Whether it’s psychiatric nurse practitioners like Whitney Fear, nurse managers like Stacey Hone or social workers like Melissa Kaiser, the work of healing, helping and saving lives every day can take a toll. And while the pandemic certainly didn’t create nurse burnout, it highlighted and aggravated the problem with such intensity that it continues to threaten the healthcare workforce like never before.
The extreme demands put on nurses over the last few years has led to not only a collective feeling of grief among the profession, but has taken an unprecedented toll on nurses’ wellbeing. The World Health Organization (WHO) went so far as to call burnout an “occupational phenomenon” in the updated ICD-11 codes. That was in 2019. In retrospect, we know that that feeling didn’t just disappear in 2022 — it worsened.
During COVID-19, more than one-third of nurses experienced some form of anxiety, stress, depression and sleep disruption. But if you thought this might be normal during a pandemic, it’s not. More nurses worldwide struggled with these symptoms during COVID-19 than they did during both the MERS and SARS epidemics. An American Nurses Foundation survey in 2021 found that 81 percent of the 22,000 nurses aged 34 years and younger expressed exhaustion; 71 percent felt overwhelmed; and 65 percent reported anxiety. In 2021, 66 percent of critical-care nurses considered leaving the profession due to the pandemic alone.
Is it any wonder that so many nurses are leaving the field? Prolonged exhaustion, heavier workloads, longer hours, understaffed hospitals, poor work/life balance, increasing nurse vacancies, climbing nurse-to-patient ratios, verbal and physical assault and even technologies like electronic health records have all contributed to an ever-widening nationwide nurse shortage. One survey found that half of nurse respondents were planning to leave their job. In another, nurses planning to leave their profession cited these top two reasons: insufficient staffing and work negatively impacting their health and emotional wellbeing. It’s a vicious cycle: short staffing leads to burnout, burnout leads to turnover, and turnover leads to more short staffing, which leads to burnout . . . and the cycle continues.
This is serious for public health, as nurses are the largest segment of our nation’s healthcare workforce. With more than 6 million employed in 2019, nurses represent nearly 30 percent of all hospital employees. In 2021, Dr. Ernest Grant, the president of the American Nurses Association, estimated that the country would need an additional 1.2 million nurses by 2022 to meet the increased demand for healthcare workers due to high turnover rates from COVID-19. Eventually, Dr. Grant wrote to Secretary for the U.S. Health and Human Services Xavier Becerra, pleading that Becerra officially declare the shortage a “national crisis.”
But even more dire and urgent than the healthcare workforce shortage is the deadly impact of burnout on healthcare workers themselves. Since the onset of COVID-19, suicides have increased among healthcare workers due to this combination of stressors. In a March 2021 study in the Journal of Advanced Nursing, risk factors for burnout included younger age, limited social and familial support to cope with pandemic-related stressors, anxiety over contracting the virus, increased workload, longer hours working in COVID-19 wards, high-risk environments, insufficiently staffed hospitals, limited resources and minimal specialized training for the virus. As many as 34.1 percent reported emotional exhaustion, 12.6 experienced depersonalization and 15.2 percent felt a lack of personal accomplishment.
Of all healthcare workers, nurses are likely to struggle with burnout the most, with female nurses more likely to experience burnout than male nurses. Why is that? Research suggests it’s because nurses are among those in closest proximity to patients infected with COVID-19, and an increased risk of infection often leads to an increase in workload. Tragically, the International Council of Nurses reported in June 2020 that, worldwide, more than 600 nurses had died due to COVID-19.
But nurses were experiencing burnout long before the pandemic. A Kronos Incorporated survey back in 2017 revealed that 90 percent of nurses needed a better work/life balance and, as a result, were considering leaving their hospital for another job. Factors that contributed to burnout before COVID-19 included heavy workloads, limited staffing, poor communication between physicians and nurses, and minimal organizational leadership — all issues that only heightened while fighting a global pandemic. Data conducted in 2018 revealed that, of those surveyed, 9.5 percent of nurses left their most recent job; and of that 9.5 percent, 31.5 percent reported that burnout contributed to their leaving their position.
Research suggests workplaces can help employees cope during an infectious disease outbreak by providing counseling services, support groups, online workshops and other training materials. But perhaps most critically, combatting burnout starts with improving the conditions of the workplace for nurses. The WHO recommends increased staffing and resources, and outlines some strategies for nurse managers — including flexible schedules, rotating nurses, effective communication, and encouraging staff to use behavioral and emotional support services.
In “Who Cares,” we meet Melissa Kaiser, an anti-human trafficking social worker who works closely with Whitney to identify and help potential trafficking victims in the community. As a social worker, Melissa has expertise in psychological interventions, emotion regulation and burnout. She shares how the practice of self-care helped her cope with burnout — but not in the way you might think. Melissa says that self-care isn’t just about bubble baths and red wine — it goes much deeper than that. “You have to have honest conversations with yourself,” she says. “Ask [yourself], ‘How am I separating myself from work?’” Melissa intentionally sets aside time, outside of work, to do things that help her recharge and bring her back to herself. In North Dakota, one of those ways was through service projects for children in her community.
As a nurse, this is certainly a moment that calls for systemic change at the institutional and national level — but that takes time, and you need relief now. Beyond reaching out to your administration and discussing solutions at work, find moments to incorporate micro-restorative techniques into your day. Then, when you finally leave work, try to set boundaries between your time on shift and your time at home. Tina Gerardi, MS, RN, CAE, executive director of the Tennessee Nurses Association (TNA), recently shared these tips: 1) take deliberate steps to find joy outside of work once again, whether that’s picking up a new hobby or returning to an old favorite; 2) develop strong relationships outside of work — while friendships are great on shift, you need someone you can process with off the clock; 3) and most importantly, whether it’s a walk around the block, getting enough sleep or seeing a therapist, be sure to care for your health, inside and out. Because while nurses are so busy taking care of everyone else, it’s important to remember that the most important person to take care of — is yourself.
- What has been your experience with burnout? Did you experience burnout before the coronavirus pandemic? After? Discuss how those experiences compared to each other.
- Can you recognize feelings of burnout in yourself or others? What tends to happen when this occurs?
- In “Who Cares,” Melissa Kaiser shared some of the ways that she separates herself from her work. Did you connect with her approach? What are some ways you personally combat burnout?
- In what way does having a strong community of fellow nurses around you play a role in helping you cope with burnout?
- Think about your own hospital (or another workplace). What resources can help with exhaustion, anxiety or stress at work?
For Further Reading
- “A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19,” Frontiers in Psychiatry Public Mental Health. 2021 Nov 10.
- “Prevention Actions of Burnout Syndrome in Nurses: An Integrating Literature Review,” Clinical Practice and Epidemiology in Mental Health. 2019 Mar 29.
- “Making an Evidence-Based Case for Urgent Action to Address Clinician Burnout,” The American Journal of Accountable Care. 2019 June 13.
- “Burnout in Nursing: A Theoretical Review,” Human Resources for Health 18, 41 (2020). 2020 June 5.
- “Evidence-based quality improvement strategies to reduce nursing burnout during the COVID-19 Pandemic,” Creating Healthy Work Environments 2021 Conference, The Sigma Theta Tau International Honor Society of Nursing. 2021 Mar 12.
Organizations & Community Resources to Make a Difference
- Healthy Nurse, Healthy Nation™ (HNHN)
- “Managing Stress & Self Care during COVID-19: Information for Nurses,” American Psychiatric Nurses Association.
- American Holistic Nurses Association’s Stress Management Website
- Online series: “Staying Calm and Well in the Midst of the COVID-19 Storm,” The Ohio State University (OSU).
- The National Academy of Medicine’s Action Collaborative on Clinician Well-being
- “The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department,” Journal of Emergency Nursing, Volume 45, Issue 4. 2019 July.
- “Nursing Resilience Interventions—A Way Forward in Challenging Healthcare Territories,” Journal of Clinical Nursing, 29 (19-20), 3597–3599. 2020 Apr 15.
- “Interventions to Reduce Burnout of Physicians and Nurses,” Medicine: Volume 99 – Issue 26. 2020 June 26.