Burnout, the Literature, and Understanding

[PamtheNurse, BSN, MSN]

Preventative Measures

Burnout has been a topic well researched starting with Maslach, Jackson, Leiter, Schaufeli, and Schwab (1986). As someone who has been reading literature and spending a tremendous amount of time over the past few years thinking about burnout, I have often been asked what is the cure or the preventative actions. The research is consistent in establishing the existence of burnout and the all too commonality of it.

In my reading, I found articles reporting nursing student burnout. Recent research is attempting to pinpoint where it begins for nurses, before graduation during the educative process? Or as a graduate nurse? The article I wrote recently and published here in allnurses.com titled "Are Nursing Students Burned Out Before or After They Graduate?" (2020) does delve into the topic with much greater depth. Currently, there are many more questions about student nurses and burnout than answers.

Change in Mindset?

Another nurse posted a question in allnurses.com (Destin293, March 17, 2019) "Burnout...what to do about it" had a respondent that stated “There is nothing wrong with YOU or your very reasonable feelings about this. Burnout is not the appropriate label for it. Chin up. Put your confidence and self-worth back in order, as this weight is not yours to bear. You have no professional duty to imposed nonsense. Instead be impowered. Formulate plan B and put it into action” (JKL33, March 17, 2019). A response that is well-meaning but not helpful. If burnout is the perceived experience, it is the individual’s state of being. And the description of burnout as put forth by Maslach et al. (1986) is one the encompasses an individual incapable of self-directed action as described by the respondent above.

However, the respondent that posted the above comment is not alone, many believe that burnout can be defeated with a positive attitude or thinking, pulling oneself up by bootstraps or change of outlook. Maslach et al.’s (1986) beginning and subsequent work along with a plethora of other researchers have established the construct of burnout as valid with many different mediating factors. Little research has found burnout to be mediated simply by a change in mindset.

Self-Care and Mindfulness

Some recent study, however, has explored the impact of preventative measures for nursing students e.g. self-care (Nevins et al., 2019) and mindfulness for nurses Montanari, Bowe, Chesak & Cutshall, 2019). Nevins et al. (2019) reported that an increase in exercise and hydration in baccalaureate nursing students did increase students’ described levels of wellness. Montantari et al. (2019) found that nurses’ use of mindfulness “positive implications for the well-being of nurses” to stress and burnout (p. 175). Increased resilience in nurses mediated burnout (Guo et al., 2019). All increase my hopefulness that research is on track to illuminate a burnout preventative pathway.

Faculty Burnout

Additionally, my literature reading has included the topic I plan to research, nursing faculty member burnout. Aquino, Young-Me, Spawn, and Bishop-Royse (2018) found in their descriptive survey study of doctorate nursing faculty members’ intent to leave their academic position that degree type, age, and burnout were significant predictors. Their recommendations in addressing the nursing faculty member shortage as “critical to creat[ing] supportive and positive work environments to promote the well-being of nursing faculty” (p. 35).

I have found the reading and contemplating burnout and nursing faculty members’ possible experience of it as interesting. The plethora of burnout research mentioned previously consists primarily of educators and healthcare providers as subjects. Little burnout research is of nursing faculty members despite the “great demands placed on many nursing faculty” (Aquino, Young-Me, Spawn & Bishop-Royse, 2018, p. 35).

My doctorate topic is nursing faculty member burnout. I plan to offer qualifying allnurse.com members access to a survey. The qualifications include current full-time employment and one year of experience as a nursing faculty member. Interested? It is coming soon.

[Arafelle, ADN]

Part of what burns me out is that, living in the Seattle area, ADN's are being progressively relegated in the hospital setting in lieu of BSN prepared nurses. I haven't even graduated my ADN program yet, and I already feel like I made a mistake and should have just gone for a BSN program or a different career altogether. Moving isn't an option for me.

Something I have seen from a few professors and online is that there is such a thing as "academic elitism". The notion that ADN-prepared nurses are inferior to BSN-prepared nurses for the bedside role infuriates me so much. We are up against so much more just to get our first job compared to BSN new grads in this area.

[Susie2310]

Burnout appears to be a common phenomenon in nursing students and in nurses working in all kinds of positions and with all levels of education.

We know that people enter the nursing profession for a wide variety of reasons, and pursue advanced nursing education for a multitude of reasons. Nurses who post on this site quite often say that they became nurses for the money, or for job security. I would be interested to know if the rate of burnout is higher in student nurses/nurses whose primary motivation for becoming a nurse is money, job security/status, family pressure, etc., versus those who are primarily motivated by wanting to care for sick people.

[HarleyvQuinn, MSN, RN, NP]

1 hour ago, Susie2310 said:

Burnout appears to be a common phenomenon in nursing students and in nurses working in all kinds of positions and with all levels of education.

We know that people enter the nursing profession for a wide variety of reasons, and pursue advanced nursing education for a multitude of reasons. Nurses who post on this site quite often say that they became nurses for the money, or for job security. I would be interested to know if the rate of burnout is higher in student nurses/nurses whose primary motivation for becoming a nurse is money, job security/status, family pressure, etc., versus those who are primarily motivated by wanting to care for sick people.

Personally, I think burnout increases the more the work environment increasingly becomes one of "do more with less" and there are increasing demands placed on fewer nurses with the expectation of perfection in their care of sicker patients. You can't run a workforce to death and expect them to be healthy, happy, hale, and whole. Then blame them for not being such. No exercise regimen, perfect diet, or meditation program is going to make normal human beings into superhumans capable of going at 300% day in and day out without breaks, working at perfect efficiency, unhindered by any other factor in their lives. It's just not possible. One human being can only do so much.

[JKL33]

On 6/19/2020 at 12:02 PM, PamtheNurse said:

Another nurse posted a question in allnurses.com (Destin293, March 17, 2019) "Burnout...what to do about it" had a respondent that stated “There is nothing wrong with YOU or your very reasonable feelings about this. Burnout is not the appropriate label for it. Chin up. Put your confidence and self-worth back in order, as this weight is not yours to bear. You have no professional duty to imposed nonsense. Instead be impowered. Formulate plan B and put it into action” (JKL33, March 17, 2019). A response that is well-meaning but not helpful. If burnout is the perceived experience, it is the individual’s state of being. And the description of burnout as put forth by Maslach et al. (1986) is one the encompasses an individual incapable of self-directed action as described by the respondent above.

Well hello there.

I'm disappointed that you did not reach out to give me an opportunity to explain my perspective on burnout before labeling my words unhelpful. I, too, have a lot of thoughts about it, and I'm pretty sure I've even previously posted some explanations of why I feel the way I do.

If I have time I might read what Maslach said 34 years ago. I was not in the workforce back then, but I'm guessing it's safe to say the backdrop has changed significantly. Nurse treatment has devolved even since I've been a nurse (in my own opinion). My consistent philosophy has been that it is wrong and unethical to treat people poorly and then have the focus be on them and their altered responses to the poor treatment -- as if they're the ones with the problem or there is something inherently wrong with them. The ones with the problem are those who disparage nurses, seek to rob them of all autonomy, make them dime-a-dozen "workers" and treat them with disdain while constantly nitpicking and being generally meddlesome. Then nurses get to read articles about doing yoga or spending time with loved ones in order to not feel "burned out." Any of my comments on the topic will hinge upon my philosophy that descriptions of the problem are misfocused.

Forgive the simple comparison but this whole topic is akin to kicking a dog repeatedly and then seeking to find out why he cowers and doesn't enjoy it and researching what he can do to develop healthy coping--instead of asking why the **** people need to keep kicking him and asking what is wrong with them.

There you have it. Thank you.

[JKL33]

I think it would be helpful to include the link to the post from which you have misappropriated quotes:

Your response, a year later, was to tell this person there is indeed something wrong with him/her and that they should seek treatment.

While I will agree that individual treatment may help to process feelings, gain perspective and formulate plans, the general response should revolve around calling out the wrong, making the wrong unacceptable, and empowering those who lack power--much the same as is needed in response to other types of abusive relationships.

?As far as I can tell, most people actually do not enjoy the type of treatment this poster described in the post. There isn't something inherently wrong with someone because they don't enjoy poor treatment.

[PamtheNurse, BSN, MSN]

I am extending my gratitude to all of the article commentators and their observations. Burnout, or at least the subject of it and ensuing discussion has caused some consternation. Maslach et al. (1986) would be gratified to know that the study they initiated of burnout, and the continued extensive study conducted by them and many others in the intervening years continue to be a subject of discussion and concern. As demonstrated in the article commentary it is of serious concern in nursing. A concern that has been justified by many researchers of burnout who focused on healthcare providers primarily nurses and educators. My work is focused on the existence of burnout in nursing faculty members. Nursing faculty members are both healthcare providers and educators, yet there is little research focused on their possible burnout experience. I hope to bring attention to that gap and assist in filling it with my research. Research that will begin here in allnurses.com, soon. PamtheNurse

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach burnout inventory, 21, pp. 3463-3464. Palo Alto, CA: Consulting Psychologists Press.

[Arafelle, ADN]

11 minutes ago, PamtheNurse said:

I am extending my gratitude to all of the article commentators and their observations. Burnout, or at least the subject of it and ensuing discussion has caused some consternation. Maslach et al. (1986) would be gratified to know that the study they initiated of burnout, and the continued extensive study conducted by them and many others in the intervening years continue to be a subject of discussion and concern. As demonstrated in the article commentary it is of serious concern in nursing. A concern that has been justified by many researchers of burnout who focused on healthcare providers primarily nurses and educators. My work is focused on the existence of burnout in nursing faculty members. Nursing faculty members are both healthcare providers and educators, yet there is little research focused on their possible burnout experience. I hope to bring attention to that gap and assist in filling it with my research. Research that will begin here in allnurses.com, soon. PamtheNurse

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach burnout inventory, 21, pp. 3463-3464. Palo Alto, CA: Consulting Psychologists Press.

Hi Pam. I'm a nursing student right now and something I observe in faculty that are long-tenured is that they have a higher inclination to becoming jaded. Tenureship also fosters a mindset of immunity to feedback and improvement, as well as accountability for staying engaged with students as an educator.

[PamtheNurse, BSN, MSN]

Arafelle,

Thank you for your commentary. Tenure and the associated drawbacks have been a subject of conversation for many years in higher education. It is on the downward trend of availability for faculty, particularly nursing faculty members. If you are interested there is further information, discussion boards, articles, and research publication(s) regarding tenure at higheredjobs.com.

PamtheNurse

[Susie2310]

52 minutes ago, PamtheNurse said:

I am extending my gratitude to all of the article commentators and their observations. Burnout, or at least the subject of it and ensuing discussion has caused some consternation. Maslach et al. (1986) would be gratified to know that the study they initiated of burnout, and the continued extensive study conducted by them and many others in the intervening years continue to be a subject of discussion and concern. As demonstrated in the article commentary it is of serious concern in nursing. A concern that has been justified by many researchers of burnout who focused on healthcare providers primarily nurses and educators. My work is focused on the existence of burnout in nursing faculty members. Nursing faculty members are both healthcare providers and educators, yet there is little research focused on their possible burnout experience. I hope to bring attention to that gap and assist in filling it with my research. Research that will begin here in allnurses.com, soon. PamtheNurse

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach burnout inventory, 21, pp. 3463-3464. Palo Alto, CA: Consulting Psychologists Press.

While your work is focused on the existence of burnout in nursing faculty members, you did refer to burnout affecting other nurses besides faculty members in your article, hence my question to you above. Unfortunately, I don't currently have the time to read Maslach et al., but if you are able to answer my earlier question to you below I would be grateful to you.

On 6/20/2020 at 10:05 AM, Susie2310 said:

I would be interested to know if the rate of burnout is higher in student nurses/nurses whose primary motivation for becoming a nurse is money, job security/status, family pressure, etc., versus those who are primarily motivated by wanting to care for sick people.

[JKL33]

To me, being personally burned out on something requires that there be nothing inherently wrong with that thing; rather, the one burned out is just tired of it and ready for something new.

Example I have posted before: If I have a fresh and nutritious salad every day at lunch for 10 years, there might come a point where I say, "Meh, I'm pretty burned out on salad for lunch. I think I need to find something else for awhile." On the other hand, if I am upset that someone expects me to happily eat a sh*t sandwich....that isn't burnout. That's just being intolerant of poor treatment.

***

On 6/20/2020 at 1:05 PM, Susie2310 said:

We know that people enter the nursing profession for a wide variety of reasons, and pursue advanced nursing education for a multitude of reasons. Nurses who post on this site quite often say that they became nurses for the money, or for job security. I would be interested to know if the rate of burnout is higher in student nurses/nurses whose primary motivation for becoming a nurse is money, job security/status, family pressure, etc., versus those who are primarily motivated by wanting to care for sick people.

Do you have a theory about it?

My theory would be that those who are in it for money or job security will be shown to fare much better with regard to "burnout" [a concept whose application to nursing is misfocused]. Those who wanted to serve others' needs, take care of sick people and provide excellent nursing care are in for a world of hurt in our current system. It would not surprise me in the least to hear that this latter group has a more difficult time with the dog and pony shows that are championed as representing good care.

[PamtheNurse, BSN, MSN]

"I would be interested to know if the rate of burnout is higher in student nurses/nurses whose primary motivation for becoming a nurse is money, job security/status, family pressure, etc., versus those who are primarily motivated by wanting to care for sick people."

Susie2310,

Thank you for your question. I can imagine that a study of such would be fascinating. However, the difficulty would be in determining the population that would represent those nurses that are in the profession for the monetary gain only. Thoughts?

PamtheNurse