Nursing Burnout: A Concept Analysis

Nursing Burnout: A Concept Analysis

 Nurses have a load they are carrying on their shoulders when caring for patients in any environment. “Nursing staff have certain professional expectations and inclinations that make them susceptible to suffering burnout” (Manzano-Garcia & Ayala, 2017). With nurses being the forefront of healthcare, burnout is so high within this profession. A concept analysis is an approved language used to explain certain defining attributes. Concept analysis can be used in the nursing profession to test theories and develop new theories in different concepts and aspects seen throughout different practices. Burnout needs to be looked at closer in the field of nursing. Nurses become exhausted emotionally, physically, and mentally with long work hours, inability to take proper breaks, short staffing, and no appreciation which causes nurses to leave the profession. The importance of examining nurse burnout in a concept analysis cannot be overstated. This paper will define and explain what nurse burnout is while providing literature reviews, one antecedent with a one consequence, two empirical referents on how to measure burnout, applying the application of theory using the conservation of resources theory, then closing with a conclusion.

Definition and explanation of nursing concept

The definition of burnout from the Merriam Webster dictionary says, “an exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration” (Burnout, n.d.). Burnout is nothing new and is continuing to grow in the nursing profession. Burnout can lead to many issues with nurses and nurse practitioners alike. Among many examples of burnout, Raferty & Poole (2015) found compassion fatigue, physical, mental, and emotional exhaustion, stress, decrease in personal goals, poor physical and mental health, self-conscious about job performance, broken relationships, decrease in productivity, increased call-ins are among the mix. Burnout is believed to be more common in healthcare because of the high stress levels involved with their job, performance, and work environment (p. 653). Nurses have the responsibility of many different types of patients. They give so much of themselves, physically, emotionally, and mentally, to properly care for patients, which leads to nurse burnout. There are many names for nursing burnout, but all lead to the same problem where nurses become overwhelmed with the duties needed to complete their shift. Burnout is not limited to just nurses; it can affect anyone working in a high-stress work environment. Burnout happens when personal achievements are not completed, and job discomfort increases causing a decline in effort and overall health. The affects happen gradually over time. The very things that brought one to nursing, such as passion and enthusiasm, are taken over by thoughts of frustration and feeling unappreciated which they never had before deciding to become a nurse.

Literature Review

All the literature I read for nurse burnout showed how large a problem, it is and how and why it needs be prevented. Burnout is individualized causing long effects on nurses, environments and patient safety and outcomes. Call-offs leave nurses short staffed leading to more errors and less time for each patient leading to burnout. The literature showed that physical, mental and emotional fatigue, stressful work environment, anticipated failures and job discomfort are directly related to burnout (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). Nurses working short staffed, long hours and mandated overtime give their time and energy to patient care which leads to burnout over a period of time.

Job related stress controls how one sees themselves and control their temper and attitude. With burnout being a result of continued high stress levels at work, the literature also supports this type of levels can lead to decrease in good health and increase the development of a disease (Savagioni et al., 2017). Increased levels of stress and inability to reach personal goals can lead to different consequences such as negativity among and towards workers, attitudes, and undesirable patient satisfaction scores. 

Literature states burnout can happen to anyone, anywhere and anytime while working in a stressful environment. “Growing evidence has accumulated in the past decades that burnout is a widespread phenomenon among health professionals with adverse consequences on individual health, organizational functioning, quality of care, and patient outcome” (Heeb and Haberey-Knuessi, 2014, p 1).

Empirical referents can be different types of questionnaires. Nurses and nurse practitioners could be assessed by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The survey includes personal and work-related characteristics. According to Heeb and Haberey-Knuessi (2014), a 22-item questionnaire which reflects the different levels of emotional fatigue, inability to focus on future, and decrease in completion of personal goals (p. 2).

Chronic stress at work can cause many problems to the physical and mental health of nurses such as high cholesterol, diabetes, different heart diseases, pain with changes in experiences, chronic fatigue, migraines, stomach issues, breathing problems, and injuries to any part of body (Savagioni et al., 2017). Education and interventions, beginning sooner than later, will lead to better outlooks towards the personal and work environments where the high levels of burnout occur (Savagioni et al., 2017).

Defining Attributes

An attribute identifies parts of a concept. Research has shown a high-stress environment, working long hours, mental, physical and emotional fatigue, stress, and decreases in personal goal completion are some of the most important attributes to nurse burnout. Nursing requires the delivery of humane, empathetic, culturally sensitive, proficient and moral care, in working environments with limited resources and increasing responsibilities such as the imbalance between providing high quality care and coping with stressful working environments can lead to burnout (Khamisa, Oldenburg, Peltzer & Ilic, 2015, p. 653). Things adding to the stressful work environment include no leadership, no guidance, decrease meshing of peers and patients, ever-changing demands and mandatory overtime go with many areas of burnout (Khamisa, Oldenburg, Peltzer & Ilic, 2015, p. 653).

Antecedent and Consequence

Antecedents looks at data that can cause a concept. The antecedents physical and mental fatigue caused by high acuity patient loads and unrealistic expectations of staff. Physical emotional, and mental fatigue cause nurses to be pushed past their limits when caring for patients. Physical, emotional and mental fatigue cause reactions that lead to burnout in this profession.

 A consequence of nurse burnout is where the antecedents result in overworked staff who have to bear heavy workloads and cannot provide proper care to the patients that lead to poor patient outcomes. Staffing issues reports as one of the highest reasons for nurses because of an inability to meet the demands of their job due to poor staff management, which may negatively affect morale and lack of resources which may negatively affect patient care (Khamisa, Oldenburg, Peltzer & Ilic, 2015, p. 660).

Empirical Referents

One empirical referent is a subscale that assesses various aspects of burnout, specifically emotional fatigue, depersonalization, and personal accomplishment (Gómez-Urquiza, et al , 2017, p. e3). Maslach Burnout Inventory-Human Services Survey (MBI-HSS) is another empirical referent to measure levels of emotional exhaustion, fatigue, depersonalization, and decrease in personal accomplishment (Heeb and Haberey-Knuessi, 2014, p. 2). Nurses and nurse practitioners can be measured using both empirical referents to determine nurse burnout.

Construct Cases

Situations made up or true events showing the use or absence of nursing burnout. An imaginary picture showing how the attributes define nurse burnout. 

Model Case

 A nurse named Corrine works in a hospital full-time on a cardiac step-down unit while attending school to earn her BSN. She is a divorcee with one daughter. Corrine recently lost her mother and father, who was her rock. She has met someone who she intends to marry in the next year. Corrine works an extra day a week to have extra money to keep up with the bills. She has worked overtime for 6 months now. Every shift she has to stay over to finish charting for the day. She has volunteered to be a super user for nursing skills and computer skills checkoffs. Corrine has had lots of gastrointestinal problems. Lately, Corrine has become easily frustrated and angry. Her patients have made complaints about speaking rude to them and being rough while moving them. Corrine also is the president of the PTO at her daughter’s school.

 The model case shows many attributes of nurse burnout. Corrine work and personal life are both very stressful. She works forty hours a week in a busy medical/surgical unit, works more and longer hours, which adds to fatigue and are mentally, physically, and emotionally draining. Corrine works and lives in a high stress place. Like any mother and nurse, she puts her family before herself, ignoring all her own health problems.  

Borderline Case

Melissa is a nurse on a busy SICU unit. She is married with two teenage daughters. Melissa has decided to return to school to receive her Nurse Practitioner degree.  She picks up extra shifts for extra money for bills and pay for her classes while taking no time off for herself. Melissa has become frustrated and angry, causing her patients to complain to the nurse manager with her being rude, disrespectful and forgetful. Melissa would like to have more time to herself, but can’t due to school and extra, long hours at work. 

The borderline case shows that Melissa shows many attributes of burnout because of the long, extra hours she works at her stressful position at the hospital. She needs some time off for herself.

Contrary Case 

 Jackie is medical/ surgical nurse who works three 12-hour shifts per week. She treats her patients with respect, dignity, and made to feel like they are her family members. She has one son who plays baseball. Jackie has regular yearly check-ups with her family physician, gynecological physician, eye doctor, and dentist. She knows she needs to lose a few pounds but eats a healthy diet. Jackie is active with her son’s baseball team, walks regularly, and enjoys spending time with her family and friends. This case shows nurse burnout is not involved in Jackie’s life. She has an even balanced life between work and home life.

Theoretical Application of Concept

 The purpose of a concept analysis is to clear up inconclusive concepts in a theory. In this paper, I chose the conservation of resources theory. It focuses on four aspects such as objects, conditions, personal characteristics, and energy (Prapanjaroensin, Patrician, & Vance, 2017). This theory can be used to explain how burnout exists in the nursing profession. According to Prapanjaroensin, Patrician, & Vance (2017), nurse burnout affects work performances, increase tiredness, and decreases the quality of patient care. The conservation of resources theory can decrease nurse burnout while increasing research to look at the relationship between nurse burnout and the care they provide to their patients (Prapanjaroensin, Patrician, & Vance, 2017). Nurses need to be physically and mentally stable in order to show patients compassion, respect and dignity. Nurses need to take care of themselves, physically and mentally, in order to provide proper care to patients’ health.  

Conclusion

 The concept chosen for this concept analysis paper was burnout. Burnout is caused by many different things in the nursing profession: short staffing, high acuity patient load, long work hours, emotionally, physically, and mentally draining, physical and mental fatigue, and no teamwork while working. Poor health conditions of nurses increase when placed under stress and poor working conditions. Knowing the concepts seen in advanced practice nurse settings, such as a Family Nurse Practitioner, can help in understanding how the concept goes together in a nursing theory. Theories can help nurse practitioners provide better patient care by taking care of themselves. Nurses and nurse practitioners focusing on their self-care will provide better patient care and outcomes. The conservation theory of burnout affects over-all health by decreasing the abilities to cope which in turn cause physical, mental and emotional fatigue, lowering the ability to be social (Khamisa, Oldenburg, Peltzer, & Ilic, 2015).

 Through my research on burnout for my concept analysis paper, I have learned a little more about what it means to become burnout in nursing. I can see there are times I fall into the burnout stage at work myself. I become physically, mentally, and emotionally drained most of the time at work. Now, I have learned ways to recognize the signs and symptoms of burnout. I have also learned ways to address the signs and symptoms of burnout with self-care techniques. I believe this paper will help me grow as a nurse into a nurse practitioner who can help teach self-care theory to the patients I see in my practice.

References

• Burnout. (n.d.). Retrieved November 10, 2019, from https://www.merriam-webster.com/dictionary/burnout
• Filgueira Martins Rodrigues, C. C., Pereira Santos, V. E., & Sousa, P. (2017). Patient safety and nursing: interface with stress and Burnout Syndrome. Revista Brasileira De Enfermagem, 70(5), 1083-1088. doi:10.1590/0034-7167-2016-0194
• Gómez-Urquiza, J. L., De la Fuente-Solana, E. I., & Albendín-García, L., Vargas-Pecino, C., Ortega-Campos, E.M., & Canadas de la Fuente, G.A.  (2017). Prevalence of burnout syndrome in emergency nurses: A meta-analysis. Critical Care Nurse, 37(5), e1-e9. doi:10.4037/ccn2017508
• Heeb, J. & and Haberey-Knuessi, V. (2014). Health professionals facing burnout: What do we know about nursing managers? Hindawi Nursing Research and Practice, 2014 (681814), 1-7. dx.doi.org/10.1155/2014/681814
• Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International Journal of Environmental Research and Public Health, 12(1), 652-666. doi.org/10.3390/ijerph120100652
• Manzano-García, G., & Ayala, J. (2017). Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study. Plos One, 12(4), e0175352. doi:10.1371/journal.pone.0175352
• Prapanjaroensin,A., Patrician, P.A. &Vance, D. E. (2017). Conservation of resources theory in nurse burnout and patient safety. Journal of Advanced Nursing, 73(11), 2558-2565 https://doi.org/10.1111/jan.13348
• Raferty, C. & Poole, L. (2015). Nurse practitioners: Do we care? The Journal of Nurse Practitioners, 11(6), 653.
• Salvagioni, D. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. d. (2017). Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. Plos ONE, 12(10), 1-29. doi:10.1371/journal.pone.0185781