Burnout in Nursing: Literature Review

Work-related stress and burnout are common issues in the healthcare setting. Nursing practice is often challenging and demanding as nurses have to work long hours, have diverse shifts, manage conflict, implement complex procedures, and so on (Baye et al., 2020). The problem is apparent on a global scale, and it is more pressing in the public sector (Pahlavanzadeh et al., 2016). The COVID pandemic aggravated the work-related stress nurses had to endure, which made the problem more visible to administrators, researchers, and practitioners (McLemon, 2020). Numerous stress management programs have been introduced and evaluated to address the problem (Botha et al., 2015). It has been acknowledged that such initiatives have a positive effect on nurse performance and retention, although the outcomes depend on the characteristics of the program and the peculiarities of its implementation.

Work-related stress has been in researchers’ lenses for decades, and the phenomenon is explored in detail. Although numerous definitions of this concept exist, they are quite similar and characterized by several key components: job-related factors, nurses’ psychological and physical state, and practitioners’ performance, as well as patient outcomes. For instance, Sarafis et al. (2016) define the term as “a situation wherein work-related factors interact with an employee, changing his/her psychological and physiological condition in a way that the person is forced to deviate from normal functioning” (p. 1). Mainly, researchers concentrate on the influence of job-related stress on nurses’ performance, functioning, and overall psychological state. Poulsen et al. (2015) focus on nurses’ resilience, self-care practices, as well as sleep quality. Lin et al. (2019) examined the effects of a stress-management program and looked into the outcomes related to resilience development and job satisfaction. Thus, work-related stress has been properly researched in terms of its effects on nurses’ health and performance.

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As mentioned above, various programs have been developed, and researchers provide some features of such incentives that can be beneficial in diverse settings. Botha et al. (2015) state that a one-day mindfulness-based program can have a positive effect on nurses’ resilience and performance. Lin et al. (2019) also report the positive impact of an eight-week mindfulness-based program on nurses’ performance and resilience. However, the program had no effect on nurses’ job satisfaction (Line et al., 2019). Both studies displayed the outcomes immediately after, one month, and three months after the intervention.

Some researchers concentrate on particular skills associated with stress reduction and its effective management. For example, Pahlavanzadeh et al. (2016) evaluate the effectiveness of a stress-management program stating that stress management is one of the primary skills necessary to cope with job-related stress successfully. The researchers assessed nurses’ skills immediately after and one month after the implementation of the intervention and reported the positive effects of the program.

It is noteworthy that the studies exploring work-related stress and the effectiveness of interventions aimed at addressing the problem display quite similar results, although researchers may focus on different aspects of the problem. It is clear that nurses are largely affected by stress, and adverse effects are apparent when it comes to nurses’ physical and mental states, functioning, and behaviors. One study stands out from the rest due to the researchers’ attention to job satisfaction. Although it could be expected that job satisfaction would be improved when nurses have built resilience and are able to manage stress, empirical data suggest that there is no direct link between the two variables (Lin et al., 2019). These findings shed light on various factors that have an impact on nurses’ job satisfaction, attitudes, and functioning.

It is noteworthy that the reviewed articles are based on sound evidence and methodology. Researchers employed quantitative and qualitative research designs to explore a variety of aspects of the problem. A meta-analysis study is also a valuable source of evidence as it summarizes the current knowledge base on the matter (Botha et al., 2015). The use of different methods to explore job-related stress characteristics and the effectiveness of associated programs serves as the necessary background for further analysis of the topic and the introduction of new projects.

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Although a considerable bulk of the information is available, some gaps are yet to be addressed. One of the major limitations to the studies evaluating the effectiveness of programs aimed at reducing work-related stress in nurses is their limited time frames. Researchers assess the outcomes of incentives immediately or several months after the program implementation. However, no evidence is provided regarding the effects of a lasting program or various initiatives’ long-term effects.

Another significant gap to be filled is associated with the scope of the existing studies. The majority of research has been conducted in particular healthcare facilities or communities, so the generalizability of data is a significant concern (Baye et al., 2020; Lin et al., 2019; Sarafis et al., 2016). In many cases, the sample size was rather small, as fewer than a hundred nurses took part in some of the studies (Poulsen et al., 2015; Pahlavanzadeh et al., 2016). Therefore, further exploration of the topic is necessary, and the gaps can be addressed in diverse ways.

First, it is critical to analyze the long-term effects of the interventions aimed at job-related stress reduction. Programs can have a different time frames ranging from one day to several weeks. For example, even a 1-day intervention can be effective, as stated by Poulsen et al. (2015). Clearly, shorter but intensive programs can be preferable due to the lack of resources. However, it is pivotal to measure the outcomes of such programs immediately, a month and several months after their implementation. It can be effective to estimate the optimal regularity of such interventions, which will ensure the provision of high-quality care without any disruptions.

Furthermore, it is also important to include more participants and more units or facilities. Studies should involve several units or facilities, and it is necessary to implement state-wide or nation-wide studies. The development of a set of programs or guidelines that can be applied in many settings can have a positive effect on the advancement of nursing practice. Clearly, the utilization of various methods and strategies is an important premise for the development of the field.

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In conclusion, it is necessary to note that the existing research suggests that nurses have to encounter job-related stress on a daily basis, which has considerable adverse effects on these professionals’ functioning, physical and mental health, performance, as well as patient outcomes. Numerous programs and incentives have been introduced to address the problem, and researchers have examined the effectiveness of these projects. Although some programs can have limited effects, they all are proved to be effective in terms of nurses’ resilience and functioning, which are central to these practitioners’ proper performance and appropriate physical and mental state.

References

Baye, Y., Demeke, T., Birhan, N., Semahegn, A., & Birhanu, S. (2020). Nurses’ work-related stress and associated factors in governmental hospitals in Harar, Eastern Ethiopia: A cross-sectional study. Plos One, 15(8), 1-12.

Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness-based programs in reducing the stress experienced by nurses in adult hospital settings: A systematic review of quantitative evidence protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 21–29.

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2019). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace Health & Safety, 67(3), 111–122.

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McLemon, L. M. (2020). COVID-related nursing shortages hit hospitals nationwide. CIDRAP.

Pahlavanzadeh, S., Asgari, Z., & Alimohammadi, N. (2016). Effects of stress management program on the quality of nursing care and intensive care unit nurses. Iranian Journal of Nursing and Midwifery Research, 21(3), 213-218.

Poulsen, A. A., Sharpley, C. F., Baumann, K. C., Henderson, J., & Poulsen, M. G. (2015). Evaluation of the effect of a 1‐day interventional workshop on recovery from job stress for radiation therapists and oncology nurses: A randomized trial. Journal of Medical Imaging and Radiation Oncology, 59(4), 491–498.

Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., Bamidis, P., Niakas, D., & Papastavrou, E. (2016). The impact of occupational stress on nurses’ caring behaviors and their health-related quality of life. BMC Nursing, 15(1), 1-9.

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