The purpose of this column is to review a given topic from a historical perspective. It then seems odd to write about nursing burnout. After all, nursing shortages and its association with burnout seem to be in the news on an almost daily basis (ie, O'Donnell1). Yet, nursing burnout is not a new phenomenon.
Merriam-Webster2 defines burnout as "exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration." The term appears to have been first used in the 1940s. Burnout is an occupational phenomenon caused by chronic unsuccessfully managed workplace stress. The 3 dimensions of burnout include "feelings of energy depletion or exhaustion, increased mental distance from one's job, or feelings of negativism or cynicism related to one job, and reduced professional efficiency."3 Researchers have studied nursing burnout since the 1980s and 90s. Findings have remained consistent over decades.
Nursing burnout has been linked to workload, staffing levels, lack of control, low reward, job demands, lack of empowerment, role conflict, low autonomy, negative nurse-physician relationships, negative team relationships, and a negative work environment among other reasons.4 Consequently, burnout leads to staff turnover, job dissatisfaction, poor-quality care, poor patient safety, and adverse events like patient falls and medication errors, as well as negatively affecting nurses' psychological and professional quality of life.4-6
Based on the World Health Organization's3 definition previously, burnout is caused by workplace stress. Hence, healthcare systems need to address workplace conditions and how they contribute nursing burnout. For many years, this included telling nurses to become more resilient7,8 without improving the conditions these nurses worked in. However, the COVID-19 pandemic changed the system. Rather than just continuing to deal with workplace stresses, nurses decided they had enough and considered leaving their positions or-worse-nursing altogether.9,10
Healthcare systems, now faced with even more significant nursing shortages, are paying attention. A recent article in Becker's Hospital Review11 provided suggestions to counter burnout to include competitive wages, tuition reimbursement, peer mentoring, mental health services, professional development, inclusion in organizational decision-making, and implementing technologies that increase workflow efficiency and decrease busywork. This is a good start, but barely touches working conditions for many nurses who care for too many patients and forego bathroom breaks and meals. More recently, nurses across the country successfully went on strike to demand and were promised better working conditions.12-15
Ultimately, to alleviate nursing burnout several things have to happen: (a) more new nurses need to join the workforce, (b) healthcare systems need to address unfavorable workplace conditions, which in turn will hopefully lead to, (c) experienced nurses remaining in the workforce. To accomplish the first, nursing schools need to graduate more students. This requires more faculty, but also strategic collaboration between nursing schools and hospitals to establish more clinical training sites.16,17 If healthcare systems want an increase in available nurses, they need to support nursing education by welcoming student nurses with their faculty into their hospitals.
Second, healthcare systems need to create positive work environments. Healthcare leadership needs to do more than say they value their nursing staff. Rather, they must invest into their staff-hire so that there is adequate staff, cap beds if not enough nurses are available, listen to concerns, and collaborate to find actual solutions. Nurses are well-trained professionals without which the healthcare system could not function. They are not secretaries who answer phones, serve meals, obey provider orders, or jump when a provider or an administrator calls. During the COVID pandemic, nurses who felt strengthened in their commitment to being a healthcare provider were significantly less likely to leave the nursing workforce.9,18 Hence, points (a) and (b) need to be addressed to prevent further nurses from leaving the profession.
Either way, healthcare systems create the environment that favors nursing burnout or have the potential to alleviate nursing burnout. The bottom line is that nurses are not a commodity that can be traded at the cheapest rate possible. Nurses are humans that demand to be respected. It is time for healthcare systems to step up and put their time, effort, leadership, and money where their mouth is.
-Alexandra Michel, PhD, CNM, FACNM
Nancy Atmospera-Walch School of Nursing
University of Hawaii
Honolulu, Hawaii
References