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Nursing Burnout: Concept Analysis

Amie Seitz

Chamberlain College of Nursing

NR 501: Theoretic Basis for Advanced Nursing Practice

October 2017
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Nursing Burnout: Concept Analysis

Nurses carry a heavy burden of caring for others causing burnout quickly. Healthcare has

one of the highest instances of burnout and nurses are at the forefront of this (Gómez-Urquiza,

De la Fuente-Solana & Albendín-García, 2017). In the field of nursing, a concept analysis

provides a way to test nursing theory and develop new theories based on concepts and

phenomenon that are seen in practice. Burnout is one of the unexplained phenomena. With such

a high prevalence of nurses becoming emotionally exhausted in their jobs causing high job

turnover it is important to explore a concept analysis on nursing burnout. For the purpose of this

paper, the concept of burnout will be reviewed using Orem’s theory of self-care. This paper will

define and explain the nursing concept of burnout, provide a literature review, review

antecedents and consequences, empirical referents, construct cases, theoretical application and

conclusion.

Definition and Explanation of nursing concept

Burnout is defined as exhaustion or cessation of operation (Burnout, n.d.). This concept is

thought to be more prevalent in healthcare professionals because of the type of high-stress jobs

performed and the environment they work in (Manzano-García, & Ayala, 2017). In healthcare,

nurses take on the responsibility of caring for sick and dying patients and at many times invest

much of their physical and emotional strength into the care that is given, thus leading to burnout.

Nursing burnout has been known as many other terms such as burnout syndrome, chronic stress,

and compassion fatigue all of which are a result of a personal phenomenon where a nurse is no

longer able to operate the duties given (Filgueira Martins Rodrigues, Pereira Santos & Sousa,

2017). Burnout can affect anyone not just nurses, but any worker in a high-stress environment

(Salvagioni et al., 2017). Burnout is an effect of the lack of personal accomplishments and job
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dissatisfaction that causes a decrease in productivity and decreased overall health in nursing

(Conceição das Merces et al., 2017). This is a problem that needs to be addressed.

Literature Review

Much of the literature reviewed revealed that nursing burnout has become a problem that

is preventable. While burnout is an individual phenomenon, there are outreaching effects on the

work environment and patient outcomes (Jaracz et al., 2017). All of the literature reviewed

confirmed that emotional exhaustion, depersonalization, work environment, perceived failures

and job satisfaction are directly related to burnout (Conceição das Merces et al., 2017; Filgueira

Martins Rodrigues, Pereira Santos & Sousa, 2017). With nurse working long hours and giving so

much time and energy to the patient the literature supports that burnout is possible.

With burnout being a result of chronic stress at work, the literature also supports that this

stress has consequences to health promotion in the nurse and progression of disease (Savagioni et

al., 2017). The prevalence of burnout in one study was linked to levels of nursing autonomy in

the workplace, micromanagement, staffing, and the workload a nurse has (Khamisa, Peltzer &

Oldenburg, 2013). Job-related stress was also found in the literature to influence the perception

of self and personal temperament (Jaracz et al., 2017). It is also important to note that high levels

of stress and underachievement of personal goals influence consequences such as lateral

violence, medical errors and unsafe patient outcomes (Filgueira Martins Rodrigues, Pereira

Santos & Sousa, 2017).

While the literature stated that burnout can happen to anyone in high-stress environments

emergency room nurses and ICU nurse specialties were some of the highest likelihood to present

with burnout due to stress and job demands (Gómez-Urquiza, De la Fuente-Solana & Albendín-

García, 2017). Evidence from literature stated that working conditions and a person’s
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socioeconomic status pose a risk for nursing burnout (Gómez-Urquiza, De la Fuente-Solana &

Albendín-García, 2017).

The literature used different types of empirical referent like different types of

questionnaires were used to measure job-related stress. One literate found through these

questionnaires hat nurses have a higher rate of anxious temperament and experienced greater

intensity of job-related stress (Jaracz et al., 2017). A cross-sectional study of nurses in Bahia

Southwest concluded, using the Maslach burnout inventory and Human Services Survey, that the

prevalence of Burnout was 58.3% in nurses (Conceição das Merces,2017). Using Maslach

Burnout Inventory one study delved in further to find that Emotional Exhaustion is 36% of

burnout, Depersonalization is 36% of burnout, and low Personal Accomplishment 29 % of

burnout (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). Manzano-García &

Ayala used the e-Delphi web-based questionnaire, to show the factors that working nurses felt

influence burnout were relationships between work related stress, burnout, job satisfaction and

general health (2017). Manzano-García & Ayala found that little research has been done on

burnout, however, there is inconsistency in the antecedent that leads to burnout (2017). Burnout

was found to be a leading cause of disease progression and poor health in nurses (Khamisa,

Peltzer & Oldenburg, 2013; Savagioni et al., 2017). Some specific diseases are

hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to

cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue,

headaches, gastrointestinal issues, respiratory problems, insomnia, depression, irritability, mental

illness, severe injuries and mortality below the age of 45 years (Gómez-Urquiza, De la Fuente-

Solana & Albendín-García, 2017; Savagioni et al., 2017). Manzano-García & Ayala suggested

that more research needs to be done in recognizing tasks that nurses perform that lead to nursing
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burnout (2017). Also, it was shown that the lack of organizational support contributes to the

prevalence of burnout and increases the feelings of failure by nurses (Filgueira Martins

Rodrigues, Pereira Santos & Sousa, 2017). The need for early intervention and education can

improve personal and work-related impacts of burnout (Conceição das Merces et al., 2017;

Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017; Jaracz et al., 2017; Savagioni et al.,

2017).

Defining Attribute

A defining attribute is used to show when the concept may be present. Through the

literature review, the common attributes leading to burnout include a high-stress environment,

working long hours, and disease progression. High levels of burnout are a direct result of

workplace stress and are related to role conflict in nursing (Khamisa, Peltzer & Oldenburg,

2013). Role conflict as described by Khamisa, Peltzer & Oldenburgs study is when nurses feel

that their job doesn’t matter to the employer and they are unclear how to perform their duties any

longer (2017). The hours worked by nurses’ effect physical health and mental problems, leading

to burnout if untreated (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017).

Antecedent and Consequence

Antecedents are presented to give evidence of what leads to a concept. Two antecedents

that seem to go hand in hand with burnout would be physical and mental fatigue. These

antecedents keep nurses from being able to focus on their own self-care. A person’s reaction to

physical and mental fatigue is stress, which can lead to burnout in their profession (Jaracz et al.,

2017).

A consequence of burnout is decreased quality of care and poor patient outcomes from

the nurse to the patient. Poor patient outcomes are a consequence from nursing errors and even
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lateral violence and incivility to patients when a nurse is over stresses and has burnout in the

professions (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017).

Empirical Referents

Empirical referents will quantify the existence of burnout in the field demonstrating the

occurrence of the concept. One Empirical referent, an indicator of occurrence, is the use the

emotional exhaustion and depersonalization subscale (Gómez-Urquiza, De la Fuente-Solana &

Albendín-García, 2017). The use of this subscale assesses various aspects of burnout,

specifically emotional exhaustion, depersonalization, and personal accomplishment (Gómez-

Urquiza, De la Fuente-Solana & Albendín-García, 2017). A second empirical referent is the use

of burnout questionnaires. The uses of questionnaires, like the e-Delphi questionnaire, gathers

data about nurse’s opinions of what was influencing nursing burnout (Manzano-García & Ayala,

2017). The use of the empirical referents will give data that can be interpreted into application.

Construct Cases

Construct cases are formed to show how the defining attributes are illustrated in either

real life or fictitious examples.

Model Case

Nurse Theresa works in the hospital in the ICU. Theresa has been married for 5 years, has

four kids and is in school for her master’s degree. Theresa picks up 2-3 extra shifts every week

for extra money. Every shift she stays after work for more than an hour. She has also volunteered

to be on the education committee in the hospital. Theresa never takes time off for herself and has

built up 200 days of paid time off. Recently she had surgery for stomach ulcers related to stress

and came back to work the first available day she could. Theresa has become irritable at work

and there have been many complaints from patients that wrong meds were given to them and that
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Theresa has been rude. Theresa also coaches her daughter soccer team and is the team parent for

her son’s baseball club.

This model case illustrates all the attributes of burnout. Theresa works in the ICU which

is a high-stress environment, she stays late and puts family and patients’ needs above her own.

This nurse gave all she could to her job, her family and her schooling. She also has been having

health problems and not taking time to deal with them.

Borderline Case

Some attributes are provided in borderline cases. Nurse Gretchen works in a demanding

emergency room. Gretchen is married but has only dogs at home and is in school for her master’s

degree. Gretchen works registry nurse positions at least 1 day a week for extra money. Gretchen

never takes time off for herself and has built up 80 days of paid time off. Gretchen has become

irritable at work and there have been many complaints from patients that she has been rude and

forgetful. Gretchen spends what time she can with her husband and dogs, but wishes she could

spend more.

Gretchen is showing some attributes of burnout, she works long hours and extra hours

due to financial constraints. Gretchen has a high-stress job and takes little time off.

Contrary Case

Nurse Amie works three 12-hour shifts a week. She treats her patients equally and

finishes all her charting and work on time. Amie regularly sees the doctor for her physicals and is

happy with how her health is. Amie teaches in church and coaches her daughter’s soccer team.

This case is an illustration of what the concept is not. This nurse is comfortable in both work and

home and has found a happy medium.

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A contrary case will show none of the defining attributes of the concept. Amie is happy

in both her work life and at home. She shows no signs or attributes contributed to burnout.

Theoretical Application of Concept

Concepts are building blocks used to increase knowledge and understanding of nursing

theory. The use of Orem’s self-care deficit theory validates the concept of burnout in nursing.

According to this theory when an agent has a deficit it must be corrected in order to care for

others (Mills, Wand & Fraser, 2015). Providing a theory along with a concept helps to analyze,

give meaning and remove any limitations placed on a theory. For a nurse to provide

compassionate care, they must have the mental and physical capability to do so. The capacity to

care is questionable if the nurse neglects to care for their own physical and psychological needs

(Mills, Wand & Fraser, 2015). Orem’s theory suggests that it is essential for mind and body to be

in harmony (Mills, Wand & Fraser, 2015). When the attributes of burnout become evident,

implementing self-care theory can put into check the nurse’s overall health and focus health on

the self-care needs. This would require self-reflection either through journaling or through the

use of any of the empirical referents.

Conclusion

Concepts give a foundation for the knowledge and understanding of nursing theory.

Burnout is a concept in nursing that comes as a result of many things: heavy workloads, physical

fatigue, mental fatigue, and long hours. The progression of the disease states can increase as

stress and poor working conditions are placed on the nurse. Understanding the relation of

concepts seen every day in advanced nursing practice, like Family Nurse Practitioner, can help in

the integration of nursing theory. By using theories such as Orem’s self-care, a Nurse
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Practitioner can provide for better outcomes. Nurses focusing on self-care need treat their body

and mind first then they can, in turn, provide better patient care and outcomes.

The information gained here from this concept analysis is important to future practice.

The use of evidence-based research and the use of theoretically based concept analysis can

provide direction and education on emerging phenomenon. Moving into future practice, concept

analysis provides reasoning for a phenomenon that seems unrelated and provides knowledge that

gives better nursing judgment. Also, understanding the significance of concepts provides for the

new development of theories that validate the field of practice.

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References

Burnout. (n.d.). Retrieved November 10, 2017, from https://www.merriam-

webster.com/dictionary/burnout

Conceição das Merces, M., Almeida Lopes, R., de Souza Silva, D., Sousa Oliveira, D., Lua, I.,

Santana Mattos, A. I., & D'Oliveira Júnior, A. (2017). Prevalence of Burnout Syndrome

in nursing professionals of basic health care. Revista De Pesquisa: Cuidado E

Fundamental, 9(1), 208-214. doi:10.9789/2175-5361.2017.v9i1.208-214

Filgueira Martins Rodrigues, C. C., Pereira Santos, V. E., & Sousa, P. (2017). Patient safety and

nursing: interface with stress and Burnout Syndrome. Revista Brasileira De

Enfermagem, 70(5), 1083-1088. doi:10.1590/0034-7167-2016-0194

Gómez-Urquiza, J. L., De la Fuente-Solana, E. I., & Albendín-García, L. (2017). Prevalence of

Burnout Syndrome in Emergency Nurses: A Meta-Analysis. Critical Care Nurse, 37(5),

e1-e9. doi:10.4037/ccn2017508

Jaracz, M., Rosiak, I., Bertrand-Bucińska, A., Jaskulski, M., Nieżurawska, J., & Borkowska, A.

(2017). Affective temperament, job stress and professional burnout in nurses and civil

servants. Plos ONE, 12(6), 1-11. doi:10.1371/journal.pone.0176698

Khamisa, N, Peltzer, K. Oldenburg, B. (2013). Burnout in Relation to Specific Contributing

Factors and Health Outcomes among Nurses: A Systematic Review. International Journal

of Environmental Research and Public Health. doi:10.3390/ijerph10062214

Manzano-García, G., & Ayala, J. (2017). Insufficiently studied factors related to burnout in

nursing: Results from an e-Delphi study. Plos One, 12(4), e0175352.

doi:10.1371/journal.pone.0175352
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Mills, J., Wand, T., & Fraser, J. A. (2015). On self-compassion and self-care in nursing: Selfish

or essential for compassionate care?. International Journal Of Nursing Studies, 52(4),

791-793. doi:10.1016/j.nedt.2013.07.011.

Salvagioni, D. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. d.

(2017). Physical, psychological and occupational consequences of job burnout: A

systematic review of prospective studies. Plos ONE, 12(10), 1-29.

doi:10.1371/journal.pone.0185781