The RN’s Guide to Recognizing and Avoiding Burnout

In February 2016, the Agency for Healthcare Research and Quality (AHRQ) published a “Perspective on Safety” that linked burnout among health professionals with a decrease in patient safety. Although nurses use the term burnout to describe many things, it is, in fact, a syndrome that can cause physical, emotional, mental, and spiritual distress.

What is “burnout”?

The AHRQ defines burnout as “a syndrome characterized by emotional exhaustion that results in depersonalization and decreased personal accomplishment at work.” You probably learned about Hans Selye’s general adaptation syndrome (GAS) model at some point in your career. In that model, Selye describes three general stages of the stress response:

  1. Alarm – “Fight or flight” due to stimulation of the hypothalamus and sympathetic nervous system
  2. Resistance – The body attempts to adapt to the stressor
  3. Exhaustion – Adrenal exhaustion occurs, and extremely high cortisol levels result

Burnout is that final stage when you are completely exhausted by the stress you experience. Every nurse experiences stressors every day that can disturb your balance. When you can no longer adapt to these stressors, you will begin to show signs and symptoms related to elevated catecholamines and corticoids.

How can you recognize burnout?

Elevation of these hormones can lead to fatigue, sleep disturbances, loss of appetite, mood swings, reduced concentration and ability to think, and gastrointestinal problems.

During the alarm stage, you will see increased heart rate, blood pressure, respiratory rate, muscle tension, and alertness. When the stressor goes away, the symptoms also go away.

During the resistance stage, the body tries to adapt to the stressor by attempting to use calming or coping mechanisms that have worked in the past. Deep breathing, yoga, and relaxation techniques are common during the resistance stage. If the body is exposed to the stressor for too long, these mechanisms will no longer work.

During the exhaustion phase, blood glucose levels will begin to drop, resulting in decreased energy. This exhaustion leads to reduced stress tolerance and susceptibility to mental and physical problems. And this exhaustion is what nurses call “burnout”.

How can you avoid burnout?

The best cure is prevention. If you can avoid burnout, you will never have to worry about getting to the final stage of exhaustion.

The first step in avoiding burnout is to recognize unhealthy stress. Not all stress is unhealthy; however, even good stress can cause burnout. If you are planning a wedding, that is an exciting and good time, but it can be stressful. Unfortunately, your body is not able to differentiate between good and bad stress. Any stress can lead to burnout if it is strong enough and lasts long enough. Therefore, it is important that you recognize all the stress you are feeling in your life.

A second way to avoid burnout when you are under stress is to learn to relax. This is always important, but relaxation becomes particularly important when you begin to recognize the symptoms associated with stress. The Mayo Clinic relaxation techniques are a great way to reduce stress and the effects of stress. In general, relaxation techniques include things such as:

  • Deep breathing exercises will increase oxygen delivery to your brain that will activate the parasympathetic system
  • Meditation
  • Yoga
  • Slowing down for even 30 seconds as you breathe deeply and close your eyes can help the parasympathetic system get back on track to help calm you down
  • Communicating with friends, family, and coworkers about how you are feeling. Find someone with whom you work that you can trust and talk to when you get stressed.
  • Gentle massage
  • Acupressure or acupuncture
  • Laughing!

Although you may not be able to do all of these things in a busy work environment, learn to treat yourself to one or more of these techniques as often as possible.

A third technique to avoid burnout is to get plenty of exercise outside of the work environment. As we have already learned, an excess of cortisol can increase stress levels and push you into the alarm (fight or flight) stage of stress. When you exercise, the body releases cortisol. However, you say, I thought excess cortisol is what is causing symptoms of burnout? That is true, but if you exercise regularly, the amount of cortisol released will begin to decrease, and you will begin to function better under stress.

What is the difference between burnout and compassion fatigue?

Compassion fatigue and burnout are often thought to be synonymous, but they are quite different and recognizing which one you are suffering from is crucial to properly addressing the symptoms. Charles Figley, PhD, director of the Tulane University Traumatology Institute, formally defined compassion fatigue as a combination of burnout and secondary traumatic stress, specifically the kind of stress experienced by people who care for others who are traumatized or suffering. When experiencing burnout, you may feel frustrated, angry, or cynical while compassion fatigue will result in feelings of sadness or numbness. Understanding compassion fatigue is the best measure nurses can take to avoid and overcome it.

What can you do to “cure” burnout?

So, you didn’t read this article soon enough, and you already have symptoms of burnout? There are some simple “cures” you can try to decrease your symptoms of burnout.

  1. The same things that will help you avoid burnout will also help to cure burnout. In particular, meditation and yoga are long-term answers to the symptoms of stress since they will both increase the workings of your parasympathetic system. Again, exercise can help reduce the stress that has caused your burnout.
  2. Do something to further your personal goals. Abraham Maslow called this process self-actualization. As a nurse, you are busy every day taking care of others. If you are a parent or child of an aging parent, this care-taking does not end when your shift ends. It is important to do something for yourself every day that will move you toward the achievement of your personal goals.
  3. Keep a journal that documents your stressors and, more importantly, your accomplishments. Often, this small affirmation will help keep stress at bay. A journal can also help identify the stressors that you may not recognize “in the moment”.
  4. Finally, avoid the tendency to self-medicate with alcohol or drugs. While these may offer temporary relief, they will only exacerbate the symptoms over the long term.

Burnout is a well-recognized and real syndrome that can happen in any field. It has been well-documented in healthcare professionals who often do not take the time we need to decompress from a stressful day. Recognizing and developing some simple habits can help avoid and cure burnout when it happens to you.