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It's Official: Workplace Burnout Gets an ICD-11 Code

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by Melissa Mills Melissa Mills, BSN (Member) Writer Innovator Verified

Melissa Mills has 20 years experience as a BSN and specializes in Health and Wellness Writing, Leadership.

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Did you know that until this week workplace burnout wasn't considered an actual diagnosis? The World Health Organization made the change this week by adding it as an occupational phenomenon in ICD-11. Discover more in this article.

It's Official: Workplace Burnout Gets an ICD-11 Code

You’ve probably felt the effects of workplace burnout at least once in your nursing career. As of this week, burnout has officially been recognized by the World Health Organization (WHO) as a formal occupational phenomenon. Clinicians of all types have been living with the effects of short staffing, stress, and other patient barriers that seem to zap their energy and ability to provide the best care.

Burnout is now defined as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It’s characterized by reduced professional efficacy, feelings of exhaustion, and increased mental distance or negative feelings about your work environment.

Nurses and Burnout

The concept of burnout has been around since the 1970s when psychologist Herbert Freudenberger coined the term. When you’re under high levels of stress for an extended period, it’s common to start to feel tired and unhappy. However, the phenomenon doesn’t only make you want to sleep. It can create psychosomatic issues like anxiety, depression, and insomnia, too. Nurses in burns units, critical care, pediatrics, and emergency departments are at a greater risk of developing the condition. The high levels of care and increased uncertainty of outcomes in these areas can take their toll on the mental and physical faculties of any nurse.

Other causes of burnout include inadequate staffing and caring for those who are nearing death or actively dying. You might also struggle with burnout if you’re a newer nurse or have continued conflicts at work that challenge your values.

How Can You Prevent Burnout

Many people think that burnout is driven by the way each nurse deals with stress. However, some experts believe that burnout is a consequence of administrative processes. This means that preventative measures must be initiated on a global level if you want to see changes in the level of burnout nurses experience. Here are a few ways administrators can help to minimize the number of nurses affected by burnout.

Improving Communication Methods

The concept of interoperability isn’t limited to the patient’s medical record. If you must access multiple platforms to gather information and then manually synthesize the data to make care decisions, this could be adding to your level of burnout. Another factor in communication involves having to search for policies and procedures, rather than having these types of resources in one central location.

Think About Scheduling

Whether you work 3-12 hour shifts or 5-8 hours shifts, nursing is challenging. Many nursing units have rigid scheduling policies that make it challenging to take a day off at the last minute for “mental health” needs or family events. You might also not get your schedule more than a week or so in advance, so scheduling life outside of work can be difficult.

Facilities need to learn ways to adopt flexible scheduling policies so that nurses get the time off they need. This might mean hiring more staff, so that weekend rotations are decreased or using “prn” staff to fill in during times of high acuity. Some units use self-scheduling as a way to increase satisfaction with schedules

Consider Nurse-to-Patient Ratios

A 2018 study conducted at Marshall University concluded that nurse-to-patient ratios are directly related to nurse productivity and overall health, including mental, emotional, and psychological factors. Not only did the researchers find that the health of the nurse was in jeopardy during times of inadequate staffing, but they also suffered from job dissatisfaction. In California, nurse-to-patient ratios are mandated, but the rest of the country is left to the individual policies of healthcare facilities.

More nurses are advocating for set staffing ratios and working with lawmakers to initiate legislation. However, this can take years for it to become the norm across the nation.

Does the New Recognition from WHO Help?

Do you feel that recognizing burnout out as a workplace phenomenon will help support issues such as staffing ratios, long hours, and job stress? Will employers finally look for new methods to fix the problems that plague nursing units?

What do you think? Share your thoughts in the comments below.

Melissa is a professor, medical writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. She is available for writing, editing, and coaching services. You can see more of her work at www.melissamills.net.

9 Followers; 111 Articles; 22,172 Profile Views; 271 Posts

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I agree with it however, let's say you are under so much stress at one facility, receive the diagnosis because of horrible conditions, will that affect you getting a job at another facility? 

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Thirty four years of nursing in hospital and dialysis nursing left me with PTSD. Attempting to manage 24/7 acute coverage with a very short staff took a horrendous toll. Now on disability, it is reassuring to know the stress that can accumulate is recognized. 

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I’m at this point now. Had horrible stress several years ago. Diagnosed with Takot-Subo. Left that job and was better. My last two positions have really maxed my stress level to the point of I just want to sleep. I’m physically ill again from stress. Where do I start ? 

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21 hours ago, Melissa Mills said:

Burnout is now defined as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.

Great. 🙄

No, I don't agree with this. I think there is a fundamental problem in defining this and labeling it and applying this diagnosis to an individual or to thousands and tens of thousands, maybe even millions of people.

Outside of the way "burnout" and "[being] burned out" are being applied in nursing, we typically would use those terms to describe a situation that is just fine but that we individually and personally have had enough of it for our own reasons (even just basic overexposure). The example I've given before is that if you eat a nice big healthy salad for lunch day after day for 10 years, you might eventually say you're kinda burned out on lettuce and would like to try something new for lunch.

In common usage we do not say we (individually) are "burned out" in reference to situations that are fundamentally bad.

Burnout, the word itself, is one that suggests an individual problem (and also sort of a hopeless one, if you think about it). Totally burned out buildings don't rebuild themselves, they sit abandoned or get bulldozed. Burned out candles don't regenerate their wicks, they get thrown in the trash generally. Lightbulbs? Trash. Etc. Etc. 

Anyway. We have to ask ourselves why this matters. Well, it matters a great deal because the proposed solutions will flow from the way the problem is viewed. Is the solution for tens of thousands of millions of people to believe there is something wrong with them and that are only suffering because they individually can't cope perfectly with badness?

Well....that depends on what the badness is.

If it is something like being chronically exposed to (natural) patient death and not having a healthy perspective about it, then yes that calls for individual coping or else a change of scenery or individual-level interventions/professional help, etc.

But if it is something like large-scale, chronic poor treatment that others could choose to control/improve, then calling yourself  or allowing yourself to be called "burned out" or being labeled as suffering with "burnout" doesn't make sense.

If someone is in a relationship that is chronically emotionally abusive, for example, would we expect that person to say that they are "burned out?" Or that they are suffering with "burnout?"

Ah, NO.

So, let's take the case of the typical LTC story we read here, where a business model involves needing a licensed nurse, but there is no intent to have the nurse function as per his/her ethical duties because that is not financially profitable. One licensed nurse has dozens of patients and must de-prioritize some of the items that could fairly be called prudent, ethical nursing duties in order to handle this kind of load. Chronically. Some of the re-prioritization will involve things that others can easily come along and point a finger at and declare the person negligent. I won't go on and on, I think we all understand the scenario.

So should this person say s/he  is "burned out" due to this???

If anyone thinks the solution to this is really actually that they (and the next, and the next, and the next person ad infinitum) must "find a new job" or do x, y, z, to cope with this, I will vehemently disagree.

In fact, I think those useless refrains are part of the reason that the situations continue.

How about acute care? Appearance-wise it isn't as bad, because a lot of money is spent on preventing a poor reputation. But it's a version of the same. A licensed nurse is (for now, at least) required to provide the care that is being sold by others. But there is really no steadfast business effort to have a system whereby the nurse can practice without having to de-prioritize something that someone could legitimately say is important. Every day, every shift, every hour, in every acute care facility, nursing "prioritization" decisions are made by individual licensed nurses, that someone could easily come along and say were negligent. Correct, mind you, but still could be isolated and called negligent by a "prudent nurse."

Meanwhile, we have a ~50 pg Code of Ethics that is still being taught and we are all still attempting to practice.

I fail to see how the toxic collision of nursing/patient care and the corporate business world should be allowed to amount to thousands++ of people being called "burned out" or diagnosed with "burnout."

This is akin to gaslighting.

 

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Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

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7 hours ago, JKL33 said:

Great. 🙄

No, I don't agree with this. I think there is a fundamental problem in defining this and labeling it and applying this diagnosis to an individual or to thousands and tens of thousands, maybe even millions of people.

 

My understanding is that WHO is recognizing it as a workplace phenomenon but not a medical condition, and definitely not a diagnosis.

I could be wrong.

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@JKL33 well said. I am a physical therapist and I have seen the administrative wheel grind and have me stretched thin with tasks with the ever increasing demand, "can't you just see more patients?" And I am now supposed to shame myself for being burned out when I work in an unrelenting, uncompromising system that would spit me out and replace me in a heart beat. The last place I worked decided to solve this problem by hiring new grads. Giving them an unrealistic schedule, churning out evals, with the technicians giving the bulk of the treatment. The new grads would stay maybe 2-3 years before deciding they deserved to be treated better....but the company didn't care. New grads are cheaper than seasoned clinicians and they don't have enough bargaining room to complain about the unrealistic workload. There is a never ending pool of graduates every year. I fear the labeling of burnout as an individual issue and one that would allow businesses to get rid of employees in favor of those with better coping stategies, or those who don't speak up. What does it ultimately mean once you're labeled with this new ICD-11 code? 

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11 hours ago, Nurse Beth said:

My understanding is that WHO is recognizing it as a workplace phenomenon but not a medical condition, and definitely not a diagnosis.

I could be wrong.

Thanks. I see the distinction you are making.

But regardless whether it is called a diagnosis or not, the main purpose of an ICD code is so that treatment for the condition/syndrome/phenomenon/dx can be billed. And admittedly, yes, so stats involving it can be tracked, the situation can be studied, etc., etc. The question is, will we study and react to the correct thing.

You can read about this in regular/popular media and understand my concern. Themes along the line of workers being able to get help more readily because of specific ICD code. Or, 'even though some people say these workers are  just lazy...look, it's a real syndrome;' [they have a real problem].

And that's just it, that is exactly what my argument is against. I think all of it focuses on the wrong thing. And it's a total, "Aw, poor you....you have problem. Look here: you're suffering from workplace burnout. This is what you should do about it."

I think burnout applied to nursing workforce is even more toxic than regular talk of workplace burnout, because seemingly a decent portion of the difficulty in nursing is the constant ethical compromise and ethics are a major part of what we're about. My observation/belief is that the demand for these types of compromises have ramped up significantly in recent years.

Meanwhile on the other end of things,  we have known about work-life balance for a looooong time, and most people (well, everyone I know except for extreme and troubled workaholics) have a normal, decent work-life balance. They/we go to work and do the best we can, take care of ourselves/families/loved ones, have some community connections and help others out in the community, take a vacation here and there and socialize the "normal" amount; do some things we enjoy, practice hobbies and talents, etc., etc., etc. That still doesn't mean that workers learn to enjoy positions of disdain or thrive (at work) when exposed to that treatment 40-80 hours a week. At some point it's not about nurses and their problems (which have already been studied extensively). It's about people who can't [blank]ing figure out how to treat others right.

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Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

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@JKL33 I think I understand, thanks.

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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Does this mean that the ANA will change their position and support California ratio laws? Will we be able to get people FMLA for workplace burnout so that they can miss work without fear of job loss? Also, when will most U. S. providers start using ICD 11 rather than 10?

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Jennifer Peck has 3 years experience as a BSN, RN.

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I am currently experiencing burn out at my current job. I work on an acute care telemetry unit. I started 3 years ago as a new graduate. The unit itself was something of an “experiment” when it was first opened about 6 months before I started. Administration decided to see how a unit would cope if only new nurses were hired to work. Although we all learned a lot through helping each other and the nurse bullying was never something we experienced, the turn over rate was exceedingly high and still is. With 8 months of experience, I was the senior nurse on a night shift with almost all new hires. Responsible for covering a full team of 6 patients, act as charge nurse as well as be the go to person for any questions was exhausting. Not only was I myself still unconfident and inexperienced, I now had to worry about other nurses as well. Yes, there were covering managers and educators but it still felt inadequate due to the limited resources alavailble at night. I used to leave with anxiety every shift, afraid every time I heard the phone ringing thinking it was a mistake I made. However, I pushed through determined to impress my new employers and secure a respected position in the hospital system. 

 Fast forward 3 years later, I’m not on day shift on the same unit. Being one of the only “original” nurses left on the unit, the turn over rate continues to climb. 3 years of chronic understaffing with patients way too acute to be on a unit with a 1:6 ratio, and distant managers, I can say I am officially burnt out. I am lucky to be able to run to the lobby cafe and grab coffee during a 12.5 hour shift and rarely leave on time. Managers are aware of this but offer no help and are constantly adding more to the workload. I’ve had shifts where at 5pm, 10 hours into the day, I haven’t even gotten a moment to pee or change a tampon. My urine after a shift looks worse than the 90 year old kidney failure patients I’ve cared for throughout the day and I’ve started to speak up. 

   My yearly evaluation this year consisted of my manager telling me that it’s my negativity about work causing me to feel that the work environment is toxic. Everyone other staff member, besides nurses, receive scheduled breaks no matter how busy the unit is, and leave at the exact minute they’re supposed to. Nurses are required to sit the telemetry monitors daily so that the techs are able to go eat, yet no one comes to relieve us. 

   There have been many times I should’ve have left like my other coworkers. However, I don’t like to job hop and want to ensure I know what I want before I make a leap to leave. Instead of these hospital administrators rewarding loyalty, the use us up and then tell us there’s something wrong with how we’re coping. I am know so burnt out that I plan to resign without another job lined up. It has made me hate the nurses profession and regret my decision to become an RN. I know my thoughts are out of exhaustion and anger and that one bad job shouldn’t determine a career which is why I’ve decided to be unemployed. At 27 years old, only 3 years in, no one, in ANY profession, should feel defeated in a way that they are emotionally, physically and spiritually drained. 

its quite a contradiction that nurses are taught to be professional, compassionate and competent yet cannot receive any recognition or respect from the health care industry when we stretch ourselves too thin. The believe that “nursing is a thankless profession” is the reason things will never change. Just because we have dedicated our lives to the service of strangers does in NO WAY mean we have to ignore our physical or psychological health in order to do so. 

My only advice to nurses who feel this way is to leave when they feel it’s time to move on. Pushing yourself to the limit will only dig your hole deeper. My depression and anxiety used to only show itself on work days and the nights before work. It has now become a chronic issue that I can’t seem to get myself out of. No job, pay or benefits are worth feeling this way for. 

   

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Hospitals have a way of destroying your soul if your not careful. Lots of death and suffering going around with just the patients. Nevermind the other stuff that messes up an employee's head. Been a healthcare worker since 1993.

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