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Nurse Burnout Article Cover

How COVID-19 has exacerbated the burnout crisis in U.S. nursing

September 1, 2021
September 1, 2021

“Healthcare workers are needed now more than ever as COVID-19 has spread around the world” according to KOLD News, and University of Arizona researchers fear a nurse and medical provider burnout [epidemic] could be the next COVID-19 crisis” (McNeil, 2020). For healthcare organizations, this potential workforce disaster could have a calamitous impact. One nurse who worked in New Jersey COVID-19 units for several months as the pandemic unfolded offered that “she had seen more death in two months than in the more than 20 years of her nursing career” (McNeil, 2020). Not only did it leave her an “emotional wreck,” but she ended up needed to see a therapist to cope with the stress. The nurse adds that she thinks “a lot of people are going to be emotionally done” with working in healthcare and cautions, “I think this is playing a toll on healthcare workers” (McNeil, 2020).

University of Arizona researchers fear a nurse and medical provider burnout [epidemic] could be the next COVID-19 crisis.

McNeil, 2020

The risk of burnout is nothing new when it comes to nursing in the United States and elsewhere. Some would say that this risk comes as a side product of the job of nursing, which often occurs in a stressful environment, where practitioners are regularly making decisions upon which lives depend. According to the University of Saint Augustine, as an occupational phenomenon burnout is not even “specific to nursing: Professionals in any industry, from teaching to engineering, can suffer from this type of exhaustion caused by unrealistic expectations, lack of sleep, and other work-related stressors” (USAHS, 2020). The risks of burnout are compounded, however, now that COVID-19 is having such an exaggerated impact on everyone in healthcare.

Defining burnout

The University of Saint Augustine defines burnout as “the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes” (USAHS, 2020). Nurses facing these compounding situations “may start feeling disengaged and detached, the first warning signs of burnout.“ An additional risk of burnout is that clinical professionals without grounding in a strong self-care practice can experience “feelings of cynicism, hopelessness, and even depression” (USAHS, 2020).

Nurse burnout was already a serious issue before COVID-19 pandemic

Nurse burnout was a recognized problem for the profession long before COVID-19 began to challenge the healthcare industry.

By 2019, healthcare organizations had been sounding alarms about the issue to the extent that the Joint Commission established measures to address it. Concerned about the effect of stress and burnout on nurses’ health, as well as their ability to do their jobs well, the agency released “Quick Safety Issue 50: Developing Resilience to Combat Nurse Burnout, to help healthcare facilities with the process of personal protection from burnout for nurses and other frontline staff” (Palmer, 2020).

This initiative was an effort to draw attention to the problem of burnout, examine some of its root causes, and suggest ways that building resilience in the healthcare professions could combat it. Not only are there ways for organizations to make a positive impact against nurse burnout, but healthcare leaders can model empowering behaviors in the interest of combating this problem.

HealthLeaders cites the 2019 Joint Commission national nursing engagement study, noting that “of the 2,000 healthcare providers who participated in an April 2019 [survey]… more than 15% of all nurses reported feelings of burnout, with emergency department nurses at a higher risk. A second survey in 2019 found that burnout is among the leading patient safety and quality concerns in healthcare organizations” (Palmer, 2020). Demonstrating the progress that still needs to be made to combat burnout, the same article shares, “Only about 5% of respondents surveyed said their organization was highly effective at helping staff deal with feelings of burnout. Only about 39% said their organization was ‘slightly effective’ at dealing with burnout, and 56% said their facility was either slightly or highly ineffective at it” (Palmer, 2020).

When it comes to understanding why burnout occurs, HealthLeaders mentions a 2017 Joint Commission international study of 3,000 nurses that “found that the most common factors related to burnout are exclusion from the decision-making process, the need for greater autonomy, security risks, and staffing issues” (Palmer, 2020). All of these factors can contribute to occupational stress, which healthcare professionals have long recognized and is commonly “regarded by many to be part of the job” (Palmer, 2020).

COVID-19 has exacerbated the nursing burnout crisis

Additional indication that the COVID-19 pandemic has had a significant impact on nurse burnout can be found in recent surveys connected to HealthStream, whose subsidiary NurseGrid has conducted three separate pulse surveys of nurses about their experiences and satisfaction over the past year—one in April, one in September, and one in late December 2020. With 10,000 or more nurses responding to each one, there’s a high level of confidence that the profession is well represented in their responses, across all ages, types of nursing, healthcare organizational sectors, etc. The goal of this cumulative nurse survey effort “has been to shine a spotlight on issues impacting nurses during the pandemic, with the hope that by raising nurses’ voices we, together, can inform and empower healthcare leaders to do all they can to further support and enhance the working conditions for our healthcare heroes” (NurseGrid, 2021).

Some of the findings have special significance when it comes to causing burnout. While confidence increased over the year in the nurses’ ability to treat COVID patients successfully, there were still concerns about patient and staff safety, as well as inadequate supplies of PPE and other equipment. Likewise, having to abandon or ignore core nursing beliefs in hands-on care has been a stressor. The nurses surveyed “identified two key challenges in providing quality patient care in today’s COVID-19 environment. First, the vast majority noted a shortage of nurses (mentioned by 78.5%). The second is a shortage of ICU beds (mentioned by 46.7%)” (NurseGrid, 2020).

Specific survey concerns about burnout and mental health

The NurseGrid survey also pinpointed multiple risks of burnout that nurses have identified for themselves and their colleagues. By the time the December survey was conducted, it was clear that they had become “far more concerned about their own burnout and mental health than they were in April” (NurseGrid, 2020). Results showed that “The constant stress is taking its toll, with 61% expressing concern about burnout as compared to only 25% in April” (NurseGrid, 2020). In a notable indication for healthcare organizations, the nurses surveyed indicated dissatisfaction with their career choices and path, with ”a substantial number [stating] they will either leave bedside care (18.0%) or completely change their career (4.1%)” (NurseGrid, 2020). Looking back over the course of a pandemic that has not yet subsided, the evidence is strong that “Nurses’ senses of well-being and career fulfillment have declined” (NurseGrid, 2020). The healthcare industry is only beginning to see the workforce and caregiving impacts of the extended trauma many of experience. In its assessment of survey results and the industry outlook, NurseGrid suggests the need for immediate relief, without which “additional nurses [will] question their role in nursing and possibly their career path” (NurseGrid, 2020). In addition to efforts focused on nurses’ working conditions and mental health needs, NurseGrid advises that “administrative leaders MUST develop a plan for individualized care and support to handle the aftermath of an ailing, traumatized staff at scale” (NurseGrid, 2020).

In a 2020 NurseGrid survey, nurses surveyed indicated dissatisfaction with their career choices and path, with ”a substantial number [stating] they will either leave bedside care (18.0%) or completely change their career (4.1%).”

The impact of nurse burnout

A common nurse response to burnout is to completely leave employment in healthcare, adding extra pressure to understaffed healthcare organizations and especially to the staff members who stay behind. In addition to increasing the numbers of nurses who might leave the profession at a moment when we need them most, burnout also can seriously affect patient outcomes. One significant risk is “a decrease in the quality of patient care. Mistakes due to exhaustion can lead to patient discomfort, infection, and even (in extreme cases) death” (USAHS, 2020). The University of St. Augustine also cites a Marshall University finding that higher nurse-to-patient ratios, a natural result as nurse shortages occur and as clinicians leave the field, can lead to increased hospital mortality.

Measures to combat nurse burnout

The good news is that it is “possible to prevent nurse burnout before it occurs—and to treat it immediately when it happens (USAHS, 2020). Doing so helps safeguard outcomes for patients and healthcare organizations and forestalls negative impacts on employees. Some potential measures for addressing and preventing burnout suggested by the University of St. Augustine include:

  • Schedule improvement - Limit nursing schedules to a reasonable cadence and shift length so that nurses can achieve work-life balance.
  • Endorse time off and vacations - Nurses need to relax and recharge during regular extended stays away from their jobs.
  • Provide support - Nurses need outlets for discussing their frustrations related to the job with coworkers and other understanding listeners. Especially for feelings of depression or hopelessness, a professional counselor is necessary.
  • Help staff learn to cope with work pressure - Skills for handless stress are endless and depend on the individual—from exercise and meditation to breathing techniques and journaling. A mandatory need is to encourage staff’s focus on mental and physical well-being.
  • Encourage specialty change within the organization - Over time a specialty can become too stressful, necessitating a career change for an individual clinician. Working on a new direction can itself be empowering (USAHS, 2020).

The importance of fostering resilience among healthcare staff

As mentioned earlier, healthcare organizations need to act on their responsibility for supporting their clinical and nursing staff in an effort to address the causes of burnout. An overarching goal should be to encourage employee resilience to counteract the effects of stress and pressure. According to the Joint Commission, one of the best ways to do this is by “developing and fostering resilient environments and individuals” (Joint Commission, 2019). The same source offers that “Health care organizations that implement burnout interventions — such as mindfulness and resilience training — may experience increased employee retention, reduced staff turnover and performance problems, and increased patient satisfaction, ” while at the same time warning that:

"mindfulness and resilience training alone cannot effectively address burnout unless the leadership is simultaneously reducing and eliminating barriers and impediments to nursing work flow, such as staffing and workplace environment concerns"

Joint Commission, 2019

HealthStream resilience training

By offering Resilience in Healthcare courseware, HealthStream enables healthcare organizations to protect their patients and staff with training designed to support improved behavioral health and self-care during crises like the COVID-19 pandemic. The courseware contains two pathways—for licensed professionals and non-licensed healthcare staff—and helps learners follow a personalized learning pathway and develop action plans for their own resilience. For relevant staff, it even offers CE credit. By making a resource like this available to employees, organizations can support the mental and physical health of staff and simultaneously protect every patient and visitor encounter.

References

Joint Commission, “Developing resilience to combat nurse burnout,” Quick Safety Issue 50, July 2019, Retrieved at https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf.

McNeil, M., “Could healthcare worker burnout be the next COVID-19 crisis?,” KOLD News, September 21, 2020, Retrieved at https://www.kold.com/2020/09/21/could-healthcare-worker-burnout-be-next-covid-crisis/.

NurseGrid, “A Pandemic’s Toll on Nurses,” NurseGrid (with the Support from AORN, January 2020, Retrieved at https://nursegrid.com/nurse-pulse-survey-update/.

Palmer, J., The Joint Commission Tackles Nurse Burnout,” HealthLeaders, January 17, 2020, Retrieved at https://www.healthleadersmedia.com/nursing/joint-commission-tackles-nurse-burnout.

University of Saint Augustine for Health Sciences (USAHS), “Nurse Burnout: Risks, Causes, and Precautions,” July 2020, USAHS Blog, Retrieved at https://www.usa.edu/blog/nurse-burnout/.

Author

Kim White, Senior Program Manager,
HealthStream