What's Burnout?

Burnout in healthcare has reached epidemic proportions with nearly 40% or more of nurses experiencing some dimension of burnout. But the term is used so often, do we really even know what is or how it's truly defined? This is of utmost importance, because how can burnout be dealt with if it can't be easily defined?

What's Burnout?

A silly question. Right?

As nurses we all can easily answer that one. I mean, come on. We've heard that word burnout so many times in our careers it seems to have lost its meaning.

But seriously. Take a moment and write down how you define burnout.

Did you have a difficult time defining it or did the definition easily flow from your pen?

So, maybe there is more to my silly question.

I'm guessing that if I read a few of your responses, I'd likely get many different answers. Ranging from an overall hatred of your job, to being totally fed up and wanting to quit, to being so exhausted you just want to sleep for 3 days straight, to truly hating your worthless manager.

While there are elements of truth in those likely responses...the real definition might surprise you.

Why so hard to define?

I believe it's because we tend to focus on its effects- which can be different for each person, rather than a text book definition. This is what muddies up the water when trying to define it; when we add our feelings, emotions, experiences, and beliefs to our definition. These are very important, but can make giving a solid definition difficult.

Learning how burnout is defined can be an important first step to addressing it and helping to limit its damage in our lives. It makes sense that you must know what you're dealing with before effective action can be taken.

By definition

Burnout pioneer and researcher Christina Maslach Ph.D. defines it this way,

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Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with other people in some capacity

In her book Burnout, The Cost of Caring (2003), Dr Maslach states,

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Burnout is a response to the chronic emotional strain of dealing extensively with other human beings...particularly when they are troubled or having problems. Thus, it can be considered one type of job stress...what is unique about burnout is that the stress arises from the social interaction between helper and recipient.

Emotional Exhaustion

This is about being very involved emotionally and overextending yourself and feeling overwhelmed by the demands of your patients. The natural response to this is emotional exhaustion.

You just feel used up, chewed up, and just totally drained.

Your reserves are tapped out.

It's like you've given and given and given some more and have just run out of steam.

Depersonalization/Cynicism

Once the emotional exhaustion sets in, it makes sense you don't feel able to give of yourself any longer. It's not that you don't want to help- it's just that you can't climb one more mountain.

So, what do you likely do?

Start to distance yourself from others, but you're a nurse so this could be a big problem.

Enter cynicism, that negative, callous, or very detached response to various aspects of your job.

Does this ring a bell, "The patients are always so needy...I really don't care what happens...it's not my problem...they'll have to deal with it themselves...The patients always treat the nurses so horribly."

The result of this thinking and attitude can lead to developing a poor opinion of our patients, expecting the worst from them, and even actively disliking them.

At this point, we have a nurse who is physically/emotionally exhausted and unable to give another a drop of anything to anyone. And she has a very negative, detached response not only to her patients but to other staff as well. This isn't a pretty picture. Then, to add insult to injury, a third ugly aspect of burnout is brewing- a feeling of reduced personal accomplishment

Reduced Personal Accomplishment

Feeling negative about others can naturally lead to feeling down on yourself. You might even feel guilty about how you've thought about your patients.

Dr Maslach (2003) states, "They sense they are turning into the very type of person- cold and uncaring- that nobody, especially them, likes very much."

Because of this, you might feel inadequate in your ability to relate to your patients which could result in declaring yourself a failure.

What now?

Burnout is a complex issue that we as healthcare providers deal with daily. While burnout happens in other industries, it seems to hit particularly hard for nurses based on the nature of our work.

Remind yourself that being a nurse isn't easy, committing yourself to a lifetime of helping others never is, but the personal rewards can be great. And arming yourself with this knowledge can be an important initial step in combating burnout.

I encourage everyone to take a serious look at how burnout might be negatively impacting your life. Realize this syndrome isn't limited to your clinical practice and over time can start to cause havoc in other areas of your life as well.

Reference

Maslach, Christina (2003). Burnout, The Cost of Caring, 1, 2-7.

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MattRN95

About MattRN95

Hello, I'm a former RN who made the career transition out of nursing and into a role that was a better fit. For me, Career Coaching was an excellent option. Now, I work with nurses to assess their current level of burnout, workplace mismatch, and co-create solutions to re-energize and experience more joy and sanity. For those who are totally fed up with nursing and want out, I also specialize in career transition. During my 13 years bedside I worked in various positions from a cardiac stepdown, to open heart recovery. Then, decided to be a travel nurse and see the amazing USA. As a traveler I did assignments in 8 states (mainly sunny ones as was trying to avoid snowy Northwest Ohio) and at 18 hospitals nationally. An amazing and profound experience I highly recommend.

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Specializes in Critical Care, Education.

I also like Heather Laschinger's research on Nurse Burnout which identifies (lack of) workplace empowerment as a predictor of burnout. She's done a ton of work in this area. Very informative

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Specializes in Open Heart Recovery, Trauma/Burn, Tele.

Ok awesome! Thanks so much for the link, look forward to reading her research.

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I hoped you would have not left out the also real issues of the Healthcare system. We are far behind in being given the monies we so deserve to improve the field, help patients get better and also provide a climate of kindness and productive teaching, along with praise for hard work and compensatory pay, for those in our society who have made a professional and personal choice to care for the "wretched of the earth".

My experience, in the later years of my 30 year career, is that the patients are definitely not the major issue when it comes to being burnt out. Many of those in upper level management contribute to employee unhappiness. I have witnessed extreme nepotism, and the lies that go hand in hand with it. Yelling at those who aren't liked for not sucking up, not being pretentious, though working very hard. And caring very much. We're often understaffed.

The system needs to change. Nurses are often voted the most admired from the public, but because of the abuse we are subjected to, many take it out on their co-workers. The environment needs to thrive for all. For me, the patients aren't usually the issue.

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Matt thank you so much for writing this article. It's like you wrote it specifically for me. I have completely burned out and I'm afraid I'm past the point of no return. I am an RN in a Surgery Trauma ICU at a Level I Trauma Center in a major metropolitan area. We are the number one trauma center in the state so we get it all. I've been working here for 8.5 years. Over the past few years I have felt I was starting to burn out. I spoke to one of our NP's who had just completed his DNP and did a lot of work on burn out and his suggestion was to read some articles on the AACN's website about it. Not the help I was hoping for.

Fastforward to this May/June when the flame went out for me. There was a major trauma pt I admitted and who was there over 3 weeks. His wife eventually made him a DNR then she withdrew care and he passed away. One of the Trauma Attendings ended up starting a war with Nursing because she wasn't happy that the pt's wife made him a DNR and no one discussed it with her, even though she wasn't there because it was not her week on. (We have 10 Attendings and they each are on one week at a time and cycle through). Even though all these things were communicated with the Attending that was actually on service at the time all these things happened, this particular MD threw Nursing under the bus. I'm not going to go into details but it was really, really bad to the point Ethics and administration got involved. And this was something this Attending has done in the past and is known for. Of course nothing ever happens to her disciplinary wise.

It was at this point where I was done. I officially burned out. That was this past June and things just keep getting worse for me. I get anxious every day that I wake up and I know I have to work that night. I am angry at work. I hate my patients and their families. I snap on almost all the residents. I hate my boss because she has not once ever spoken to any of us nurses about this issue with the Attending. I used to put my all in my job and would work tirelessly for some patients. Now, to be frank, I just don't give a f#$! I am sick and tired of our Attendings flat out lying to patients' families about the patient's prognosis or treatments. I'm tired of the verbal and physical abuse by the patients and nothing being done about it. I'm sick of the verbal abuse of visitors and nothing being done about it. I'm tired of being treated like a doormat. I'm done. Finished. I hate nursing and everything that is involved with it. I never want to work closely with patients again. If I could manage it financially, I would walk away from healthcare this second and never look back.

I went to my Nurse Clinician asking for help for how I was feeling but got nothing. I'm at the end of my rope and I don't know what to do. No one seems to either want to help me or there is nothing at my hospital to help people who are going through this.

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Specializes in Open Heart Recovery, Trauma/Burn, Tele.

Thank you for your insightful response. As you know, burnout is a far reaching and complex issue that can impact numerous areas. The real issues of the Healthcare system you reference are numerous as well and beyond the scope of my intent for this article (which was to give a basic definition of burnout). But I look forward to discussing them in a future article. I appreciate your input.

And again, burnout is really an individual response to various stressors and mismatches in the workplace.

I encourage others to draft their own definition which is tailor made for them.

So for you, patients are not a source of burnout possibly because of your 30 year career; developing functional and effective methods of dealing with them. However, for a newbie who hasn't developed those skills, patients can be a central issue of them starting to burnout. It really is individual and doesn't always stick to an overall definition; there is room for flexibility.

Thank you for sharing your valuable experience and your 30 years of commitment to nursing.

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Specializes in Open Heart Recovery, Trauma/Burn, Tele.

Thank you for sharing your struggle, my heart goes out to you. I'm glad you were able to connect to the article.

It seems like you're pretty clear on wanting to be done with nursing once and for all. I get it. I would be glad to speak with you about how coaching could help you create a way forward and through what you're currently dealing with.

Your last paragraph is the main reason I wanted to focus on burnout in nursing. There is currently little to no help for healthcare workers dealing with this issue. I know countless nurses are dealing with this and it can leave you feeling helpless and disempowered to say the least. Remember you have more personal power than you realize. And, you can change a situation (at least how you see it/ mindset) or career if you want, it's not easy but can be done.

I always say, "Life is short, don't waste it being miserable."

I commend you on reaching out and wanting something better for your life.

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Nurse burnout is not caused only by the increased stress of having too many patients and not enough time to adequately do their jobs. There are other causes as well. Hostility from other staff members, verbal and physical aggression from Physicians whom the hospital management, never seems to do anything about, and having computerized charting systems that take too much time away from patient care, and finally having a hospital administration that cares more about profits than their employees and patients. This all leads to a feeling of powerlessness, frustration and burnout. There is so much stress on the job that nurses no longer feel that they have accomplished anything at the end of their shift, but they go home wondering what they might have forgotten. Unless nurses are allowed to do their jobs properly without managerial interference, have enough time, staff, and sufficient supplies, to do their jobs, burnout will continue to be a huge problem. Nurses at Magnet Hospitals who are truly empowered by having a say in how to do their jobs, suffer far less from burnout. It's time to put quality care back into nursing.

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Specializes in Open Heart Recovery, Trauma/Burn, Tele.

Thanks for your comment Sally. I fully agree that burnout is way more complex than the area of workload mismatch (patients/not enough time). There are actually 5 other areas that when mismatched also contribute to burnout and they include control (perceived capacity to influence decisions affecting work, autonomy, role conflict), reward (the extent to which rewards-monetary, social and intrinsic are consistent with expectations), community (which is what you're referencing; the overall quality of social interaction and capacity to function as a team) fairness (the extent to which work decisions are perceived as being equitable), and values (the ideals and motivations that initially attracted the worker to the job in the first place).

Thank you for pointing out additional aspects of burnout. It shows that the issue is complex and multifactorial.

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Specializes in Med Surg, Parish Nurse, Hospice.

To me, burnout ( and yes I had it several years ago) means that I felt each day that I had to go to work, I was going to drop dead while I worked. It seemed to me that I was one of the few staff members that wasn't sitting and chatting most of the day. I was too busy doing the patient care that I had learned as a young nurse 30 plus years ago. I wanted my patients to be turned every two hours, their teeth ( or at least oral care) brushed and helped to eat.

One of the things that pushed me over the edge was scripted conversations with patients and families. I felt that I knew what to say to patients and didn't want to be told what to say and how to say it.

How did I beat my burnout? It took several years. When I first noticed it, I was off work for about 2 months and saw a psych dr and counselor. I was able to work as a staff nurse for about 4 more years. When I felt my self burning out again, I really had to take a hard look at my life and what were my priorities. It was a hard decision, but I left bedside nursing for a parish nurse position. I took a major cut in pay, but I am much less stressed and love what I am doing . I don't make much money, but the satisfaction is great. I love the people that I see. I tell everybody that I feel I have the best part of nursing with out the worst part. I have always loved to listen to people. Everyone has a story that they want to share. As a bedside nurse, the time is very limited. Now I can listen and I have learned much about life and values.

I am becoming involved with the homeless program in my town and find great satisfaction in being a part of the team that helps others. Of course if the ability to retire was dropped on my doorstep tomorrow, I would take it and run. But until that day comes, I continue to work and again enjoy being a nurse.

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Specializes in Open Heart Recovery, Trauma/Burn, Tele.

Thank you for sharing your burnout journey. It sounds like you're in a much better place now. I commend you on taking necessary steps to look within and discover a better path for yourself. I believe this is critical to creating a more functional work relationship and to actually enjoy your life again. Very inspiring!

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