University Healthcare Report: Nurse Burnout Implications and Avoidance

This report critically examines the pervasive issue of burnout among mental health nurses, exploring its implications and potential interventions. It begins by defining job burnout and highlighting its high prevalence within the nursing profession, citing emotional exhaustion, depersonalization, and reduced personal accomplishment as key characteristics. The paper then delves into the theoretical frameworks of the Job Demands-Resources model and the Maslach theory of burnout, explaining how job demands, resources, and individual characteristics contribute to burnout. It presents statistical data on burnout rates, illustrating the significant impact on healthcare professionals, including poor health, job performance, and patient care. The report discusses the implications of burnout, such as increased absenteeism and turnover, and substandard care services. Finally, it reviews intervention strategies at the organizational, nursing management, and individual levels, emphasizing the importance of addressing this critical issue to improve nurse well-being and enhance the quality of patient care. The analysis is supported by a review of relevant literature.

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Implications Of Burnout For Mental Health Nurses And How It Can Be Avoided
Introduction
Job burnout describes negative work-associated attitudes that are often characterized by feelings
of emotional exhaustion with work, depersonalization and minimal individual attainments (Paris,
& Hoge, 2010). Burnout is a major public health problem experienced by mental health nurses at
a prevalence of 67% (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2012). The nursing
profession is stressful and continues to change more often. Sjølie, Binder, and Dundas (2017)
observed that mental health workers are constantly exposed to intense emotional torture, suicidal
thoughts, and the distressing behaviours of mental health patients. Despite the difficulty
associated with the provision of mental health services, the sector is more often affected by
financial constraints thus causing job uncertainty and understaffing (Honberg, Kimball, Diehl,
Usher, & Fitzpatrick, 2011). Notwithstanding these setbacks, the healthcare providers are still
expected to ensure customer safety and that their decision making does not interfere with
emotional state. Burnout in the nursing profession has also been attributed to the dynamic needs
of the patients which makes it difficult for nurses to cope. Owing to the magnitude of burnout in
the health profession, multiple intervention strategies have been proposed to help monitor the
case. Despite the existence of strategies to address the issue, there is still a high prevalence of
burnout among mental health workers. This paper purposes to assess the implications of burnout
for mental health nurses and potential interventions to reduce it. A critical review of relevant and
current literature will be carried out to achieve the objective of the study.
Theoretical perspectives
The theoretical framework for this paper was obtained from the jobs demand-resources model
and the Maslach theory of burnout.

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The Job Demands-Resources model (The JD-R Model)
This model was established in 2006 by Arnold and Evangelia to modify the existing models on
the same subject. The JD-R model is made up of two sections: the job demands and job
resources. Job demands are the mental, physical, and social characteristics of the work such as
workload, job insecurity, work conflicts and work pressures. Job resources include physical or
social structures of the institution that are established to help the staff to be effective in their
work. Examples of job resources include good leadership, work safety, management, working
tools and good interactions between employees. According to the JD-R model, high job
demands and low job resources leads to stress and burnout among staff. On the other hand, high
job resources and low job demands lead to positive outcomes such as engaged and motivated
employees at the workplace (Schaufeli & Taris, 2014).
The model emphasizes the significance of striking a balance between job demands and job
resources. These two factors are dependent on each other to establish a successful work-place.
Job resources can mitigate the adverse effect of job strains such as effective supervision,
management and association with a supervisor can aid in leveraging job strain due to insecurity
and workload. Additionally, when the staff feel they are listened to, appreciated, rewarded for
outstanding performance, and given positive feedback, their wellbeing will also be positively
influenced (Schaufeli & Taris, 2014).
The Maslach theory of burnout.
The first research by Maslach was aimed at assessing emotions which later culminated to
occupational burnout. The initial studies on burnout emphasized on caregiving jobs in which
there was a relationship between the provider and recipient of care. Further research was

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broadened to factor in other occupations apart from human service (Vassar, Worley, & Barnes,
2011). Maslach observes that burnout is due to a disparity between the individual assigned to the
work and the demands of the work. Burnout can only be avoided when there is a match between
the employee undertaking the work and the demands of the work.
The theory suggests that burnout is made up of three aspects which include emotional
exhaustion, depersonalization and inefficacy (Wheeler et al, 2011). The most notable among the
three aspects is emotional exhaustion because the majority of employees undergoing burnout
easily cite exhaustion. Observable symptoms of emotional stress include moodiness, anxiety,
frustration which is likely to make an individual unable to manage emotional and physical
dimensions of work. Depersonalization creates a barrier between colleagues and disinterest at
work which is also accompanied by undesirable feelings. Such scenarios usually take place once
staff is not able to keep up with job demands resulting in detachment from the work. Emotional
exhaustion more often influences depersonalization and cynicism, and can also result in job
dissatisfaction. Employees can be perceived as objects instead of human beings. At this stage, an
employee feels worthless and incompetent after self-assessment based on job performance.
Individual attainments reduce after self-evaluation. The theory also demonstrates that burnout
has negative impacts including turnover, job performance and adverse effect on other staff which
lead to conflict. Continuous work regardless of burnout has been found to lead to poor job
performance (Wheeler et al, 2011).
Prevalence
Burnout among mental health nurses is a global public health problem with severe consequences.
(Morse et al., 2012) carried a literature review on burnout in mental health services and found

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out that burnout incidences among mental health nurses varied from 21% to 67%. López‐López
et al. (2019) conducted a meta-analysis to determine the prevalence of burnout among mental
health nurses and associated factors. The authors found out that depersonalization, emotional
exhaustion and low individual achievements accounted for 25%, 15% and 22% respectively. a
prevalence study on burnout among nurses in the Arabian countries found out that there were
high emotional exhaustion, depersonalization and low individual attainments of 81%, 80% and
85.8% respectively. The considerable factors that were associated with burnout include gender,
service duration, nationality, working hours and shift frequencies (Elbarazi, Loney, Yousef, &
Elias, 2017). The measurement of burnout levels using the Maslach Burnout Inventory and its
subscales by Abdo, El-Sallamy, El-Sherbiny, and Kabbash (2016). showed that 66.0% of the
participants experienced an average level of burnout with high burnout accounting for 24.9%.
Some of the predictors of burnout included gender, age, frequency of violence at work-place, and
workload. Nurses attached to psychiatric wards experienced high emotional exhaustion and
depersonalization compared to their counterparts working in the surgical, burns and internal
medicine wards (Sahraian, Davidi, Bazrafshan, & Javadpour, 2013). Another study carried out
among Italian psychiatrists found out that 49% of the health care providers had high levels of
emotional exhaustion (Kumar, Sinha, & Dutu, 2013). Whereas there is disagreement in the use of
cut-off scores to measure burnout levels due to unreliability, the use of a cut-off for a non-
clinical disorder is defective (Bianchi, Schonfeld, & Laurent, 2017). The outcomes are evidence
of high-stress levels and negative attitudes among mental health employees. High-stress levels
have a significant effect on employee’s productivity because they request for more sick days than
those in acute care. Stress associated to work was also higher with over 40% of the nurses

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reporting sick as a result of stress over the past 12 months compared with 35% in acute care
(Bianchi et al., 2017)
Implications for Practice
Burnout among nurses has been attributed to serious negative implications such as poor health
and job performance. Nurses showing signs of burnout are likely to resign from their present
work and have high absenteeism cases which finally affects productivity and efficiency (Morse
et al., 2012). Researchers have found out that burnout and its harmful influences are linked to job
demands, work satisfaction, coping strategies and work stressors. According to Al-Turki (2010)
burnout is highly prevalent among very demanding occupations, stressful daily tasks, and those
characteristic of high-performance level activities. Mental health experts have been classified as
one of those professions with a high risk of burnout as a result of high-stress levels and job
demands.
However, a conceptual evaluation of burnout among healthcare professionals has indicated that
the existence of burnout varies across workplaces (Morse et al., 2012). Healthcare professionals
that are assigned to workplaces that require high levels of commitment such intensive care units,
mental health, accident and emergency, and oncology. These nurses begin to undergo high
psychological and physical stress levels, and subsequently have incidences of burnout (Al Turki,
2010). Burnout nurses will ultimately offer substandard care services to clients, with a
substantial decline in performance and the provision of low-quality healthcare. These further
undesirable impacts on the safety and well-being of the patients. Nevertheless, it is important to
observe that burnout is usually experienced at an unconscious state because the victim is not
usually cognizant of their stress and fail to notice the prices effect it has on their ability to offer
effective quality care (Al-Turki, 2010).

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Mental health nurses provide healthcare services to patients and their families concurrently in
addition to perpetual witnessing of grievous harms, morbidity, isolation, pain and death.
Consequently, such experiences are commonly known as ‘the emotionality of nursing’ which
shouldn’t be lightly regarded because they can result to psychological trauma which further
increases the risk of burnout among healthcare workers (McAndrew, & Roberts, 2015).
Moreover, the existing healthcare settings seem to increase the risk of burnout among nurses
because of the labour shortages, intricate shift patterns and increased client keenness (Xie, Wang,
& Chen, 2011). Studies have shown that some factors in three specific groups are directly
associated with burnout undergone by nurses (Xie et al., 2011). Demographic characteristics are
the first category which usually includes nursing experience, age and qualification; buffering
factors are the second category and it consists of survival mechanisms; and thirdly,
organizational factors like poor retention. Likewise, Van Bogaert, Clarke, Willems, and
Mondelaers, (2013) showed that high workload levels are positively associate with emotional
exhaustion and thus negatively affects expert efficacy. The study by Wu, Chi, Chen, Wang, and
Jin (2010) suggested that continued stressful experiences lead to burnout, more so when there is
a mismatch between job demands and individual capacity.
Nurses working in a healthcare setting with high patient-to-nurse ratio are at a high risk of
undergoing burnout in their occupational life (Xie et al., 2011). The study examined the issues
nurses face in China as a result of burnout among nurses and its relation with job stress. The
study found out a positive correlation between increased burnout levels and job-associated stress
undergone by the nurses. Therefore, these results indicate that job-related stress is a critical
factor in predisposing nurses to the incidence of burnout.

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Certainly, work-related stress is a causal factor of burnout and is likely to derail the health and
well-being of nurses and consequently the health of the patients (Xie et al., 2011). Suner-Soler et
al. (2013) also arrived at the same conclusions by asserting that elevated burnout levels
compromise the health of the nurses. Studies have also found out that burnout affects the quality
of life of nurses. Work-associated stress among nurses is very dangerous and are often caused by
excessive workload, different types of tasks, constantly evolving healthcare sector among others.
an estimated 40% of all nurses attached to hospitals experienced burnout and its associated
impacts to the extent of resigning jobs. As a result, the healthcare services offered to patients is
ineffective. The affected nurses described themselves as unhealthy and unhappy at their jobs
(Sabbah, Sabbah, Sabbah, Akoum, & Droubi, 2012).
Interventions Strategies for Burnout among Mental Health Nurses
Burnout negatively affects nurses’ well-being and job performance and is highly associated with
high rates of infection, death, job loss and costs (Cimiotti, Aiken, Sloane, & Wu, 2012). Thus,
there is a need for establishing intervention strategies to help address the issue. A literature
review of the interventions indicated that the strategies were focused on nursing management,
individual characteristics and organizational leadership.
Nursing management, organization and leadership at all levels
It is the responsibility of nursing managers and organizations to ensure that work-related health
standards are attained at the job place by providing resources to help manage the demands. The
responsibility of making organizational policies is solely left to the management and positive
organizational, nurse and patient outcomes can be accomplished through effective management
that focuses on administrative supportive structures with the ability to foster innovations and
improvements. A conducive working environment such as adequate staffing is critical in

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improving nurse-patient ratios and thus minimizing workload which is the major cause of
burnout among healthcare professionals. Studies have indicated that effective leadership and
management are important in easing stress in the healthcare sector (Van Bogaert, Kowalski,
Weeks, & Clarke, 2013). There is a need for the management to be aware of the working
conditions of nurses and be ready to accept feedback and work on it as a way of showing
support. Furthermore, nurses should be involved in the decision-making process to help address
the nurses’ perception of being underestimated and unacknowledged (Alenezi, 2017).
Retreats and team-building gateways
The nursing profession is characteristic of teamwork to offer support to one another, and thus
promoting team building activities and support groups are critical in addressing work stressors.
Studies have found out that getaways and team building programs are effective in reducing
burnout in a healthcare setting. Approximately 150 oncology nurses attended an organized
retreat in the United States to foster social support, offer relaxation, and strengthen professional
interest. There was a positive impact of the retreat on the nurses because it resulted in positive
growth, relaxation and low-stress levels (Henry, 2014). Another staff retreat was carried out in
Southeastern US was aimed at team building. Some of the topics included role clarity and
teamwork. There was a 25% increase in job satisfaction as pertains to responsibility, leadership
and administration (Henry, 2014)
Social networks and support outside work
Social networks are effective in reducing burnout among nurses. A study carried out in China
among nurses on the capacity to manage job demands and stress through social support outside
work found out that having people outside work such as families and friends helped alleviate
burnout rates among nurses (Zhao et al., 2016). Building resilience has also been demonstrated
to be effective in coping with stressful work settings (Mealer et al., 2014). Miller (2011)

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proposes the use of strategies such as strong social networks, flexibility and self-esteem. Self-
esteem is important in a good performance and being flexible prepares one to accept, embrace
and manage change.
Conclusion
Burnout among mental health nurses is a global public health concern that affects the effective
delivery of healthcare services. The nursing profession itself is demanding and diverse and the
dynamic nature of the needs of patients further makes the work complex. Burnout is affected by
both individual and organizational factors but is generally characteristic of emotional exhaustion,
depersonalization and efficacy. Furthermore, burnout has significant implications such as poor
health, poor job performance, absenteeism among others. Due to the magnitude of the issue,
multiple strategies have been proposed to help address burnout among mental health nurses.
These strategies focus on the causal factors namely individual characteristics and organizational
leadership

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