Burnout in nursing: a theoretical review

Abstract

Background: Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients-is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout. Methods: We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce. Results: Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/ social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave. Conclusions: The patterns identified by these studies consistently show that adverse job characteristics-high workload, low staffing levels, long shifts, and low control-are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach's theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

Resilience and Burnout Resources in Respiratory Care Departments

“…Though the relationship between RT leadership and burnout has not been specifically studied, studies of physicians and nurses have found leadership behaviors significantly impact burnout and well-being. [14][15][16] Nursing studies indicate that low support from leadership, inauthentic leadership, and negative team relationships are associated with burnout. 16 The first step in combating burnout within RT departments is to accurately measure burnout rates and identify key drivers in individual centers.…”

“…[14][15][16] Nursing studies indicate that low support from leadership, inauthentic leadership, and negative team relationships are associated with burnout. 16 The first step in combating burnout within RT departments is to accurately measure burnout rates and identify key drivers in individual centers. RT leaders could then use these data to focus on specific leadership behaviors as a strategy to combat burnout.…”

“…High work load in nurses was associated with burnout in 13 of 15 studies, although no studies have been performed in RTs to date. 16 Interestingly, 15 studies reported that high patient to nurse ratios were associated with burnout, but there were no studies that found an association with more than sufficient staffing and burnout. 16 Thus, for RTs, simply increasing staffing to reduce burnout is an effective strategy only when short-staffed, and it may not be impactful when staffing is already sufficient.…”

Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU

“…Burnout is characterized by emotional exhaustion, cynicism, and depersonalization due to chronic exposure to workplace stressors and lack of emotional resources and supports ( 5 ). A recent review of 91 empirical studies on nurse burnout found significant associations between burnout and intent to leave, sickness absence, decreased job performance, and decreased perceived general health ( 6 ). Nurse burnout can occur as a result of moral distress and is identified in the literature as negatively impacting interprofessional teamwork and contributing to nurse attrition ( 6 , 7 ).…”

“…A recent review of 91 empirical studies on nurse burnout found significant associations between burnout and intent to leave, sickness absence, decreased job performance, and decreased perceived general health ( 6 ). Nurse burnout can occur as a result of moral distress and is identified in the literature as negatively impacting interprofessional teamwork and contributing to nurse attrition ( 6 , 7 ). Further, moral distress is linked to poor collaboration with physicians, thereby jeopardizing the quality of decision making in the ICU environment ( 7 , 8 ).…”