Top Causes and Symptoms of Nursing Staff Burnout and Ways to Help Reduce The Burnout

Susan Sears, BSN, RN

Burnout is a work-related stress syndrome resulting from chronic exposure to job stress, and healthcare is a leader in work-related stresses. In Long Term Care (LTC), long before the pandemic, nurses were burned out; the pandemic just magnified the already stressed and tired nursing staff.

As a registered nurse for over sixteen years, working both in management and as a floor nurse, I have felt burnt out and have seen the changes in the medical field that increase these feelings in healthcare staff. What are the causes and symptoms of nursing staff burnout, and is there anything we can do to help this situation as employers or as residents or family members in the case of LTC?

Reasons for Staff Burnout

Short staffing

Continually working without enough staff adds workload to existing staff, causing them to feel they cannot complete the high demands placed upon them. With adequate staffing, frustration is decreased, and caregivers can provide the necessary attention to each LTC resident.

Feeling unable to complete patient care effectively

The staff feels ill-equipped for the needed patient care. This can be due to short staffing, and it can also be due to a lack of training in specific care areas.

The acuity of patients is changing within LTC. The changes in insurance coverage cause people to stay home or receive outpatient care; this means only the truly sick qualify for benefits. The acuity changes result in more complicated patients and can cause nurses to feel ill-equipped for complex patient care.

Staff pressure from other staff

This has been receiving more attention by the media lately, but it is staff bullying, and it is prevalent in any work position, including nursing. The proper term is workplace harassment¹, and it is an issue that can cause staff burnout.

Extended work hours

Nursing is a 24/7 occupation; there is no time that a facility closes or stops. Nurses frequently work long hours; many work twelve-hour shifts, and if they go over, it can quickly and legally turn into a sixteen-hour shift. Due to shortages, many will repeat this cycle frequently, leading to healthcare fatigue and burnout². Even working eight-hour shifts without time off adds stress to the employee.

Heavy Responsibility & Family Expectations

The responsibility of an LTC employee is always heavy as they attempt to meet resident needs, satisfy state requirements, and the resident's family expectations. This can cause an employee to feel overwhelmed.

Family expectations³ can be the most difficult for an employee. So, we must work with staff and family to assist with family expectations.

High turnover rate

LTC facilities are at the top of staff turnover rates. This is no surprise, as LTC facilities have had staffing difficulties long before the COVID pandemic. With current PJB reporting⁴, turnover statistics are even more alarming than previously thought. The high turnover rate can lead the staff that stays in a facility to be in a continual cycle of training new staff. This can easily lead to burnout for this employee.

Fatigued Employees

A fatigued employee is not an effective employee. The fatigue can be due to the high workload or personal commitments that demand an employee's time, causing limited time for actual sleep.

A lack of sleep causes detriments in job performance, and productivity and an increase in job-related accidents, absenteeism, counterproductive work behaviors, and reduced patient care.

Emotional Exhaustion

The spillover effects of personal and family stress can cause emotional exhaustion. According to one study, the crossover between family and work⁵ is a crucial reason for emotional exhaustion in a healthcare worker.

Stressful work environments

Long Term Care is unlike acute care due to the high number of residents with dementia. These patients can be verbally or physically abusive towards staff and demand a higher care level.

Increase Numbers of Declining Patients

Having patients declining health and the death of their health care recipients can add significantly to nurse burnout. COVID-19 has expounded this in the LTC setting by the increased death toll causing employees to deal with trauma and loss⁶.

Top Side Effects of Nurse Burnout

Illness of employee

Increased risk of illness of healthcare workers due to work-related stress; according to Freudenberger, a psychoanalyst from the 1970's⁷, healthcare workers are particularly vulnerable to emotional exhaustion, cynicism, and depersonalization.

Increased risk of mental health issues and risk of suicide

Handling the day-to-day responsibilities and not feeling satisfied in their role can lead to depression.

We lost three successful young medical staff to suicide in my facility. It weighed heavily on everyone within the facility. People think healthcare workers are tough; a nurse can handle it all. Not only do we deal with the effects of trauma, but the people who want to blame a nurse for everything that goes wrong, even though it may be a medical impossibility to change the road that an ill person is heading. The result is young nurses who are gone too soon – taken by suicide because they could not handle it all.

Job bouncing or low staff census

The death and the low pay make LTC a less desirable choice for employment. The lure of high-paying sign-on bonuses or travel nursing has caused many nurses or techs to move toward higher-paying or less stressful jobs.

Lower quality care of patients

When staff members are burnt out, the quality of patient care goes down. The effects of short staffing and weary staff can cause intentional or unintentional harm to residents and can even be considered abusive. The results can be devastating – trauma, increased medical emergencies, hospitalizations, and even death for the resident.

Five Things You Can Do to Reduce Staff Burnout - For the Employer

Recognize scheduling gaps so that you can fill the gaps with appropriate staff to reduce the stress on those working on the floor.
- While staffing with a grid count, count only staff truly working the floor – the MDS nurse or any other office worker is not providing direct patient care, so they should not be counted in the grid.
- Managing call-offs⁸ and tracking the staff working in direct patient care will reduce the short staffing problem, reducing staff burnout.
Be a positive team leader - One of the most significant levels of respect I have felt is when my nursing director came in on her day off – a day that we were particularly short-staffed and asked where she could help. She admitted she could not help with the complicated patients, but she could help in other areas. She promptly began answering call lights and passing medications. She worked with us until our morning rush was through. She was indeed an inspirational leader and made us feel that we all work as a team.
Allow for self-scheduling to help with the family and work stresses. Using LTC workforce scheduling software⁹ can help you identify staffing gaps and allow staff to pick dates around family obligations.
Invest in mental health benefits for your facility – staff breaks, staff vacations, and the ability for mental health benefits¹⁰ are all important for your employee's wellness. The long-term result of providing this for your employees will be a healthy staff.
The most important tip is a quote from Forbes magazine; The economist's answer could not be simpler: Want to hire in a tight labor market? Pay more.

Five Things to Reduce Staff Burnout - For the Resident or Family

Recognize the hard work that the employees are completing and show appreciation for this care.
Be a volunteer in the facility that your loved one is in – someone doing nails, hair, or helping with crafts at a facility can aid staff in keeping the residents occupied.
- When my children were younger, and my grandmother was in long-term care, we would visit often – my son would play piano or help with games or other activities.
- The result was happier residents as they always enjoyed these visits and children who learned the value of kindness.
Let young job seekers know about this type of care. Help fill the gap of short staffing.
Provide open communication with your expectations but be realistic. An employee caring for several residents simultaneously will not be able to fulfill every need. Fulfill the needs of your loved ones that you can.
Always look for ways that you can praise an employee. Any act of kindness goes a long way to the already tired and stressed-out employee.

At a time of facilities closing due to lack of employees, we are demanded to look at and address staff burnout. If we want quality facilities with quality employees, we must all work together to address this critical issue.

References

¹4 Types of Workplace Harassment and How to Stop Them

²The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction

³Establishing Expectations with Family Members of Long Term Care Residents

⁴Nursing Homes Have 94% Staff Turnover Rate — With Even Higher Churn at Low-Rated Facilities

⁵Work, Home, and In-Between: A Longitudinal Study of Spillover

⁶Grief and Loss Among Healthcare Workers: Finding Support and Connections

⁷Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies

⁸COVID-19, Callouts, and Compliance: How You Can Automate Your Callout Process

⁹Staff Scheduling Software for Long Term Care and Senior Living facilities

¹⁰Workplace mental health: 5 ways to support employee wellness