Nurse Burnout: Physical, Emotional & Behavioral Signs

Introduction

The most common reason nurses cite for entering the profession is their desire to help others. However, because nurses are often placed in the role of caretaker, they seldom have the ability to engage in positive self-care — especially under highly stressful situations when a patient's life is at risk, or when the organization for which they work is understaffed yet depends upon split-second, accurate responses from its nurses. The result of these pressures is the phenomenon of nurse burnout, a state that manifests itself in physical, emotional, and behavioral symptoms and, if left untreated and ignored, can result in the nurse leaving his or her current position and even the profession of nursing entirely (Burnout: Warning signs, 2009). Nurse burnout is a serious issue, given the increasingly critical shortages of nurses across the nation. To reduce the rate of burnout among nurses, it is important to define its core features, which encompass physical, emotional, and behavioral manifestations.

Physical Symptoms of Nurse Burnout

Physical symptoms of burnout are manifestations that affect the physical body of the nurse. Nursing is a demanding profession — mentally, emotionally, and physically. Because of the lack of nurses at many facilities, "many nurses work 12-hour shifts and have more schedules during which they work on their feet all day, lifting, rolling, and moving equipment and patients" (Gelinas, 2003). A nurse can never simply "coast" through her day: unlike an office worker, he or she must be fully alert every second of a shift. The physical demands may manifest themselves in back pain, swollen feet, or other occupational injuries. In addition, the mental and intellectual demands placed upon nurses may produce physical symptoms such as high blood pressure, nausea, cravings for high-carbohydrate foods, an inability to eat, and other stress-response manifestations.

Additionally, like many shift workers — particularly those who see little daylight because of irregular hours — nurses may find it difficult to eat and sleep properly due to their schedules alone. This is how the nurse's environment can predispose her to an unhealthy physical state. A poor diet, addiction to caffeine or nicotine, and even reliance on prescription and non-prescription stimulants are ways that nurses may self-medicate to get through a difficult day, ironically sacrificing their own health while caring for the health of their patients. "Fewer nurses mean more work for all. Inadequate staffing results in a tailspin of events that is ultimately doomed to failure, resulting not only in loss of energy, burnout, and disengagement, but also eventual loss of nurses. Many nurses feel overburdened by heavy patient loads and the increasing intensity of service that sicker patients require. They'll work a double shift today when asked, but leave tomorrow" when the demands become too great and the nurse simply breaks down under the pressure (Gelinas, 2003).

The physical stresses on nurses demonstrate how health is holistic in nature — a nurse cannot be physically healthy enough to care for others if the environment places unsupportable physical and emotional demands on her. If the job requires heavy lifting, monitoring too many patients, and provides no counseling or professional support services, the nurse cannot physically sustain the demands of nursing over time, even if she can manage them in the short term. A lack of opportunities for positive self-care — such as access to healthy food and adequate sleep — is also a contributing factor in burnout. A hospital that lacks such elements is especially debilitating to nurses working long night shifts, when there may be few opportunities to obtain decent food or a proper place to rest.

Emotional Manifestations of Burnout

The emotional manifestations of burnout are symptoms that develop psychologically, within the nurse's inner life. They may be the most spiritually and psychologically debilitating, even though they are the least visible to others. Dealing with patients experiencing catastrophic illnesses can take an emotional toll on even the most mentally stable nurses. Nurses may feel as though no one truly understands them: even their partners outside of nursing may not fully comprehend what nurses deal with on a regular basis, day in and day out at the hospital. Nurses may also be isolated from one another at work — too busy to talk with like-minded colleagues in any meaningful way — or may encounter physicians who are unsympathetic to the unique demands of nursing. Increasingly, nurses are pressured to take on more at work to compensate for declining numbers of caregivers, and may be called upon to perform additional duties traditionally carried out by doctors and physician's assistants, straining the traditional definitions of their role.

Nurses may feel as though their unique professional insights are ignored. Despite their hard work and direct patient experience, hospital administrators and staff may not give credence to their concerns about patient care. Dealing with hospital bureaucracy compounds this frustration: "dysfunctional, unhealthy hospital cultures are one of the primary reasons nurses leave their jobs, not burnout. Lack of confidence and respect for hospital management, especially the front-line supervisor, is a key reason cited for leaving" (Gelinas, 2003). Depression, a sense of powerlessness, and feelings of being unappreciated — both at home and at work — are the hallmark emotional symptoms of burnout. Some nurses may experience anxiety attacks; others may struggle to get through the day because of low energy, grief, and persistent sadness. Of course, emotional and physical health are deeply interrelated: a lack of mechanisms for emotional self-care and a diminished sense of personal efficacy negatively affect every dimension of a nurse's health.

Conclusion and Solutions

Just as the manifestations of nursing burnout in this conceptual model are physical, emotional, and behavioral, the solutions must address all of these negative components of the phenomenon as they affect the nurse as a whole person. Interventions must strive to change negative hospital or care environments and improve nurses' health and capacity to provide adequate care. Ensuring adequate staffing to make nurses' duties manageable, reducing patient loads to improve the quality and accuracy of care, and providing professional support services for stressed nurses are all ways in which hospitals can address the contributing factors of burnout.