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Addressing nurse burnout

Dunn, Phyllis J. MSN, RN

doi: 10.1097/01.NME.0000415014.03944.c5
Department: On the Horizon

Nurse Manager, GI and Bronchoscopy • VA Medical Center • Nashville, Tenn.

The author has disclosed that she has no financial relationships related to this article.

At the beginning of every nurse's career, the driving force is the care of patients from the onset of illness through recovery. However, burnout is a global nursing workforce challenge, which some experts say undermines nurse retention. The literature suggests that burnout is the number one reason for the inability of facilities to retain nurses.

One study identified three dimensions of burnout: emotional exhaustion, depersonalization (or cynicism), and a feeling of a lack of personal accomplishment. Other studies have explored environmental factors, such as job dissatisfaction, extreme workload, and lack of senior leadership support. The economy plays a role in nurse burnout as well; many facilities are relying on voluntary and mandatory overtime to solve staffing problems, leading to nurses' exhaustion and dissatisfied with their jobs.

Factors that influence nurse burnout include both physical and mental exhaustion, the feeling of being stuck in a dead-end job, and feeling unappreciated by management. So what can you do to avoid burnout?

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Identify the problem

In order to find a solution to nurse burnout, it must first be identified. The Maslach Burnout Inventory (MBI) is the gold-standard instrument used to assess burnout, and its reliability and validity have been well documented. Dr. Maslach emphasizes that burnout isn't just related to an individual; rather, it's a social problem derived by the interactions of individuals in a mismatched work environment.

The MBI comprises 16 self-descriptive statements in three separate categories: emotional exhaustion (EX), professional efficacy (PE), and cynicism (CY). The EX subscale assesses the nurse's feelings of being emotionally overextended and exhausted by his or her work. The PE subscale measures feelings of competence and achievement in the current work environment. Finally, the CY subscale assesses the unfeeling and impersonal response toward recipients of one's care.



Each question is scored on a Likert-type scale of 0 to 6, with 0 being never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week; 5, a few times a week; and 6, every day. This questionnaire is self-administered and takes approximately 20 to 30 minutes to complete. The scores are averaged for each of the three categories and according to where the score falls, burnout is identified as low (EX: 0 to 7, PE: 0 to 23, CY: 0 to 5), moderate (EX: 8 to 15, PE: 24 to 29, CY: 6 to 12), or high (EX: 16 or higher, PE: 30 or higher, CY: 13 or higher) risk. If burnout is identified, management can put measures in place to correct the issues.

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Practical solutions

There are several interventions you can use to address burnout at various levels:

  • Set goals. A goal provides a sense of direction and gives you something to work toward. Goal setting has a highly beneficial impact on performance when combined with quality supervision and feedback. Goals can challenge you to stay focused, interested, and motivated. Managers and supervisors can ask employees to set personal goals; however, organizational strategic goals may also be used to help staff members feel more a part of the organization and that they have a purpose.
  • Participate. Participation is the one thing that makes employees burnout-resistant. The literature suggests that when employees are given an opportunity to participate in decision making, they feel like part of the process. Participation is also a way for management to gain important information about things that are happening on the front line and gives you an opportunity to provide feedback, resulting in shared governance.
  • Make an action plan. If you feel like you're on the edge of burnout, or if you manage individuals who are exhibiting signs of burnout, create an action plan. To take control of your work environment, define the problem, set objectives, take action, and track your progress. In some situations, you may have to realign priorities and consider changing to another work environment. Strategies that can help reduce burnout include improving the work environment, such as adding bright colors, plants, and even aromatherapy; hiring to par to give staff more personal time off and decrease the nurse-patient ratio to a manageable level; and encouraging staff to participate in activities that reduce stress and anxiety, such as walking, yoga, journaling, and meditation.
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Stay burnout free

Burnout is a problem that continues to exist; however, there are practical ways to address the issue. Identifying factors influencing nurse burnout will give management an opportunity to correct them and hopefully retain experienced nurses, enabling the delivery of safe and efficient patient care.

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Learn more about it

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