Nurse Burnout: How to Stop it Before it Starts

Nursing is tough. Long shifts in high-stress environments can easily cause burnout in even the best and most experienced nurses. 

There are several things you can do to prevent burnout such as staying healthy and getting enough rest between shifts. Having some non-work hobbies and making sure you actually use your vacation time will help too. 

However, if you find yourself feeling irritable at work, being overly resistant to change, or just going through the motions you may want to reach out to a friend. You could be on the verge of burnout.

What is Nurse Burnout?

Nurse burnout happens when nurses become physically, mentally, and emotionally exhausted as a result of repetitive overwork and unmitigated stress. Caregivers who experience it may become irritable, cynical, emotionally distant, and sometimes progress to a state of true clinical depression.

Nurse burnout unfortunately results in many nurses prematurely leaving the bedside or exiting the nursing profession altogether.

Nurse Burnout Statistics

According to a 2018 MedED study, one-third of all US nurses reported high emotional exhaustion which indicates high levels of burnout. This staggering statistic indicates just how serious nurse burnout has become.

A study conducted by Kronos in 2017 also revealed:

  • 98 percent of hospital nurses said their work is physically and mentally demanding
  • 85 percent said their jobs make them feel fatigued
  • 63 percent reported that their job has caused burnout at some point
  • 44 percent believe patient care will suffer because they are so tired
  • 41 percent have considered changing hospitals within the year (2017)

As nurses continue to leave the bedside, the growing nursing shortage becomes even larger. As a result, nurse-patient ratios grow as well, which contributes to even more burnout.

Causes of Nurse Burnout

Long shifts

Long shifts in busy work settings require constant mental attention and continuous compassion. 

12-hour shifts are common in most hospitals, and the idea of a three-day workweek is enticing. During a long stretch of days off, it truly feels like part-time work. However, working back-to-back-to-back shifts, often with less than 12 hours of time to eat, sleep, and take care of a family is enough to wear down even the strongest shift worker.

Although difficult, repetitive shiftwork alone doesn’t cause nurses to become burned out, when combined with other potential causes, it definitely can accelerate the process.

High-Stress Settings

Nurses in particularly high-stress areas such as an ICU or ER are often even more likely to become burnout victims. Frequent critical decisions must often be made in these settings, especially during a busy shift. 

These were the exact departments I worked in as a new nurse; I landed a job as a new grad in the CVICU and moved into the ER next. Looking back at my early career, it is easy to see how poorly managed stress contributed to early fatigue.

A few short years into my nursing career, I was already headed down the path toward burnout.

Instead of talking openly about stressful events at work, I bottled them up and kept problems to myself. Rather than debriefing with coworkers or family members, I silently entertained arguments in my own head during my long drive home from work.

It became common for me to come home after an especially taxing night shift and have a beer to relax. Before long, one drink turned into two, then a few more. It’s a pretty uncomfortable place to be when you need several drinks in the morning after a long shift to be able to sleep.

Coping with Death and Grieving

Coping with death is an unfortunate job requirement for most nurses. Assisting families with the loss of a loved one and helping them to begin the grieving process is an acquired talent.

Informing an anxiously waiting family that you did everything possible, but couldn’t save their dying child’s life never gets easier, and these heavy responsibilities can quickly become emotionally draining for even the most seasoned nurse.

I’ll always remember a patient I took care of during the first few weeks of my first job in the ER. I hadn’t even finished orientation.

An ambulance brought a nine-year-old drowning victim that had been playing near a creek with his ten-year-old brother. Neither could swim, and both fell into the water.

After several minutes of CPR, putting him on a ventilator, and giving many different medications, he was barely clinging to life. His mother arrived, and we found out that his brother was taken to another nearby hospital but had died.

At that time, I was a fairly new father. My first child was less than a year old. Watching mom, who had just lost one child, try to hold herself together sparked a lot of emotion.

The next day, we learned that our patient also died shortly after being transferred to a local pediatric hospital. I never paused to discuss or process my feelings or emotions. Now I can clearly see that what truly bothered me was not simply that two children had died. I had chosen to block out the raw emotions that mom was experiencing.

It is imperative to debrief after emotional events and talk about heavy feelings rather than try to look past them and keep working.

Pressure to Increase Productivity

Although even the best manager seeks to provide support to his or her staff, frontline nurses are often asked to do more with less.

Increasing productivity is a topic that carries a lot of weight with hospital managers. When the already overextended nurse is repeatedly asked to take on more responsibility, the progression toward nurse burnout accelerates.

Individual Personality

A nurse’s individual personality can also be a factor in early nurse burnout.

Nurses often thrive as part of cohesive teams, but some simply work more effectively by themselves than in team settings. For these independent thinkers, the pressure to conform can be stressful. Additional staff meetings, certification requirements, and constantly changing standards increase stress levels in such people.

Warning Signs of Nurse Burnout

Frequent Sick Calls

A 2020 study on nurse burnout related to sick leave surveyed 460 nurses and found that excessive workload increases nurse burnout, resulting in more frequent sick calls.

The study also concluded that when nurses repeatedly took on extra work or tasks on a long-term basis, results were detrimental to patient care quality.

Exhaustion

True exhaustion, especially when away from work, is a tell-tale sign of burnout.

Although long, taxing 12-hour shifts are tiring, a nurse should be able to easily recover after some time away from work. If she feels physically and mentally exhausted, even when away from work for extended periods, nurse burnout may very well be at least part of the cause.

Constant Irritability

Everyone gets irritable from time to time, but when it starts to occur more frequently, it may be a sign that burnout is lurking in the shadows. Feelings of constant irritation at work or just before work is definitely cause for concern if it is occurring every shift.

For the most part, I work the same schedule — every weekend. Several years ago, I noticed a growing trend. As my friends who work traditional schedules got excited for the weekend, I was filled with feelings of anxiety and irritation.

I wasn’t a fun person to be around near the end of the week. That began to change when I finally started to take better care of myself mentally and physically.

Resistance to Change

Frequent changes in nursing are an unfortunate reality. Change can sometimes be hard to keep up with. But, when you’re beginning to notice a firm resistance to change, you may be getting closer to a state of burnout.

The emergency room is a dynamic, constantly changing environment. It’s not uncommon for policies and procedures to change on a daily or weekly basis. I found myself irritated with even minor tweaks in charting software and small changes in staffing.

That type of impatience can be made a lot worse by gossiping – like throwing gasoline onto a fire. It’s really important not to get caught up in that cycle of complaining about things that really aren’t that important.

Mentally “Giving Up”

Nurses who clock in, simply go through the motions for an entire shift, and clock out may be on a fast track to nurse burnout. This sort of mental resignation is a subtle signal.

Nurses may be entirely task-based and show little or no enthusiasm for interaction at work – a hallmark sign of fatigue. I clearly remember feeling this way. At one point, I simply wanted to do the absolute bare minimum. That’s no way to go through a job or through life.

Clinical Areas with Increased Risk of Nurse Burnout

Emergency Room

Things rarely unfold in an organized manner in most emergency rooms. Chaos is common, and a sense of urgency is the norm.

During a typical day in the ER, a nurse may be involved in the care of as many as 40-50 patients. Managing large volumes of patients in high-pressure scenarios often requires significantly lower levels of detail and attention. When it becomes common to feel that the department is one step away from disaster, risk for nursing burnout increases.

Intensive Care Units

These units care for the sickest patients in the entire hospital. Lengths of stay and death rates are often higher than in other areas. ICU nurses must constantly maintain a heightened sense of awareness in order to recognize subtle changes that may lead to decline in patient status. Constant required mental awareness can make ICU nurses more prone to nurse burnout.

Oncology

Oncology nurses regularly care for cancer patients for extended periods. It is not uncommon for these nurses to form lasting relationships with their patients, many of whom fight cancer for long periods of time. A compassionate oncology nurse often feels the loss of a patient more heavily.

Overcoming Nurse Burnout

Recognize the Warning Signs

We all experience some of the individual signs of burnout from time to time. However, when you are feeling stressed more often than not, or when multiple signs are visible at the same time, it is cause for concern.

Take a moment to think about your coworkers. It won’t be too difficult to envision at least one who has fallen victim to burnout.

I remember one nurse I worked with, Jennifer. She was always in a testy mood. She had a sarcastic response to everything and complained about how long the day felt less than halfway through the shift. She absolutely hated change (and made that fact well-known), and just seemed miserable to work with almost all the time. Does that sound like anyone you know?

Looking back, Jennifer wasn’t always this way. When we first started working together, she was cheerful, helpful, and I really enjoyed working with her. But over time, she became a burnout victim.

Prevention is Key

Burnout is a much easier problem to prevent than to fix.

It is absolutely imperative to be able to recognize these warning signs of nurse burnout when they first appear. Take immediate action. You may be reluctant to address this issue with a coworker, but by doing so, you may be saving her from a very long, uncomfortable process. You may ultimately help to save her career, family, happiness, and livelihood. It really is that important.

It’s equally important to be able to recognize warning signs with yourself. If you do, it is time to make some changes right away.

Emphasize What You Like About Your Job

It is easy to become distracted by all the things that you dislike, especially during a busy shift. It’s almost second nature sometimes for us to become task-based, just checking off items on a list throughout the shift.

What do you like most about the position you are in?

For me, it’s finding a way to relate to people and making them feel more comfortable. When I’m rushing to get to the next patient, hurrying to give all of my meds that are due, or silently complaining to myself about having more work to do than my coworkers, I never get to the parts of my job that I really enjoy. I have to remind myself that it’s okay to slow down a little.

After addressing the reason for the ER visit, I try to make a point to ask patients, “What type of work do you do?” or some similar ice breaker type question. It gives them a chance to open up a little, which is often difficult to do in the emergency room. It shifts attention away from the illness or injury.

Besides, most people love to talk about themselves, so it’s usually not a difficult conversation to start. A few minutes of genuine conversation usually helps relate to your patient a little better and makes future interactions much easier.

Practice Self-Care

Self-care looks a little different for everyone, but the concept is the same. Take good care of yourself outside of work.

Spend time with your spouse and kids. Get to know them a little better and strengthen that family bond. We’ve recently (pre-COVID) started traveling more; exploring new places makes us happy. Seeing my family happy makes me happy.

Find activities you enjoy outside of work, block off some time, and actually do them.

  • Sports
  • Reading
  • Cooking
  • Gardening,
  • Home improvement projects
  • Surfing
  • Learning to play an instrument
  • Crafting

These are a few examples of activities you can get involved in that have nothing to do with work. It’s imperative to find something you like to do that doesn’t have any overlap with your job.

Putting a daily routine in place has also helped me a lot. My day starts with a cup of coffee and some daily meditation and reflection and ends with a little journaling.

Get Enough Sleep

Getting good quality sleep, especially if you work a non-traditional shift, is often not easy to do. I’ve worked nights for several years, and it definitely can be a challenge. But, if I’m going to be productive at work and during my stretch of days off, good sleep is non-negotiable.

Put your phone in Do Not Disturb mode. If you’re worried about missing calls, most phones have a setting that will allow them to ring from certain numbers. I set mine only to ring if the same number calls twice within three minutes. I’m not completely unreachable in an emergency. Text messages, e-mails, and social media notifications can wait until after you wake up.

Sleeping during the day isn’t the norm, but it can be done. The Cleveland Clinic recommends establishing a regular bedtime routine and sticking to it. A cool, dark, quiet bedroom is important too. Invest in some good blackout curtains for your room — you won’t regret it.

Try to stop drinking caffeine a few hours before you go to sleep. I used to drink soda and coffee straight through my shift, especially during the 5am-7am window when it’s really hard to stay awake. Try replacing that with water or something else without caffeine. This made a huge difference for me.

Diet and Exercise

I’ve recently started exercising again. I had no idea how much being out of shape was costing me. That changed when I started eating healthier and dropped a few pounds. Better mental health usually follows good physical health.

If you’re strapped for time, start with something simple like a walk around the neighborhood when you wake up. On workdays, exercising right after waking up seems to be best for me. I’ve found that if I wait until after a 12-hour day, I’m usually too drained to do much of anything.

Challenge yourself to go for two weeks and only eat the food you cook at home. It takes some preparation, but going to work with enough food to last an entire 12-hour shift is pretty refreshing. It’s nice not to spend extra money ordering pizza when you’re overwhelmingly busy. Saving money is an added bonus.

Big changes start with small steps.

Take Some Time Off

Many nurses can end up with an extended amount of time off just by using PTO for a few shifts. This is a huge advantage that shift workers have. By requesting only three shifts in a row, I end up with eleven consecutive days off.

During my first several years working as a nurse, I was very hesitant to use any of my vacation time. My hospital allows me to take up to five weekends off per year (I work a weekend-only schedule). There is a lot that can be done with five eleven-day periods of vacation each year.

When this long-awaited break from work finally happens, make a point to completely disconnect from work. No checking work email. No phone calls to the hospital. Nothing. Just enjoy yourself and your family. Explore a new place, even if it’s right in your hometown.

Summary

Nurse burnout is a growing problem that is causing many nurses to leave the bedside early. Be on the lookout for irritability, inability to relax and recharge on your days off, and resistance to change at work.

If you start to see symptoms of burnout, take action. Take some time off to recharge. When you return to work, stay focused on what you love about your job.

Nurses practicing in the ER, ICU, and oncology should be especially on guard.

We need to look out for one another. Don’t be afraid to talk to a coworker or friend about feeling fatigued.

To avoid burnout in the first place, consider developing meaningful interests and hobbies away from work. Exercise regularly. And use that vacation time to get closer to family and to explore new things and places.

4 thoughts on “Nurse Burnout: How to Stop it Before it Starts”

  1. Great article and so true. I used to work 8 hour shifts back in the 70s and 80s and despite everyone thinking 12 hours are great, me included, I believe it’s never been the best thing for nursing or patients. I’ve done 49 years. The first 15 in the ICU and the remainder in the ER and I feel the pain. I finally have change my status to Perdiem and found out how important decompressing and rest can be.

    Reply
    • Yes, 12-hour shifts are a double-edged sword. I feel like a zombie after a long weekend at work, but nothing beats being home with my family during the week. I really don’t know how people that work traditional hours get routine things accomplished like going to the bank or appointments.

      Reply
  2. Great article Steven! I can add sometimes you have “done your time” on a unit and leaving is not always the best option. Talk with managers and see if there are other options if you like you coworkers. Sometimes temporarily there are other roles that need additional help or even lateral moves. It’s important to continually re-create yourself and when opportunity presents- give it a try. Nurse burnout is real, especially during this recent pandemic. Reaching out and asking for help is important. So glad I have stayed in the ED. There are still days when you need to stop yourself from looking at what doesn’t work and be thankful for all that does. Enjoyed reading!

    Reply
    • Very good point Allyson. I usually find when I get uncomfortable that it has more to do with me than outside circumstances. As you know, I learned pretty quickly that the ER is where I’m meant to be after trying a few other things.

      Reply

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