From Burnout to Balance—7 Resilience Boosters for Nurses

 

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Nursing is one of the most rewarding careers, but it is also one of the most challenging. Research suggests that as many as 50 percent of nurses report symptoms of burnout, and up to a third of nurses have reported leaving their jobs because of burnout. That figure may be even higher, with as many as one of every two nurses planning to leave the profession.

“Whether it's navigating policies that clash with patient care, dealing with ethical dilemmas, or pushing through high-stakes/high-stress environments, nurses are feeling the weight like never before,” says Rebeca Leon, MSN, RN, NPD-BC, a nursing professional development specialist with Winship Cancer Institute of Emory University and a host of Nurse.org’s Nurse Converse podcast.

It’s possible to thrive as a nurse today, but most will need help along the way, adds Leon, who podcasts under the name “Nurse Reb” and appears on social media as @EnfermeraMami.RN. Organizations that employ nurses are increasingly recognizing their responsibility to provide the resources and practice environments necessary for nurses to develop resilience.

Emory School of Nursing and Nurse.org have teamed up to host a series of podcasts on a range of issues that today’s nurses are facing, as well as the special skills necessary to thrive. Whether you are a clinician, manager, or healthcare leader seeking ways to address burnout, here is how to tap into resources and advocate for the support you and your care setting need.

What is burnout?

“Burnout takes many forms, but at a general level, we’re talking about this physical, emotional, and mental exhaustion that folks have from prolonged exposure to stress or overwhelming workloads,” explains Nicholas Giordano, PhD, RN, FAAN, a tenure-track assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.

Burnout has been an issue for nurses for decades, but it was not always openly discussed. The challenges and traumas of the COVID pandemic, however, brought the issue into public consciousness. “It’s become much more socialized and normalized to talk about these feelings and, more importantly, to raise them to the attention of colleagues, clinical leadership, and peers,” Dr. Giordano says.

Why is burnout so pervasive?

It can feel draining to perform high-quality, evidence-based nursing care while at the same time feeling stressed about things you cannot control at the institution or system level, explains Dr. Giordano. “That all bubbles up when you're trying to provide care to patients at one of their lowest points in life, when they're sick and in the hospital,” he says. The tension was amplified during the pandemic, when nurses faced staffing shortages while confronting a disease that was impacting patients and clinicians alike.

Another contributor to burnout in healthcare settings is bearing intimate witness to the trauma and grief experienced by patients. That stress can be magnified if you have experienced similar strains in your own life.

“‘Vicarious traumatization’ is where someone’s going through something, and I’m feeling that, too,” explains JoEllen Schimmels, PhD, DNP, PMHNP-BC, FAAN, a psychiatric mental health nurse practitioner and clinical professor at Emory School of Nursing.

A Surgeon General’s report on healthcare worker burnout issued in 2022 itemized a range of contributors to burnout. According to Drs. Giordano and Schimmels, these come down to several key drivers. In addition to excessive workload, central factors include:

• Staffing shortages and limited staffing support, stemming from a legacy of underinvestment in the nursing workforce
• Administrative burdens, including excessive documentation while navigating electronic health records (EHRs)
• Workplace violence, including acts of aggression, harassment, and bullying from patients and colleagues

Although these drivers are largely systemic, they are felt by each nurse in their working lives.

Consequences of burnout

Burnout leaves us feeling exhausted and stressed. It is also related to, and can contribute to, a condition called moral distress. This is when clinicians know the right thing to do but feel helpless or unable to do it because of limited resources or circumstances beyond their control.

Moral distress can, over time, lead to moral injury, which is linked to feelings of guilt, shame, anger, helplessness, and disconnection, says Dr. Schimmels. These factors can lead to missed work (absenteeism) and presenteeism, in which a clinician is physically present but mentally disengaged from the work at hand.

Nurses not only suffer psychologically from burnout, with increased risks of anxiety, depression, and substance abuse, but physically as well, with higher risks of heart disease and diabetes, to name some outcomes. The eventual effects on patients are dramatic, too. With burnout, quality of care goes down and rates of medical errors and serious accidents go up.

“Not only is there this personal, individual-level consequence, but ultimately it's manifesting at the team level, the patient level, and the health system level,” says Dr. Giordano.

Fostering resilience at the system level

Common solutions to burnout are typically aimed at individuals. These include practices to cultivate self-care and resilience. But finding the time, space, and resources to practice self-care while holding down a job is difficult. “It puts the onus on the person who’s struggling,” says Dr. Schimmels.

The most effective approach to address nursing burnout, say Drs. Schimmels and Giordano, begins at the levels of organizations and teams. That means healthcare institutions need to take steps to recognize and address burnout among their employees. Necessary measures include the following:

Increase staffing

Research has consistently shown that the top contributor to nurses’ well-being is adequate staffing levels, says Dr. Giordano.

Decrease workloads

That includes leveraging technology to reduce the amount of time nurses must spend on administrative tasks like charting so they can maximize time with patients.

Invest in employee well-being

This means providing psychosocial support for staff, including companywide well-being programs, resilience training, and employee assistance programs, and fostering cultures that encourage their use. “We can create a workspace where we normalize accessing these resources,” says Dr. Giordano.

Some examples:

• Atlanta’s Resiliency Resource for Frontline Workers (ARROW), facilitated by Emory, provides free mindfulness-based continuing education trainings to clinicians as paid time. Research has shown that the ARROW program's offerings helped improve professional quality of life among healthcare workers, including nurses.
• Compassion-Centered Spiritual Health is another mental wellness approach that may provide similar improvements in resilience and stress management for healthcare workers.

Emphasize positive work environments

That means leadership must encourage nurses to report issues when they detect them. It also means fostering better communication between colleagues to create environments that are not only physically safe but psychologically safe as well, says Dr. Schimmels.

Value nurses’ voices

Nurses give everything to their patients but often feel shame or stigma when asking for help for themselves, says Dr. Schimmels. Team leaders can meet staff more than halfway by holding regular staff meetings or short, structured check-ins to gauge stress levels and well-being, making these conversations part of the culture. 

As Leon puts it: “Community care matters just as much as self-care.”

Prioritize professional development

Giving nurses a stake in their career growth can sustain and reignite their passion for the profession. Research conducted by Emory investigators and others indicates that this effort includes establishing mentoring programs and making sure that senior leaders have the time to spend with junior team members.

Solicit and act upon feedback

If you work for a large health system, you may get emails from leadership asking for feedback about how you are feeling. Although these surveys often seem annoying to fill out, they provide rich data that can drive improvement and investment around burnout, well-being, professional satisfaction, and secondary traumatic stress, says Dr. Giordano. Take the time to fill out surveys and make your voice heard, as this feedback can guide health system leaders’ decision-making on staff resources.

If there is any silver lining to the experience of COVID, it is that burnout among nurses is being discussed and taken seriously by an increasing number of health organizations.

“The bigger policy level to support nurses, talking openly about seeking treatment, about getting care, getting the help they need to be able to provide the care to patients, still need to be done. But it's happening,” Dr. Giordano says.

🤔Nurses, what changes would make the biggest impact on your well-being at work? Share your thoughts in the discussion forum below!