Essay that touches on the broad topic of burnout in nursing.

1. Running head: NURSING BURNOUT: A COMMUNICABLE DISEASE 1
Nursing burnout: A communicable disease
Edward Struzinski, RN
Kaplan University

2. NURSING BURNOUT: A COMMUNICABLE DISEASE 2
The career of nursing can frequently prove to be very challenging. As new graduates
come into the field they are met with a host of responsibilities that can seem endless and
unwarranted. Eyes are opened and they suddenly have a new understanding of their nursing role
that they did not have as great an appreciation for while in school. New graduates are a valuable
resource needed to a healthcare field currently plagued by a nursing shortage reportedly due to
only worsen in the coming years; however, research has shown many new nurses to leave their
positions within their first year often because of poor working conditions and destructive
influences seen on their units (Laschinger, Wong, & Grau, 2013). Combined with the physical
requirements of the job and psychological demands, as well as incivility encountered in the
workplace and other incidents invoking moral distress, all of these factors may lead to an undue
amount of psychological stress. Even with proper reduction exercises, compassion fatigue may
begin to take course. Over time, this may also lead to burnout.
Burnout is a significant issue in nursing, with effects that can spread like a communicable
disease in the organization, such as destroying employee morale on the unit, poorly affecting the
retaining of experienced nurses for a quality workforce, causing budgetary financial costs to the
organization in missed days, and ultimately affecting the delivery of quality patient care. It has
been determined to also be a factor increasing patient mortality and admission length of stays, as
well as a drop in Press Ganey scores referring to general patient satisfaction of their care. This
essay aims to discuss the concept of burnout in nursing, beginning with definitions and further
discussing its implications and hopeful solutions. The goal of this essay is to shed light on the
issue of burnout, increase awareness and understanding, and hopefully invoke positive change in
the current culture seen in nursing.

3. NURSING BURNOUT: A COMMUNICABLE DISEASE 3
Definitions
What is burnout? A literature review found multiple descriptions and, although no true
definition exists that is specific to the nursing career, “the most widely used definition of burnout
is Maslach and Jackson’s (1996), who defined it as a syndrome of emotional exhaustion,
depersonalisation [sic] and reduced personal accomplishment” (Mahony, 2011, p.30). Burnout is
essentially referred as a psychological syndrome, occupationally induced, and being at the
extreme opposite of engagement whereby the individual experiences a collapse of their human
spirit (Epp, 2012). It is a state of emotional, mental, and physical exhaustion resulting from long-
term involvement in situations that are emotionally demanding, such as found in nursing
(Fradelos et al, 2014). It is also described as a syndrome comprised of depersonalization,
emotional exhaustion, and a feeling of reduced or poor personal accomplishment (Lang,
Patrician, & Steele, 2012; Stewart & Terry, 2014) and also a syndrome of emotional exhaustion
and desensitization that is seen particularly among those serving as support service to the general
public (Tekindal, B., Tekindal, M., Pinar, Ozturk, & Alan, 2012). One psychologist expressed
burnout as a state of disappointment, physical and psychological fatigue, a feeling of
underachievement, general tiredness, and having the desire to leave work, and that it is more
common in care-taking careers (Aytekin, Yilmaz, & Kuguoglu, 2013).
Breen and Sweeney (2013) describe burnout to be the experience of emotional, physical,
and spiritual fatigue resulting from chronic exposure to demanding work stressors that are found
in healthcare. In the hospital, primary care, and residential elderly care settings, it is seen as the
mental fatigue associated from the stress on the individual’s conscience of caretaking (Juthberg,
Eriksson, Norberg, & Sundin, 2010). Burnout is further described in another relevant study as
feelings of psychological deprivation, poor or lack of accomplishment, efficacy and fatigue

4. NURSING BURNOUT: A COMMUNICABLE DISEASE 4
(Özcakar, Kartal, Dirik, Tekin, & Guldal, 2012). And finally, in the most broad sense or
definition, nursing burnout is understood to be a severe psychological reaction to chronic work
stress encountered in the environment (Kalicińska, Chylińska, & Wilczek-Różyczka, 2012).
Attributes, theoretical and operational definitions
The signs and symptoms of a nurse experiencing burnout of their profession are
individualistic. They are listed here in no particular order: fatigue, frustration, argumentative,
overall job negativity, despair, lack of compassion or empathy, increasing conflicts with staff,
habitual tardiness and/or sick outs, carelessness, incivility behaviors, increasing errors, cynicism,
depression, crying, spousal or relationship difficulties, alcohol and/or substance abuse, suicidal
ideation, multiple patient complaints, blaming others, etc.
The burnout concept, whether in nursing or other related field, or another field entirely
outside of healthcare, is the same. It can be theoretically defined as a state of mind in which the
individual may have feelings of loss, sadness, depression, frustration, or even anger. Used in
research studies, operational definitions of concepts look more closely at the forms of distress
felt by the subjects being studied and also have a measurable scale or means to quantify the
results. The most widely used research measure in the burnout field is the Maslach Burnout
Inventory (MBI) survey (University of California, Berkeley, 2013), an indexing tool designed to
measure hypothesized characteristics of the burnout syndrome, notably: emotional exhaustion,
personal accomplishment, and depersonalization (Maslach & Jackson, 2007). Questions found
on the survey offer a subjective assessment to rank the individual’s potential or present level of
burnout and aims to calculate the most validated score.

5. NURSING BURNOUT: A COMMUNICABLE DISEASE 5
Cause and effect
Burnout is the end result of a process of events leading up to it. An assessment of peer-
reviewed literature states that it is a syndrome having three key elements: emotional exhaustion,
depersonalization, and a reduction of personal accomplishment. Job satisfaction is but one factor
involved in the burnout process, with the individual feeling less and less of it than is needed to
maintain their energy for job performance and work relationships. Job stress increases as the
individual’s emotional and psychological well-being decreases, worsening the situation; without
appropriate therapeutic interventions, the process continues to escalate. Even the most caring
professionals may develop compassion fatigue, a feeling of indifference to the condition that an
individual is suffering from. This occurs after frequent and repeated exposure to caring for the
same. Compassion fatigue is not the same as the burnout syndrome, which occurs insidiously
over a period of time rather than the more rapid onset usually seen in compassion fatigue (The
American Institute of Stress, 2014). Burnout can happen in any nursing discipline although it is
associated with higher prevalence in areas of increased patient acuity, such as emergency
departments, intensive care units, and operating rooms. It can have an impact on patient care as
well as the nursing unit atmosphere, and it has been shown to have a direct, negative effect on
the nurse’s quality of life. One study that researched subjects in a neonatal critical care
environment positively showed the nurses experienced a moderate amount of emotional
exhaustion and personal achievement, and that as the burnout level increased, the quality of life
for the nurses decreased at significant levels (Aytekin et al., 2013). Burnout results in poor health
outcomes, such as depression and debilitated physical health; it is also a viable threat to patient
care and organizational performance (Laschinger et al., 2013).

6. NURSING BURNOUT: A COMMUNICABLE DISEASE 6
The consequences of burnout are equally concerning, bearing significant weights that can
have a domino effect on others. These include a decline in resource effectiveness and employee
productivity, increased absenteeism due to reported sickness (whether real or perceived), low
morale on the unit, poor job performance and patient care, and increased staff attrition
(downsizing) and turnover of nurses. However, nurse turnover is not necessarily a completely
negative situation to occur. Marquis and Huston (2012) explain some turnover to be normal and
actually desirable as it infuses the atmosphere with freshness, new ideas, and reduces a
“groupthink” situation in which everyone is sharing a similar pattern of thinking and ideas. All of
these issues feed upon each other and impact the organization in more than one dimension, and
they are also as costly as much as they are preventable.
Workplace incivility
Incivility can be identified as another cause for job dissatisfaction and a factor of burnout,
with either the nurse being the recipient or the initiator of the behavior. In either case, incivility,
which is globally defined in many resources as being rude, brash, unnecessary and often
unwarranted behavior toward another individual, generates an unhealthy and unhappy
atmosphere. A previous literature review has demonstrated incivility to be commonplace in
healthcare environments, especially nursing. Using inductive reasoning, incivility cannot be
discounted as a factor leading to nursing burnout. It would, in fact, escalate it. Overwhelming
evidence in both nursing and management literature shows common links between nursing staff
turnover related to attitudes and behaviors like empowerment (positive correlation) and
workplace incivility and burnout (negative association) (Spence Laschinger, Leiter, Day, &
Gilin, 2009). Job satisfaction and a commitment to nursing staff by hospital administration are
consistently found to be important qualities that positively affect outcomes in turnover. Studies

7. NURSING BURNOUT: A COMMUNICABLE DISEASE 7
show job satisfaction was consistently projected to occur by autonomy, good communication
between management and bedside nursing staff and organizational commitment. Another
revealed it indirectly affects turnover by nurses wanting to stay with the organization (Spence
Laschinger, et al., 2009). These studies help to shed light on the positive correlation between the
incivility behaviors experienced in nursing, or the general disrespect and professional disregard
for colleagues, and its contribution to burnout.
Empowerment and collaboration
Two powerful tools that can be found in the arsenal against burnout in nursing are the
impressionable skills of empowerment and collaboration. Each is an effective talent shown to
have positive outcomes when utilized in solutions. Empowerment is recognized to be excellent
attribute that is important to the effective functioning of an organization, such as a hospital; it is
evidenced by nurses who are inspired and motivated to contribute their talents and who are
confident that they will be acknowledged and valued for doing so (Larkin, Cierpial, Stack,
Morrison, & Griffith, 2008). Empowerment can be accomplished through the following four
practices, as outlined in Rosabeth Kanter’s theory of structural empowerment: providing access
to information, access to resources, receiving support, and being given the opportunity for
learning and professional growth (Blais & Hayes, 2011). The benefits of empowering the nursing
staff are noteworthy. It has been shown to substantially lessen the disempowering effects of
stressful working conditions commonly experienced in healthcare (Laschinger et al., 2013)
which are known contributors to the burnout syndrome. Conversely, additional research has
shown higher levels of burnout in which there were significantly lower levels of empowerment
provided to nurses (Laschinger et al., 2013).

8. NURSING BURNOUT: A COMMUNICABLE DISEASE 8
Collaboration among co-workers is another outstanding approach to take in an effort to
prevent nurses from leading toward a burnout syndrome due to the daily stressors of the job.
Collaborative environments require mutual respect of all individuals, but most importantly, it
requires all staff to share responsibilities of one common goal equally and hold each other
accountable in reaching it. Although the idea of working in collaboration with each other would
seem obvious, the reality of it occurring in clinical practice is quite different. It means bringing
all professional positions, men and women alike, across all ages and cultural backgrounds, to
drop their preconceptions of each other and learn to get along as true professionals are expected
to, and should be doing. It means eliminating an inequality barrier that is still very present in our
world that has come so yet still has evidence of racial and gender biases.
Working together collaboratively also warrants the eradication of power of all involved:
that no one individual holds power over the other. This can be a difficult and humbling change
for many who take great pleasure in the feeling of owning authority. But it is necessary if a
group of individuals are to band together as one united team. Wilmot and Hocker (2007) state the
advantages to promoting this type of atmosphere are that it encourages mutual respect and
drawing ideas from each individual party, and that disadvantages include the fact that individuals
having better verbal skills can be manipulative, steering the direction of the group.
Each of the aforementioned qualities that are associated with improved job satisfaction
(collaboration and empowerment) is not surprisingly also noted to be qualities found in hospitals
holding Magnet status. Magnet is the leading source of best nursing practices and strategies
worldwide, recognizing hospitals for their nursing excellence and quality patient care. Reaching
this designation is the ultimate credential for high quality nursing (American Nurses
Credentialing Center, 2014). Hospitals achieving this highly acclaimed status have been proven

9. NURSING BURNOUT: A COMMUNICABLE DISEASE 9
through research to have lower rates of nursing burnout versus non-Magnet designated facilities.
They also reveal higher job satisfaction scores, have better staff retaining ability, reduced
needlestick exposures, and lower patient mortality rates congruent with lower lengths of
admission stays (O’Mahony, 2011).
Concept application into clinical practice
Understanding and practicing these ideas of collaboration and empowerment in the
clinical setting coincides with Rosemarie Parse’s Theory of Humanbecoming, in the sense that
people are intentional beings. They choose attitudes, directions, and ways of thinking and acting;
that humans are fluent and must have an enduring respect for another individual’s ability for
change and possibilities (Alligood & Tomey, 2010). Placing into practice these skills, combined
with an understanding of behaviors that delineate workplace incivility and steering clear from
them, supports Parse’s theory by showing a deeper concern for each other, another’s feelings,
and acknowledging their human dignity.
Conclusion
Burnout in nursing is an insidious problem, progressing slowly over time from any
variety of factors causing psychological, emotional, or other form of distress, including
compassion fatigue. Research is increasingly showing that burnout occurs out of a disparity
between the individual and the job (Sabo, 2011). It can occur in any discipline of nursing
although areas of critical care interventions have higher proportions than most. Several
definitions exist but all revolve around three key elements that characterize the burnout
syndrome: emotional exhaustion, depersonalization, and poor personal accomplishment.

10. NURSING BURNOUT: A COMMUNICABLE DISEASE 10
People need to feel a sense of achievement to maintain psychological motivation for
personal and professional expansion: stagnancy is mentally exhausting and detrimental to the
human psychological perspective. When opportunities to advance are lacking in the organization,
nurses’ efforts may go unnoticed and unacknowledged; professional development may be
hindered, creating feelings of inadequacy and hunger for personal growth; left as unsupported,
this may eventually be expressed as burnout (Ushiro & Nakayama, 2010). Job satisfaction,
another cause for burnout, can be related to other issues happening in the workplace, such as:
incivility among co-workers or hostile working environments, a non-collaborative style
atmosphere in which nurses do not feel respected by their peers for their education or experience,
or not feeling empowered in their positions as primary caretakers.
The importance of fostering a supportive environment filled with charisma,
empowerment, and collaboration cannot be over-emphasized. Not only as an intervention for
those nurses already experiencing feelings of burnout in their jobs but also for new graduates
entering the career. They represent the new age, and with them, new ideas. Collaboration in
working together is not entirely targeted for patient care but also providing a lighted path for the
new, inexperienced nurses to follow. This promotes good will that reflects good patient care, and
progressively over time it can promote a much-needed growing workforce of nurses that
continue to breed a positive culture: all of which can help prevent burnout in nursing and its
associated negative effects that have the ability to spread like a communicable disease.

11. NURSING BURNOUT: A COMMUNICABLE DISEASE 11
References
Alligood, M.R., & Tomey, A.M. (2010). Nursing theorists and their work (7th ed.).
MarylandHeights. MO: Mosby Elsevier.
American Nurses Credentialing Center. (2014). ANCC Magnet recognition program.
Retrieved from http://www.nursecredentialing.org/magnet.aspx
Aytekin, A., Yilmaz, F., & Kuguoglu, S. (2013). Burnout levels in neonatal intensive care
nurses and its effects on their quality of life. Australian Journal Of Advanced Nursing,
31(2), 39-47.
Blais, K., & Hayes, J. (2011). Professional nursing practice: Concepts and perspectives (6thed.)
Upper Saddle River, NJ: Pearson.
Breen, M., & Sweeney, J. (2013). Burnout: The experiences of nurses who work in inner city
areas. Mental Health Practice, 17(2), 12-20.
Epp, K. (2012). Burnout in critical care nurses: a literature review. Dynamics, 23(4), 25-31.
Fradelos, E., Mpelegrinos, S., Mparo, C., Vassilopoulou, C., Argyrou, P., Tsironi, M., & ...
Theofilou, P. (2014). Burnout syndrome impacts on quality of life in nursing
professionals: The contribution of perceived social support. Progress In Health Sciences,
4(1), 102-109.
Juthberg, C., Eriksson, S., Norberg, A., & Sundin, K. (2010). Perceptions of conscience, stress
of conscience and burnout among nursing staff in residential elder care. Journal Of
Advanced Nursing, 66(8), 1708-1718. doi:10.1111/j.1365-2648.2010.05288.x
Kalicińska, M., Chylińska, J., & Wilczek-Różyczka, E. (2012). Professional burnout and social
support in the workplace among hospice nurses and midwives in Poland. International
Journal Of Nursing Practice, 18(6), 595-603. doi:10.1111/ijn.12003

12. NURSING BURNOUT: A COMMUNICABLE DISEASE 12
Lang, G., Patrician, P., & Steele, N. (2012). Comparison of nurse burnout across Army hospital
practice environments. Journal Of Nursing Scholarship, 44(3), 274-283.
doi:10.1111/j.1547-5069.2012.01462.x
Larkin, M., Cierpial, C., Stack, J., Morrison, V., Griffith, C., (2008). Empowerment
theory in action: The wisdom of collaborative governance. OJIN: The Online Journal of
Issues in Nursing, 13(2). doi: 10.3912/OJIN.Vol13No02PPT03
Laschinger, H., Wong, C., & Grau, A. L. (2013). Authentic leadership, empowerment and
burnout: a comparison in new graduates and experienced nurses. Journal Of Nursing
Management, 21(3), 541-552. doi:10.1111/j.1365-2834.2012.01375.x
Marquis, B., & Huston, C. (2012). Leadership roles and management functions in nursing
(7th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Maslach, C., & Jackson, S. (2007). The measurement of experienced burnout. Journal of
Organizational Behavior, 2(2). doi/10.1002/job.4030020205/pdf
O’Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse,
19(5), 30-37.
Özcakar, N., Kartal, M., Dirik, G., Tekin, N., & Guldal, D. (2012). Burnout and relevant factors
in nursing staff: What affects the staff working in an elderly nursing home? Turkish
Journal Of Geriatrics / Türk Geriatri Dergisi, 15(3), 266-272.
Sabo, B., (2011). Reflecting on the Concept of Compassion Fatigue. OJIN: The Online Journal
of Issues in Nursing, 16(1), Manuscript 1. doi: 10.3912/OJIN.Vol16No01Man01
Spence Laschinger, H., Leiter, M., Day, A., & Gilin, D. (2009). Workplace empowerment,
incivility, and burnout: impact on staff nurse recruitment and retention outcomes.
Journal Of Nursing Management, 17(3), 302-311. doi:10.1111/j.1365-2834.2009.00999.x

13. NURSING BURNOUT: A COMMUNICABLE DISEASE 13
Stewart, W., & Terry, L. (2014). Reducing burnout in nurses and care workers in secure
settings. Nursing Standard, 28(34), 37-45.
Tekindal, B., Tekindal, M., Pinar, G., Ozturk, F., & Alan, S. (2012). Nurses' burnout and unmet
nursing care needs of patients' relatives in a Turkish State Hospital. International Journal
Of Nursing Practice, 18(1), 68-76. doi:10.1111/j.1440-172X.2011.01989.x
The American Institute of Stress. (2014). Compassion fatigue. Retrieved from
http://www.stress.org/military/for-practitionersleaders/compassion-fatigue/
University of California, Berkeley. (2013). Christina Maslach. Retrieved from
http://psychology.berkeley.edu/people/christina-maslach
Ushiro, R., & Nakayama, K. (2010). Gender role attitudes of hospital nurses in Japan: their
relation to burnout, perceptions of physician-nurse collaboration, evaluation of care, and
intent to continue working. Japan Journal Of Nursing Science, 7(1), 55-64.
doi:10.1111/j.1742-7924.2010.00138.x
Wilmot, W., & Hocker, J. (2007). Interpersonal conflict (7th ed.). New York, NY: McGraw-Hill.