Are Nursing Students Burned Out Before or After They Graduate?

PamtheNurse, BSN, MSN

When does nursing student burnout begin?

The burnout study of nursing is extensive and ongoing. Evidently, nurses are either burning out or burned out. However, when does the burning out begin, nursing school? Graduate nursing? Beginning practice? Or possibly later, after many years of practice?

There is an ongoing study of nursing students’ burnout, however, without the extensive history that is found in nurse burnout study. The most recent research of nursing student burnout suggests that it may start in nursing school (Ching, Cheung & Rees, 2020; Rios-Risquez et al., 2016; Robins, Roberts & Sarris, 2018; Valero- Chillerón et al., 2019).

If burnout does start in nursing school for nursing students, the questions of immediate thought are many, is burnout and the nursing student personality or some other personal factor of the nursing student need investigation (Majerníková, 2017)? Is it the environment either societal, home, or school (Njim et al., 2018)? Is the presentation or volume of information required? Or the teaching approach? Nursing student perception of instruction and/or supervision? And/or other nursing school factors such as clinical learning leading to burnout in nursing students (Babenko-Mould & Laschinger, 2014)?

I discovered the articles reporting the study of nursing students’ burnout when conducting a literature search for my doctorate study topic: Nursing Faculty Burnout. The discovery caused another avalanche of thought, and the question: Is the nursing faculty burnout related to nursing student burnout? A literature search of nursing student burnout using CINAHL Complete, Academic Search Complete, and Gale Academic OneFile with peer review and 2017-2020 as limiters revealed 549 research articles. However, none were of nursing faculty burnout and nursing student burnout. Why? If nursing faculty are experiencing burnout symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment would that influence nursing student stress and present modeling of burnout behavior creating students at increased risk for burnout?

Moreover, of greater prevalence particularly recently is the study of nursing student incivility, violence, bullying, and aggression (Hogan et al., 2018; Hostetier, 2019; Streiff, 2019). Is nursing burnout and/or nursing faculty burnout factors in this extreme behavior? Nursing faculty burnout has been linked to the nursing faculty shortage and further has been linked to the global nurse shortage (AACN, 2019; WHO, 2017; WHOA, 2018). The nurse shortage creates an environment that exacerbates the burnout factors with overwork and overburdening demands that lead to chronically incomplete tasks. That environment causes an increase in suffering and decreased safety for patients that are unacceptable to the caring nurse. The typical nursing faculty member has 20 years of experience before joining the ranks of academia. Burnout tends to stick like burrs. Nursing faculty burned out leads to less nursing faculty. Less nursing faculty causes fewer openings for nursing students to attend nursing school. Moreover, it results in nursing student exposure to burned-out nursing faculty (AACN, 2019). The nursing student after experiencing nursing faculty modeling burnout behavior, exposed to the nursing school environment graduates to hire into the selfsame situation that caused the nursing faculty members’ burnout some twenty years previous. Is that circular linkage a factor?

Further, is resilience as the counterpoint to burnout a factor? There are a few, mostly recent, studies of resilience, nurses, and nursing students as a predictor of burnout experience with interesting results. Garcia-Izquierdo et al. (2018) in a study of 218 nursing students found a significant relationship between resilience, burnout, and psychological health. Brown (2018) conducted an integrative review of the impact of resiliency on nurse burnout that yielded yet more interesting and positive recommendations.

What is happening in nursing schools? The nursing faculty burnout survey that I will be posting for allnurses.com members to complete will have some interesting outcomes? Will it not?

There are many more questions I am sure that will occur to others. Previous articles regarding nursing students and nursing faculty have instigated comments and exchange of ideas here in allnurses.com, I hope for more.

turtlesRcool · May 28, 2020

Is it really burnout, though? One school of thought is that clinician burnout is actual moral injury. From that standpoint, it's not a matter of resilience or innate nursing personality or any other personal flaw.

If it starts in nursing school, that means that from the time a student nurse is in clinicals, he or she is already having to negotiate the tension between what is best for the patient and what actually happens in healthcare.

Too many patients, not enough time for each, not enough resources, and we start to see patients receive care that is not up to the standards we have been taught they deserve. We fail over and over to give the best care because of the circumstances we are placed in. We have conflicting allegiance to our patients, our employers, and ourselves/families. Many of us enter nursing because we deeply care about all of those, and the state of our healthcare system means we frequently cannot do right by everyone.

PamtheNurse, BSN, MSN · May 29, 2020

turtlesRcool,

“Is it really burnout, though? One school of thought is that clinician burnout is actual moral injury.”

That is an interesting thought. As a former Medical Ethics Instructor, I would like to read the argument behind that assertion. Would you happen to have the reference?

“From that standpoint, it's not a matter of resilience or innate nursing personality or any other personal flaw.”

Morality by definition is personal: “concerned with the principles of right and wrong behavior and the goodness or badness of human character. holding or manifesting high principles for proper conduct. a person's standards of behavior or beliefs concerning what is and is not acceptable for them to do.” (2020, Lexico.com).

“If it starts in nursing school, that means that from the time a student nurse is in clinicals, he or she is already having to negotiate the tension between what is best for the patient and what actually happens in healthcare.”

Yes, this is the point. Nursing students may be experiencing this very tension along with negotiating learning, maintenance of grades, attendance, and the multitude of student tasks. Additionally, the personal challenges of family, friends, societal expectations, etc. Burnout? Maybe.

“Too many patients, not enough time for each, not enough resources, and we start to see patients receive care that is not up to the standards we have been taught they deserve. We fail over and over to give the best care because of the circumstances we are placed in. We have conflicting allegiance to our patients, our employers, and ourselves/families. Many of us enter nursing because we deeply care about all of those, and the state of our healthcare system means we frequently cannot do right by everyone.”

Yes, again you have the point. Nurses do deeply care, is that not a personality characteristic? And does that mean nurses are set-up for burnout because of the state of the current healthcare system? Additionally, are individuals drawn to become nursing students because they possess the selfsame characteristic? Therefore, they are set-up for burnout?

PamtheNurse