Nursing Burnout

Introduction

Nurse burnout is a phenomenon that is characterized by a reduction in energy of the nursing staff and leads to emotional exhaustion, lack of motivation and frustration resulting in a reduction of work efficiency and underperformance (Prapanjaroensin, 2017).  Through this report, the purpose is to discuss the nursing burn out issue and how it can impact the patients and the overall medical care. Nurses on an average do a twelve-hour shift, which is the common practice in nursing. The nurses not only continue to monitor the regular patient cases, but they have to stretch over an emergency case as well.  The work timings are also odd hours leading to lack of good work-life balance and maintaining an insufficient help to take care of their health. A study has done over 500+ registered nurses across 10 hospitals that have revealed high levels of burnout due to emotional exhaustion and depersonalization with a low or moderate sense of achievement over the personal accomplishment of the nursing activity.

What is Nurse Burnout?

The study related to Nursing burnout reveals there are certain factors related to work conditions, nurses’ demographic traits are significantly correlated with the burnout categories (Nantsupawat, 2017). The study is based on the importance of the role of nurse leaders in improving work conditions and empowering and motivating nurses to decrease nurses’ feelings of burnout, reduce turnover rates, and improve the quality of nursing care. Since the shortage of health care providers is a major concern worldwide, and according to World Health Organization (WHO) report, the concern of the issues of the health care provider needs immediate attention as there is already a shortage of nurses and it should be given a global level solution as the situation is similar everywhere and it would take the effort of all the governments to provide a solution to nurse burnout as the prevalent trend of medical tourism has made it difficult to contain nurses to a specific country or region.  Due to the lesser number of people choosing nursing as a profession and labor migration, there is a shortage of skilled and experienced nurses and a young nursing workforce. The exodus from nursing as a career is also because of unrealistic job expectations, poor work conditions, work demands that exceed resources, poor collegial relationships, increased work hazards, and poor autonomy and control over practice (White, 2019). Another aspect herein is the organizational characteristics and leader behaviors that would empower nurses to use their knowledge, behaviors, and skills to control their work and thus they would be able to improve organizational commitment, job satisfaction, and quality of care, increase trust in management, and reduce the level of nurse burnout. While the leadership is considered a key factor in creating workplace empowerment and a positive work environment  

If taking a closer look, burnout is a common psychological phenomenon among nurses and is characterized by a decline in physical, emotional, and psychological energy resulting from work-related stress and eventually leading to indifference towards clients and colleagues and feelings of low self-efficacy. The burnout could arise due to work overload; a lack of resources, control, and justice; value conflicts; and the absence of a sense of community and includes three key aspects (White, 2019):  

• Emotional Exhaustion (EE): this is a stage wherein nurses feel physically and emotionally exhausted by work stress resulting in low energy, fatigue, depression, hopelessness, and helplessness.
• Depersonalization (DP): this stage is marred by an indifferent attitude that nurses develop due to burnout and start feeling negative and detached from others and become indifferent to instructions.
• Low Personal Accomplishment (PA): this is a state of negativity wherein a nurse goes low on confidence and self-esteem becomes impatient and anxious and feel low contributor (Nantsupawat, 2016). 

Why do nurses burn out?

Nurse burnout gets triggered by various organizational factors including but not limited to the length of time spent at work. In the majority of cases and studies, nurses having more working hours had a higher level of stress than nurses working for lesser hours (Liu, 2018). Since the role of a nurse role continually expands from the bedside to the waiting room to the boardroom, the stress and busyness of the profession can equally escalate. Nurses are on the frontlines of direct medical care, medical education for others, advocating for patient needs, and comforting patients and their families. Combined, these responsibilities can easily result in nurse burnout. A major factor involved in maintaining high-quality, multi-faceted care is becoming familiar with patients and their families. Making time for emotionally taxing conversations with patients and families adds a physiological affliction to a nurse's already chaotic shift. However, to keep patient care as a priority, nurses must invest in each patient's well-being. While a nurse does all her work professionally, they are bound to get drained out and thus it hampers their work-life balance big time and ads up to their restlessness and anxiety. Due to multi-tasking in modern days due to an increase in the number of patients, there are multiple occasions wherein nurses are not able to fix=knish their work on time and this adds up to their stress levels and they keep rushing from one job to other and work very hard to make ends meet. All these ads up to stress situations and drain out energies of a nurse causing burn out. All this gets escalated a sin modern days, nursing and as a profession has taken a hit and new generation is not too keen to join nursing as a profession and thus there is a shortfall in nurses and it adds up to work pressure of existing nurses. Also, it is a known fact that nursing profession does not get its due share and nurses do not get their due credit and become indifferent towards their work in due course of time and feel low on confidence and self-esteem and thus could lose interest as they would feel a low contributor work and become demotivated and also adding up to burnout situation. Burnout could be seen as a similar situation as the low performance of employees and could be a costly affair for both the nurse and hospital. However since the nursing profession deals with human life and not files, it is a serious issue and needs proper attention and care and counseling. Since shortage of nurses and good nurses are few, the hospital management needs to think of the nursing staff and amicably sort the issues at the earliest. 

Nursing burnout occurs majorly due to work fatigue in the first place and other factors as well, we hereby suggest certain ways for nursing staff to face the fatigue in a better way and as studies have revealed that a feeling of stress could look bit easy if we take a small timeout and detach from the stress and go in a vacuum zone thus enabling us to breathe and take control of ourselves. This would give us time to think and find a way to be out of the stress situation and nursing staff could plan and execute better. (Lewis, 2016) Also, since many other factors of burnout are related to individual inhibition and mental health and willingness, nursing staff should do self-meditation and figure out factors affecting them and try to reduce them by taking guidance or counseling form the senior staff of professional counselors. Also, nursing staff needs to learn to say "No" in case they are already feeling fatigued or exhausted as this would help them regain their balance and also ensure that the patient is not affected. A situation of overwork could lead to serious burnout and could be fatal and thus it is important to know one’s boundaries and be within them. It is important to say no rather than saying a yes under pressure and goofing up later which could be fatal for the hospital, patient and nursing staff as well. It is also important for nursing staff to be judicious and exercise appropriate delegation wherever required as this would help them remain out of fatigue and they would be able to concentrate on the work at hand and do it properly (Lee, 2016). Also, it is advised that nursing staff need to set up a self-disciplined life and obey their work ethics and understand that they should take care of their personal lives as it is the only factor that could maintain their work-life balance and keep them motivated to work. All this is being advised to promote a healthy mind and body and a good state of mind so that they perform tier professional duties with a happy state of mind and do not get fatigued. It is also very important to be in the right state of mind so that nurse burnout remains at a low level. It is also important that nurses get ample time to rejuvenate themselves and start the day afresh. 

Steps to prevent nursing burnout?

The issues of a nurse burn out can have far-reaching consequences, studies prove that stress from long hours at work, rotating shifts and infrequent breaks slows down reaction times, reduces motivation, and increases errors all of these can affect patient care. Nurse burnout could even increase rates of infection in patients. While disturbing the work-life balance and job satisfaction of nurses, nurse burns out situation could also have an adverse effect on patient satisfaction levels. A recent study found a positive correlation between patient happiness and nurses who experienced adequate administrative support and had good relations with doctors and other staff. Also, these nurses were less likely to report burnout. Looking at various factors that could reduce the burn out factor in the nurses including from their training in institutes, to their professional work ethic and culture and to the hospital they work for (Dutra, 2019). 

For nursing institutes:

1.  Signs -: Nursing institutes and centers should understand the mental and physical resilience of all the nursing staff and keep a log of their abilities and workload. This is done to understand the maximum workload an individual can take and what would be his boiling point or the burnout point. Also, it would be helpful for individuals as well as the hospital can gradually make them more resilient through proper training and make them prepared for adverse situations so that they do not get burned put easily.

2. Educate resiliency and self-care: the nursing institute needs to build in curriculum wherein there is the training of soft skills given to nurses as it would make them versatile and their endurance to bear workload and pressure would increase and they would be better prepared to face practical life scenarios (Carthon, 2020). 

For hospitals 

3.  Positive environment. The hospital needs to create an environment wherein nurses are free to express themselves professionally and are free to discuss their issues with a colleague or senior staff.  Since the role of nursing staff is very critical the hospital should have open policies for them and pay proper attention to all their grievances as their workload is both physically and mentally challenging and also includes work in odd hours. Hospitals should have an open-door policy and listen when there are serious concerns (Buckley, 2020). In terms of workload, hospitals could put policies in place to limit nurse-to-patient ratios and also keep track of off days to make sure that the nursing staff gets proper family time and rest to make them fresh and energetic. 

4. Staffing concerns -: In today's global scenario of medical tourism and rising epidemics, the pressure on nursing staff is immense and they need to cope up with changing trends and patients' requirements quickly and thus need to adapt to situations pretty quickly. This sometimes could lead to a rush situation wherein things could go wrong. Hospitals should thus keep training schedules ready and keep on to assign training to staff to be abreast with changing service delivery. Also, in a situation of staff shortage, hospitals could find means to address the situation by managing work shifts with ease or by hiring new college graduates or nurses from temporary staffing agencies to help boost staffing for some time until they're able to hire full-time permanent people or the patient census drops. Since times immemorial, nursing as a profession has not got its due share and credit and it’s up to modern-day hospitals to make a difference and recognize the efforts of nursing staff and make them feel important staff of hospitals and be proud of them their work (Boamah, 2017). 

For nurses

5.  Regular breaks: Since the nursing staff has a very stressful job which involves physical and mental labor, they need to keep taking small duration breaks or time off so that their body does not gets fatigued and also they remain fresh mentally and ready to provide best of their services. It is also important so that they could be energetic and does not get burned out and are available for work and serve the community.

6. Disconnecting: Nursing staff needs to observe solitude for some time as their work involves great involvement on the technical front and thus it could lead to mental deprivation and possible mistakes and lack of seriousness and would lead to sure burnout situation. Nursing staff are a very important tool of a hospital and forms backbone and could be the differentiating factor in the healing of a patient and his fondness to a particular hospital beside the availability of a doctor and thus should be taken care off and should be noticed that they remain the first and last point of contact for a patient and thus needs to be given a fair treatment (Boamah, 2017).

7. Support-: Due to the hectic work schedule and unplanned day, nurses have very little time to channel their thoughts and are majorly engrossed in the execution of orders and managing other protocols and find less time for themselves. Such a situation could lead to a mental break down and leading to burning out a situation wherein they could become indifferent to certain human feelings and orders. Thus they need to express themselves and seek the support of fellow staff, seniors or another counselor. Nurses should have outlets to channel their thoughts, feelings, and emotions. There needs to be someone with whom they can share their frustrations and be done with them. 

Conclusion

To conclude, nursing burn out is a common phenomenon and it is important to establish some necessary facts that nurses would help to support and provide the necessary action to control and prevent it. Nurse has a vital role to play, looking into the criticality of the staff of a hospital. They form backbone for smooth operations but because there is a decline in choosing nursing as a profession and increase in the workload of hospitals with an increase in several patients and change of technology which nurses are supposed to adopt, their work-life balance goes for a toss and they in due course of time become under stress and feel low esteem and indifferent to their work and also become drained out mentally (Dutra, 2019). Due to increased workload, they also become very tired and with rotational shift and odd hours work they also get drained out physically, this situation is called a burn out wherein the nursing staff is at fatigue and drained out both mentally and physically. There are multiple resolutions to avoid such a situation, the key to success revolves around training and conditioning of minds for nurses and hospitals and both of them need to remain calm and understand each other and try to help each other. It is to be noted that a happy nurse can make all the difference in a patients treatment and care and can leave happy memories and thus hospitals need to think of solutions to comfort their nurses who are in burn out phase and try and confirm them by reducing their workload and making plans to make them feel happy and energetic to work.