Addressing the Nursing Burnout Crisis

Although this is not novel to the COVID-19 pandemic, nursing burnout has become a significant problem to global healthcare systems. Nurses are leaving the profession faster than they can join it. We must do something to stop it before it becomes too late.

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Addressing the Nursing Burnout Crisis

Nursing burnout is an ongoing crisis in the U.S. healthcare system and is one of the main contributors to the mass exodus of nurses currently leaving the profession. Those who have stepped up to the plate and continued caring for patients amidst these national staffing shortages are now struggling with combating feelings of burnout. 

Although it can stem from many factors, burnout is usually a result of emotional and physical exhaustion, depersonalization (or compassion fatigue), and low professional achievement. Not only is this a matter of staffing shortages, but a significant patient safety issue. 

A 2021 nursing burnout review evaluating the results of over 15 studies and almost 20,000 nurses determined that 34.1% of respondents are emotionally exhausted (one of three major burnout factors). The passion nurses have for their profession is being stretched thin. They are exhausted, overworked, and burnt out at the bedside. 

With the continuance of the COVID-19 pandemic, it seems as if there is no end in sight to this ongoing burnout crisis. Something must be done, but what? 

Whether you are a nurse in the field or are simply passionate about the status of our current healthcare system, it is vital that we recognize, address, and develop initiatives that will actively work to decrease the prevalence of nursing burnout.

What is the Nursing Burnout Cycle?

Although nursing burnout has been around for many years, the COVID-19 pandemic has only exacerbated the situation. The cycle, however, has remained consistent. Let’s break it down.

Phase 1: 

A healthcare facility is understaffed, and those who were planning to head home after their shift are now being asked to stay to cover the next until a replacement can take their spot.

This is now a daily occurrence. 

Phase 2: 

A couple of weeks go by and a nurse has compiled over 100 working hours in just one pay period (equaling out to 50 hours per week). The other nurses on staff are beginning to argue with each other, and it is evident that the workplace morale is exceptionally low. 

Although the overtime payout is nice, the nurse is beginning to feel detached from reality and disconnected from her team. She has confided in a colleague that she is struggling mentally.

Phase 3:

Despite talking to her superior about not wanting to work any more overtime because it is affecting her health, she is told that they are so short-staffed that no one else is able to come in to fill the gaps; she feels compelled to push her feelings aside and continue to work. Lives are on the line.

Phase 4:

At this point, both physical and emotional exhaustion are in full effect. The workplace morale has only worsened over time, and it seems like no one is able to get along or work together. 

The nurse is beginning to miss changes in vital signs, and her quality of patient care delivery has plummeted. She is now a risk to patient safety.

She discloses with her superior that she is burnt out and that she is putting in her two-weeks' notice, as she feels that she can no longer live under the circumstances that she has been for the past several months.

The hospital is now one nurse short and they cannot afford to lose anyone else, as it would detrimental to their continuously rising patient influx. 

This is just one of many examples of the nursing burnout cycle. If you are a nurse, I am certain that you have experienced something similar during your career. 

The question is, “how can we stop this?”

What You Can Do 

Unfortunately, there is no tried-and-true way to reduce this never-ending cycle. Everyone is different, and what may work for you, may not work for someone else. 

However, it cannot hurt to try various methods!

The Cleveland Clinic suggests setting boundaries (if possible) or engaging in healthy activities outside of the workplace.

From an organizational standpoint, more needs to be done to prevent nursing burnout. 

Institutions hire providers to care for patients, so they must be able to return the favor when their employees are struggling to stay afloat.

If workload demands are going to continue to increase because of staffing shortages, there must be processes or initiatives that are put in place to assist those who are continuing to work, and potentially at their own health’s expense, too. 

From burnout-specific trainings, mental health and well-being initiatives to various educational resources, there is so much that can be done to help providers who are struggling with burnout that does not solely involve monetary benefits. 

Hospital administrators and executives must make these initiatives a priority before it is too late.   

Positive patient outcomes are on the line, and nothing is going to improve if we do not address, recognize, and act on implementing true changes.  

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Nursing CE Central

About Nursing CE Central

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Shane Slone is the founder and CEO of Nursing CE Central, bringing more than a decade of hands-on experience and insight to the nursing education community. His diverse professional background spans from national initiatives with the U.S. Public Health Service, to nursing education as a university faculty member. Shane’s hands-on experience in ER settings, and various ICUs as a doctorally-prepared nurse practitioner offers valuable and relevant inside knowledge of the nursing industry and its clinical applications. With specialized expertise in areas such as sepsis care, rapid response, code blue, and both cardiac and surgical ICU from a tertiary academic hospital, Shane excels at uniting the academic and clinical worlds of nursing.

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Wrong turn at #4.

You write of these misses as if this is a story about some superhero whose superpowers are shorting out. The "misses" are not misses, they are things that didn't happen because they were impossible anyway, due to free-will choices of many other players.

The suggested interventions (other than #3 and 4) and the themes that flow from that ^ kind of misunderstanding of the problem will be useless. We have two sets of moral-ethical standards, one for business execs and one for the workers. Until things like that are addressed it really doesn't matter how many times or how many ways workers are told they are the problem--things will not improve.

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On 1/4/2022 at 7:27 AM, Nursing CE Central said:

6. Practicing gratitude

For what?!! 

This is the kind of ivory tower BS that is driving nurses away.

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     I've predicted for a long time that conditions for acute care nurses will continue to deteriorate until hospitals are almost entirely staffed with travel nurses.  My experience is that we're almost at this tipping point.  New nurses always hire on as permanent staff, gain a short amount of experience and then leave to travel and make more money; rinse and repeat.  Administrators just don't get that if they create better, safe workplaces for nurses and act in a manner that shows respect (especially in terms of compensation), hospitals can't significantly improve their retention rates for nurses.  I'm not holding my breath though:(

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Specializes in Pediatrics.

Solution:  Unionize.  Pool together to get your workplace needs met by admin.  And reject anyone who tells you that 'recharging' and 'regenerating' yourself individually is the way to solve this problem.  The problem is with the system therefore it is the SYSTEM that has to change.

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For Phase 3 I would add that you start to resent and maybe even hate your coworkers for calling off and stealing your time off. 

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Specializes in Med-Surg.

We have hundreds of positions open where I work.  Management is offering $15,000 referral bonuses to split with a nurse you bring on.  There just aren't enough nurses out there willing to take positions in this community where there is a lot of competition for nurses.  I think they are honestly trying.

In the meantime I, and I'm speaking only for myself because I've gotten close to burnout, need to practice self-care and set work boundaries.  This means saying no to overtime when I am not in the right head space, and as trite as it sounds doing some stress reduction techniques like a hobby,  exercise, meditation and yes practicing gratitude.  

Certainly, I can advocate and demand they fix things.  Over and over in meeting after meeting I've done this.  I see them hire 60 nurses and 60 nurses quit and move on to other things.  It's crazy.  

Now with Omicron running through Florida and so many staff is out sick.  I can say to management "fix this!  unionize! make my job easier" but in the here and now I have to cope with a bad situation.

Or not.  I can quit and move on or I can go with my choice to stay in the trenches and take care of myself preventatively before burnout and proactively when I feel myself about to burn out.

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On 1/7/2022 at 7:31 PM, Tweety said:

In the meantime I, and I'm speaking only for myself because I've gotten close to burnout, need to practice self-care and set work boundaries.

I think many of us experience something like this. In my case, I will not call it burnout--which I consider to be more of a personal/individual problem where one is clearly having a crisis of sorts that is not fundamentally connected to set of significantly poor external circumstances that are a major source of dissatisfaction for many others, not just oneself. But I will say that I became 100% intolerant of those circumstances and finally rejected them. It was a much slower process than it should have been to accept things for what they were and make different life plans. It actually involved some sort of grieving and then moving-on process.

Any other situation where a group of people is systematically used and disrespected would not be called burnout when those people don't enjoy that kind of treatment.

My advice would be for people to take stock of the situation and to not take/waste an inordinate amount of time to see it for what it is. Then make plans and choices to get oneself into a better situation if the current one is unacceptable. The enjoyment of hobbies, the ability to experience true quality time with loved ones, take a walk....whatever--these things are not the prescription, they are the result of positive moves in one's best interest.

I do respect your account of your lived experience though, and yes we all should do what we can to mitigate stressors in our lives, for our own peace and well-being.

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Specializes in Long Term Care.

I get slightly frustrated with this situation quite a lot. These places where we're expected to give the best care to patients rarely give the best care to us. Your expected to keep satisfaction high, while at the same time juggling a ridiculous amount of patients with little assistance and then are guilt tripped when you finally say enough is enough. The patients suffer as a result of these conditions and we definitely can see it and it eats at all nurses but even when you make the complaints and offer solutions nothing changes. So instead we just end up looking for other opportunities. This is one of the reasons travel nursing is pretty big right now too. If the situation is crappy everywhere, you might as well go with the job that pays better but often puts you in the same situation. If these hospitals and other care environments just took proper care of their employees so that they could actually take care of the patients, these problems wouldn't exist. But thats too simple of an answer unfortunately because theres a lot that goes into that situation.

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Specializes in Critical Care.

I think its not that simple, and its more of an individual journey to burnout, not as a workplace. Yes, workplace conditions greatly influence it, but we all see different people burn out at different times based on how they deal with situations.  

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Specializes in Home Health Care.

The problem is obvious: too many patients per provider: Doctor, Nurse, CNA, etc.

 

The solution is simple: hire more staff and assign less patients per provider. Where do we get the money for this? Um, Hospitals are FOR PROFIT, take it out of the profit.

 

There is no reason Travel Nurses should be getting paid 5 or 10 times the amount as a Staff Nurse when they could have hired 5 more Nurses and 10 more CNAS INSTEAD OF HIRING 1 TRAVEL NURSE!

 

When a house's support beams and wood skeleton start breaking one by one you don't just paint the wood a new coat of paint do you? No, you replace that wood with new wood and more more to keep the house from collapsing in on itself.

 

I do care how much I get paid, but you CAN NOT pay me to do a job that is IMPOSSIBLE for 1 person to do on a daily basis: 9-15 patients a CNA is common yet people only listen when the Nurses start walking out. But without CNAs THERE IS NO HOSPITAL.

 

 

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Specializes in oncology.
On 3/10/2022 at 1:06 PM, FlameHeart said:

Hospitals are FOR PROFIT, take it out of the profit.

If you keep taking all the money out of the profit, you end up with antiquated rooms, services, leaking rooms etc. Have you ever been in a dilapidated hospital? We have to have someone in charge of emptying the buckets where the rood leaks, someone to run materials from pharmacy and central supply because the dumbwaiters don't work.  If you work on the 10th floor, your patients will get NO hot water and the list goes on and on. I HAVE worked with all the above.....the most inefficient  patient care delivery I have ever known. 

On 3/10/2022 at 1:06 PM, FlameHeart said:

There is no reason Travel Nurses should be getting paid 5 or 10 times the amount as a Staff Nurse when they could have hired 5 more Nurses and 10 more CNAS INSTEAD OF HIRING 1 TRAVEL NURSE!

If you want an educated, seasoned, experienced, RN you have to provide their salary. We don't all work for the promise of a better life in the hereafter..You would never ask a man to take less money to raise his children, support his wife, have a sound and safe house because his reward will be in heaven.  I know you like your CNA job but 10 CNAs really are not what  is needed with high acuity patients. 

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