Preventing Burnout Within Nurses

Kaela Mowrey

Ms. Barnhart

AP Literature and Composition

11 December 2018

Literature Review
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Throughout the medical field of work, employees constantly have feelings of immense

stress and burnout. Burnout is categorized by emotional and interpersonal stressors that could be

measured through levels of emotional exhaustion, feelings of detachment from the job, inhibited

work habits, and lack of personal accomplishment. Medical workers, specifically nurses,

experience constant stress due to long hours, hefty workloads, and altercations dealing with

family or coworkers. Burnout is a growing phenomena occurring within nurses, but with the help

of varying strategies, may be hindered. This topic was researched using scholarly articles with

valid information that could enlighten any reader on the situation. A great deal of time went into

ensuring the articles being analyzed were valid and reliable before they were added to the list of

sources being used for the investigation. After researching this phenomena, the following sources

will be organized chronologically, starting in 2013, in order to see how research and solutions

have evolved over a short period of time in order to show how research and society has helped to

diminish this ongoing problem. In 2013, nurses nationwide started to leave their occupations due

to high levels of stress and emotional exhaustion which would put them at risk for burnout. This

epidemic caused scholars to initiate research on how to prevent the issue.

In the article “Stress, Social Support, and Burnout Among Long-Term Care Nursing

Staff” written by Erin L. Woodhead, Lynn Northrop, and Barry Edelstein, the authors review an

experiment they conducted. This source was published through Southern Gerontological Society,

which is a network of the South’s most respected gerontology professionals. This publisher is

highly credible due to its level of respect and knowledge. In the 2013 experiment conducted by

the three psychologists with PhDs, nurses working at a long-term care facility were tested on

their feelings of burnout based on their levels of stress and amount of social support. The

objectives of this experiment were to determine the amount of job demands and resources,
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examine the correlations between demographic variables, job demands, and job resources, and to

examine the amount of variance accounted for by each of the job demands resources. Their

findings revealed that both personal and occupational stressors increase the likelihood of

burnout, however personal stressors had a greater impacts on the subjects’ stress levels. Evidence

shows that support from others at work, “[...] particularly support from supervisors, may be

particularly important in decreasing stress among long-term care nursing staff” (Woodhead et al.

87). Social support of some kind is important for nurses to obtain to help deal with both work-

related stress and personal stress.

As a solution, the psychologists concluded that some type of burnout reduction

intervention that teaches how to socially support others will help supervisors and coworkers

reassure other employees of their passions and decrease their feelings of burnout. The authors

use a multitude of sources in order to validate their experiment and findings. Statistics and other

data documented during the experiment are also present throughout the piece in order to

highlight the importance of social support. The data found in this experiment will reinforce the

need for social support in hospitals and promote a change. The psychologists are implicitly

stating that hospital workplaces now are not providing the employees the social needs and

comfort that is needed to exhibit proper patient care. The psychologists’ experiment initiates the

time period being observed and is the beginning of the timeline of evolution surrounding the

amount of help given to nurses in order to prevent burnout. This source heavily relates to the

thesis question being investigated because it explains a cause of burnout and how it could be

inhibited. These are facts that are key to this investigation as they establish the cause, effect, and

solution of the issue being analyzed.

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The next source, an investigation conducted only a year after the previous source, being

utilized for this investigation written by Sarah A. Smith is titled “Mindfulness-Based Stress

Reduction: An Intervention to Enhance the Effectiveness of Nurses’ Coping With Work-Related

Stress.” Sarah A. Smith, a nursing laboratory coordinator and the University of Hawaii Hilo with

a PhD, conducted a 2014 experiment in order to find a solution to reduce stress induced upon

nurses caused by patients and hospital budget cuts. The experiment mainly focused on

mindfulness-based stress reduction (MBSR) which is a specific type of meditation that could

help nurses cope with work-related stress and increase their patient care skills. This meditation

technique promotes both mental and physical health, as it combines the use of deliberate,

conscious breathing and some sort of exercise, specifically yoga. Results from Smith’s

experiment showed increased empathy, self-improvement, improved mood, improved focus,

decreased anxiety and stress, and lesser feelings of burnout within the test subjects. In short, the

author’s central idea is how with further investigation and use, the MBSR technique could help

decrease stress levels in nurses and, in turn, prevent feelings of burnout.

Key conclusions that can be drawn from this experiment include that the stress brought

upon nurses at work affect their work habits and emotional state, and the MBSR meditation

technique can help diminish this issue. Smith consults many other pieces to further her research

and includes an abundance of data from her experiment to ensure her conclusions are reliable.

This source implicitly states that nurses’ coping skills regarding stress are not at the strong levels

required for the field of Nursing. Their ineffective coping, defined as, “‘[...] the inability to form

a valid appraisal of stressors, inadequate choices of adequate practical responses and/or inability

to use available resources[...]’” (Smith 119), need to immensely improve. Smith conducted

research on the MBSR technique in order to give nurses a reliable way to improve their coping
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skills. Evidence from this experiment could impact society by promoting change and taking

additional steps in order to make MBSR more widely known. This source builds off of the

previous source by suggesting additional ways for nurses to decrease their stress levels and, in

the long run, prevent their chances of burnout. A combination of social support and MBSR

techniques could lead to a discovery of peaceful and stress-free work.

The third source being analyzed written by Adam Waytz is titled “The Limits of

Empathy.” This article from the January-February 2016 issue of Harvard Business Review

discusses the multiple problems with the feeling of empathy. The author’s central idea about the

piece is how excessive empathy released by anyone can lead to another form of burnout.

Empathy has a list of faults including the fact that it is exhausting, it is zero-sum, and it erodes

ethics. The main issue with it being exhausting is always present in medical workers. The

constant requirement of empathy from medical workers can lead to compassion fatigue, which is

defined as, “[...] an acute inability to empathize that’s driven by stress, and burnout [...]”

(Waytz). Ways to reduce excessive empathy could be to split up the work, empathy is less

bounded if it is managed across multiple employees, or to give people breaks, it takes extreme

effort to dive into another person’s mind and give them compassion.

From this piece, readers can conclude that nurses need to find a way to manage their

empathy. While empathy is important in the medical field, too much empathy can create a strong

relationship between the patient and caregiver which can cause the several problems previously

listed. The author hyperlinks several other sources such as alternative studies and data to build

his knowledge and solidify his argument against excessive. These additional sources build

credibility because they are experiments and research conducted by other scholars. The idea that

people in the medical field are under a great amount of pressure to show feelings of empathy to
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patients is implicitly stated within this piece. This could impact nurses by enlightening them on

how to manage the amounts of empathy they give. Unlike what was stated in the first source that

suggested more social support from coworkers, this piece suggests nurses could use time alone.

In this time alone, workers could relax or maybe even meditate like the second source proposed.

The next source being used, written by David A. Runge, is titled “Prevention of Burnout

by Use of Balint Method of Group Therapy.” Runge, a Nurse Practitioner who received a

Doctorate of Nursing at the University of Massachusetts Amherst, conducted a 2015 experiment

which analyzed the effects of Balint group therapy on nurses. Runge published his experiment in

2016 with ScholarWorks from Umass Amherst, a database showing a collection of research done

by professionals at this school. The Balint method is a type of group therapy that can reduce

stress, prevent burnout, and have positive effects overtime. Runge stated that the ultimate goal of

the Balint method is for, “[...] self-reflection through group experience of difficult cases to better

prepare the group of participants for difficult patient encounters” (Runge 11). The objectives of

the experiment included getting a group of recent graduates to attend multiple group sessions

each, for the people to actively participate in multiple Balint sessions, having participants fill out

a burnout questionnaire each session, and to survey participants to document decreased feelings

of burnout and desires to leave their profession. The results of the experiment showed that

through mentorship and the use of Balint therapy, workers will see decreases in feelings of

isolation, dissatisfaction, burnout, and desire to leave the profession.

Key conclusions that can be drawn from this research are that Balint group sessions have

a positive effect on burnout prevention in nurses. If the method was more widely known and

further researched, hospitals could integrate this group therapy technique into their work

routines. The group sessions will give employees more guidance and overall improve their
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emotions in the workplace. The author referenced several other works to validate his research

and solidify his knowledge of the subject being studied. This built credibility because Runge set

aside a great deal of time and mastered the study of the technique before he implemented it in his

own experiment. This source implicitly states that if the Balint group sessions are used in a more

enduring method, the work habits will increase while stress levels decrease in nurses. Scholars

are left with the last steps of conducting more research and implementing these therapy sessions

more often in order to see change. This source agrees heavily with the first source on social

resources and support. The Balint methods use group sessions to decrease stress, so these

sessions are allowing for an increase in social interaction between workers which will in turn

allow for greater support.

The fifth source analyzed jumps a period of time and was published in 2018. This source

written by Cortia Bryan-Rose and Paul Andrew Bourne is another experiment titled, “Factors

Determining ‘Burnout’ Among Nursing Staffers at a National Hospital in Jamaica.” This article

was published through Juniper Online Journal of Public Health, an international journal

dedicated to articles discussion research, research methods, and program evaluation in the field

of public health. This experiment analyzed nurses working at the Spanish Town Hospital in

Jamaica, a hospital surrounded by communities of violence. Due to the surrounding violence,

several employees of this hospital left the occupation to work abroad, leaving the hospital short-

staffed. Because of the increase in shift hours and the number of patients cared for by individual

nurses that was left by the understaffing, nurses working in this hospital are under constant stress

and at a great risk for burnout. The experiment conducted by Cortia Bryan-Rose (College of

Health Sciences School of Allied Health and Nursing, University of Technology, Jamaica) and

Paul Andrew Bourne (Department of Quality Management and Institutional Research, Northern
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Caribbean University, Jamaica), had three main objectives. These objective included determining

the level of burnout among nurses at the Spanish Town Hospital, establish the factors

contributing to this burnout, and to observe if the burnout affected the nurses’ attitudes towards

working. The results concluded that the poor management of the hospital which resulted in

longer hours and heftier workloads was the main cause of stress in these workers.

The important conclusion that must be drawn from this piece is that the poor management

occurring at the Spanish Town Hospital is the primary source of burnout in these nurses and is an

issue that must be addressed urgently. Managers of this establishment failed to make up for the

understaffing left behind by the nurses that fled Jamaica which created an intense burden on the

remaining employees. The researchers of this experiment referenced a great deal of works and

included several data and statistics retrieved from the subjects. These statistics showed the

nurses’ attitudes towards work were influenced by, “[...] socioeconomic conditions such as social

class, income, occupational status and education […]” (Bryan-Rose et al. 4). These statistics

could impact the management at the hospital and promote adjustments in the system.

Considering the employees’ attitudes towards to occupation were influenced by occupational

stress, the management should find alternatives to reduce this stress and create a positive

workplace. The authors implicitly state how if employees at this specific town were influenced

so greatly by the severe loss in staff, hospitals nationwide with understaffing could experience

the same stress. This implication will promote management alterations in many hospitals and

burnout levels of nurses will decrease. This source builds off of the second source about

Mindfulness-Based Stress Reduction regarding budget cuts. A decrease in manager involvement

resulting in budget cuts and understaffing negatively impacts employees and does not help

diminish the burnout situation.

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The sixth and final source being analyzed was published in spring of 2018, only a few

months after the previous. This source is titled “A Systematic Review: Factors for Burnout and

Compassion Fatigue in U.S. Nurses” and is written by three students from the University of

Akron: Kaitlyn Marcum, Tabitha Rusnak, and Mckenzie Koch. This article was published

through IdeaExchange at the University of Akron, the public research university in Northern

Ohio. This article researches multiple sources in order to determine major causes of compassion

fatigue and burnout. Their research found that factors such as the work environment, nurse’s

specialty, education level, and coping skills influenced the levels of burnout experienced by

nurses. After extensive research, the authors concluded that uninterrupted working breaks,

decreases in changed to the specialty unit, and a progressive and positive management style

could help decrease the changes of compassion fatigue and reverse negative feelings towards the

occupation. The authors additionally concluded that, “ Meaningful recognition of hard work or

other positive attributes could also help to increase satisfaction” (Marcum et al. 11). Relaxation

periods, a steady routine, and appreciation all play a role in creating a positive attitude towards

the occupation.

Some key conclusions that could be drawn from this source include that a variety of

variables are synthesized in order to cause burnout, and by reversing these variables burnout can

be avoided. Several workplace and demographic variables play a role in nurses’ chances of

compassion fatigue. By creating a positive workplace environment, and increasing the amount of

recognition and appreciation from staff and managers can reverse these burnout effects. The

authors used a multitude of sources in order to increase and solidify their grasp on the concepts

that cause compassion fatigue and burnout. This piece implicitly states that changes in daily

routines heavily alter an employee’s attitude towards working. When workers are on a set
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schedule of what needs to occur every shift, they become comfortable and confident with their

work habits. However, when these rhythms are altered, it can become difficult for the employee

to adapt to their new surroundings. This could impact hospitals nationwide by enlightening them

on what not to do when discussing management changes. This source agrees heavily with the

fifth source that discussed management issues. Faulty and messy management immensely alters

nurses’ work habits and creates an intense amount of stress that could be avoided.

Works Consulted

Bryan-Rose, Cortia and Paul Andrew Bourne. “Factors Determining ‘Burnout’ Among

Nursing Staffers At A National Hospital In Jamaica.” Juniper Online Journal Of Public

Health, 2018, pp. 1-25,

https://juniperpublishers.com/jojph/pdf/JOJPH.MS.ID.555608.pdf.
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Marcum, Kaitlyn et al. “A Systematic Review: Factors For Burnout And Compassion

Fatigue In U.S. Nurses.” IdeaExchange at UAkron, 2018, pp. 1-25,

https://ideaexchange.uakron.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/

&httpsredir=1&article=1639&context=honors_research_projects.

Runge, David A. "Prevention Of Burnout By Use Of Balint Method Of Group Therapy.”

ScholarWorks At Umass Amherst, 2016,

https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1070&amp=&context=nursi

ng_dnp_capstone&amp=&sei-

redir=1&referer=https%253A%252F%252Fscholar.google.com%252Fscholar%253Fstart

%253D10%2526q%253Dnurse%252Bburnout%252Bprevention%252Btechniques%252

Bamerica%2526hl%253Den%2526as_sdt%253D0%252C5%2526as_ylo%253D2014#se

arch=%22nurse%20burnout%20prevention%20techniques%20america%22.

Smith, Sarah A. “Mindfulness-Based Stress Reduction: An Intervention To Enhance The

Effectiveness Of Nurses’ Coping With Work-Related Stress.” International Journal Of

Nursing Knowledge, 2014, pp. 119-130,

https://pdfs.semanticscholar.org/8687/c55d34339caef6ec5c4b7890af4c99212dc7.pdf.

Waytz, Adam. "The Limits Of Empathy.” Harvard Business Review, 2016,

https://hbr.org/2016/01/the-limits-of-empathy.

Woodhead, Erin L. et al. “Stress, Social Support, And Burnout Among Long-Term Care

Nursing Staff.” Southern Gerontological Society, 2016, pp. 84-105,

https://journals.sagepub.com/doi/pdf/10.1177/0733464814542465.