Robin Hertel, EdS, MSN, RN, CMSRN
President, Academy of Medical-Surgical Nurses (AMSN)
Much has been said recently regarding the impact of burnout on nursing and other medical professionals. Blogs, research articles, social media posts, and webinars are rife with discussions about the causes and the remediation to combat burnout. Estimates on the percentage of nurses experiencing burnout range from a low of 33 percent to as much as 70 percent.
What is burnout?
Burnout can be defined as an occupational phenomenon resulting in emotional exhaustion, depersonalization, and disengagement. Burnout not only negatively impacts the nurse, but also is detrimental to the patients they care for.
Emotional exhaustion is a chronic condition resulting from the high stress levels and excessive demands of providing patient care in today’s healthcare environment. Manifestations of emotional exhaustion can include apathy and feelings of indifference toward job responsibilities. If this is not addressed, emotional exhaustion can progress to depersonalization.
Depersonalization is a feeling of detachment from one’s work. For nurses experiencing depersonalization, it becomes easier to refer to patients by their diagnoses rather than as individuals in need of care. As feelings of depersonalization continue, the nurse can become disengaged completely.
Disengagement refers to a lack of interest and productivity. Nurses may experience feelings that no matter what they do and how hard they work, it is never enough and there is always more that is left undone.
Ultimately, these three factors result in poor decision-making, an increase in medical errors, and potentially, the nurse leaving the position or the profession.
Reasons for burnout
Although every nurse’s experience is different, common causes of burnout include high workload, technology challenges, incongruence of personal values with the job requirements, lack of control in the workplace, lack of recognition, and lack of community. Insufficient time to recover from the elevated stress level increases the risk of emotional exhaustion and, eventually, burnout.
The electronic medical record was designed to increase safety and quality as well as be a time saver. However, there is an increasing amount of time spent on documentation that is required more often than not, resulting in less time actually spent with direct patient care and teaching.
Burnout can be addressed and even prevented. However, it requires a multi-pronged approach beginning with the schools of nursing as well as the nurse, the facility in which they work, and professional organizations.
Schools of nursing and nursing faculty can help prevent nurse burnout by recognizing the factors associated with burnout, de-stigmatizing burnout so nurses are comfortable seeking assistance, and providing support and techniques to improve self-care by nurses.
Facilities can integrate self-care and wellness. They can promote the development and continuation of support systems. Interventions making the largest impact in addition to effective teamwork and collaboration, however, include promoting nurse autonomy and access to responsive leadership.
By the numbers
Nurses who experience burnout are also more likely to leave their current position. This turnover increases the cost to facilities, who must hire and onboard new nurses at a cost that averages up to $88,000 (or 1.3 times their salary) for each nurse. The empty positions left by the nurses who leave result in a loss of ability to manage patients safely. The results are either an increase in the number of patients each nurse is required to care for, or a decrease in the number of patients that can be admitted. Healthcare workers, including nurses, who experience burnout result in increased numbers of healthcare-associated infections. The cost of treating the infection can range anywhere from $1,000 to more than $50,000 per patient. Hospital profits and the ability to purchase new equipment can drastically be impacted as a result of unaddressed nursing burnout.