How to Combat Nurse Burnout

Many people feel called into nursing careers. Nurses get the unique opportunity to directly serve people in achieving better health. But while nursing offers many rewards, the stress of the job can also lead to burnout. Left unchecked, career burnout can drive even the most dedicated nurses to leave the profession altogether.

Anyone considering a nursing career should start by having realistic expectations of what day-to-day life is like as a nurse—especially in acute care settings.

Ingrid Flanders, RN, BSN, MN, FNP-C, a visiting assistant professor at the Linfield-Good Samaritan School of Nursing in Portland, Oregon, says

sometimes the job is different from what a nurse might expect. “Maybe they don’t have a full understanding of the role and the responsibilities that go with it,” says Flanders. “Then they’re surprised at the level and intensity of the workload. Maybe they haven’t prepared themselves physically, mentally, and emotionally for the work involved; because a nursing role, regardless of what setting you’re in, is really demanding.”

Flanders notes that patients have high expectations of nurses’ proficiency, which can create pressure. There’s also the pressure that many nurses put on themselves. “Generally, the people who are drawn to be nurses have high expectations of ourselves and so we try to give it all away and we don’t always have enough left for ourselves,” explains Flanders.

What starts out as a passion for helping people can soon lead to chronic job stress or what Vicki S. Good, DNP, RN, CPHQ, CPPS, vice president of quality and safety at Mercy Hospital Springfield Communities in Springfield, Missouri, calls burnout syndrome (BOS)—work-related stress that remains unresolved. “BOS has three elements: exhaustion, depersonalization, and perception of decreased personal and professional accomplishment. BOS is directly related to stress at work and not related to stresses outside of work, although outside stresses may impact the stress at work,” explains Good.

Good says that nurses in high-risk, high-stress work environments (such as critical care nursing) are at especially high risk for developing BOS, where they are asked to care for patients during a vulnerable time in the patient’s life, and often at the end of life, with the accompanying ethical issues.

“Nurses are engaged in high-stakes decision making on a daily basis,” says Good. “The nurse is the clinician who is constantly at the bedside of the patient, giving their entire physical and emotional self to care for their patient and their family. Combine this with one of the most challenging workforce shortages in nursing and nurses have rates of BOS equal and often higher than their physician colleagues.”

One extreme consequence of nursing job burnout is nurses deciding to leave the profession—a choice that nurses are making in unprecedented numbers according to Good.

“By raising awareness and educating nurses on how to respond and mitigate symptoms of BOS we hope to prevent nurses from leaving the profession. BOS has been called a ‘silent epidemic’ because nurses and other clinicians have been afraid to speak up about their feelings, and instead the nurse ‘votes with their feet’ by leaving the unit and/or profession,” says Good.

Warning Signs of Impending Burnout

Because nurses invest vast amounts of time, education, and money into entering the field and growing their careers, it’s important that they practice good self-care and watch out for the warning signs of chronic stress and burnout.

Nursing career burnout can be sneaky, warns Anna Rodriguez, BSN, RN, CCRN, PCCN, a critical care nurse who launched TheBurnoutBook.com to help nurses combat burnout. “It comes on so gradually, one bad shift at a time, and before you know it, you dread clocking in to work,” says Rodriguez. “Early recognition is key. You need to pause and assess yourself frequently for signs of fatigue, depression, or feeling cynical or apathetic toward your work. You might go home feeling emotionally or physically drained more days than not. You might feel anxious and find your mind racing, thinking about work. These are all unhealthy signs that the work is getting to you and, if it continues, will lead to full-blown burnout.”

Good says that unfortunately, most nurses do not realize when they are developing the signs and symptoms of BOS. “This is one reason that raising awareness of this syndrome is so important to our profession. As a professional nurse, it is critical to be able to recognize the warning symptoms so that one can then take action to mitigate the potential outcomes of the syndrome,” says Good.

So, what do nurses need to watch out for as they go about their daily work?

“As a nurse, the first thing to become keenly aware of are any changes in energy levels related to work—both physical and emotional. Exhaustion is one of the key symptoms. If the thought of going to work makes you exhausted, pay attention, ask questions, and seek intervention,” Good advises.

Flanders agrees that nurses should watch out for fatigue. Another common symptom is a lack of resilience or tolerance for challenging situations where you feel more impatient or more irritable than usual.

This lack of resilience may cause nurses to become disengaged in their work and interactions with coworkers and patients. “If a nurse was previously highly engaged in social events and activities on the unit and stops participating, this may be a sign of BOS development,” says Good.

Finally, watch out for the general feeling that you’re not making a difference as a nurse for your patients/community. Good notes that this lack of a personal and professional sense of accomplishment is a warning that burnout has set in.

How to Avoid Burnout—or Nip it in the Bud

What can a nurse do if they are on the road to burnout or to prevent burnout from developing? Here are some expert tips from seasoned nurses.

Practice Self-Care. Flanders says it all starts with prioritizing self-care. This includes reading for pleasure for a few minutes every day, maintaining a healthy diet, getting regular exercise to reduce stress, and making sure you get adequate rest. “Even if you’re a nurse working on a night shift, it’s important to make sure your sleep pattern is one that’s sustainable,” says Flanders.

Develop Resiliency Skills. “Resiliency is the antidote to burnout,” says Rodriguez. “It’s the ability to bounce back after feeling that emotional, physical, and psychological exhaustion that burnout creates. It’s finding a way to balance the energy you give to others and recharging yourself so that you can continue to care for others effectively.”

Rodriguez suggests the following tips to build resiliency as a nurse:

• Be intentional on your days off to regroup and rest so that you can come back a better nurse on your next shift. Don’t say yes to extra shifts if you need to rest.
• Take breaks during your shifts (and practice self-care strategies during your break, such as eating a healthy meal or reading for pleasure).
• Plan unit-bonding activities. Getting together with coworkers outside of work is a great way to fight off burnout.

Talk It Out. Having a support network is vital for nurses. Nurses need to ensure they have other nurses to turn to vent about a bad day, a troublesome patient, or frustrations. Having nursing friends at work and/or joining a professional nursing association dedicated to your specialty, such as the American Association of Critical-Care Nurses, can be an excellent outlet.

“We need a way to talk about the things we see every day,” says Rodriguez. “There’s a lot of doom and gloom. There are morally distressing moments. There are times when we’ve given so much of our energy to others that we develop compassion fatigue and go into survival mode, shutting down our empathetic side as a coping mechanism. The ability to vent in a healthy way with our peers is essential to dealing with all of that and maintaining our empathy. No one understands what you go through better than another nurse.”

Explore Your Options

If you feel that you are already in burnout mode, take some time to explore your career options. Some nurses who experience burnout leave the profession altogether. But that may not be necessary.

Start off by exploring ways you can remain in the field by taking some time off, changing units, or finding a new job in a less stressful environment.

“A sabbatical or some time off may help, but it’s generally not a long-term fix,” says Paula Davis-Laack, JD, MAPP, owner of Davis-Laack Stress & Resilience Institute. “Remember that burnout is more about work systems, cultures, and values creating an environment that breeds burnout, so until the workplace changes, burnout will likely remain a possibility. You may just be in an environment that’s a disconnect for you. Can you switch teams, organizations, or practice settings?”

If a change in work environment or position doesn’t help, then it’s time to look at nontraditional career tracks such as becoming a health coach, nurse entrepreneur, or nurse educator.

“One of the things I’ve enjoyed about being a nurse now for almost 35 years is that there’s a variety of nursing roles within the profession, and it’s important for young nurses to know that if they’re getting to the point that they feel like they can’t do it anymore, there are other options and other roles that might be a better fit for them at that point in their lives,” says Flanders. “It’s important not to feel like you’re stuck in a corner and that you don’t have the power or ability to make it different if it needs to be different. Because when you’re in the role of taking care of other people, if you’re not doing well, then how can we possibly do our jobs as nurses?”