Stress and burnout in nurses

A nurse in the UK does double shifts known as a long day in the Accident & Emergency Department which is now a common feature on the wards for the money. She/he does not perceive any difficulty focusing but makes can occurring several small mistakes along the way. That’s until he/she gets the insulin dose wrong, and a type 2 diabetes patient falls into severe hypoglycemia. Now he/she fears safeguarding that does not compensate for the extra money he/she will get. Is it worth it? How common is this problem? How far-reaching are the consequences of nurse overworking? Is there anything we can do?

Perceived stress in England

  • Nurses are a population at a high risk of stress
  • Data from NHS England published in 2018 points out that 38% of them experienced work-related stress in 2017
  • A cross-sectional study in 2019 included 142 nurses in a psychometric survey showing that burnout and compassion fatigue are more common in professionals who do not have coping methods such as mindfulness and acceptance.
  • We need to raise awareness of the problem and likely solutions among professionals


Difficult situations faced by nurses and nursing teams


  • Different areas in the UK and worldwide are experiencing staff shortages, and nurses are often offered extended working hours or new shifts to compensate
  • A 2020 study published in the International Journal of Nursing Studies analyzed the impact of having 12-hour shifts instead of 8-hour shifts. They found that nurses in extended shifts increased their sickness absence rate by approximately 12 hours of extra sickness absence per week. Overwork is probably leading to an increase in health problems in this group. Thus, neither nurses nor institutions find any benefit in this practice.
  • Another recent study evaluated oxidative stress markers in 126 nurses and compared them against 132 healthy control. The results were compared with the nurses’ occupational stress scale. The study showed that overworked nurses had lower total antioxidant capacity and higher oxidative stress markers, especially superoxide dismutase. Overworked nurses may become more susceptible to free radical damage.
  • A foreign study involving over 1,000 nurses showed an incidence of sleep disturbances in 71% of nurses due to the extra workload during the COVID pandemics. Similar results are expected in the UK ground.


Professional consequences of work-related stress in nurses


  • Nurse work is not only technical work. It has a human side, and many cases of poor care in England are related to a lack of compassion. A recent review of the scientific literature throws light on the subject, revealing that high job demand and exhaustion lead to depersonalization and disengagement at work in nurses, and there was a negative correlation between burnout and empathy. Overworked nurses tend to reduce their empathy and quality of work. This study is also interesting because it shows that burnout decreases with age and does not increase with experience. Thus, we understand that increasing age and experience produce higher-quality relationships with colleagues and greater autonomy at work, both critical aspects to prevent burnout in nurses.
  • Another recent review of the literature covered the interesting topic of medication administration errors in nurses. They included 27 articles that met the inclusion criteria, and after analyzing the data, the researchers reported various risk factors. Being overworked was the most prevalent. The researchers stated that it is not realistic to expect nurses to avoid medical administration errors when they are fatigued and stressed out. Alarmingly, overworking nurses appear to be the norm rather than the exception, potentially impacting patient safety.


Stress management in nurses


  • A study performed at the University of Chester evaluated a promising solution to the problem in oncology nurses. They proposed stress-management techniques, including the Acceptance and Commitment Therapy/Training, which includes interventions in the field of acceptance, mindfulness, values clarification, among others. They reported that mindfulness-based training provides short-term benefits in nurses’ perceived stress. Still, a long-term behavioral change is possible if the participants feel inclined to engage with these practices beyond the training. Psychological flexibility is also a promising aspect of this training. It allows nurses to stay at the present moment, express feelings and emotions in a non-judgemental way, and continue working based on high-standard values. It helps nurses overcome experiential avoidance (nurturing negative private thoughts, feeling, and emotions that lead to behavioral complications) and reduce psychological distress. However, these promising techniques are not commonly adopted in oncology nursing staff, as revealed by this review.
  • Moreover, targeting psychological flexibility may hold the key to improving nurses’ experience in their professional skills and their professional quality of life. This skill allows them to focus on the situation at hand despite encountering challenging or distressing experiences along the way
  • These concepts and studies translate into practice through a set of individual, group, and organizational interventions. Individual interventions may include yoga, nursing supervision, individual meditation, cognitive evaluation, and cognitive coping strategies. Grupal intervention can be focused on communication skill training, highlighting the meaningfulness of work, programs to combat compassion fatigue, mental attention training, having an intervention office available, using cognitive-behavioral interventions, establishing a psychological empowerment program, providing incentives to exercise more frequently, and consuming a healthy diet, and a group meditation course. Organizational interventions could include positive changes in the working environment, offering therapeutic massage and similar techniques, improving teamwork and organizing teams more appropriately, and changing public management policies to reduce the burden on overworked nurses.


Building resilience in nursing students


  • As mentioned above, younger age and less experience are often related to nurses’ higher risk of burnout symptoms. Thus, it is essential to build resilience in prelicensure nurses to improve retention and reduce burnout. Such educational modalities enable protective factors and strengthen resilience. In a theoretical model to teach resilience in students, we can include training on positive emotions, psychological flexibility, encouraging social support, highlighting self-efficacy, having a sense of humor, perseverance, and more spiritual aspects such as faith and hope. Every nurse student should detect their own protective resources and build resilience practices by strengthening them.
  • Straightforward recommendations any nursing student can understand include listening to yourself and your own indicatives of stress, listening to others and share experiences, both good and bad, speaking with your manager to consider action plans to reduce workloads and pressure, talking with other colleagues to find social support and additional help during your practice, remembering the importance of sleep, exercising, eating, practicing mindfulness, and taking breaks. It is also essential to contact counselors and other professionals if you’re worried about how you feel.


Conclusive statements/ideas

It is time to talk about the pink elephant in the room before it is too late. That is particularly true in recently graduated nurses who will go through new challenges, meet new people, and face new difficulties before building their own tools to build resilience. We can do it before they experience burnout symptoms, feel they do not belong, and feel tempted to leave the profession.
In experienced nurses, overwork is also a concerning problem, mainly due to staff shortage and the recent public health developments. This may affect young and more experienced nurses’ professional skills, personal life, and health parameters. But there’s a vast set of recommendations we can adopt at an individual, group, and organizational level to prevent this situation and its consequences.

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