Six Savvy Ways to Beat Nurse Burnout


Six Savvy Ways to Beat Nurse Burnout

It all comes down to self care

By By Elizabeth Scala, RN, MSN, MBA
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It’s that time of year: The holiday season is upon us again. While it’s fun to make Halloween costumes, travel with our families and attend holiday parties, the hustle and bustle can leave us feeling drained. Being a nurse can add to this exhaustion.

Why? Not only do we deal with what everyone experiences during the holidays, we as nurses have an added weight upon our shoulders: the nursing profession itself!

Now, I’m sure that many, if not all, of you reading this know what burnout is. However, just so we are all on the same page, let’s pause to review some definitions:

•  The Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing and Allied Health defines burnout as “emotional and physical exhaustion resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills,” coupled with “an increasingly negative attitude toward his or her job, low self-esteem and personal devaluation.”

•  UC Berkeley psychologist Christina Maslach, Ph.D., who researches burnout using the Maslach Burnout Inventory (MBI), defines it as “a psychological syndrome involving emotional exhaustion, depersonalization and a diminished sense of personal accomplishment that occurs among various professionals who work with other people in challenging situations.”

It’s a triple whammy for nurses: We’ve got the busy time of year; the profession of nursing; and, let’s not forget, the increased likelihood of general malaise as we enter the darker and shorter days of wintertime ahead.

The Cost in Dollars — and Lives

Let’s turn this around and think about our patients. Holiday blues can impact us, the nurses, but what about the people we care for? When we are tired, unhappy, distracted or overwhelmed, what happens to them?

A few years ago, University of Pennsylvania professor Linda H. Aiken, RN, Ph.D., FAAN, FRCN, and her colleagues used the MBI to study nurse burnout and its effect on patients. The study, published in the August 2012 issue of the American Journal of Infection Control (AJIC), found that for each 10 percent increase in the number of high-burnout nurses, there was one additional catheter-associated urinary tract infection (CAUTI) and two additional surgical site infections (SSIs) per 1,000 patients each year.

Sure, one more CAUTI and two more SSIs a year might not seem like a big deal, but let’s put this into language that may have a greater impact on decision-makers: cost. According to the Association for Professionals in Infection Control and Epidemiology (APIC), per-patient costs associated with CAUTIs average $749 to $832 each while the costs associated with SSIs average $11,087 to $29,443 per patient.

Based on the AJIC numbers, Aiken’s team estimated that if nurse burnout rates could be reduced from 30 percent to 10 percent, hospitals in the state of Pennsylvania (where the research was conducted) could prevent 4,160 infections each year, with an associated annual savings of $41 million.

A 2014 study of clinician burnout in 54 Swiss ICUs, published in the January 2015 issue of Frontiers in Psychology, linked burnout to clinicians’ perspectives on safety and to patient mortality ratios.

Higher individual doctor or nurse burnout scores correlated with poorer overall safety grades. When measured at the unit level, emotional exhaustion was also an independent predictor of standardized mortality ratio. The researchers found that linkages between burnout and safety were driven by both lack of energy and impaired cognitive function.

Rediscovering Self Care

Burnout is bad for everybody: It’s bad for the patient and bad for families. It’s bad for the nurse, their teammates and the entire organization. What can be done to beat nurse burnout? Here are six self-care strategies for nurses:

1. Think back to the basics.

Okay, this first tip is all about health and wellness. If you don’t eat during the day, your blood sugar will drop and it will be harder to focus. If all you do is fill up on sweets and fast food, then your energy will crash and your mood will drop.

It’s basic self-care: Eat healthy, get proper rest and make sure you move that body. Now, what works for one person may not work for another, so be sure to figure out what you will actually adhere to. One of the issues we often have with self-care is that we try to do what others enjoy. Speaking for myself, I need external motivation, so I’d rather take an exercise class than go for a jog by myself. Figure out what you like that is healthy and work that into your life.

2. Balance “yes” and “no” responses.

This just might be my favorite tip. What are nurses notorious for? That’s right: helping out! If your workplace calls to ask you to come in a few hours early, what is your typical response? You’ve got it: “Sure!” Over time, that can lead to burnout and feelings of resentment towards work.

What I recommend is using a balance sheet. Take out a blank piece of paper, write “Working Overtime” across the top and then draw a line down the middle. Title the left column “Yes” and the right column “No.” Each time work calls, before you respond, bring out this sheet of paper and tally up your “yes” and “no” responses. See if you can balance them out so that you’re not saying “yes” all of the time.

(If going in to work for overtime isn’t an issue for you, find something or someone that you say “yes” to a lot and use that as your balance sheet title instead.)

3. Manage your time.
As a nurse, you have to juggle competing priorities. This means job, family and your own self-care — yes, you matter too. Now that you are going to be balancing your “yes” and “no” responses, this hopefully means you’ll have more free time on your hands. Instead of filling it up with carpooling or cleaning the house, why not do something fun for yourself?

The best way to manage your time is to keep a calendar. If I were to ask you to show me your calendar, I would probably see your work schedule on it. For many of you, I would also see what your children are up to in terms of school, hobbies and sports. But what about your activities and interests?

A great way to avoid burnout is to ensure that your schedule has at least two items per month that are just for you. Be sure to write them on your calendar too. That way, when you wish to decline an invitation, you can legitimately say, “I am sorry, but I have an appointment at that time” — an appointment with yourself!

4. Focus on strengths.
Often in nursing, we pay attention to what we don’t have: Supply shortages, not enough staff for this, no budget for that. When we consider what we don’t have, we only get more of it. It is a simple law of nature: What you focus on grows. Therefore, dwelling on the fact that we don’t have supplies, money or resources only makes us feel worse, causing more burnout.

However, when you start to focus on what you do have, you will actually start to see more opportunities. This isn’t just Pollyanna thinking, but the essence of a theory called Appreciative Inquiry (A.I.). The A.I. framework helps teams and individuals look at what is possible by asking questions related to strengths. Instead of looking backwards at the negatives, A.I. encourages you to focus on what might be possible in the future.

This may take some time and practice, but when you start to see solutions instead of roadblocks, burnout will decrease.

5. Allow yourself to receive.

As we discussed in strategy No. 2, nurses like to give a lot. That is great, but we are often less able to receive. Whether we think we can go it alone or feel we need to put on a brave face and say, “I’m fine,” nurses often turn down help that is offered.

However, if we take a bit of everything described above and mix it all into one, we have a nice and easy recipe for successful receiving. The key is to balance doing with non-doing and allow others to step in. When someone asks you if you need help, say “yes” from time to time.

Also, since each nurse has unique strengths and talents, you can help other nurses out when they’re having trouble. When two people help each other at work, you both feel less stress throughout your day.

6. Stay present and have fun.

One of the main reasons for burnout is we are not living in the moment. Many of us worry about the future or think back to what went wrong in the past. If we can learn to instead be mindful of the here and now, we will feel less pressure or overwhelm.

One way to do this is to focus on your breathing. Another way is to have fun in your current experience. I often ask myself if what I am doing at work is enjoyable. If the answer often happens to be “no,” I know that it is time for a change.

Staying present and doing what you love will help you avoid burning out in the long run.   


Keynote speaker and Nurse’s Week conference host Elizabeth Scala, RN, MSN/MBA, the bestselling author of Nursing from Within, partners with hospitals, nursing schools and nurse associations to transform the field of nursing from the inside out. Her website is


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