Compassion Fatigue and Burnout in Nursing: Is There a Connection Between Nursing Burnout and Patient Safety?

Nursing is a job of two extremes. On the one hand, there is nothing quite like the joy of seeing your patients recover from their illnesses and live healthy lives because of the care you provide. 

However, on the flip side, as a nurse, you will also see more sickness, death, and grief than most other professions. Daily exposure to these workplace stressors can break down even the most mentally stable of nurses, eventually leading to nursing burnout.

Nursing burnout is a little-acknowledged but extremely dangerous phenomenon sweeping the healthcare system. 

This article will help you understand nurse burnout, how it develops, and the danger it presents. We’ll also touch on the signs and symptoms of nursing burnout so you can identify it in yourself and your colleagues, as well as prevention and coping strategies you can employ to stem its growth.

Related: Nursing Pros and Cons: How Do I Know If Being a Nurse is Right For Me?

What Is Nursing burnout?

Nursing burnout, sometimes referred to more broadly as healthcare worker fatigue, is the mental, physical, and emotional exhaustion nurses feel after constant exposure to nursing-related stressors such as high mortality rates, long work schedules, and rapid decision-making.

It is a subtype of regular burnout syndrome, with many of the same signs that accompany it. However, it differs in that nursing burnout has different underlying causes unique to those in the nursing profession. Additionally, this form of healthcare burnout not only affects nurses but can also have negative connotations for patient safety.

Is Nurse Burnout a Real Problem? Nursing Burnout Statistics

The word burnout, because of popular usage, has lost the severity it once carried. Perhaps that is why it is easy to overlook the problem of nurse burnout and dismiss it to the back burner. However, the data reveals that nursing burnout may be an even bigger problem than we realize.

In 2017, a Kronos study found that 63 percent of hospital nurses reported experiencing burnout at some point. Barely four years later, in a similar study conducted by Nursing CE Central, that number had surged to 95 percent.

Even though 38 percent of respondents in the Nursing CE Central study attributed their burnout to the Covid-19 pandemic, a larger majority cited existing problems in the nursing industry. Many included low staffing, emotional exhaustion, and high work demands as the reason for their burnout.

The study also revealed that 32 percent of nurses have considered leaving their current nursing job or even leaving the nursing profession altogether in the last three years. These findings seem to reinforce an earlier study in 2018 which found that of all the nurses who left their employment, 31.5% did so because of burnout.

These statistics reveal that nurse burnout is not a transient or trivial problem. It is very real and needs to be taken seriously.

Nursing Burnout Trends

America is facing a looming nursing shortage which may exacerbate nursing burnout. Even though the Bureau of Labor Statistics projects that registered nursing jobs will grow by nine percent, this growth cannot make up for the number of nurses leaving the profession due to retirement. We know this thanks to a 2020 survey which revealed that:

• the median nurse age is 52,
• nurses 65 and over make up 19 percent of the total nurse population, and
• 20 percent of nurses plan to retire in the next three years.

Also, even though student enrollment in nursing programs has increased, a recent survey reports that more than 80,000 qualified candidates were rejected due to faculty shortage, finances, and infrastructure.

What Causes Burnout in Nursing?

As mentioned earlier, nurse burnout results from sustained exposure to nursing-related stressors. These stressors may be inherent to the job itself or may be the result of some other external factor. Some of the most prevalent causes of nursing burnout include:

Low Staffing

Nurses have to do more to meet patient needs when hospitals are understaffed or lack crucial ancillary job positions. They may need to wear multiple hats and go beyond the scope of their job to ensure patient safety. This increased workload frequently requires you to work overtime, which results in higher stress and eventually burnout.

High Nurse-to-Patient Ratio

If you are a nurse with a nurse-to patient-ratio greater than 1:4, you are at risk of burnout. Research also shows that for every patient added to your shift workload, the chance of burnout increases by 23%.

Challenging Schedules

Nurses have one of the most challenging work schedules of any profession. They are always on their feet, working 12-hour shifts with little to no downtime. They may also have to work night shifts, which can affect their sleep cycle, making it harder to get the rest they need before working again.

High-Stress Environment

Nurses undergo a lot of stress. Making rapid-fire decisions, dealing with combative patients, and wrestling with ethical dilemmas are all in a day's work for them. Some nursing specialties, such as emergency, telemetry, or intensive care, are even more demanding, as you must address the most critical conditions daily. The stress from all this can build up, leading to burnout.

Lack of Support

The absence of a safety net to fall back onto, such as counseling, buddy systems, and wellness programs, can dramatically heighten your chance of getting burnt out. A toxic workplace with poor leadership and teamwork can make matters even worse and accelerate your burnout.

Emotional Strain

One of the most rewarding aspects of nursing is the satisfaction of helping your patients get better. However, you will see lower recovery and higher mortality rates if you work in critical or end-of-life care. This can lead to compassion fatigue and increased rates of burnout.

Signs of Nurse Burnout: Nursing Burnout Symptoms

Nursing burnout manifests differently depending on the person, but the earliest warning signs are usually feelings of disengagement and detachment. 

Other common symptoms include:

• Checked-out behaviors
• Fatigue
• Work-related anxiety
• Feeling underappreciated
• Unexplained illnesses
• Changes in sleep pattern
• Changes in appetite

If left unchecked, a nurse who is feeling burnt out at work, can develop chronic burnout syndrome which can result in serious medical, behavioral, and emotional conditions. 

Nursing Burnout vs. Compassion Fatigue

Nursing burnout is often mistaken for another stress-induced condition that plagues health care workers — compassion fatigue. While the two share some similarities and are connected, they are distinct phenomena that can occur independently and even coexist side by side.

The major difference between burnout and compassion fatigue in nursing is that while nursing burnout occurs due to constant exposure to nursing stressors, compassion fatigue occurs as a result of prolonged emotional strain. The former leaves you too exhausted to properly fulfill your duties, while the latter attacks your ability to feel empathy for your patients.

Additionally, with nursing burnout, you experience the stressors directly, while compassion fatigue results from secondary exposure to traumatic experiences. Compassion fatigue tends to develop quicker than burnout and can be easier to treat if caught early.

However, for all their differences, the two are also intricately connected. For healthcare professionals, compassion fatigue can be a precursor to burnout, with similar signs and symptoms. Additionally, it is important to recognize that with burnout syndrome, a person can develop an inability to feel compassion or empathy for others as a symptom. This can happen even if full-blown compassion fatigue does not exist.

Who is Most Likely to Suffer From Nursing Burnout?

We see the highest nursing burnout rates among nurses working in critical care specialties such as emergency departments and Intensive Care Units. Nurses in demanding healthcare departments such as oncology units and telemetry are also highly susceptible.

However, they are not the only ones at risk. Nurses who work long shifts, experience sleep deprivation, or already suffering from stress disorders are also at high risk of burnout.

It is even possible for ordinary people to suffer from nursing burnout, provided they operate in a nursing capacity, whether to a spouse or family member.

Consequences of Nursing Burnout

Nursing burnout can have serious and devastating effects on you as a nurse, your patients, the organization you work for, and the healthcare institution at large.

How Does Nursing Burnout Affect Nurse Well-being

Nursing burnout leaves you constantly exhausted, affecting your performance at work. It can also carry over into your personal life, causing you to be short with friends and family, experience mood shifts and feel dissatisfied with your life. Some other effects it can have on your life are:

• Desire to Quit: Nursing burnout can make you lose your passion for the job and make you want to quit.
• Depressive Disorders:  Research links nursing burnout with depression, drug/alcohol abuse, and even suicide.

Nursing Burnout And Patient Safety: How Does Nursing Burnout Affect Patient Care?

As recipients of care, patients are secondary victims of nurse burnout. Burnout can cause a decline in the quality of care they receive, which in turn may lead to things such as:

• Patient Dissatisfaction: Nursing is an extremely demanding profession, and it requires you to draw on your physical, mental, and emotional resources to ensure the highest standard of care for patients. If you suffer from nurse burnout, you cannot replenish your energy reserves, and consequently, the quality of care you can provide declines, leading to patient dissatisfaction.
• Increased Medical Errors:  Exhausted workers are prone to make mistakes, and while in other professions, such mistakes can be easily overlooked, in nursing, they can be life-threatening.

Institutional Effects of Nurse Burnout

If nurses are the backbone of the healthcare industry, burnout is the straw that broke the camel’s back. If left unchecked, it can hurt your organization's bottom line as well as the entire healthcare system at large by causing:

• Financial Losses: Several nurses leave their jobs each year because of burnout. Finding, training, and integrating replacements for them is extremely expensive, costing healthcare institutions millions of dollars annually.
• Collapse of Healthcare System: As previously mentioned, there is a correlation between high nurse burnout and turnover rates. High burnout rates lead to increased turnover, which in turn increases stress on existing workers, which leads to even more burnout. On and on, the vicious cycle continues and, if left unmanaged, can lead to the collapse of the nursing system and, consequently, the healthcare system.

How to Prevent Nursing Burnout

Nurse burnout is dangerous, but it is not inevitable. There are nursing burnout prevention steps that you, management, and healthcare institutions can take to reduce the likelihood of the condition developing. Some ways to prevent nursing burnout include:

Identify the Signs Before Things Get Worse

Knowing the warning signs of nursing burnout can help you reduce its incidence. You can catch it early and take appropriate measures. One way to determine the severity of your symptoms is by measuring your stress at work with a burnout test.

Make Sure You Get Enough Sleep

Good sleep is essential for nursing professionals to stave off burnout. Good sleep doesn't just mean quantity alone—although you should aim to get the recommended 7-9 hours of sleep—the quality of sleep is also important. So, keep a consistent sleep schedule and avoid things that cause poor sleep, such as caffeinated drinks and bringing work home.

Get Help — It’s a Sign of Strength

Don't try to shoulder the burden of your profession alone. Seek help from your co-workers, family, friends, or professionals. Relying on others and sharing your worries is an excellent way to relieve stress and better cope with work challenges.

Make a Job or Career Change

If all else fails, a change in nursing specialties or even a complete career change might be the best way to avoid nursing burnout. If you are considering this option, make sure to take a career test so that you pivot to specialties and careers that match your personality.

Leader Empowering Behaviors

Nurse managers and top-level management are responsible for providing a conducive working environment that lessens the chance of nurse burnout. They can do this by ensuring that hospitals are adequately staffed, enhancing the meaningfulness of work, and ensuring counseling and other support systems are in place.

How to Deal With Nurse Burnout Stressors

As a nurse, you will constantly be exposed to nursing stressors. There's just no way around it, and it is not likely to change anytime soon. However, what you can change is your response to those stressors. By tweaking how you react to nursing stressors, you can lessen their impact on you and your health.

Some ways you can better cope with stress as a nurse include:

• Setting boundaries between work and personal life
• Practicing relaxation and meditation
• Eating a well-balanced diet
• Taking micro-breaks at work
• Exercising and fitness
• Reflecting on your feelings on difficult days

Can I Overcome Burnout in Nursing?

Nurses are amazing people as well as the backbone of our healthcare system. Working in such a fulfilling profession can be a wonderful experience and is something to be proud of. While it is true that nurses have a high risk of developing burnout, if you combine the prevention strategies with the response habits above, you can avoid nursing burnout and enjoy your job of helping others to the fullest.