Preventing Burnout Within Nursing

Kaela Mowrey

Ms. Barnhart

AP Literature and Composition

13 February 2019
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Preventing Burnout Within Nurses

Introduction

Senior Exhibitions are approached from two viewpoints: Social Studies and English. The

Social Studies portion focuses on presentation skills, building a website, and the senior project

itself while the English approach uses a Senior Research Investigation. The Senior Research

Investigation uses rigorous research in order to enlighten students on different topics that

surround their senior projects. The senior projects allow students to explore something of their

choice and discover several things in the field of the project. The intentions are to broaden the

student’s skills and create a sense of exploration.

For my senior project, I decided to shadow a nurse. I am shadowing my mentor, Melanie

Choquette, throughout her daily work schedule in order to observe the life of a nurse. Alongside

her, I occasionally shadow other nurses and the nurse practitioner that work with her at

Pendleton Health and Rehabilitation Center in Mystic, Connecticut. My mentor works in a

nursing home, so I chose to shadow her because she works in a place outside of my ideal future

career which will challenge me and further my learning stretch. This project will expose me to

the workload and stresses of my future career, as I wish to become a Nurse Practitioner,

influence me to either enjoy or dislike working in nursing homes, and hopefully increase my

social communication skills and personality.

For the Senior Research Investigation, I chose to research the causes of burnout within

nursing and how this can be prevented. I can expand upon this thesis question and research

topics like the stress differences between doctors and nurses, the psychological effects on nurses

from the workplace environment, and how hospitals today can accomodate employees in this
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situation. I want to research this to enlighten my audience and I of the importance of nurses’

physical and emotional help, and the faults throughout the workplaces that cause this issue. This

relates to my actual senior project because both my project and research investigation are

focusing around the field of nursing in some way. My actual research question is, “How can we

prevent burnout within nurses?”

Entering into this investigation, some assumptions and beliefs lurk while forming an

argument. For example, the long and enduring shifts nurses work through physically exhaust

them and could cause mistakes and stress while working. Doctors and surgeons also require

more education than nurses, which could possibly set them up for greater success and less stress

as they enter their careers. Another hunch I have surrounding the causes of severe burnout in

nurses could be caused by a lack of recognition. Higher hospital positions, like doctors or

physicians, receive praise for their work and are glorified, leaving the nurses in the shadows. The

lack of recognition could leave nurses with feelings of uselessness or depression. With the help

of experimentation and administration, new techniques could be applied to the field of nursing to

decrease burnout.

An article on the website Thought Catalog states why people should stop glorifying

nurses and how due to the lesser education, nurses only do the dirty work while doctors do the

more complicated tasks. Instead of giving nurses more attention, this article argues nurses

complain too much about their jobs when there are other positions that work just as much

without the constant complaints. For example, nurses complain about their lengthy shifts while

doctors and surgeons work just as many hours if not more. Readers can infer that the stress

within nurses is self-inflicted. Other hospital positions as well could benefit from burnout
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experimentation rather than directing all the focus on nurses. An article on the website Nursing

Link reiterates the ideas mentioned in the previous source. This article lists things nurses should

stop complaining about such as salaries, workload, and supervisors. Points brought up in this

article suggest rather than complaining about the resources they are given, nurses should work

with what they have and consider stress amongst other people in the medical field. These sources

create strong arguments for the opposing viewpoints, showing the multiple opinions surrounding

the topic of nursing stress.

Literature Review

Throughout the medical field of work, employees constantly have feelings of immense

stress and burnout. Burnout is categorized by emotional and interpersonal stressors that could be

measured through levels of emotional exhaustion, feelings of detachment from the job, inhibited

work habits, and lack of personal accomplishment. Medical workers, specifically nurses,

experience constant stress due to long hours, hefty workloads, and altercations dealing with

family or coworkers. Burnout is a growing phenomena occurring within nurses, but with the help

of varying strategies, may be hindered. This topic was researched using scholarly articles with

valid information that could enlighten any reader on the situation. A great deal of time went into

ensuring the articles being analyzed were valid and reliable before they were added to the list of

sources being used for the investigation. After researching this phenomena, the following sources

will be organized chronologically, starting in 2013, in order to see how research and solutions

have evolved over a short period of time in order to show how research and society has helped to

diminish this ongoing problem. In 2013, nurses nationwide started to leave their occupations due
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to high levels of stress and emotional exhaustion which would put them at risk for burnout. This

epidemic caused scholars to initiate research on how to prevent the issue.

In the article “Stress, Social Support, and Burnout Among Long-Term Care Nursing

Staff” written by Erin L. Woodhead, Lynn Northrop, and Barry Edelstein, the authors review an

experiment they conducted. This source was published through Southern Gerontological Society,

which is a network of the South’s most respected gerontology professionals. This publisher is

highly credible due to its level of respect and knowledge. In the 2013 experiment conducted by

the three psychologists with PhDs, nurses working at a long-term care facility were tested on

their feelings of burnout based on their levels of stress and amount of social support. The

objectives of this experiment were to determine the amount of job demands and resources,

examine the correlations between demographic variables, job demands, and job resources, and to

examine the amount of variance accounted for by each of the job demands resources. Their

findings revealed that both personal and occupational stressors increase the likelihood of

burnout, however personal stressors had a greater impacts on the subjects’ stress levels. Evidence

shows that support from others at work, “[...] particularly support from supervisors, may be

particularly important in decreasing stress among long-term care nursing staff” (Woodhead et al.

87). Social support of some kind is important for nurses to obtain to help deal with both

work-related stress and personal stress.

As a solution, the psychologists concluded that some type of burnout reduction

intervention that teaches how to socially support others will help supervisors and coworkers

reassure other employees of their passions and decrease their feelings of burnout. Woodhead et

al., use a multitude of sources in order to validate their experiment and findings. Statistics and
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other data documented during the experiment are also present throughout the piece in order to

highlight the importance of social support. The data found in this experiment will reinforce the

need for social support in hospitals and promote a change. The psychologists are implicitly

stating that hospital workplaces now are not providing the employees the social needs and

comfort that is needed to exhibit proper patient care. The psychologists’ experiment initiates the

time period being observed and is the beginning of the timeline of evolution surrounding the

amount of help given to nurses in order to prevent burnout. This source directly relates to the

thesis question being investigated because it explains a cause of burnout and how it could be

inhibited. These are facts that are key to this investigation as they establish the cause, effect, and

solution of the issue being analyzed.

An experiment conducted a year after the previous source being utilized for this

investigation written by Sarah A. Smith is titled “Mindfulness-Based Stress Reduction: An

Intervention to Enhance the Effectiveness of Nurses’ Coping With Work-Related Stress.” Sarah

A. Smith, a nursing laboratory coordinator and the University of Hawaii Hilo with a PhD,

conducted a 2014 experiment in order to find a solution to reduce stress induced upon nurses

caused by patients and hospital budget cuts. The experiment mainly focused on

mindfulness-based stress reduction (MBSR) which is a specific type of meditation that could

help nurses cope with work-related stress and increase their patient care skills. This meditation

technique promotes both mental and physical health, as it combines the use of deliberate,

conscious breathing and some sort of exercise, specifically yoga. Results from Smith’s

experiment showed increased empathy, self-improvement, improved mood, improved focus,

decreased anxiety and stress, and lesser feelings of burnout within the test subjects. In short, the
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author’s central idea is how with further investigation and use, the MBSR technique could help

decrease stress levels in nurses and, in turn, prevent feelings of burnout.

Key conclusions that can be drawn from this experiment include that the stress brought

upon nurses at work affect their work habits and emotional state, and the MBSR meditation

technique can help diminish this issue. Smith consults many other pieces to further her research

and includes an abundance of data from her experiment to ensure her conclusions are reliable.

This source implicitly states that nurses’ coping skills regarding stress are not at the strong levels

required for the field of Nursing. Their ineffective coping, defined as, “‘the inability to form a

valid appraisal of stressors, inadequate choices of adequate practical responses and/or inability to

use available resources’” (Smith 119), need to immensely improve. Smith conducted research on

the MBSR technique in order to give nurses a reliable way to improve their coping skills.

Evidence from this experiment could impact society by promoting change and taking additional

steps in order to make MBSR more widely known. This source builds off of the previous source

by suggesting additional ways for nurses to decrease their stress levels and, in the long run,

prevent their chances of burnout. A combination of social support and MBSR techniques could

lead to a discovery of peaceful and stress-free work.

The third source, written by Adam Waytz, is titled “The Limits of Empathy” from the

January-February 2016 issue of ​Harvard Business Review​ which discusses the multiple problems

with the feeling of empathy. The author’s central idea about the piece is how excessive empathy

released by anyone can lead to another form of burnout. Empathy has a list of faults including

the fact that it is exhausting, it is zero-sum, and it erodes ethics. The main issue with it being

exhausting is always present in medical workers. The constant requirement of empathy from
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medical workers can lead to compassion fatigue, which is defined as, “an acute inability to

empathize that’s driven by stress, and burnout” (Waytz). Ways to reduce excessive empathy

could be to split up the work, empathy is less bounded if it is managed across multiple

employees, or to give people breaks, it takes extreme effort to dive into another person’s mind

and give them compassion.

The author suggests that excessive use of empathy depletes one’s mental resources and

state of mind. From this piece, readers can conclude that nurses need to find a way to manage

their empathy. While empathy is important in the medical field, too much empathy can create a

strong relationship between the patient and caregiver which can cause the several problems

previously listed. The author hyperlinks several other sources such as alternative studies and data

to build his knowledge and solidify his argument against excessive. These additional sources

build credibility because they are experiments and research conducted by other scholars. The

idea that people in the medical field are under a great amount of pressure to show feelings of

empathy to patients is implicitly stated within this piece. This could impact nurses by

enlightening them on how to manage the amounts of empathy they give. Unlike what was stated

in the first source that suggested more social support from coworkers, this piece suggests nurses

could use time alone. In this time alone, workers could relax or maybe even meditate like the

second source proposed.

Published only a few months after the previous source, the next source, written by David

A. Runge, is titled “Prevention of Burnout by Use of Balint Method of Group Therapy.” Runge,

a Nurse Practitioner who received a Doctorate of Nursing at the University of Massachusetts

Amherst, conducted a 2015 experiment which analyzed the effects of Balint group therapy on
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nurses. Runge published his experiment in 2016 with ScholarWorks from Umass Amherst, a

database showing a collection of research done by professionals at this school. The Balint

method is a type of group therapy that can reduce stress, prevent burnout, and have positive

effects overtime. Runge stated that the ultimate goal of the Balint method is for, “self-reflection

through group experience of difficult cases to better prepare the group of participants for difficult

patient encounters” (Runge 11). The objectives of the experiment included getting​ ​a group of

recent graduates to attend multiple group sessions each, for the people to actively participate in

multiple Balint sessions, having participants fill out a burnout questionnaire each session, and to

survey participants to document decreased feelings of burnout and desires to leave their

profession. The results of the experiment showed that through mentorship and the use of Balint

therapy, workers will see decreases in feelings of isolation, dissatisfaction, burnout, and desire to

leave the profession.

Key conclusions that can be drawn from this research are that Balint group sessions have

a positive effect on burnout prevention in nurses. If the method was more widely known and

further researched, hospitals could integrate this group therapy technique into their work

routines. The group sessions will give employees more guidance and overall improve their

emotions in the workplace. The author referenced several other works to validate his research

and solidify his knowledge of the subject being studied. This built credibility because Runge set

aside a great deal of time and mastered the study of the technique before he implemented it in his

own experiment. This source implicitly states that if the Balint group sessions are used in a more

enduring method, the work habits will increase while stress levels decrease in nurses. Scholars

are left with the last steps of conducting more research and implementing these therapy sessions
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more often in order to see change. This source agrees heavily with the first source on social

resources and support. The Balint methods use group sessions to decrease stress, so these

sessions are allowing for an increase in social interaction between workers which will in turn

allow for greater support.

The fifth source analyzed jumps a period of time, published in 2018, lends a cause and

solution to burnout in nurses outside of the United States. This source written by Cortia

Bryan-Rose and Paul Andrew Bourne is another experiment titled, “Factors Determining

‘Burnout’ Among Nursing Staffers at a National Hospital in Jamaica.” This article was published

through Juniper Online Journal of Public Health, an international journal dedicated to articles

discussion research, research methods, and program evaluation in the field of public health. This

experiment analyzed nurses working at the Spanish Town Hospital in Jamaica, a hospital

surrounded by communities of violence. Due to the surrounding violence, several employees of

this hospital left the occupation to work abroad, leaving the hospital short-staffed. Because of the

increase in shift hours and the number of patients cared for by individual nurses that was left by

the understaffing, nurses working in this hospital are under constant stress and at a great risk for

burnout. The experiment conducted by Cortia Bryan-Rose (College of Health Sciences School of

Allied Health and Nursing, University of Technology, Jamaica) and Paul Andrew Bourne

(Department of Quality Management and Institutional Research, Northern Caribbean University,

Jamaica), had three main objectives. These objective included determining the level of burnout

among nurses at the Spanish Town Hospital, establish the factors contributing to this burnout,

and to observe if the burnout affected the nurses’ attitudes towards working. The results
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concluded that the poor management of the hospital which resulted in longer hours and heftier

workloads was the main cause of stress in these workers.

The important conclusion that must be drawn from this piece is that the poor management

occurring at the Spanish Town Hospital is the primary source of burnout in these nurses and is an

issue that must be addressed urgently. Managers of this establishment failed to make up for the

understaffing left behind by the nurses that fled Jamaica which created an intense burden on the

remaining employees. The researchers of this experiment referenced a great deal of works and

included several data and statistics retrieved from the subjects. These statistics showed the

nurses’ attitudes towards work were influenced by, “socioeconomic conditions such as social

class, income, occupational status and education” (Bryan-Rose et al. 4). These statistics could

impact the management at the hospital and promote adjustments in the system. Considering the

employees’ attitudes towards to occupation were influenced by occupational stress, the

management should find alternatives to reduce this stress and create a positive workplace. The

authors implicitly state how if employees at this specific town were influenced so greatly by the

severe loss in staff, hospitals nationwide with understaffing could experience the same stress.

This implication will promote management alterations in many hospitals and burnout levels of

nurses will decrease. This source builds off of the second source about Mindfulness-Based Stress

Reduction regarding budget cuts. A decrease in manager involvement resulting in budget cuts

and understaffing negatively impacts employees and does not help diminish the burnout

situation.

The sixth and final source being analyzed, published in the spring of 2018 only a few

months after the previous, is a critical review of research on burnout. This source is titled “A
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Systematic Review: Factors for Burnout and Compassion Fatigue in U.S. Nurses” and is written

by three students from the University of Akron: Kaitlyn Marcum, Tabitha Rusnak, and Mckenzie

Koch. This article was published through IdeaExchange at the University of Akron, the public

research university in Northern Ohio. This article researches multiple sources in order to

determine major causes of compassion fatigue and burnout. Their research found that factors

such as the work environment, nurse’s specialty, education level, and coping skills influenced the

levels of burnout experienced by nurses. After extensive research, the authors concluded that

uninterrupted working breaks, decreases in changed to the specialty unit, and a progressive and

positive management style could help decrease the changes of compassion fatigue and reverse

negative feelings towards the occupation. The authors additionally concluded that, “ Meaningful

recognition of hard work or other positive attributes could also help to increase satisfaction”

(Marcum et al. 11). Relaxation periods, a steady routine, and appreciation all play a role in

creating a positive attitude towards the occupation.

Some key conclusions that could be drawn from this source include that a variety of

variables are synthesized in order to cause burnout, and by reversing these variables burnout can

be avoided. Several workplace and demographic variables play a role in nurses’ chances of

compassion fatigue. By creating a positive workplace environment, and increasing the amount of

recognition and appreciation from staff and managers can reverse these burnout effects. The

authors used a multitude of sources in order to increase and solidify their grasp on the concepts

that cause compassion fatigue and burnout. This piece implicitly states that changes in daily

routines heavily alter an employee’s attitude towards working. When workers are on a set

schedule of what needs to occur every shift, they become comfortable and confident with their
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work habits. However, when these rhythms are altered, it can become difficult for the employee

to adapt to their new surroundings. This could impact hospitals nationwide by enlightening them

on what not to do when discussing management changes. This source agrees heavily with the

fifth source that discussed management issues. Faulty and messy management immensely alters

nurses’ work habits and creates an intense amount of stress that could be avoided.

Conclusion

After investigating these sources, it is evident that burnout among nurses nationwide is a

growing issue that must be addressed. Because of intense stress, lack of workplace support, and

poor management in the workplace, nurses experience immense stress and desire to leave the

profession. Some advancements in the hospital workplace could be administered in order to help

resolve this issue. A multitude of changes must occur in order to diminish this ongoing situation.

If researchers refer to the methods that were investigated and replicate them on a larger scale,

more prominent effects and changes will be noticed by nurses. While the burnout phenomena has

no easy solution, the techniques already implemented are proficient entry points for further

research in order to find a universal solution.

Some of the sources investigated only focused through a small lens. It can be hard to

apply the results of these varying experiment to nurses as a whole if they concentrated on only a

sample of a population. For example, David A. Runge’s experimentation with the Balint method

of group therapy utilized newly graduated nurse practitioners and physician assistants. His goal

was to, “include these group sessions with both newly graduated physician assistants and nurse

practitioners as part of their upcoming residency program” (Runge 15-16). His experiment is

limited in scope which overlooks professional workers as well as careers with lesser degrees
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such as Certified Nursing Assistants and Registered Nurses. The stress levels within newly

graduated professionals will most likely be caused by the lack of experience. While some might

assume that workers with more experience have passed the burnout stage, increasing pressures

and schedules still impose a burden. If this experiment was conducted again with a greater

variation between experience levels among nurses, the results could establish an underlying

cause of immense stress for the entire nursing population as well as pinpointed issues in specific

areas of nursing. Slight changes and new iterations like this to the experiment would allow the

researchers to generalize the results to a larger group of nurses.

Similarly, Erin L. Woodhead’s and her colleagues’ experiment regarding stress and social

support within the workplace only zoomed in on nurses working in long-term care. The

psychologists stated, “The specific occupational demands required of long-term care staff [...]

may need to be addressed in a stress management program tailored to the nursing home setting”

(Woodhead et al. 89). While the experiment found a successful way to decrease burnout within

nurses, it only focused on the nursing home demographics. Stress levels and causes may vary

from specialty to specialty, so the resolution discussed in this experiment may not necessarily

assist a nurse working in an emergency room, for example. As a next step, researchers can use

techniques discussed in this experiment on nurses within other workplaces to see the effects. If

the results are not as beneficial as the one found with long-term nurses, other solutions can be

experimented.

Following the same trend, the piece written by Cortia Bryan-Rose and Paul Andrew

Bourne regarding nurses occupied at the Spanish Town Hospital in Jamaica experimented solely

on worker in that community. Their research investigated nurses working in a hospital

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surrounded by many communities, some that even involved in a lot of violence. The researches

state how, “[...] the workload of nurses excludes increased demands during periods of violence”

(Bryan-Rose and Bourne, 2). Because of the increased violence and the several surrounding

communities that rely on the Spanish Town Hospital, of course the employees would be under

severe stress and very prone to burnout. This source successfully established causes of burnouts

similar to the other sources, however it portrayed statistics related only to one specific area. A

nurse working in a rural area with no source of violence will have alternate causes of stress, so

Bryan-Rose and Bourne’s suggestions would not necessarily apply to them. If this experiment

had been tested on nurses in several different locations, the results could have been compared to

detect similar findings.

These sources only experimented on a sample of the nursing population as a whole. If

these experiments were conducted on a wider scale, the statistics and conclusions drawn could be

applied to the entire nursing community. The intentions of these sources were to establish a

cause of burnout and conclude how it can be prevented, however the research mechanisms were

flawed and did not consider other bodies of nursing. While focusing on a small group of people

is important statistically for the first steps of the research, it is important that the next steps of the

burnout investigation grows to a greater scale. The results of these experiments created a starting

point to the next investigations. Results from this research do, however, show importance to the

current field of nursing. This investigation revealed many beneficial techniques for decreasing

burnout within specific, varying areas of nursing that can be imposed as a temporary solution.

The issue of burnout is one that will take great experimentation and synthesis of techniques in

order to find a universal and permanent solution.

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Works Consulted

Bryan-Rose, Cortia and Paul Andrew Bourne. “Factors Determining ‘Burnout’ Among Nursing

Staffers At A National Hospital In Jamaica.” ​Juniper Online Journal Of Public Health​,

2018, pp. 1-25, https://juniperpublishers.com/jojph/pdf/JOJPH.MS.ID.555608.pdf.

Marcum, Kaitlyn et al. “A Systematic Review: Factors For Burnout And Compassion Fatigue In

U.S. Nurses.” ​IdeaExchange at UAkron,​ 2018, pp. 1-25,

https://ideaexchange.uakron.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/

&httpsredir=1&article=1639&context=honors_research_projects.

Runge, David A. "Prevention Of Burnout By Use Of Balint Method Of Group Therapy.”

ScholarWorks At Umass Amherst​, 2016,

https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1070&amp=&context=nursi

ng_dnp_capstone&amp=&sei-redir=1&referer=https%253A%252F%252Fscholar.google

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%2526as_ylo%253D2014#search=%22nurse%20burnout%20prevention%20techniques

%20america%22.

Smith, Sarah A. “Mindfulness-Based Stress Reduction: An Intervention To Enhance The

Effectiveness Of Nurses’ Coping With Work-Related Stress.” ​International Journal Of

Nursing Knowledge,​ 2014, pp. 119-130,

https://pdfs.semanticscholar.org/8687/c55d34339caef6ec5c4b7890af4c99212dc7.pdf.

Starr, Adam. “10 Things You Should Stop Complaining About in Nursing.” ​Who's Who in the

Nursing Hierarchy - Nursing Link,​

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nursinglink.monster.com/benefits/articles/9801-10-things-you-should-stop-complaining-a

bout-in-nursing.

Thomas, Hilary. “We Need To Stop Glorifying Nurses.” ​Thought Catalog,​ Thought Catalog, 10

May 2014,

thoughtcatalog.com/hilary-thomas/2014/05/we-need-to-stop-glorifying-nurses/.

Waytz, Adam. "The Limits Of Empathy.” ​Harvard Business Review,​ 2016,

https://hbr.org/2016/01/the-limits-of-empathy.

Woodhead, Erin L. et al. “Stress, Social Support, And Burnout Among Long-Term Care Nursing

Staff.” ​Southern Gerontological Society,​ 2016, pp. 84-105,

https://journals.sagepub.com/doi/pdf/10.1177/0733464814542465.