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Burnout Research at a Crossroads

Cunningham, Tim DrPH, RN, FAAN; Pappas, Sharon H. PhD, RN, NEA-BC, FAAN

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AJN, American Journal of Nursing: May 2022 - Volume 122 - Issue 5 - p 11
doi: 10.1097/01.NAJ.0000830680.08572.65
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Abstract

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Figure:
Tim Cunningham
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Figure:
Sharon H. Pappas

Research on nursing burnout is at a necessary fork in the road. The current conditions—the COVID-19 pandemic, increased global attention to wellness, and poignant media coverage of a profession in crisis—pose a new urgency for nursing leaders, researchers, and clinicians to choose a new way forward. If the narratives regarding burnout research remain the same, we are stalling any evaluation of progress and will be providing a disservice to our nation's nurses. It's time to refocus our burnout research not just on awareness that the problem exists, but rather on solutions.

For more than 30 years, the literature has been punctuated by cross-sectional studies of nurse burnout. Countless reports from consultancies like the Advisory Board to organizations like the National Academies of Sciences, Engineering, and Medicine have contributed beneficial, eye-opening information to support the fact that burnout is here and is on the rise.

Yet few studies go much further. In fact, the 2019 consensus report by the National Academies, Taking Action Against Clinician Burnout, reveals the dearth of evidence on what we need to do to reduce burnout.

Here are the two directions toward which we invite readers, researchers, and leaders to turn.

We should consider a moratorium on the funding and support of cross-sectional studies alone. Put simply, we know burnout exists and we know it's getting worse. Let's leave it at that and move forward. Let's focus on what we know might mitigate burnout, and wrap our funding, attention, and research energy around these concepts to develop implementation research and longitudinal studies to address not only the individual issues of burnout but also the impact of work systems on individuals.

Once systemic factors such as adequate staffing, equitable pay, and just policy that protects the physical and psychological safety of nurses are adequately addressed, there should be a renewed focus on individual resilience factors. Let's enroll our nurses in wait-list controlled trials that provide resilience and wellness support. Practices such as “the Pause,” resilience retreats, “three good things,” “Songs for the Soul,” gratitude practices, and narrative medicine/storytelling at work have shown promising outcomes in small studies.

More importantly, we must heavily endorse the research of systems factors that mitigate burnout. It's only commonsensical that burnout and work experience are intimately tied. It's time to look more closely at staffing, work hours, team nursing, equitable pay, and other work environment factors that may decrease burnout. Such factors include strengthening policies that support nurses when they face bias from patients and staff, meaningful rest during breaks, and adequate hydration and nutrition while at work. Nonpolicy work factors include innovative staffing, nurse workload, safe working hours, access to exercise equipment for staff, and access to safe emotional spaces, or “well-being rooms.” These tangible factors, robustly researched and tested, could direct nursing leaders toward evidence-based decisions that will change systems, thus supporting the well-being of their teams.

Another meaningful step to support the well-being of nurses would be to redirect funds toward nurse researchers working in data science. Why not use big data principles combined with the plethora of existing data on the presence of burnout to build predictive models to help us catch and treat burnout before it destroys the careers of our best nurses? Can we imagine a research-informed blueprint for a work system that uses design thinking and big data to support individual well-being? This blueprint, when guided by the voices of frontline nurses—sharing with us on social media, in meetings, and in person—can offer relevant support to the brilliant and powerful researchers in nursing who will help us bring all of these pieces together. At this time in our nation's history, we're primed to think big and think differently about burnout. Let's do this together, before we're all burned out.

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