Causes and Factors of Nurse Burnout

Job burnout and satisfaction are two areas that should often considered when taking a position as a nurse. Dissatisfaction among workers in high-stress environments and jobs has become more noticeable issue in recent years, especially in the field of nursing. This literature review aims to understand the factors and causes of burnout within high-stress positions, such as nursing the Emergency Department (ED) and in critical care units (Adriaenssens, De Gucht, & Maes, 2015). Nurses in specific departments, such as the ED or ICU, have higher stress levels than nurses in other departments due to work environments and conditions (Andriaenssens et al., 2015; Munnangi, Dupiton, Noutin, &Angus, 2018).

Rozo, Olson, Thu, and Stutzman define burnout as emotional exhaustion, low self-esteem, and having a lack of empathy (2017). Munnangi, Dupiton, Noutin, and Angus define it as a response by professional care providers to stressful environments which manifests as depersonalization, emotional exhaustion, and feelings of diminished personal accomplishments (2018).  Higher perceived stress levels directly correlation to stress-induced illnesses and higher levels of emotional exhaustion (Munnangi et al., 2018). For many reasons, burnout in the nursing field is detrimental. It has both a negative impact on nurses’ well-being, as well as the patient’s (Rozo et al., 2017). 

The purpose of this paper is to address the causes, factors, outcomes and possible solutions to issues associated with compassion fatigue (CF), compassion satisfaction (CS), and burnout. This literature review explores eight articles which address causes and factors of the nurse burnout in acute or emergent care settings. A literature review was conducted using search terms burnout, compassion fatigue, compassion satisfaction, factors or causes or influences, personality, and emergency department in EBSCOhost. A total of 449 articles were identified and parameters within the search included articles written in English and a publication date from 2014 to 2019. 

Major Causes and Factors of Nurse Burnout

The research shows that the causes and factors that lead to burnout are complex and multifaceted (Bruyneel, Thoelen, Andriaenssens, & Sermeus, 2017). They extend anywhere from environmental pressures to personality (Molavynejad, Babazadeh, Bereihi, & Cheraghian, 2019; Munnangi et al., 2018).

Environment

 Work environment has been determined as a primary cause of work stress, which can potentiate burnout and CF. Munnangi et al. identify work environment as a primary cause of burnout, perceived stress, as well as job satisfaction. Work environments in trauma units and EDs can be preceived as higher stress than other units, which is determined by a variety of factors (2018). Rozo et al.’s study presented four common themes among emergency department nurses which caused burnout: work environment, perception, workplace violence, and moral distress. According to the study, “work environment” was the most common reason for nurse burnout, partially due to overcrowding (2017). Overcrowding was due in part to poor staffing, which increased the length of work shifts, leading to chaotic and stressful work environments (Rozo et al., 2017). When overcrowding occurs, job demands increase. Adriaenssens et al. discovered a positive correlation between emotional exhaustion and job demands, meaning the higher the workload, the higher the stress levels (2015).

In their 2017 qualitative study, Rozo, Olson, Thu, and Stutzman conducted a similar study which used a phenomenological approach to better understand the factors that lead to burnout among ED nurses. The five nurses that were interviewed identified four common themes which caused burnout. The themes presented were work environment, perception, workplace violence, and moral distress. Nurses are particularly susceptible to burnout due to their work environments which often include long shifts, exposure to trauma, heavy workloads, and illness (Rozo et al., 2017).

along with poor staffing, long work shifts,  (2017).  

Management and Support

 Poor management in any field of work can be frustrating, but great management can make all the difference. Munnangi, Dupiton, Boutin, and Angus published a study in 2018 which concluded nursing management and administration are key factors in job satisfaction and burnout. One of the roles of nurse managers (or nursing administration, depending on the hospital) is adequate scheduling and staffing of the units. An understaffed unit can lead to poor work environment, but it can also cause stress because of patient-to-nurse ratios (Mudallal et al., 2017). High patient-to-nurse ratios also increase nurse turnover rates and decrease the productivity within an organization (Munnangi et al., 2018). Inadequate staff coverage brings about longer or more frequent work shifts, and the environment may be altered by enhanced expectations of patient care (Rozo et al., 2017).

Years of Work Experience

 Multiple studies have confirmed a significant correlation between newer nurses (or nurses with less experience) in critical care units with burnout dimensions (Bruyneel et al., 2017; Hunsaker, Chen, Maughan, & Heaston, 2015). Hunsaker et al. (2015) examined compassion satisfaction, compassion fatigue, and burnout in emergency department nurses in the United States. The main objective of their study was to determine what components affected these three factors: burnout, CF, and CS. Data was collected through a nonexperimental Professional Quality of Life Scale Version Survey (ProQOL 5) and a demographic survey to determine which components (work-related or demographic) affected these factors. The results yielded low to average levels of CF and burnout for these nurses and high levels of CS. Age was the major demographic characteristics which lead to the highest rate of burnout and compassion fatigue. Older nurses with more experience in the emergency department showed a higher level of compassion satisfaction, while CS were higher in those with higher education levels, shorter shifts, and more years in the nursing profession (Hunsaker et al., 2015). These results were mirrored by Bruyneel’s study, which suggested that nurses with fewer years of experience were more likely to face turnover intention that nurses with more experience (2017).

However, that information was challenged by a study published earlier this year. Molavynejad, Babazadeh, Bereihi, and Cheraghian conducted a study on the relationship between personality trains and burnout, and found that there was no link between years of workplace experience and burnout (2019). Molavynejad et al. used a convenient sample of 106 oncology nurses to participate in a 22-item survey to assess levels of burnout, personal accomplishment, and depersonalization. The results showed that personality and coping mechanisms were more indicative of burnout than years of work experience (2018).

Gender

A study conducted from 2014 to 2015 by Bruyneel et al. determined that female nurses were more likely to have turnover intention, or intentions to leave her current job, compared to males. Eleven emergency departments in Belgium participated in this cross-sectional multicenter survey. Of the 11 emergency departments, 294 ED nurses answered the survey questions.  A moderate mediation analysis was used to assess the effects of job characteristics and work environment on turnover intention (based on emotional exhaustion and job satisfaction).

However, the research in terms of gender is not conclusive. Hunsaker et al.’s research contradicts the Bruyneel study. No significant difference between females and males was found between levels of burnout, CF, and CS when compared (2015).

Nurses in specific departments, such as the ED or ICU, have higher stress levels than nurses in other departments due to work environments and conditions (Andriaenssens et al., 2015; Munnangi et al., 2018). Higher perceived stress levels have a direct correlation to stress-induced illnesses and higher levels of emotional exhaustion (Munnangi et al., 2018).

Major Consequences of Burnout

Effects on Patients

Patient outcomes is another focal point of these studies as it is directly linked to dissatisfied nurses. (….) Patients are more likely to report dissatisfaction with their care (..) and experience a lower level of care provided when their care comes from nurses experiencing burnout (Munnangi et al., 2018). Hospitals with higher patient-to-nurse ratios have higher death and “failure to rescue” rates, which is also associated with

Burnout and CF are associated with having a negative impact on patient care in addition to increased patient dissatisfaction, while CS is not (Hunsaker et al., 2015).

In addition, burnout also takes a toll on the patients for which the nurses care. Burnout has been linked to devastating results, such as deadly medication errors, high turnover rates, and even nurses leaving the practice. (Rozo et al., 2017; Mudallal et al., 2017). and substance abuse issues, depression, and permanently leaving the nursing field (Rozo et al., 2017).

Both articles address the main factors associated with ED nurse burnout and acknowledge that environmental factors, such as poor management, scheduling, and long shifts, may lead to dissatisfied nurses. Both concluded that burnout is a detrimental problem within ED settings and taking care to reduce these precipitating factors and reasons could be beneficial. Rozo et al. focused on the causes of burnout and concluded that “work environment” was the most common reason for nurse burnout. However, Hunsaker et al. looked at the bigger picture that encompassed burnout, CF, and CS and concluded that age and gender were the factors that put ED nurses at highest risk.

In addition, a participant from the 2017 study stated that overtime, nurses become “mean and bitter” (Rozo et al., 2017), while the results from the 2015 study suggested that nurses with more experience and more time in the ED have higher CS (Hunsaker et al., 2015), which suggests that more experienced nurses are happier. Lastly, Hunsaker et al. (2015) conducted a nonexperimental quantitative study, contrasting the qualitative study conducted by Rozo et al. (2017).

Effects on Nurses

Bakhamis, Paul, Smith, and Coustasse looked at the registered nurse shortage in the United States and considered the role of nurse burnout in relation to the shortage. There are approximately three times the number of nurses in the medical field in the U.S. than sugeons and physicians, so a decrease in nurse burnout could be

According to the World Health Organization report in 2006, there was an immense nursing shortage internationally (Mudallal et al., High turnover rates, leading nurses to eventually leave the field, lack of motivation, and an international nursing shortage, may be some of the consequences (Mudallal et al., 2017).and can contribute to physical, emotional, and mental illness

Effects of Hospitals

Implications and Recommendations

Identifying major themes among dissatisfied nurses could lead to more awareness and prevention of nurse burnout. With more awareness, more possible solutions can be tested to mitigate the consequences of burnout. Hunsaker et al. (2015) concluded that older nurses and those with more experience in the ED show less burnout and CF in their profession, which could indicate that more confident, competent nurses have an easier time on the job and higher levels of CS. Subsequently, this could mean that introducing new graduate programs or mentor programs may be helpful to the less experienced nurses.

Another common theme between the articles is that poor management and poor administrative support may lead to nurse burnout. When nurses are not being supported properly, there is a higher likelihood for burnout. Support systems could play a role in reducing that likelihood. The studies have shown that supportive administrative staff, management, and coworkers are key determinants in nurse satisfaction (Munnangi, 2018 & …….). Creating a cohort system for incoming nurses or pairing them with a more experienced nurse a mentor, could help nurses feel more supported in the workplace. They should also be available to those at a higher risk for burnout and should be recognized quickly and counseled appropriately (Hunsaker et al., 2015). By being able to identify the predicting factors of burnout, the nursing management staff could identify early signs of burnout and attempt preventive measures.

It is also important to understand that nurse burnout does not just affect the individual or the unit; it is a hospital wide challenge. NURSING SHORTAGES. As more insurance companies are not reimbursing based on patient satisfaction, the more satisfied the patient, the more reimbursement is distributed (Hunsaker et al., 2015). Because of the structural change in reimbursement, it is necessary to acknowledge and mitigate the causes and predictors of compassion fatigue and burnout. When the nurse is happy, the patient is usually happy (Hunsaker, 2015). By identifying which characteristics and factors propagate burnout, CF, and CS, emergency departments can reduce the risk of nurse and patient dissatisfaction.

References

• Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies, 52, 649-661.doi: 10.1016/j.ijnurstu.2014.11.004
• Bruyneel, L., Thoelen, T., Adriaenssens, J., & Sermeus, W. (2017). Emergency room nurses’ pathway to turnover intention: A moderated serial mediation analysis. Journal of Advanced Nursing, 73(4), 930–942. https://doi.org/10.1111/jan.13188
• Bakhamis, L., Paul III, D. P., Smith, H., & Coustasse, A. (2019). Still an Epidemic: The Burnout Syndrome in Hospital Registered Nurses. Health Care Manager, 38(1), 3–10. https://doi.org/10.1097/HCM.0000000000000243
• Hunsaker, S., Chen, H.-C., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 47(2), 186–194. https://doi.org/10.1111/jnu.12122
• Munnangi, S., Dupiton, L., Boutin, A., & Angus, L. D. G. (2018). Burnout, perceived stress, and job satisfaction among trauma nurses at a level I safety-net trauma center. Journal Of Trauma Nursing: The Official Journal Of The Society Of Trauma Nurses, 25(1), 4–13. https://doi.org/10.1097/JTN.0000000000000335
• Molavynejad, S., Babazadeh, M., Bereihi, F., & Cheraghian, B. (2019). Relationship between personality traits and burnout in oncology nurses. Journal of Family Medicine & Primary Care, 8 (9), 2898–2902. https://doi.org/10.4103/jfmpc.jfmpc_423_19
• Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses' burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry: a journal of medical care organization, provision and financing, 54, 46958017724944. doi:10.1177/0046958017724944
• Rozo, J. A., Olson, D. M., Thu, H. S., & Stutzman, S. E. (2017). Situational factors associated with burnout among emergency department nurses. Workplace Health & Safety, 65 (6), 262–265. https://doi.org/10.1177/2165079917705669