Work Stress and Burnout Among Nurses

Nurse burnout is on the rise during COVID

By Debra Wood, RN, contributor

Work stress and burnout have plagued nurses for a long time, but the COVID-19 pandemic has increased the risks for a number of reasons. 

“Nurses are giving all day long,” said therapist Kathryn Smerling, PhD, LCSW, in New York. “They need to recharge, and people have to recognize if they need help.” 

A study reported in 2019 by the American Nurses Association found 70 percent of nurses will put their patients’ health and safety before their own. Seventy-nine percent considered workplace stress a significant risk. Now with the novel coronavirus pandemic, that percentage is likely worse. 

“COVID is a war,” said Mark Goulston, MD, in West Los Angeles, co-author of “Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD.”

Goulston explained that the coronavirus pandemic has led to trauma for healthcare workers, because it happened so quickly, healthcare workers are dealing with a massive influx of sick patients, are working at a hospital that has become intense and overwhelming, and nurses and others are at putting their lives at risk. 

Personal protective equipment remains in short supply with nurses reusing single-use masks or N95 respirators, according to the Association for Professionals in Infection Control and Epidemiology. 

Work stress can contribute to burnout, and in turn, burnout can exacerbate work stress, according to a new study in Psychological Bulletin

Burnout also can adversely affect patient care and relationships with colleagues. 

“When people are stressed out, oftentimes, they lash out,” said Renee Thompson, DNP, RN, founder of the Healthy Workforce Institute in Tampa, Florida. “So many people are behaving in ways that are disruptive, because they are so burned out.”

About burnout

The International Classification of Diseases has identified burnout as an occupational condition but not a medical one, according to the World Health Organization. Symptoms include exhaustion, mentally distancing from the job, negativism, and less “professional efficacy.” 

Burnout is not unique to nurses in the United States. The European Society of Cardiology reported in August 2020 that more than half of nurses caring for children with heart conditions are emotionally exhausted. 

A 2019, pre-pandemic study by the research and consulting firm PRC found 15.6 percent of nurses surveyed reported feelings of burnout. That same year, The Joint Commission issued a safety advisory about burnout and advised employers to combat nurse burnout by building resilience-- the process of personal protection from burnout. 

There are steps for preventing nurse burnout during the COVID-19 pandemic.

Care for oneself

Nurses must prioritize caring for themselves, so they have the strength and energy to care for others. That self-care includes getting enough sleep, eating healthy foods on a regular schedule and exercising. Meditation, mindfulness, breath awareness and yoga can help nurses combat stress, according to the American Psychiatric Nurses Association. Monitor reactions to events and stressors and seek help if needed.  

Prioritize your own mental health, Smerling advised. Talking face to face with colleagues, even virtually, may help as will discussing feelings with therapist. 

“Nurses can feel very isolated,” said Sperling, adding that hearing someone to say, “I understand” or “I get it, it’s OK” can mean a lot. Additionally, she said COVID has created a sense of community, that nurses are in this together and will get out of it together. 

However, travel nursing work stress may persist, because travelers often have not developed relationships with their short-term colleagues. 

Smerling also suggested going outside for a walk, eating lunch on the patio, or sitting and enjoying nature. 

Find some joy in simple pleasures and ways to relax, Smerling added. That may be a bubble bath or a glass of wine or someone at home to help with meals or children. 

“We have to take care of our health workers, because without them, we are nowhere,” Smerling concluded. 

Simple strategies

People have a negativity bias, Thompson said. The brain looks to the negative to protect people from threats. Listening to the news can increase one’s stress. On the way to work, she advised listening to music or a positive audio book, silence or saying a prayer. 

“Listening to three minutes of negative news in the morning can increase the chance of a bad day by 27 percent,” Thompson said. “When you get to work, your co-workers and patients need you to be your best. Do the same thing on the way home.”

Avoiding worrying about things in the future that have not happened yet can help in preventing nurse burnout during COVID. Thompson advised, telling yourself that today is OK. I can get through today. And only focus on those things within your control. Then come up with ways to make them better. It can help reduce travel nursing work stress. 

Surround yourself with positive people, because spending time with people who are all gloom and doom will zap your energy. 

“Spend time with people who make you feel good,” Thompson said. “Your stress and distress will decrease dramatically.”

Healing rather than coping

Goulston promotes a multifaceted approach to healing rather than just coping with a trauma. People who have been through a serious stress and are coping are often not the same person they were before the trauma happened. 

“The way you heal is to safely feel the feelings,” Goulston said. 

Suggestions include keeping something near that makes you laugh, using calming affirmations, crying, carrying a reminder of something you love about your life and use it to center yourself, grounding and talking with colleagues. 

He has developed several techniques for helping people heal. That includes the 12-words exercise, featuring reading 12 negative words picking the one that most captures your feeling when stressed and focus on it at its worst. Then imaging someone you love smiling and saying “I understand.” Let their love take some of the pain away. Then image that person asking “what would be a better thing to do?”

Goulston explains how it works. Adrenalin, released in dangerous situations, allows people to push down their feelings. But when the danger goes away, those feelings will come up again. By putting a word to the negative feeling, it can be released safely. 

In another exercise, Goulston has people share a moment that they did not think they would get through but did. Everyone has one. And name a person who had helped in that time. Then thank that person or the next of kin. 

A community of sharing can help its members get through the rough times. 

“When going through hell with your peers, you also want to be coping with your peers,” Goulston said. “It develops group empathy, and it lifts you up.”

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