How the sustained physical, emotional and psychological demands of work in the nursing sector is literally destroying lives

Burnout is on the rise in our health sector. It is an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed – and, in the health and social sectors, chronic stress is the rule, not the exception.^[i] Unhealthy social and cultural norms can work against meaningful efforts to prevent or reduce stress. Demand for our services, and unmet health and social needs, are growing. Healthcare practice is becoming increasingly complex and the many, often competing, demands on our time and energy, coupled with relentless resource constraints, are simply and devastatingly wearing us down.

The growing problem of burnout

Prior to the COVID-19 pandemic, burnout was reported by around 30 per cent of healthcare workers across Australia, the United States and the United Kingdom, across disciplines and in direct and indirect roles. Rates reported ranged from 17 to 52 per cent.^{[ii]; [iii]; [iv]; [v]; [vi]; [vii]; [viii]} Job stress and fatigue rates were far higher, and people working in healthcare and social assistance roles were the second highest occupational groupings in relation to claims for mental health conditions in Australia.^[ix]

Reports on burnout during the COVID-19 pandemic are even more sobering, with more than 51 per cent of health care professionals from 60 countries reporting burnout in a recent global study which aligns with a series of single country studies reporting rates over 50 per cent and impacts on quality of life.^[x] Risks of burnout related to COVID have been shown to be higher for women, nurses, people with pre-existing psychological conditions, those who’ve experienced a COVID-related traumatic event and people who had to change their personal habits and lifestyle.^[xi]

Why burnout matters

For the person going through it, the psychological and physical consequences of burnout are significant. They can range from insomnia and other sleep disturbances to a range of physical manifestations that can mimic serious illness as well as mental health impacts – stress, anxiety and depression. Burnout impairs our capacity to sustain our professional work, with many contemplating leaving their workplace or profession. The spillover effects into personal lives can be significant, and lead to strains and conflicts in personal relationships and relationship breakdowns.

In our workplaces, burnout can impact negatively on our colleagues, have damaging flow-on effects on the health workforce, and have a negative influence on workplace culture and functioning. The growing impact of staff absenteeism and turnover can take a heavy toll on the system, compromising the quality and continuity of care and adding significant resource burdens to an already over-stretched system.

The experiences of our patients, carers and communities – those who we are here to serve directly and indirectly – are also affected. Burnout compromises patient or client experiences, and impacts on the quality and safety of care.

A health hazard we can not afford to ignore

Burnout in nurses has been shown to increase with greater patient loads and to be associated with an intention to leave their job within the next year.^[xii]With predictions of a significant nursing workforce shortage in Australia in the coming years, this is an issue that requires our focused attention and action at many levels.^[xiii]

This is a health hazard that we need to take very seriously, now.

Alison Coughlan is the author of The Health Hazard: Take control, restore wellbeing and optimise impact. Alison draws on more than 25 years’ experience in the health and social sectors and her personal experience of reaching, sustaining and recovering from burnout, after which she charted a new, more fulfilling and sustainable path for her work and her life.

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[i] World Health Organization (2020). Burn-out an “occupational phenomenon”: International Classification of Diseases. Available at: https://www.who.int/mental_health/evidence/burn-out/en/

[ii] Kane L. (2020). Medscape national physician burnout and suicide report 2020: The generational divide. Available at: https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460

[iii] Kane L. (2019). Medscape national physician burnout and suicide report 2019. Available at: https://www.medscape.com/slidshow/2019-lifestyle-burnout-depression-6011056

[iv] Imo UO. (2017). Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsych Bulletin, 41:197-204.

[v] Beyond Blue (2019). The National Mental Health Survey of Doctors and Medical Students. Available at: https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web

[vi] McHugh MD, Kutney-Lee A, Cimiotti JP et al. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signals problems for patient care. Health Aff, 30(2): 202-210.

[vii] Hansen V and Girgis A. (2010). Can a single question effectively screen for burnout in Australian cancer care workers? BMC Health Services Research, 10: 341-345

[viii] Girgis A, Hansen V and Goldstein D. (2008). Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer, 45(3): 393-399.

[ix] Safe Work Australia (2020). Available at: https://www.safeworkaustralia.gov.au/topic/mental-health#snapshot-of-claims-for-mental-health

[x] Morgantini LA, Naha U, Wang H et al. (2020). Factors contributing to healthcare professional burnout during the COVIs-19 pandemic: A rapid turnaround global survey. PLoS ONE, 15(9): e0238217. Available at: https://doi.org/10.1371/journal.pone.0238217

[xi] Lasalvia A, Amaddeo F, Porru S et al. (2021). Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of nortg-east Italy. BMJ Open, 11:e045127. Doi:10.1136/bmjopen-2020-045127.

[xii] Aiken LH, Clarke SP, Sloane DM et al. (2002). Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. JAMA, 288(16): 1987-1993.

[xiii] Health Workforce Australia. (2014). Australia’s Future Health Workforce – Nurses Detailed. Commonwealth of Australia, Canberra.

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