What Is Burnout and Why Does it Matter?
We know burnout is not new (in fact… you might even be burned out about hearing about burnout!). The term “burnout” was coined in the 1970s by an American psychologist and was used to describe the consequences of severe stress and high ideals in “helping” professions.
Nurses, nurse aids, doctors, firefighters, teachers, police… all of these (and many, many more) qualify as “helping” professions.
Today, we’re focusing on burnout and nurses. Burnout is a significant problem in nursing staff around the globe. It is correlated with nurse turnover, absenteeism, and poor patient outcomes.
Twenty years ago, the National Academy of Medicine called for changes to improve hospital work environments to make patient care safer. Despite this, we still see that poor work environments, and thus nurse burnout, are widespread across the US health system.
Though burnout is a leading patient safety and quality concern, only 5% of healthcare organizations report being “highly effective” at addressing staff burnout. Nurses agree! They also report that their organizations are not addressing burnout adequately. In 2019, over half of nurses said their facility was either slightly or highly ineffective at helping staff address.
What is burnout?
Burnout is a condition with three types of symptoms: emotional exhaustion, feelings of low personal accomplishment, and depersonalization.
If you're wondering what depersonalization means, it's a feeling of being detached from your body or self. You might hear colleagues say (or you yourself might have said) “Oh, I just work here” when confronted with a system issue or other problem in the workplace. This is a good example of depersonalizing.
Who is affected by burnout?
Between 35% and 45% of the US nursing workforce is burned out, but other studies show even high rates. One qualitative study of almost 2,000 RNs displayed that 87% of nursing staff reported some degree of burnout. This same study identified the ten top themes for the biggest challenges among the nurses; burnout second, surpassed only by concerns about staffing.
While all nurses are at risk for burnout, the literature shows that those who work in intensive care units, oncology, and emergency rooms are at the highest risk for burnout.
When we look at rates of turnover, step down, telemetry and emergency service nurses exceeded the national average in 2021, with critical care and medical/surgical RNs just behind them.
What causes burnout?
Various factors can lead to burnout among nursing staff, including poor work environments (one of the highest impacts on burnout), low staffing, stress of responding quickly to crises, complex care, heavy workload, bullying, and high-performance expectations.
Other factors that can lead to burnout include working conditions (such as hospital staffing, shift work, salary, and job insecurity), interpersonal factors (lack of justice, working environment, lack of clear duties and tasks), environmental factors (overcrowding in the workplace, noise pollution, natural lighting, color), and interactions with both others and computers.
Studies with ICU nurses have found that loud noises are significantly linked to burnout. Increased interactions with patients who have chronic or incurable conditions can lead to burnout (especially where management support is inadequate). And although computers make tasks simpler, work demands can be high with more complex decision-making capabilities and conflict over time spent in actual clinical care delivery (sound familiar?).
The literature shows that regarding staffing, there is a significant correlation between high patient-nursing ratios and two of our burnout symptoms (depersonalization and emotional exhaustion). High patient ratios are also highly correlated with low productivity. Furthermore, understaffing especially affects new nurses. They are at greater risk of experiencing emotional exhaustion and job cynicism.
Shift work makes a difference too. Night shift and shifts of 12 hours or more can contribute to burnout; shorter time shifts are likely to protect against burnout. This is a complex factor, as many nurses prefer working three 12 hour shift per week in order to have four days off.
What happens to an individual when they are burned out?
The below list gives you an idea of what can happen to someone who is feeling burned out, but is by no means a comprehensive list!
• Feelings of hopelessness
• Poor relationships
• Reduced functioning, attention, and memory
• Reduced personal accomplishment, increase in depersonalization and emotional exhaustion
What happens to a system or organizations when their nurses are burned out?
Systems with high rates of burnout have high rates of turnover (no surprise there). The average turnover rate in 2020 was 17.8%, but by 2021 the average turnover rate was 27.1%. This number can be even bigger in some systems – turnover nationally ranges from 5.1% to 64.1%.
High rates of nursing turnover are largely due to stress in the workplace and have a huge impact on patient outcomes, costs, and quality care.
Nurse turnover is inversely related to quality metrics, such as physical restraints and pressure injuries. The more burned out a nurse is, the worse the patient outcomes (there’s too much to cover when it comes to reduced quality of care here – it will require its own post!).
Patient safety concerns are compounded by disruptions in workflow, continuity of care, and variability between clinicians because of nurse turnover. There are life-threatening consequences for patients when nurses are burned out! Patients cared for in hospitals with high levels of nurse burnout have higher odds of mortality, failure to rescue (death after an in-hospital complication), and longer length of stay.
Systems with high rates of burnout have high costs related to it. The average cost of turnover for a bedside nurse is $46,100. Each additional percentage change (remember, our average is about 27%) in nurse turnover can cost a hospital $262,300 per year.
The cost of caring for poor patient outcomes due to burnout are high as well. The cost of caring for one pressure injury ranges from almost $21,000 to over $150,000. In addition, turnover rates are positively correlated to patient falls; the cost for a hospital-acquired fall is estimated at $6,694.
Nationally, work-related stress costs $200 billion annually in lost productivity. Burnout also contributes to work arounds and unfinished care, which put organizations at risk for litigation and compliance problems (more on that in another post!).
What can our nurse leaders do to correct, treat, and prevent burnout? What impact does burnout have on litigation? What happens to our patients when they are cared for by nursing staff who are burned out? Stay tuned! There’s more to come.
Do you have any burning questions about burnout? Stories about colleagues or organizations who have overcome burnout? Do you have nurse leaders who are making impactful changes? I would love to hear it! Drop a comment below, or email me at firstname.lastname@example.org.
References for the above numbers and statistics available upon request