(PDF) Burnout Among Nurses

BURNOUT IN NURSES 1
BURNOUT IN NURSES IN THE ACCIDENT AND EMERGENCY DEPARTMENT
Student’s Name
Course Name
Professor’s Name
University Name
City, State
Date

BURNOUT IN NURSES 2
Abstract
For Nurses working in the emergency department, dealing with issues of emotional
trauma is part of their daily routine. This emotional trauma among nurses resulting from their
experience helping or trying to help suffering patients may cause them to experience burnout.
The focus of this Literature review was on accessing the intensity of burnout among Ireland
Nurses working in emergency and accident department. A Number of Registered nurses working
in emergency departments in the country were sampled out. Based on the findings, there is need
to offer support to nurses working in the emergency and accident department to help them cope
with stress factors that are attributed to burnout. These interventions need to be broad because
traumatic experiences experienced by Nurses working in these departments differ hence call for
different approaches to be adopted
Key Words
Nursing, Burnout, depersonalization, emotional exhaustion, Compassion fatigue
Introduction
The complex nature of the Nursing professions makes it one of the most challenging
professions. Nurses experience multiple challenges in the course of disseminating their duties
and responsibilities. Some of the issues that nurses deal with include workplace violence,
workplace hazards, long working hours, short staffing inadequate compensation and burnout. For
Nurses working in accident and emergency department in Ireland, burnout is one of the most
prevalent challenges. Burnout is a work related stress syndrome characterized by loss of
motivation, depression, anxiety, cardiovascular disorders and physical fatigue (Lahana et al.,
2017). Burnout is nowadays considered a global issue affecting healthcare professionals. The

BURNOUT IN NURSES 3
main causes of burnout among nurses include short staffing or reduction of length of stay by
nurses caused by organization’s attempt to minimize rising operation costs. With the increase in
population and demand for health care services burnout becomes inevitable. Burnout among
Nurses is considered to have a negative impact on performance, quality of care and Nurse’s well
being (Moghaddasi et al., 2013).This paper seeks to explore the concept of Burnout among
Nurses working in Emergency and accident department in Ireland.
Review Objectives
 To find out and summarize published scholarly work on burnout among Ireland’s
accident and emergency department Nurses
 To Find out the causes of Burnout among Emergency and Accident department’s Nurses
 Identify the impact of burnout among Nurses working in accident and emergency
department
Methodology
Searches for the literature review were conducted from MEDLINE, CINAHL, Cochrane
Library collection, PubMed and Embase databases. Search terms used include Burnout
depersonalization, emotional exhaustion, Compassion fatigue and Nursing. January 2008 –
January 2018 were set as the date parameters for the review.
Literature Review
The Burnout Concept in Accident and emergency department
The term was first used by a psychologist Herbert Freudenberger to describe his
experience with substance abusers. According to the scholarly work of (Harkin and Melby,

BURNOUT IN NURSES 4
2014), the burnout construct is as a consequence of three dimensions characterized as a reduced
personal accomplishment, depersonalization and emotional exhaustion. Compassion fatigue has
been closely linked to burnout among Nurses especially those in emergency and accident
departments. It referees to the stress that nurses go through in an effort to witness and act upon
the immense suffering of patients (Boyle, 2011). (Figley, 2013) argues that although the two
terms, compassion fatigue and burnout are closely related, the likelihood of developing
compassion fatigue is caused by the presence of burnout.
Causes of Burnout among Emergency Irish Nurses
(Healy and Tyrrell, 2011) perceives the impact of stressful experiences to be immense for
Nurses working in the emergency departments. The two also argue that Taking part in the
resuscitation of patients, witnessing deaths, violence or patient’s aggression can cause immense
physical and emotional strain on Nurses (Healy and Tyrrell, 2011).Irrespective of the frequency
of these incidences for the Irish Nurses, they have not become immune to the stress caused by
these experiences. In most cases also, these nurses are not sufficiently prepared to cope with the
consequences of these experiences especially due to inadequate support. A study carried out in
one of Ireland’s regional hospitals found that nurses in the accident and emergency departments
recorded high levels of burnout (Cishahayo, Nankundwa, Sego and Bhengu, 2017).The
prevalence of depersonalization among emergency nurses was also found to be 46% which was
quite high compared to nurses in other departments (Harkin and Melby, 2014).
Findings from the study conducted by (Hooper et al, 2010) however failed to support the
argument that Nurses working in emergency and accident department were at more risk for
burnout compared to nurses working in other inpatient departments. Based on the fact that the
emergency and accident department present quite unique factors compared to other departments,

BURNOUT IN NURSES 5
these findings can be viewed as unanticipated. All nurses across Ireland are struggling to
maintain a balance between patient outcomes, levels of satisfaction and efficiency in healthcare
provision. Part of this strain is caused by an increase in patient’s expectations for outstanding
services. Based on this study also, it was concluded that the lack of a significant difference
between nurses in different departments is based on the nurse’s ability to select a patient service
environment that is in line with their individual style
According to research carried out by (Irish Medical Times, 2018) long working shifts of
up to 12 hours for nurses in emergency departments was one of the main causes of burnout. In
addition, the findings linked, high turnover among Irish Nurses and increased job dissatisfaction
to long work shifts which is increasingly becoming a common practice in Ireland (Aiken et al.,
2012) argue that burnout and job dissatisfaction are significant concerns for the Nursing
workforce world over because of their impact on nurses health and well being as well as on
quality of emergency services. This view has also been supported by a nursing study carried out
in 12 European countries among them Ireland .The study concludes that working for 12 hours by
nurses in emergency departments contributed to burnout (Ring,2015). However according to
nurses in Ireland, workloads and staffing levels are the main causes of burnout (Ring, 2015).The
study found out that 17% of nurses suffered from low personal accomplishments, 10% from
depersonalization and 27% from emotional exhaustion(Ring, 2015).
A Study carried out by (Harkin and Melby, 2014) found out that the level of burnout
differs with the age of the nurses involved .Younger nurses who had qualified recently were
Found to have higher burnout levels compared to older more experienced Nurses. This view has
been supported by (İlhan et al., 2008).In their study, they found out that the high burnout levels
among recent graduates were linked to the initial shock they of the realities of their job. A

BURNOUT IN NURSES 6
confrontation with this reality makes them suffer early burnout. For the older nurses however,
repeated exposure to these stress factors may make them develop tolerance to high burnout
levels. This has also been supported by (Lei, Dong and Hee, 2010).In their study the found a
correlation between the length of stay for emergency Nurses and the extent of burnout. They
found out that nurses with longer work duration had lower levels of depersonalization and
emotional exhaustion. They associated this to attractive psychological coping mechanisms, self
control, experience and high professional title.
According to (Bartram et al, 2012) burnout among emergency nurses can be associated
with factors such as work related emotional demands, seniority, the type of shift among other
variables. They also found out emotional exhaustion to be lower among nurses with more
experiences compared to less experienced nurses. However, for nurses working in the emergency
department they found out that those with extended stay suffered higher levels of emotional
exhaustion. The presences of too many short breaks between work shifts have also been linked to
emotional exhaustion. Burnout among nurses in emergency departments has also been associated
with a lack of associated with lack of enough time to complete tasks (Bartram et al., 2012).
Impact of Burnout among Nurses in emergency and accident department
(Li, Cheng and Zhu, 2018) argue that burnout arises as a result of exposure to stress
factors beyond an individual’s coping capabilities. They also refer to Burnout as a psychological
state arising from exposure to lengthened psychological or emotional stress. Burnout is not a
preserve for nurses in accident and emergency departments but also other healthcare provider’s
including doctors exposed to stressful work demands. However, for nurses involved in the
provision of emergency services, burnout levels can be extremely high because of the fact that
they are more exposed to patients with terminal illnesses and severe medical conditions. Their

BURNOUT IN NURSES 7
work schedules also include working on night and day shifts in environments where anxiety and
trauma are the main attributes. For those who are extremely hardworking, the risk of burnout is
higher compared to the less hardworking. The main reason for this is that work engagement and
commitment to work are linked to high stress levels (Li, Cheng and Zhu, 2018).
Burnout is linked to many negative outcomes on nurse working in accident and
emergency department. These negative outcomes include increased turnover, alcohol and drug
abuse, increased job dissatisfaction, attrition, absenteeism, occupational injuries and
musculoskeletal disorders. Burnout does not only affect nurses working in this department but
also vitally ill patients under the Nurse’s care (Li, Cheng and Zhu, 2018). In addition burnout
among emergency and accident department nurses can also lead to a decline in personal
accomplishments. One major cause of a decline in personal accomplishment has been argued to
be a lack of sufficient resources to function effectively in these demanding conditions that might
vary from time to time.
Complex work environments among emergency nurses, psychological, social and
physical stress may all lead to burnout. High levels of burnout among these nurses may be
demonstrated through a decline in job performance, lack of job engagement, emotional distress,
increased rates of absenteeism and lateness, negative attitude towards patients and colleagues
and lack of morale at the workplace. These nurses are also faced with immense pressure patients
and heavy workloads and lack of sufficient sleep. In the long run, burnout can lead to a loss of
passion, development of sleep disorders and irritability among other mental and physical
disorders (Cañadas-De la Fuente et al.,2015).
There is a need for government and others stakeholders to provide the necessary support
to nurses working in the accident and emergency department to enable them to deal with burnout

BURNOUT IN NURSES 8
and consequences that come with it. For less experienced nurses social support can help them to
help them manage negative feelings and attitudes towards patients. They also require more care
and support compared to older and more experienced nurses. Additionally, working conditions
for these nurses demand high professional qualities to deal with the ever changing work variables
and busy work schedules (Wei, Ji, Li and Zhang, 2017). For them to handle these factors,
comprehensive support becomes important
Conclusion
In conclusion burnout is a major issue affecting nurses working in the emergency and
accident department in Ireland. It is associated with characteristics such as loss of motivation,
depression, anxiety, cardiovascular disorders and physical fatigue. Three dimensions characterize
the concept of burnout among nurses. These include emotional exhaustion, reduced personal
accomplishment and depersonalization. Burnout among nurses working in emergency and
accident department is caused by multiple factors. These factors include witnessing death and
aggression, taking part in patient resuscitation. These can lead to emotional strain on Nurses and
affect their overall well being. Incapacity and lack of support to deal with these stress factors
among Irish Nurses can make them the most affected by burnout compared to those working in
other departments. This aspect is also true because nurses working in these departments are faced
with unique factors that may change on a daily basis unlike those working in other departments.
Burnout has been associated with many negative consequences among nurses working in the
emergency and accidents department. The most prevalent are drug and substance abuse,
increased turnover, absenteeism, job dissatisfaction and musculoskeletal disorders. It has also
been linked to increased occupational injuries. These consequences can be more severe to the
more hardworking emergency nurses as compared to the less hardworking.

BURNOUT IN NURSES 9
.

BURNOUT IN NURSES 10
References
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., Bruyneel,
L., Rafferty, A.M., Griffiths, P., Moreno-Casbas, M.T. and Tishelman, C., 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. Bmj, 344, p.e1717.
Bartram, T., Casimir, G., Djurkovic, N., Leggat, S.G. and Stanton, P., 2012. Do perceive high
performance work systems influence the relationship between emotional labour, burnout and
intention to leave? A study of Australian nurses. Journal of Advanced Nursing, 68(7), pp.1567-
1578.
Boyle, D.A., 2011. Countering compassion fatigue: A requisite nursing agenda. Online J Issues
Nurs, 16(1).
Cishahayo, E.U., Nankundwa, E., Sego, R. and Bhengu, B.R., 2017. Burnout among nurses
working in critical care settings: a case of a selected tertiary hospital in Rwanda. International
Journal of Research in Medical Sciences, 5(12), pp.5121-5128.
Figley, C.R., 2013. Compassion fatigue: Coping with secondary traumatic stress disorder in
those who treat the traumatized. Routledge.
Cañadas-De la Fuente, G.A., Vargas, C., San Luis, C., García, I., Cañadas, G.R. and Emilia, I.,
2015. Risk factors and prevalence of burnout syndrome in the nursing profession. International
journal of nursing studies, 52(1), pp.240-249.
Harkin, M. and Melby, V., 2014. Comparing burnout in emergency nurses and medical
nurses. Clinical Nursing Studies, 2(3), pp.152-163.

BURNOUT IN NURSES 11
Healy, S. and Tyrrell, M., 2011. Stress in emergency departments: experiences of nurses and
doctors. Emergency nurse, 19(4).
Hooper, C., Craig, J., Janvrin, D.R., Wetsel, M.A. and Reimels, E., 2010. Compassion
satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in
other selected inpatient specialties. Journal of emergency nursing, 36(5), pp.420-427.
İlhan, M.N., Durukan, E., Taner, E., Maral, I. and Bumin, M.A., 2008. Burnout and its correlates
among nursing staff: questionnaire survey. Journal of advanced nursing, 61(1), pp.100-106.
Irish Medical Times (2018). Irish nurses' long shifts causing burnout. [online] Irish Medical
Times. Available at: https://www.imt.ie/clinical/irish-nurses-long-shifts-causing-burnout-17-09-
2015/ [Accessed 7 Nov. 2018].
Lahana, E., Papadopoulou, K., Roumeliotou, O., Tsounis, A., Sarafis, P. and Niakas, D., 2017.
Burnout among nurses working in social welfare centers for the disabled. BMC nursing, 16(1),
p.15.
Lei, W., Dong, W. and Hee, K.Y., 2010. A review of research and strategies for burnout among
Chinese nurses. British Journal of Nursing, 19(13), pp.844-850.
Li, H., Cheng, B. and Zhu, X.P., 2018. Quantification of burnout in emergency nurses: A
systematic review and meta-analysis. International emergency nursing.
Moghaddasi, J., Mehralian, H., Aslani, Y., Masoodi, R. and Amiri, M., 2013. Burnout among
nurses working in medical and educational centers in Shahrekord, Iran. Iranian journal of
nursing and midwifery research, 18(4), p.294.

BURNOUT IN NURSES 12
Ring, E. (2015). EU study blames long shifts for nurse burnout. [online] Irishexaminer.com.
Available at: https://www.irishexaminer.com/ireland/eu-study-blames-long-shifts-for-nurse-
burnout-353386.html [Accessed 7 Nov. 2018].
Wei, R., Ji, H., Li, J. and Zhang, L., 2017. Active intervention can decrease burnout in ED
nurses. Journal of Emergency Nursing, 43(2), pp.145-149.