article peer -review

The degrees of healthcare burnout

Niniana Oehler, November 16th, 2021

The mental wellbeing of employees has long impacted the future of companies and the global pandemic of COVID-19 has shed new light on a mental health crisis. Whether employees feel motivated, are productive, safe at work and overall healthy can make or break an organization’s success. Chronic work stress can lead to burnout and throw a person’s physical, mental and social wellbeing out of balance (Leka et al., 2003) Other factors come into play when the company’s mission is to take care of the sick. Between nurses, patients and entire corporations; who suffers really when healthcare professionals burn out?

While stress symptoms can influence the health of employees in many fields, healthcare professionals are more often exposed to chronic stress leading to the according symptoms of burnout such as depersonalization, reduced performance and psychological exhaustion.

In times of a global pandemic, they are more at risk of burning out due to rising census and staffing shortages leading to longer, and more exhausting shifts (Noguchi, 2021). A Polish study on nursing personnel showed drastic changes in nursing care by comparing employees who worked a total of 8 hours to 12-hour shift workers. The study concluded that employees who worked a 12-hour shift lacked attention during crucial skills in resident care and alertness to resident behavior (Jennings, 2008). Even back in 2012 staffing shortages and their effects within the healthcare field were researched and raised red flags around the world. During a survey conducted on 12 European countries and the United States, researchers came to the result that an average of 6.1 nursing staff are attending the needs of 25 patients, ranging from 2.7 in the hospitals with poorest staffing to 13.8 in the best-staffed health institutions. This shows that the staffing disparities vary greatly depending on location even within the United States causing one nurse to take care of at least 9 patients in a worst-case scenario (Aiken et al., 2012).

Knowing the long hours healthcare professionals work and the vast number of tasks they complete, it seems more than likely to assume that patients often go without the attention their condition requires. Besides the quality of care provided studies have also shown that a person’s capacity of empathy is closely connected to the impact of stress factors. Empathy is the key to understanding and sympathizing with another person’s emotions. The ability to form inter-human connections, show compassion and feelings becomes especially important in healthcare. When understanding a patient’s feelings, healthcare professionals use very cognitive and emotive aspects of empathy, but empathy also incorporates a behavioral characteristic which comes into play when healthcare professionals troubleshoot and collaborate for a patients’ health benefits. A person’s capacity to be empathetic suffers through the burnout syndrome of dehumanization. Empathy requires a lot of energy from nurses, aides, et cetera which also explains why studies proved that high burnout can result from high empathy (Wilkinson et al., 2017). It becomes more and more clear that protection for healthcare workers need to be implemented externally, as the field has seen challenges even prior to the pandemic. In order for burnout to be eliminated in this industry sector, education about mental health and burnout awareness needs to be implemented to teach healthcare professionals how they can listen to their body and mind in order to fight the symptoms of burnout. Figure 1 shows the three different responses to work stress and any stressful situation. These categories are physiological, interpersonal and cognitive or emotional. The items highlighted in red are responses to stress that can be harmful and contribute to burnout. Do any of these look familiar? The green items are positive ways to deal with stress which allow a person to be resilient. The three areas overlap showing that they are connected and can interfere with one another. Therefore, the point of being resilient versus burning out lies in the middle, where all planes affected by stress join. Self-awareness is a skill which can and should be taught in the healthcare field to deepen employees’ understanding of their own mental health. Externally a healthy and engaging work environment can majorly impact the perception of stress factors as the interpersonal plane shows (Albott et al., 2020). The ability to openly communicate in the workplace is a key in avoiding and resolving stress factors. A Japanese study conducted among nursing professionals in long-term care facilities showed lower burn-out rates in nurses who were actively engaged not only in-patient care, but also the values of the company they work for. A better understanding of company values and better relationships to the administrative bodies of a healthcare facility seemed to have positive effects on a nurse’s performance and job satisfaction. As a direct result, this study strongly encouraged more conference meetings to encourage a discussion of feelings and values between nursing staff and management in order to foster engagement further (Saito et al., 2018).

Figure 1 Responses to stressful situation. (Albott et al., 2020)

In the worst-case scenario stress factors and burnout can actually influence the well-being of patients and risk their lives. To show an example of direct impacts of employees’ lack of mental health a study published by the American Journal of Infection Control suggests that almost 7 million patients in hospitals acquire infections while being treated for other conditions because of burnout. The study focused on information collected by a council report on 161 hospitals in Pennsylvania and drew connections between those infections and burnout. The two most common infections identified were urinary tract infections (UTIs) and surgical site infections. The study brought new insights into how nursing performance and care can be directly connected to health outcomes: “We found that increases in both urinary tract and surgical site infections were largely attributed to differences in nurse burnout; every 10% increase in burned-out nurses in a hospital increased the rate of urinary tract infections by nearly 1 per 1,000 patients and the rate of surgical site infections by more than 2 per 1,000 patients.” (Climiotti, et al., 2012). Close to 6700 nursing professionals participated in the study and over one third of these team members reported high levels of work-related burn-out. The study concludes by identifying short-staffing as major cause of stress factors for the hospital teams. It also suggests the possibility of preventing a total of 4160 infections in total by lowering the proportion of nurses with high burn-out from an average of around 30% to 10%. As the infections prolong the care of patients, the costs associated are immense. Just through this 20% change in staffing and investment into employees’ mental health the state of Pennsylvania could save $41 million along with saving lives and the trustworthiness of its healthcare (Climiotti, et al., 2012).

The research speaks for itself. Nursing professionals are not the only individuals who suffer when stress takes over. From families to patients to organizations, everyone is impacted when mental health is set aside out of desperation or financial concerns. A change within this system is long overdue and it is up to the healthcare industry and the public to take a stand. Now that our frontliners are needed more than ever, policy makers need to make reformative changes within healthcare while especially considering healthcare personnel. It is also time for the public to raise awareness for the working conditions of doctors, nurses and caregivers. The answers to this crisis may span from better education or mental health resources for healthcare professionals to completely revising the certification requirements for lower-qualified healthcare positions in order to avoid short-staffing. The time to act is now and the focus point now more than ever needs to be mental health.

Reference:

Aiken, L. H., Sermeus W., Van den Heede K., Sloane D.M., McKee M. et al. (2012) Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal. http://www.bmj.com/content/344/bmj.e1717

Albott, C. S., Wozniak, J. R., McGlinch, B. P., Wall, M. H., Gold, B. S., & Vinogradov, S. (2020). Battle buddies: Rapid deployment of a psychological resilience intervention for health care workers during the COVID-19 pandemic. Anesthesia and analgesia, 131(1), 43–54. https://doi.org/10.1213/ANE.0000000000004912

Cimiotti, J. P., Aiken L. H., Sloane D. M., & Wu E. S. (2012). Nurse staffing, burnout, and health care–associated infection. American Journal of Infection Control. http://doi.org/10.1016/j.ajic.2012.02.029

Jennings, B.M. (2008). Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK2668/

Leka, S., Griffiths, A. & Cox, T. (2003). Work organization & stress. World Health Organization. https://www.who.int/occupational_health/publications/en/oehstress.pdf

Noguchi, Y. (2021). Health workers know what good care is. Pandemic burnout is getting in the way. NPR. Retrieved from https://www.npr.org/sections/health-shots/2021/10/02/1039312524/health-workers-know-what-good-care-is-pandemic-burnout-is-getting-in-the-way

Saito, Y., Igarashi, A., Noguchi-Watanabe, M., Takai, Y., & Yamamoto-Mitani, N. (2018). Work values and their association with burnout/ work engagement among nurses in long-term care hospitals. Journal of Nursing Management, (4), 393. https://doi.org/10.1111/jonm.12550

Wilkinson H., Whittington R., Perry L., Eames C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research. http://www.sciencedirect.com/science/article/pii/S2213058617300025#bibl0005