There isn’t a job on the planet that’s 100% “stress-free.” For those of us who don’t work in health care – you’ll often hear the joke: “at least nobody died” or “it’s not brain surgery”. That’s because the daily decisions most of us make at work have exactly zero impact on whether someone lives or dies.
For registered nurses: The exact opposite is true.
The very environment in which a registered nurse works is by nature extremely high stress. Every decision that’s being made can absolutely impact the lives of patients. So extra care needs to be taken to avoid the mental and physical health condition commonly known today as “nurse burnout”.
According to a report by the American Nurses Association 51% of nurses reported signs of burnout. 18% reported they plan to leave their current nursing role in the next 6 months. 4% are planning to leave the profession all together.
Every profession has its fair share of burnout – but those in nursing and other medical professions are at an increased risk for burnout. Especially during the last year and a half dealing with the COVID-19 pandemic.
COVID-19 Has Exasperated The Situation
The Bureau of Labor Statistics projects that employment for RNs will grow by 12% between 2018 and 2028. But it’s not enough to meet the demand needed of ever increasing hospital patient censuses. All being exasperated by COVID-19 and an aging Baby Boomer generation. Both of which have added to the ongoing issues of grossly understaffed hospitals, overworked nurses and a prevalence of nurse burnout.
Nurse Burnout Defined
The condition of nurse burnout can present as mental, physical, or emotional exhaustion. It is caused by long hours, the constant pressure of patient care decisions, and the mental hardship caused by caring for patients with poor outcomes or high acuity rates.
Signs of Nurse Burnout: Signs of burnout can include: anxiety, fatigue, an inability to concentrate, lack of energy, emotional exhaustion, disengagement, detachment, increased irritability, low motivation, poor career satisfaction and substance abuse.
By addressing nurse burnout immediately, nurses can avoid succumbing to depression and other mental health issues.
Causes for Nurse Burnout
Marshall University Study: Causes for Nurse Burnout
The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction
Pub Med: Nursing specialty and burnout
Lack of Sleep
When you’re working long hours, and multiple, consecutive shifts, it can be difficult to maintain a regular sleep pattern. In a study conducted by Kronos, 25% of registered nurses reported not being able to get enough sleep in between shifts.
It should come as no surprise that registered nurses with who work in high acuity areas (such as those with the nursing specialty of ED or ICU) are at an increased risk for nurse burnout.
Studies Done on Stress Related Burnout
Psychology, Health and Medicine Journal published a study that explored these trends for nurses within the ED nursing specialty. The study attributed the high burnout rate to the nature of working in an environment in which you have very little control over outcomes. The study also noted that ED nurses in particular have to deal with a patient population that can often be combative and mentally unstable.
The American Journal of Critical Care published a study on nurses with the nursing specialty of ICU. This study found that 25-33% of ICU nurses showed severe symptoms of nurse burnout. And 86% exhibited at least one symptom of nurse burnout. It was attributed that these high burnout rates are caused by the high morbidity and mortality of ICU patients. This is in addition to the frequent ethical dilemmas and traumatic situations ICU nurses are frequently placed in.
Lack of Support
Health care environments that are characterized by conflict, don’t have good communication systems set into place and have a complete lack of cooperation amongst departments will experience higher rates of nurse burnout. As opposed to environments where registered nurses feel supported, heard, and taken care of.
When environments aren’t set up to support health care staff, medical errors are also more likely to occur.
Emotional Weight of Patient Care
As mentioned above, registered nurses who work in critical care specialties, tend to have higher rates of burnout. This is tied to the constant letdown of working with patients with lower recovery and higher mortality rates. Both of which can lead to compassion fatigue in addition to increased rates of burnout.
Unhealthy nurse to patient ratios can also lead to increased burnout. In a report by Marshall University it was found that patient ratios higher than 1:4 led to increased burnout. And each additional patient increasing that risk by 23%.
Why is Nurse Burnout Dangerous?
Nurse burnout can have a negative, lasting effect on a nurse’s health and career. It can also have a huge impact on the reputation and financial astuteness of health care institutions. As a result of registered nurses not being able to provide the best care possible these institutions will that suffer from poor patient satisfaction scores.
High Turnover Rate
High turnover rates are directly tied to nurse burnout and have resulted in the ever-increasing staffing shortages we’re currently seeing across the nation.
A registered nurse who is burned out or experiencing burnout will be more likely to leave bedside nursing or leave the profession altogether.
Lower Quality of Care
Of course, a registered nurse who is at the end of their rope with their job, will not provide the highest quality of patient care. Mistakes due to emotional exhaustion can affect a patient’s comfort level. They can also lead to higher infection rates and decrease the all-around level of care patients receive.
Marshall University conducted a study that directly tied nurse to patient ratios of greater than 1:4 to a 7% increase in patient mortality rates.
Prevent Nurse Burnout
Following are some options registered nurses (and the health care systems they work for) can utilize to prevent nurse burnout.
Are You Naturally Resilient?
Having coping mechanisms in place to deal with trauma and emotional stress, helps to prevent burnout. Resiliency in nursing is simply a belief that you have a positive impact (no matter how small, no matter the result) on the lives of your patients. You spend less time asking “why” something happened. And you take the notion to “accept” the outcome and acknowledge that you did all you could do.
Those who possess a large capacity for “hope” in any circumstance tend to be more resilient than those that don’t have these things. The same can be said for those who have some sort of spiritual/religious background to turn to.
Do You Practice Self-Care?
“Self-care” is an umbrella term that means many different things to many different people. For some, it may be regular exercise. For another, it may be a strong meditation practice or using up available paid time off. For others, it may be a weekly massage. Whatever fills your soul with a little bit of peace and quiet is what self-care will mean for you.
Can Self-Care Prevent Burnout?
Registered nurses who have reported engaging in a healthy “self-care” routine are less likely to succumb to nurse burnout. If you aren’t sure what’s right for you, try a bunch of different things and see how each of them make you feel. This can be exercise (yoga, running, rock climbing, swimming, etc.). Or an extra-curricular activity (pottery making, cooking classes, scuba diving lessons, etc.). Or utilizing paid time off for mental health days or a staycation.
Have Your Checked for Symptoms?
Burnout can be more easily navigated when you are as self-aware as possible and notice when you start to feel the signs of burnout. Symptoms can include fatigue, apathy, hopelessness, detachment, etc. Take steps to acknowledge and care for yourself during these times.
This could look like advocating for yourself by seeing if you could perform administrative duties for a few days instead of working bedside nursing. Or you could take some time off work to regroup. Another option could be to make a temporary switch to a lower acuity level at your same hospital. Lastly, you could investigate travel nursing if you felt a little more control over when and where you work would be helpful.
Is Your Work Environment Supportive?
You spend anywhere from 36 to 48+ hours every single week at the hospital in which you work. A huge component of preventing nurse burnout is having strong relationships with your fellows. Registered nurses who reported that they had a supportive work environment reported lower rates of burnout.
A Healthy Hospital Environment?
A healthy hospital environment is of course required to build and foster these sorts of relationships. That starts with a management team who is experienced and effective with communications. Which brings us to our last tip on how to prevent nurse burnout…
Strong Administrative Support?
The responsibility for addressing nurse burnout does not lie squarely on a registered nurse’s shoulders. A strong health care institution will have strong policies in place to support their nursing staff and help circumvent nurse burnout all together. This includes healthy administrative policies designed to support health care staff. This can include such things as healthy work schedules such as three, 12-hours shifts a week, or five, 8-hour shifts a week. Avoiding nurse overtime. Implementing a mandatory vacation day policy. And instituting healthy and safe nurse to patient ratios.
The Pandemic’s Toll on Nursing
Due to the COVID-19 pandemic, a growing number of registered nurses are leaving the profession altogether. Some are seeking to continue their nursing education to qualify for other nursing positions outside of bedside nursing.
Reasons For Leaving or Changing Their Profession Vary
- Felt disposable when hospitals put them in unsafe work environments when PPE was scarce
- Inadequate staffing compromised patient care
- Patient censuses that were overwhelming
- Physical injury due to additional physical duties associated with poor staffing and overly populated hospitals
- Benefits being cut (e.g., cut pensions)
- Unhealthy schedules (e.g., having to work 6 days a week)
- Being forced to use PTO if they refused to work overtime
- No emotional support for the toll working the pandemic has taken (e.g., zero help for PTSD)
- Constantly changing protocols and not enough training
- Emotional burden of high acuity rates
- A reduction in tech staffing – forcing registered nurses to take on those responsibilities in addition to their own
- Unhealthy patient ratios
A 9% Nursing Shortage
As burnout increases, and nurses leave, nursing shortages grow. In response to an inability to keep staffing ratios high, hospitals have increased their hiring efforts, boosted their benefits packages and have been relying heavily on travel nurses to fill in workforce gaps. But with travel nurses making up just 2% of the nursing workforce, and hospitals trying to fill a 9% nursing shortage – it’s clear why travel nurses have been seeing such high weekly rates to address this increased demand.
Travel Nursing is the Answer to the Staffing Shortage?
Because of these high pay packages, more registered nurses than ever before are leaving their staff positions in favor of travel nursing contracts.
Bloomberg recently reported that there are currently about 30,000 open travel nurse positions across the U.S. This is up about 30% from this time last year. According to industry experts, however, it isn’t sustainable for hospitals to continue to manage staffing ratios by outsourcing at such a high level.
The Emotional Impact on Nurses
We’d be remiss to not address the emotional impact COVID-19 has had on registered nurses. It is an obvious contribution to the increasing rates of burnout in the health care field.
Here’s What Our Nurses Have Said
Throughout the last several months we’ve interviewed several registered nurses about their experience travel nursing over the last year and half. Whether these nurses were first time travelers, or veteran nurses, the responses we received have all been very similar.
Many bedside nurses feel traumatized, some with symptoms of PTSD, due to the high acuity and record breaking deaths they’ve had to witness. Registered nurses who have been in the industry for 30+ years expressed that they’ve seen more death in the last year than they have in their entire careers.
Why Some Nurses are Inspired to Keep Working
Some registered nurses expressed that their desire to help, is what keeps them on the floors.
“If I help even just one family get through the tragic loss of a close family member, I’ll know I did at least one small thing to bring some good to what’s happening right now.“
~Janet R, ED-RN
But Some Nurses Want to Leave Altogether
Other registered nurses expressed the opposite – that the pandemic made them feel defeated because it prevented them from providing the level of care that they knew they could provide.
“We’re so understaffed that I have such a limited amount of time with each of my patients and their families. I can’t provide the level of care that I used to. If there is a death in one room – I feel like I’m on a timer when I’m trying to console the family- because there’s about to be a death in another room.“
~Stacey M. ICU-RN
Taking Control Over Your Nursing Career
Too many times to count we have spoken with registered nurses about their reasons for switching from staff to travel nursing. Their answer has been some form of: I needed to have more control over the situation.
With an ongoing pandemic and the constant changes registered nurses have been forced to go through over the last year and a half it’s no surprise that many of them were looking for a light at the end of the tunnel. Here is what some of them had to say:
Some registered nurses wanted more control over their earning potential:
I was tired of working 6 days a week and seeing that I was earning less than a travel nurse who was only working 3 days a week.
After 14 years dedicated to one hospital and going above and beyond in every aspect of my job, I had my pension cut in half, just 6 months into the pandemic.
I wasn’t able to take time off for my daughter’s wedding and had to call in “sick” even though I’d never called in sick before.
Other registered nurses wanted a better quality of life:
I just couldn’t mentally handle the high acuity of the ICU anymore and wanted to make a switch to a lower acuity floor – but my hospital told me that wasn’t possible.
I was tired of protocols changing so much and not really knowing what to expect when I stepped on my floor each day. My mental and physical health was taking a dive – and I knew that taking control of my day-to-day would help.
My mom is aging, and I really wanted to have more time at home with her. I knew with my 40+ hour work week, every week and just 2 weeks off a year – I’d never get the amount of time I needed during my mother’s last few years.
Maybe Travel Nursing is the Answer
Are you a registered nurse experiencing symptoms of burnout? Perhaps travel nursing might be the change you need to reignite your nursing career. Check out our highest paying travel nursing jobs of the week here.
Suffering From Depression?
Are you’re a registered nurse experiencing signs of depression and don’t have adequate health insurance coverage to assist you during this difficult time? Here are a few free resources that might be helpful for you:
Crisis Text Line
Text “HOME” to 741741
SAMHSA’s National Helpline
National Suicide Prevention Lifeline
Travel Nursing Tips for Travel Nurses
How to Make a Travel Nurse Resume + A Real-Life Sample Resume
Top 10 Toughest Travel Nurse Interview Questions (and Answers!)
What is Block Scheduling?
Travel Nurse Salary: Top 3 Ways to Make the Most Money
Qualifications: What Paperwork Do You Need?
Contracts: How to Avoid Cancellations
Benefits: Health Insurance & 401(k)
Travel Nursing Testimonials
Goal: Make More Money
Wanted to Take Control of Her Mental Health
Traveled 16-Years Ago and Why She’s Back
Desired a Healthier Work Life Balance
Tips for First Time Travelers
Stayed with her hospital when covid hit. After 8-months started travel nursing
Started traveling the second she got 2-years nursing experience
They cut her pension – so she quit and started travel nursing
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