Avoiding Nurse Burnout Nursing CE Course

sly. Not only did the COVID-19 pandemic have a significant impact on HCPs experiencing burnout, but many of them also experienced CF. The pandemic brought on more feelings of isolation, emotional exhaustion, and post-traumatic stress as HCPs witnessed the suffering of critically ill patients (Clark, 2023; Compassion Fatigue Awareness Project, 2022; Garnett et al., 2023).

The Impact of Burnout

The prevalence of burnout among HCPs varies significantly across the literature. However, after the COVID-19 pandemic, the rate of burnout increased from 32% in 2018 to nearly 50% in 2022. Although these numbers can vary across time and health care institutions, researchers have concluded that most nurses experience burnout at some point during their careers. For example, in the 2017 Kronos study, researchers found that 63% of nurses working in the hospital have experienced burnout. The CDC evaluated self-reported mental health symptoms among US workers from 2018 to 2022 using data from the General Social Survey Quality of Worklife Module. They found that HCPs reported an increase in poor mental health during the previous 30 days (from 3.3 to 4.5 days) from 2018 to 2022. Of the HCPs who responded, nearly 50% reported intending to search for a new job (Clark, 2023; Nigam et al., 2023; Wickstrom, 2023). Additional statistics highlight the prevalence of nurse burnout in the United States.

• 43% of nurses in the hospital setting experience emotional exhaustion.
• 33% of nurses providing direct care in hospitals experience burnout.
• 18% of nurses in the hospital have considered leaving the bedside.
• 50% of nurses have considered leaving the profession; of the nurses considering leaving the profession, 31% reported burnout as the reason.
• Nurses working more than 40 hr a week are more likely to leave their jobs due to burnout.
• Burnout has been associated with substance use disorder in HCPs.
• 37% of nurses in long-term care experience burnout.
• 36% of nurses in the hospital setting and 47% in the long-term care setting reported that workload had impacted their ability to recognize changes in patient conditions (Clark, 2023; Merlo & Teitelbaum, 2025; Shah et al., 2021; WGU, 2019).

Nurse burnout has also been identified globally. Ge and colleagues (2023) conducted a meta-analysis to evaluate the global prevalence of nurse burnout and found that over the last 10 years, the prevalence has varied widely across studies. Across 94 studies, the global prevalence of burnout is 30.0% (95% CI, 26% to 34%), with a significant number of nurses reporting moderate to high levels of burnout.

Impact on the Health Care Organization

              Burnout has a significant impact on health care organizations. For example, burnout in nurses and other health care team members has been linked with decreased job satisfaction, increased turnover, decreased patient satisfaction, patient safety issues, and an increase in medication errors. Li and colleagues (2024) conducted a systematic review and meta-analysis to evaluate the impact of nurse burnout on health care organizations. They found that nurse burnout was associated with a diminished safety culture, lower safety grade, and more frequent nosocomial infections, patient falls, medication errors, missed care, and adverse events. They also found that nurse burnout was associated with lower patient satisfaction ratings. Diminished job satisfaction can increase turnover, as nurses choose to leave their current job due to burnout. Nurse turnover is costly for health care organizations, with a national average turnover rate ranging from 8.8% to 37%, depending on the nursing specialty and geographic location. Significant expenses are incurred to recruit, hire, and orient new nurses. It is estimated that health care organizations incur approximately $262,500 in costs per year for each percentage point change in nurse turnover. In the interim, the health care facility must fill that nurse's position by paying overtime to current staff nurses or hiring agency or travel nurses on short-term contracts. As a result, there may be days or shifts where the unit works in a short-staffed situation, with less than the required number of nurses on the unit. Inadequate staffing negatively impacts patient safety and patient satisfaction. A nurse-to-patient ratio of 1:4 (not including some specialty units such as intensive care) is recommended for safe and quality care. For every additional patient the nurse cares for on their shift, there is a 7% increase in patient mortality. In addition, researchers have found that when nurses are experiencing burnout, their patients often have a higher risk of surgical site infections, and they often receive lower patient satisfaction scores (Haddad et al., 2023; Jun et al., 2021; Nursing Solutions, Inc., 2024).

             

Risk Factors for Burnout

Various individual and work environment factors contribute to prolonged stress that can lead to burnout in nurses. The work environment is one source of burnout within the health care organization. Fast-paced work environments are often the standard for nurses, whether their workplace is an ambulatory surgery center, an emergency department, or a busy inpatient unit. Many of the patients are critically ill and have complex health care needs. It can be challenging for nurses to provide high-quality, comprehensive patient care when working nonstop and prioritizing care needs. An increased workload without sufficient staffing is another source of burnout for health care organizations. Research has shown that nurses with more than four patients have higher rates of burnout. In addition, nurses are twice as likely to experience burnout when they work longer shifts (10 to 13 hr) than shorter shifts (8 to 9 hr). Specialty settings such as the emergency department and intensive care unit have the most significant rates of nurse burnout. Working in areas where patients have low recovery and high mortality rates can have an emotional toll on nurses, leading to burnout and compassion fatigue (CDC, 2024; US Department of Health and Human Services [HHS], WGU, 2019).

Workplace culture can significantly impact the stress level of nurses and other HCPs. Burnout is more prevalent when health care organizations and clinical units do not have a culture that promotes teamwork and collaboration. Poor teamwork and communication can also increase the risk of serious safety events. Incivility in the health care organization is also a source of burnout. Incivility increases the stress level in the nursing unit and health care organization. Incivility can also impact the individual nurse's stress level and increase their risk for burnout. Therefore, it is recommended that all health care organizations have a zero-tolerance policy for incivility in the workplace (CDC, 2024; HHS, 2022; WGU, 2019).

Individual factors can also increase the risk of experiencing burnout. Nurses often have many opportunities to work additional hours due to the widespread nursing shortage. As a result, many nurses often volunteer for overtime or extra shifts and frequently skip their breaks. Skipping breaks includes not taking frequent enough or long enough breaks, missing meals, not stepping away from job responsibilities, and eating at the desk or nurses' station. While the willingness of individual nurses to volunteer for extra shifts or overtime improves the unit's staffing level, a persistent pattern of overwork contributes to the development of burnout (CDC, 2024; HHS, 2022; WGU, 2019).

Inadequate self-care behaviors are another source of burnout in nurses. Nurses tend to focus on their patient's health care needs to the extent that they ignore their own. Consistent exercise, healthy eating, relaxation techniques (meditation, mindfulness, breathing techniques), adequate sleep, and regular vacations are self-care strategies that can greatly aid nurses. Nurses often work long, consecutive shifts that interfere with adequate sleep hygiene. Researchers have found that 25% of nurses reported that they could not get enough sleep between shifts (CDC, 2024; HHS, 2022; WGU, 2019). Williams and colleagues (2022) found that self-care strategies for nurses can include working less than 40 hr per week, working consistent shifts without rotations, taking time to exercise, participating in a support group, getting proper sleep, eating healthy meals, and practicing mindfulness techniques.

Clinical Manifestations of Burnout

To recognize the signs and symptoms that may indicate that they or another HCP is experiencing burnout, nurses must be aware of the manifestations of burnout, and health care leaders must also be adept at recognizing when staff is experiencing burnout (WGU, 2019). The signs and symptoms of burnout can include the following.

• chronic fatigue
• emotional and physical exhaustion
• dreading going to work
• constant dread or panic when at work
• loss of appetite
• loss of sleep
• apathy towards others
• frequent absenteeism or tardiness
• negative attitude at work
• lack of engagement with friends and family
• resistance to change
• poor work quality
• patient safety issues
• increased anxiety or depression (HHS, 2022; Singh et al., 2023; WGU, 2019)

As discussed previously, CF and burnout have similarities but are fundamentally different phenomena. However, these phenomena can manifest with the same signs and symptoms, making distinguishing them challenging. The fundamental distinguishing factor is the precipitating factors (burnout due to demanding work conditions and CF due to caregiver burden and trauma associated with watching patients suffer). Nurses can simultaneously suffer from burnout and CF (Clay, 2020; Wolotira, 2022). The signs and symptoms of CF can include the following.

• exhaustion
• disrupted sleep patterns
• anxiety, depression, and post-traumatic stress disorder (PTSD)
• headaches and upset stomach
• irritability
• numbness
• a decreased sense of purpose
• emotional disconnection
• difficulty with personal relationships
• self-contempt
• impaired judgment and behavior
• a decline in morale
• a decrease in cognitive function (Clay, 2020; Wolotira, 2022)
• 
  

Strategies to Prevent and Manage Burnout 

A common adage states that an ounce of prevention is worth a pound of cure. In the context of nurse burnout, this can be seen often. Therefore, it is more effective for nurses and health care organizations to implement strategies to prevent burnout. Nurse burnout can occur due to factors within the health care organization, individual factors within the nurse, or both. Leadership within the health care organization must identify and address the organizational factors that can cause burnout in nurses. Individual nurses also need to recognize risk factors to improve their work-life balance. Various organizations, including the CDC and The Joint Commission (TJC), have put forth recommendations for improving HCP well-being to reduce burnout and manage fatigue and stress during times of crisis. HCPs continue to provide care despite challenging work demands, increased stress, and more complex care needs in times of crisis. Health care organizations are faced with the challenge of caring for the health and safety of patients while also considering the needs of their staff. This delicate balance is challenging to achieve, and there may be times when stress is unavoidable, but burnout can be prevented. Managing stress and exhaustion is a shared responsibility between the individual HCP and the health care organization. By working together, effective prevention and treatment strategies can be instituted (Hittle et al., 2020; TJC, n.d.). TJC outlines a five-step approach to address the challenge of improving clinician well-being (TJC, n.d.).

• Commit to work well-being as an organizational priority. Creating a healthy and supportive work environment is essential for the well-being of HCPs and the delivery of high-quality care to patients. In order to address burnout, health care organizations must commit to making well-being a priority. Strategies to accomplish this include incorporating workforce well-being into the strategic plan, creating a clear vision with defined goals, and allocating resources as a long-term strategy.
• Appoint a senior leader to inspire, achieve buy-in, drive strategy, and advance well-being. Appointing a senior leader, such as a chief wellness officer, can foster a positive and supportive organizational culture. This individual should focus on actively promoting a healthy work environment through resources, actions, and policies. Strategies to accomplish this include determining the necessary resources to support this role, determining the appropriate scope and function of this leader, and building an infrastructure to support a sustainable culture of well-being.
• Assess worker well-being to establish a baseline. A key strategy to improve worker well-being is to measure it, implement targeted interventions, and remeasure it. Conducting a baseline assessment can help identify contributing factors of burnout and strategize solutions to address these factors. Strategies to accomplish this include choosing a valid and reliable tool that fits the intended audience and does not take more than ten minutes to complete.
• Implement organization-level strategies that target areas of need. Organizational-level interventions should be multifaceted and tailored to the specific needs and challenges of the organization. Organizations accomplish this by identifying strategies that combat burnout, prioritizing these strategies, and piloting these strategies prior to broad implementation.
• Monitor progress by periodically reassessing worker well-being. Conducting periodic, regular assessments of worker well-being helps inform targeted strategies and monitors the success of these strategies. Strategies to accomplish this include leveraging existing data when possible to monitor the progress of well-being, outlining future data collection points, and establishing shared accountability among leadership to obtain the data.

There are several additional strategies that the health care organization can implement to prevent nurse burnout. The first organizational strategy provides administrative support for education on recognizing and preventing burnout: "know the problem and get educated about what burnout is and what to do about it" (Maslach & Leiter, 2017). Another organizational strategy to prevent burnout is promoting a positive work environment. A positive work environment includes zero tolerance for workplace incivility, recognition of staff nurses who set a good example to others at their jobs, and a culture of teamwork and collaboration (HHS, 2022; Hittle et al., 2020; Sillero & Zabalegui, 2018).

Improve scheduling and staffing must be implemented consistently to prevent nurse burnout. Nurse managers need to be knowledgeable about the workflow in their units and adjust staffing appropriately. Nurse managers should be accessible and willing to assist nurses when needed. For example, if the unit typically receives numerous admissions, or there are more cases on the ambulatory surgery center schedule on certain days of the week, nurse managers should schedule some of their nurses to start later in the day so there is sufficient staffing to handle the workload. Nurse administrators could also implement a pool of as-needed/per diem nurses who can be scheduled during periods of higher workload (HHS, 2022; Hittle et al., 2020; Sillero & Zabalegui, 2018).

Providing wellness benefits for nursing staff can also prevent burnout. Wellness benefits include funding smoking cessation programs, free or reduced gym membership fees, calorie count information, healthy food options in the hospital cafeteria, stress reduction training, and meditation programs. Another critical aspect of training occurs at the universities and medical schools that educate the next generation of HCPs and nurses. Academic institutions need to educate students about burnout and burnout prevention strategies. This training will make preprofessional students aware of burnout syndrome and how to cope with it when they enter the workforce (Ezenwaji et al., 2019; HHS, 2022; WGU, 2019).

While organizational factors contribute to nurse burnout, factors attributed to the individual nurse can also result in burnout. First, the individual nurse must recognize the signs of burnout. Nurses should identify the changes in their minds and body when they start to feel burned out to better care for themselves. Next, nurses need to embrace the concept of work-life balance. Nurses are caregivers who often put the needs of their patients ahead of their own, which can be difficult. However, a nurse who prioritizes self-care and embraces work-life balance will be more content and function more effectively in the workplace (WGU, 2019). Additional strategies that nurses can use to prevent burnout include (American Nurses Association, 2024; Fishbein, 2023; HHS, 2022; WGU, 2019; Williams et al., 2022):

• Improve schedules. Nurses should minimize rotating between shifts throughout the week. Also, HCPs should avoid working overtime or extended shifts.
• Take breaks. Nurses should utilize their vacation time to step away from the workplace. During the workday, nurses should not skip breaks or their scheduled mealtime. Getting away from the unit for brief periods throughout the day is crucial.
• Learn to say no. Nurses often want to help others, which can sometimes be problematic when the nurse overextends themself. Learning to say no and setting boundaries can prevent burnout.
• Ask for help. Nurses who are feeling signs and symptoms of burnout should be empowered to speak up. Making their needs known can help health care leaders make appropriate changes to ensure the HCP's well-being.
• Reignite the passion for nursing. When nurses experience signs and symptoms of burnout, reflecting on why they chose their career can be helpful. Sometimes, getting involved in a new initiative they are passionate about can change those feelings of burnout into personal accomplishment. Nurses may also consider going back to school to advance their careers.
• Seek support. Nurses should seek out support groups, colleagues, or mentors that can serve as an outlet to vent frustrations or discuss challenges. Creating peer mentors encourages teamwork and collaboration, decreasing the risk of burnout.
• Learn coping methods. Resilient nurses are less likely to become burned out. Therefore, effective coping is critical to HCP well-being. Potential approaches include breathing techniques, mindfulness, meditation, restorative exercise, journaling, and a post-work relaxation routine.
• Changing specialties or focus. One of the unique features of nursing is that there are numerous different specialty areas. If the current work environment is causing significant stress, a change of pace or setting may be necessary. Strategies could include changing units or facilities, moving from inpatient to outpatient, or changing roles.
• Prioritize physical wellness. Basic strategies could include healthy eating, regular exercise, sleeping at least 7 hr per night, smoking cessation, yoga, and limiting alcohol intake.

The prevention strategies discussed above can also be used as management strategies for nurses experiencing burnout. Nurses should focus on work-life balance, self-care strategies, and reducing workplace stressors. Mindfulness-based stress reduction programs have effectively mitigated the signs and symptoms of burnout in nurses and other HCPs. In addition, health care organizations should create environments that foster resilience and self-care for their staff. Some strategies that leadership can use to create a nurturing environment to manage burnout can include the following strategies.

• Encourage staff participation in self-care activities at work (walking, mindfulness, meditation, journaling).
• Invite staff to go on a walk and listen to their stories.
• Have conversations with staff about the signs and symptoms of burnout.
• Diversify or decrease staff workload.
• Support staff in having time off, including vacations.
• Encourage participation in debriefing after traumatic events.
• Provide positive recognition of staff.
• Acknowledge and recognize the loyalty of staff members.
• Promote peer support, teamwork, and collaboration.
• Empower staff in professional development.
• Support employee autonomy (Wolotira, 2022).

Conclusion

Burnout and compassion fatigue can negatively impact patient care. Therefore, nurses need to be able to recognize the symptoms of burnout to implement individual burnout prevention strategies. In addition, hospital administrators and nurse managers must be aware of the sources of burnout within the health care organization to address these proactively and avoid nurse burnout (Singh et al., 2023; WGU, 2019).

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