We often think of the pandemic as an obstacle undermining many of our own personal goals, but we often take less time to consider the many implications it has on others, specifically of those who have been hit the hardest: our nurses. Over the past year, the pandemic has brought the long-standing issue of burnout in the nursing community to light. Today, approximately 1 in 5 nurses experience some form of burnout and a recent poll has shown that a staggering 68% of nurses considered leaving their position . Nurses are an indispensable part of our hospitals, spending the most time caring for those most important to us. Prioritizing our nurses’ physical, emotional and mental wellbeing, therefore, is the bare minimum.
But what is burnout really? Colloquially, burnout is a term used to vaguely describe stress, depression, lack of motivation, or exhaustion . However, the term burnout has been extensively researched. In fact, it was recently described by the WHO as an “occupational phenomenon” and added to the “International Classification of Diseases, 11th Revision” . Throughout the scholarly literature, burnout is classified by the Maslach Burnout Inventory (MBI) a widely used scale based on three factors: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) .
According to a 2017 study done by Rola Mudallal, one of the biggest contributors to emotional exhaustion is hospital type . In Jordan, nurses in public Ministry of Health (MOH) hospitals exhibited the highest levels of EE and DP, and the lowest levels of PA . Likewise, nurses in the ICU and surgical centers experienced the highest amounts of EE and DP . The study concluded that “favorable environment in terms of better hospital organization, support for quality of care, leadership and collegial support, staffing and resource capability, nurse-to-patient ratio, as well as low daily census rate,” all contribute to these superior levels of EE, DP, and PA . In general, these unfavorable hospital settings were a major player in decisions to leave or consider leaving a nursing position. Even before the pandemic, burnout among nurses was a growing problem–in 2017, 31.5% of nurses cited burnout as the reason they left their job, up from 17% in 2007 . This growing problem has only been exacerbated by COVID-19; understaffing in hospitals in New York and Illinois, severe nursing shortages, high patient volumes, pandemic-related anxiety, are sending our nurses, the backbone of our healthcare system, skydiving without a parachute . Consequently, patient care is suffering, the likelihood of medication error is increasing and patient dissatisfaction and complaint is increasing .
While the scientific studies detailing the factors which determine burnout give us great clarity, focusing solely on the literature would be a disservice to our nurses. Individual experiences are typically more enlightening in connecting with the strife and struggle of others and understanding the status quo of the nursing career around the country is no different. Sue Wolfe, a nurse from Madison, Wisconsin working at the university hospital for 38 years shares her experience during the pandemic. She explains that she has “never seen anything like this before,” and that it’s “hard to see these people” because she and her colleagues are “not able to give the care that they want to give” . She goes on to say that “it’s frustrating,” and she feels “angry,” that the unvaccinated who have COVID-19 are putting the patients she works so hard to treat at risk . She tells her story while holding back tears, and the defeated tone in her voice is simply heartbreaking; it is unacceptable for someone who cares so deeply about the quality treatment of her patients to be pushed into such a corner. Unfortunately, Wolfe’s pandemic experience is not unique. This wave of burnout has been referred to by nurses around the country as a “rope frayed at both ends” and a “death by a thousand cuts” . This is unsustainable–as Dr. April Kabu, President of the American Association of Nurse Practitioners, points out, “we’re people, we’re humans, and we need time to breathe too” .
But there is a path forward. Internationally, authorities in both the United Kingdom and Australia are calling for recently retired nurses to return to practice and their plan includes considering fast-tracking the associated registration process, and establishing a COVID-19 temporary register for nurses who have left . This plan would improve the shortage of nurses and help hospitals that are understaffed. Along with addressing the immediate problems of the pandemic, there must be long-term reform of hospital systems, which includes possible peer support groups, chief wellness officers and changing the culture where nurses will not be looked down on for speaking up about their mental health . To this point, the National Academy of Medicine recommends “health care organizations routinely measure and monitor clinician burnout and hold leaders accountable for the health of their organization’s work environment” . Furthermore, the same 2017 study done by Rola Mudallal identified LEBs or leader empowering behaviors such as “enhancing the meaningfulness of work, fostering opportunity to participate in decision making, and expressing confidence in high performance,” all lead to decreased depersonalization and emotional exhaustion, along with increased feelings of personal accomplishment . These results show that introducing LEBs to a workplace environment can significantly decrease the feelings of burnout that nurses experience on a day-to-day basis.
While hospital administration and policy reform are an imperative part of this process of change, no amount of reform can alleviate the pressure of overflowing hospitals. We as a community must be a part of this process; whether that means getting the vaccine or booster, quarantining when experiencing symptoms, or consistently following mask-wearing guidelines. Burnout is not caused by one traumatic event, but rather a consistent overload of our hospitals, and by consistently doing our part in minimizing the number of potential hospitalizations, we can maximize the effect of administrative and policy reform on our healthcare system.
Edited by: Arjun Singh
Illustrated by: Neha Adari