Burnout. It affects the retention rate of nearly every hospital in the country. It causes nurses to feel exhausted and unable to care for their patients. It prevents new people from seeking a career in nursing. Are you one of the many nurses experiencing burnout? Here’s how to recognize burnout, ways to treat it, and strategies to prevent it from happening to you.

How Big of a Problem Is Burnout?

“Burnout is a very big problem, and it’s widespread,” says E. Carol Polifroni, RN, EdD, CNAA, associate professor of nursing, University of Connecticut, Storrs, CT, and a recognized expert on workforce issues.

In a 2001 ANA staffing survey, nurses were asked how they felt when they left their jobs each day. The majority of nurses responded with the following: “I feel exhausted and discouraged”; “I feel saddened by what I couldn’t provide for my patients”; “I feel powerless to effect change necessary for safe, quality patient care.”¹ “When you’re taking care of seven, eight, nine patients on a day shift, that’s an overwhelming amount of stress. Is it any wonder that nurses feel burned out?” asks Polifroni.

Warm, Warmer, Burned Out

Burnout is classically viewed in three phases, according to Polifroni. Phase one of burnout is the stress arousal phase. This happens when the nurse experiences anxiety, insomnia, forgetfulness, inability to concentrate, feelings of being overwhelmed, frustration, sadness, and new physical symptoms, such as headaches. If the nurse does not recognize that these symptoms require intervention, Polifroni says, the next phase of burnout takes hold.

The second phase is energy conservation. In this phase, the nurse starts to call in sick to work, or he or she may be chronically late getting to work. Deadlines are not met, a cynical or resentful attitude develops, and a persistent sense of fatigue pervades both the nurse’s personal and professional life.

If the signs of this phase are not addressed, the symptoms become chronic, leading to a sense of isolation and overwhelming exhaustion. According to Polifroni, this isolation and exhaustion are the last phase of burnout when nurses finally leave their jobs.

Causes and Remedies

What causes burnout in the first place? Burnout on the job can be a direct result of inadequate staffing, according to Polifroni. If hospital administrations don’t work with employees to ensure adequate staffing ratios, nurses need to speak with their feet, says Polifroni. “I’m not suggesting job-hopping. But a nurse does not have to stay in a job because it’s the only game in town,” she adds.

It isn’t just poor staffing that contributes to burnout. It can also be the nurse’s lack of autonomy at the bedside. “Some things as fundamental as respect for what a nurse knows and what a nurse does are at issue,” says Polifroni. When a nurse has to call in a resident or intern to the bedside to make a decision that the nurse is capable of making, the nurse’s knowledge and skills are ignored and diminished. “When this happens, the system loses, the nurse loses, and the patient loses.”

In addition to staffing and autonomy, lack of recognition of the professional nurse contributes to burnout. Instead of giving bonuses to attract new nurses, hospitals should use bonus money to help the nurses who choose to remain, according to Polifroni. She adds that spending money on evaluating a new model of care or providing more personnel who can help nurses stay at the bedside are ways of recognizing the value of the professional nurse and avoiding burnout.

Burning Out Nurses — or Empowering Them

Burnout happens in every profession because there simply might come a time when you don’t want to do what you do anymore. But burnout in nursing is happening early on, often within the first four years of practice.² “Nursing is asking men and women to walk through the door and do the impossible every day,” says Polifroni. “Institutions should be saying, ‘We’re not going to ask you to do the impossible anymore. We’re asking you to engage in one of the most powerful experiences of your life, and we’re going to support you.’”

If institutions were to change the work environment through decreasing the nurse-patient ratio, increasing nurses’ pay commensurate with assigned responsibility, and valuing and recognizing the nurse’s skills and knowledge, we wouldn’t have to talk about burnout, according to Polifroni. “I don’t like talking about burnout. It’s negative. It’s reactive. I’d rather talk about empowerment, which is positive and proactive. If we empower nurses with appropriate staffing, autonomy at the bedside, and recognition of their value, we wouldn’t have to discuss burnout in the first place.”