Burnout

Burnout is a popular term for a mental or physical energy depletion after a period of chronic, unrelieved, job-related stress characterised sometimes by physical illness. The person suffering from burnout may lose concern or respect for other people and often have cynical, dehumanised perceptions of people, labelling them in a derogatory manner.

Causes of burnout particular to the nursing profession often include:

• stressful, even dangerous work environments
• lack of support or respectful relationships within the health care team
• low pay scales
• shift changes and long work hours
• understaffing of hospitals
• the responsibility of providing high levels of care over long periods
• frustration, disillusionment from the reality of the job not meeting your expectations.

Source: Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier

The average business would usually expect a staff turnover of 3-4 percent. Within the nursing and midwifery professions, the staff turnover increases to 3-6 percent.

Nurses and midwives are at higher risk of developing symptoms of burnout due to the challenges the workforce is facing. With over 36 percent of the nursing workforce over the age of 50, additional pressure is placed on the retirement rate and skill mix and results in a workforce shortage.

Nurses and midwives have been voted the most trusted profession for the last 22 years running in the Roy Morgan Image of Professions Survey 2017. The public feels a high level of trust and accountability for the profession. The flip side to this is that nurses work in one of the most stressful professions.

Depersonalisation is when you continually have a distant or indifferent attitude towards your work. Often those experiencing depersonalisation are emotionally distancing themselves in all aspects of their work and life.

Examples include:

• negative, callous, cynical behaviour or interactions with colleagues and those in your care
• unprofessional comments directed to colleagues
• blaming or judging clients and patients for their medical problems, or
• inability to show empathy or care and concern.

Nurses and midwives work at the coal face of health care, aged care and community care 24/7. They manage traumatic situations, are placed in compromising situations, witness critical incidents and are increasingly exposed to occupational violence.

The qualities that motivated you to join the nursing and midwifery profession can be the same ones that can lead to burnout. Being driven to care, solve, fix and heal, often with a lack of adequate resources and support can be stressful. The cumulative effect of this may lead to job dissatisfaction, disillusionment and burnout.

Nurses or midwives who experience burnout are usually high achievers, with high standards. They often hold responsible positions, are key decision makers, and may start to feel a loss of job satisfaction over time.

The demands of the profession have increased over the years with more expectations including:

• role diversity
• increased workloads
• constant changes in organisational structures
• changes to roles and responsibilities
• feeling helpless in the face of workplace change
• poor consultation
• limited opportunity to input into changes to systems and processes
• limited career progression opportunities
• increase in occupational violence.

You have your own personality traits and tactics for managing your daily life and stressors. Personal characteristics that may increase your vulnerability to developing burnout syndrome can include:

• self-criticism
• idealism
• perfectionism — unrealistic expectations of self and others
• over commitment
• work and life imbalance
• inadequate support systems outside of the work environment
• poor sleep quality and/or quantity, or
• engaging in unhealthy coping strategies.

Burnout can often be workplace-specific, which may be confusing when you are generally feeling satisfied in your personal life.

Emotional effects:

• emotionless, running on empty, adrenal fatigue
• easily agitated
• increased irritability, insensitivity
• feelings of being completely overloaded and overwhelmed
• becoming more isolated and withdrawn
• losing passion and zest for your job
• indifference to patients/residents/clients and colleagues
• not finding meaning and purpose in your day, decreased resilience
• hypercritical
• feeling cynical and downtrodden.

Feelings of detachment:

• anhedonia, loss of joy in your life
• disinterest in your work or life 
• avoidance of dealing with patients/residents/clients
• denial that there is anything wrong
• blaming others and becoming critical or self-blaming
• struggling to stop even though you are exhausted
• isolation, loneliness, depression and anxiety
• a sense of hopelessness and helplessness in the face of change.

Loss of job satisfaction:

• feeling discouraged and resentful
• isolated from work colleagues/friends/family
• lack of direction, stuck in a career rut
• wanting to leave the profession
• disenchanted with work and life
• reduced flexibility and resistant to change
• increased absenteeism
• increased risk of health issues
• increased errors
• feeling exhausted.

Burnout can be managed and you can learn strategies to prevent it from happening.

Family, friends and colleagues may notice before you do that you are stressed and burnt out. Think about their concerns – it may help you to start the conversation and get support.

Being able to confide in trusted professionals can reduce the shame, stigma and fear that there is something wrong with you. Burnout is sometimes hard to predict, prevent and understand. Many long-term nurses and midwives wonder “why am I feeling burnout now?”.

Paying attention and taking control of your own health can be the first step to creating change in your life. Many nurses and midwives find that they need permission from a colleague or peer to stop or do something differently.

Learn to stop

Being able to stop sounds easy. But what if you are leading the management of an emergency, in charge of a shift and have two agency staff on with a full unit? The concept of mindfulness relates to all aspects of our lives. If we are in tune with our responses it can increase our ability to intercept the decline into fear and anxiety.

Use the breath

You can use breath to slow down physical reactions to situations, and regain control over your reactions and emotional responses. Slowing one’s breathing reduces anxiety, fear and negative thoughts. Taking 10 deep breaths helps to increase attention, concentration and your ability to make sound decisions.

Reflect

Being mindful and developing strategies to create awareness and pay attention to cues that may lead to a fight-or-flight response is crucial. Developing the skill to reflect and self-nurture following stressful situations can help to prevent burnout.

Access support

Accessing regular, professional, peer-based supervision has many benefits. Talking to another nurse or midwife who understands the profession can be vital. Routine supervision can provide structured opportunities to learn self-care skills, build resilience, develop a career plan, upskill, increase awareness, build resources to support and motivate you with personal and professional development.

Identifying if you are experiencing burnout can be the first step towards changing your life path.

When you are experiencing signs of burnout:

• take some of your entitlements – a mental health day or a holiday
• create some ‘me’ time and stick to it
• reduce sugar and refined foods in your diet if you are feeling lethargic
• exercise = endorphins. Go for a walk or do a physical activity that you enjoy
• review your current job. Are you performing well? Do you enjoy it? Do you get positive feedback?
• develop a career plan. Where are you going? What do you need to get there?
• do more of what you love when you’re away from work
• tell a friend or family member how you are feeling
• be realistic – reduce your goals to more manageable plans.

If you have tried some of these strategies and you really don’t feel any different it might be worth speaking to your GP as you might be experiencing a mental health issue which could require a mental health plan - this is nothing to be ashamed of. Seeking the right treatment for you is individual preference - some people prefer other therapies such as meditation, naturopathy, acupuncture etc.

Read some of our articles that look at staying healthy promoting your wellbeing:

• Sleep
• Mindfulness

Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.

If you would like to know a bit more about the service before getting in contact — take a look through accessing support.