. This helps to increase job satisfaction and decrease the turnover rate.

Another way to manage stress is for the nurse to develop a post-work relaxation routine, such as exercise, meditation, or journaling to increase physical and mental health and well-being. There is no best way to relax. Each nurse should create a designated time to do what is most relaxing for themselves.

Conclusion

Nurses may experience burnout because of a variety of reasons. Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, working in a high-stress environment, lack of support, and emotional strain from patient care. In order to reduce the risk for burnout, the nurse should consider prioritizing their own physical, mental, and emotional health by getting adequate sleep, using earned time to step away from work, eating a healthy diet, using appropriate relaxation tools, seeking a coworker to collaborate and share the workload with, and seeking counseling when needed. In addition, employers should consider educating staff on sleep and self-care strategies, provide strategies to ensure that nurses are taking adequate breaks, and monitor staff for symptoms of burnout. Through a team effort, nurse burnout can be reduced, thereby reducing nurse turnover rates, cost to the institution, and improving patient care and safety.  

References
  1. Are you on the road to burnout? The 5 stages of burnout — Health InfoCast. (2021, November 22). Health InfoCast. 
  2. DuBois, A. L., & Mistretta, M. A. (2019). Compassion fatigue. Overcoming Burnout and Compassion Fatigue in Schools, 59-76. 
  3. Kelly, L. A., & Adams, J. M. (2018). Nurse leader burnout: How to find your joy. Nurse Leader16(1), 24-28. 
  4. Overcome compassion fatigue and burnout. (2017). Journal of Nursing & Healthcare2(2). 
  5. Wang, S., Liu, Y., & Wang, L. (2013). Nurse burnout: Personal and environmental factors as predictors. International Journal of Nursing Practice21(1), 78-86. 
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