Burnout in Nursing staff with treatment and solutions to burnout is there

1. BURNOUT & ALARM FATIGUE
Dr. SUDHIR KHUNTETA
M. D. (Internal Medicine), FICCM
Chief Intensivist & Director,
SHUBH HOSPITAL
Gen. Secy. , Transport Medicine Society
Chairman, SAMVAAD
Jaipur

2. What is Burnout ?
• BURNOUT is a state of mental and/or physical
exhaustion caused by excessive and prolonged
stress.

3. International Classification of
Diseases ICD-10 defines
Burnout
Clinical condition or a work-related neurasthenia with the
following symptoms-
A persistent and distressing complaints of exhaustion after
a minor mental effort, or a persistent and distressing
complaints of fatigue and bodily weakness after minimal
physical effort.
At least two out of the following six distress symptoms:
1. Muscular aches and pain,
2. Dizziness,
3. Tension headaches,
4. Sleep disturbance,
5. Inability to relax,
6. Irritability

4. Diagnostic and Statistical Manual of Mental
Disorders DSM-IV Definition of Burnout
• A mental adjustment disorder which are
characterized by “the development of
clinically significant emotional or behavioral
symptoms in response to an identifiable
psychosocial stressor or stressors.

5. These all definitions provide
Three hallmarks or characteristics of burnout
• Mental Exhaustion
• Depersonalization
• Lack of Career accomplishment

6. Historical facts
• Mid-1950s
 Stress has been regarded as an occupational
hazard.
• In 1960
 Work stress in nursing was first assessed.
• In 1974, Term “burnout” coined (Freudenberger)
• Mid-1980s,
 Nurses’ work stress escalated due to the
increasing use of technology,

7. Why More concern
with nurses only
Nursing has been one of the
fastest growing professions for
the past 20 years and is
projected to keep growing 19%
faster than all other occupations.

8. Stages of burnout
 Three stages :-
 A. Stress arousal,
 B. Energy conservation, and
 C. Exhaustion
These symptoms are triggered by a mismatch
between the person and the social environment
of the workplace.

9. Physiological and psychological responses,
which are EXHIBITED AS:-
 Persistent irritability,
 Persistent anxiety,
 Periods of high blood pressure,
 Bruxism (the grinding of teeth during sleep),
 Insomnia,
 Forgetfulness,
 Heart palpitations and arrhythmia,
 concentration problems,
 Headaches,
 Gastrointestinal symptoms

10.  First attempt to compensate for stress and
includes.
 Excessive lateness,
 Postponement or delaying in work
 Excessive time off,
 Decreased desire for sex,
 Persistent tiredness,
 Social withdrawal from friends and family,
 Increased cynicism and distrust,
 Resentment,
 Substance use (nicotine, caffeine, alcohol,
prescription drugs, etc.),
 Excessive apathy

11.  The most serious stage with symptoms
 Chronic sadness or depression,
 Chronic stomach or bowel problems,
 Chronic mental fatigue,
 Chronic physical fatigue,
 Chronic headaches or migraines,
 The desire to be drop out of society,
 The desire to get away from family & friends,
 Recurrent suicidal ideation.

12. Physiology of Burnout
• 1. Stress:
– Physical environment,
– Responsibility,
– Role overload,
– Role boundary;
• Strain:
– Physical,
– Psychological,
– vocational,
– Interpersonal
• Coping:
– Selfcare,
– Recreation,
– Rational/cognitive,
– social support.

13. Etiology of Burnout
• 6 Major work problem causing burnout:
• work role conflict,
• lack of manager support, - Most iportant
• physical environment problems,
• poor promotion prospects,
• job not secure,
• skills under used

14. Factors determining stress
• Each individual’s cognitive appraisal, their
perceptions and interpretations, gives
meaning to events and determines whether
events are viewed as threatening or positive.
• Personality traits also influence the stress
equation because what may be overtaxing to
one person may be exhilarating to another

15. Challenges in Nurse`s role
Nursing is a Stress-filled work as involves:-
 Physical labor,
 Human suffering,
 Working hours,
 Interpersonal relationships
 Increasing use of technology,
 Continuing rises in health care costs,
 Turbulence within the work environment.

16. Challenges in Nurse`s role
 A Female have to juggle with multiple roles
related to the home and family, for which she
have sole or major responsibility.
 Non-work stress may be particularly salient
to nursing, a predominantly female
profession.
Particularly female nursing staff

17. WORK Life
FAMILY LIFE

18. Why not all……
►All nurses share similar pressures BUT
25% of all nurses suffer from burnout(Landau, 1992).
►Nurses often experience burnout when
there is a reduced sense of personal
accomplishment and a sense of failure.

19. Causes of Burnout in Nurse

20. Shift length and burnout
• Shift length : 8-hour or 12-hour ??
• Working 12-hour shifts reported significantly
higher levels of stress than 8-hour shifts.
• Nurses on 12-hour shifts experienced
significantly more chronic fatigue, cognitive
anxiety, and emotional exhaustion.

21. GENDER EFFECTS IN BURNOUT
 Found more frequently in female (79 percent) than male
(62 percent).
 Burnout was lower if female worked the number of hours
they preferred.
 For Females, Work interfered with family more than family
interfered with work.
Particular relevance for nursing as the profession is predominately
female.

22. Effect of Job strain
• Karasek’s job categories:
– High strain
– Active Strain
– Passive strain
– Low strain.
Comparisons of the high strain and low strain groups
revealed significant (P = 0.0001) differences for both
structural and psychological empowerment as well as
organizational commitment.
• Laschinger 2001

23. Verbal Abuse
Incidence rate : 96% had been spoken to in a verbally
aggressive manner
• 79% indicated verbal abuse by patients,
• 75% by other nurses,
• 74% by attending physicians,
• 68% by patients’ families.
Abuse Frequency
• Co-worker -27% -The most frequent source
• Patients’ families 25%,
• Physicians 22%,
• Patients 17%.
• Verbally abusive experiences Related to errors in
patient care- ONLY 13%
• Rowe 2005

24. Emotional aspect of work result in
Burnout
• 30-day mortality – More the mortality in duties -
More the Burnout- P < 0.001)
• failure to rescue -More the Burnout- - P < 0.001
• Nurses who cared for more patients exhibited high
emotional -More the Burnout- - P < 0.001).
• Can be reduced by increasing staffing.

25. Suicide -
• Hopelessness has been considered as a major risk factor for suicide.
Female nurses are at increased risk of committing suicide.
• They included personal stress and occupational stress as possible
contributory factors to nurses’ suicides
• a combination of high workload and low autonomy (especially in
making decisions) is likely to cause job dissatisfaction and health
problems.
• They found that an increased risk of committing suicide in nurses
was associated positively with smoking and negatively with caffeine
consumption.
• Access to means for suicide, such as drugs and medication, was a
less important risk factor for nurses when compared with suicide
risk in doctors.

26. Working environment :
Administration role
• Positive work environments were associated
with lower burnout (-0.62),
• Higher levels of autonomy, control, and
collaboration were associated with higher
levels of trust in management which was
associated with higher perceptions of care
quality and less burnout.
• Laschinger 2001

27. Empowerment have a POSITIVE role
• Higher perceived access to empowerment
was associated with lower job tension
• Empowerment was associated with Increased
work effectiveness
• Laschinger 1999

29. Emotional exhaustion and burnout phase
decreased as the coworker trust and
support increased.
 Lee 1996

30. What is NOT BURNOUT
• Burnout has often been mistaken for Stress,
Depression or Post-Traumatic Disorder due to
similarities in their symptoms.
IN STRESS
• Stress produces urgency and hyperactivity.
Burnout, on the other hand, produces
helplessness.
• Emotions associated with stress are over-
reactive, those associated with burnout are
more blunted. ( Burisch, 2006)

31. What is NOT BURNOUT-2
• IN DEPRESSION
• Depression may extend over every life domain (e.g.,
work, family, leisure).
• Burnout, however, is specific to work context. (Maslach et al., 2001).
• IN POST-TRAUMATIC DISORDER
• Post traumatic stress disorder (PTSD) is “caused by the
exposure to a traumatic event or extreme stressor that
is responded to with fear, helplessness, or horror”.
Burnout, on the other hand, is caused mainly by
interpersonal and emotional stressors in the workplace
and is characterized by different reactions e.g emotional
exhaustion.(Mealer, et al 2009).

32. Effect of Burnout on Nurse
• Nurses with Burnout Syndrome
– They view responsibilities negatively,
– find it difficult to work and
– have an absence of innovation,
– causing an overall reduced performance with all
daily responsibilities

33. IMPACTS OF BURNOUT
 Nurses shortage often leads to burnout with
resultant effects:
 Impact On Nurses
 Inadequate staffing and continuous overtime for
nurses
 Decrease quality of care
 The potential for medication errors

34. IMPACTS OF BURNOUT
 On Patients
 Increase patients neglect, cross infections or
complications.
 Medication adverse effects for patients and patient
mortality.
 Patient Dissatisfaction.

35. IMPACTS OF BURNOUT
 On Management
 High rates of employee turnover
 Increased employee absenteeism due to clinical
symptoms of diseases.
 It creates a hostile and toxic work environments and
increases lawsuits for the management.

36. Treatment: Defense clusters
• 1. Turning Against the Object (TAO) involves defenses that
respond to conflict by attacking an external object, such as
the defenses of displacement, regression, and identification
with the aggressor.
• 2. Principalization (PRN) involves defenses such as
intellectualization, rationalization, and isolation of conflict.
• 3. Turning Against the Self (TAS) involves defenses that deal
with conflict by directing aggressive thoughts or behaviors
toward oneself, such as masochism and introjection.
• 4. Reversal (REV) involves defenses that deal with conflict
by responding neutrally or positively toward a frustrating
object, such as denial.
• 5. Projection (PRO) is the attribution of negative qualities to
an object as a justification for the expression of aggression.

38. RECOMMANDATIONS
to Treat or Prevent
burnouts

39. Lifestyle Modification Approach
• Take Care of Yourself First
• Nurses are trained to put the care of others ahead of
themselves.
• You have to recognize that self-care is not
equivalent to selfishness; rather, self-care is
essential for energizing, restoring, and maintaining
the physical and emotional stamina to reduce fatigue
and manage stress.
• Nurses should also seek outside activities that will
help them disengage from their professional routine
and provide enjoyment, such as yoga, music, art,
reading, journaling, sports, and volunteerism.
– Maslach C. (2003)

40. FLEXIBILITY:
1. Consider new ways of doing your
current job;
2. Take some time off;
3. Talk to colleagues;
4. New Schedules/workloads;
5. Learn new skills like meditation

41. Recommendations for Nurses Contd.
• Quick identification of the signs and symptoms
of stress overload and burnout should be a
continuous process
• individuals should remain alert to the use of
unhealthy and ineffective coping mechanisms,
such as excessive use of caffeine, alcohol, or
prescription medication; overeating or
undereating; smoking; inactivity; or social
withdrawal
• Seek help from professional counseling if
necessary
• (American Psychological Association,2015)

42. Recommendations for Nurses Contd.
• Enhance Interpersonal and Social
Relationships by remaining connected to a
Positive Social Network of people.
• Grief Well: accepting the reality of the loss,
experiencing the pain of grief, adjusting to
the absence, and moving on with life
• Become an advocate for changes in the work
environment can help nurses increase a
sense of control.

43. Recommendations for managment
• Structural Empowerment
• An integral step in preventing burnout is to survey staff about
important aspects of the organizational culture
• Organizations can protect nurses from burnout by creating an
organizational culture of trust, support, and open communication
and fostering a healthy work environment through
• 1. Appropriate staffing
• 2. Meaningful recognition
• 3. True collaboration
• 4. Skilled communication
• 5. Effective decision making
• 6. Authentic leadership

44. • Improve Issues Related to Staffing and Work
Hour: how?
• Employers should stop using mandatory
overtime as a staffing solution
• Employers should adopt official policy that gives
Nurse the "right to accept or reject a work
assignment" to prevent risks from fatigue.
Recommendations for Management

45.  The criterion standard for measuring burnout
is the MBI (Maslach Burnout Inventory), a
self-assessment tool first published in 1981
by Maslach and Jackson.
 Reliable, valid, and easy to administer and in
several languages for use around the world.
 Often used in conjunction with other
assessments to evaluate the relationship
between burnout and organizational policies,
productivity, and social support

46.  Another useful tools is The General Health
Questionnaire
 in conjunction with the MBI which can help
professionals gain a better understanding of the
sources of stress for individuals.
 The General Health Questionnaire has been
translated into several languages and in a variety
of versions.
 Most often version used GHQ-28.
 A score of 0 to 3 is assigned to four possible
responses ("not at all," "no more than usual,“
rather more than usual," and "much more than
usual")
 Jackson C. (2007)The General Health Questionnaire. Occup Med.

47.  Another tool is the Burnout Risk Survey.
 Designed to demonstrate the probability of
mismatches between an individual and his or
her work environment.
 A "yes" response to three or more of these
items indicates a risk of burnout and
 a "yes" response to four or more items
indicates a high risk.
 Pfifferling JH. (2015) Burnout Risk Appraisal.

48. Let bring humanity back
to our workplaces

49. Let us fight burnout with
our cool calm and collected approach

50. Dr. SUDHIR KHUNTETA