November 09, 2022

Why more understanding – and a more comprehensive response – are so badly needed

by Jin Jun, PhD, RN

Burnout — a psychological condition involving a prolonged response to enduring interpersonal stressors — has almost become a descriptor for nursing work in recent years. The COVID-19 pandemic has pushed many already-stressed nurses into a deep state of burnout, as evidenced by research that finds one in two nurses reporting symptoms of burnout.1

As an increasing number of healthcare leaders, policymakers, researchers and nurses raise this critical issue, there is a need to distinguish other syndromes that overlap with burnout. The impacts of these specific conditions on individuals cannot always be differentiated. Still, it is vital to highlight the key nuances in order to address the causes of these harmful emotional and psychological conditions and to develop strategies to prevent and minimize the exposures or impact:

  • Burnout: a work-related stress syndrome characterized by emotional exhaustion, depersonalization and reduced personal accomplishment
  • Moral distress: arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action
  • Moral injury: an injury to an individual's moral conscience, resulting from an act of perceived moral transgression that produces profound emotional guilt and shame
  • Post-traumatic disorder: psychiatric disorder caused by exposure to a traumatic event or extreme stressor or confrontation with an event or events that involve actual or threatened death or serious injury and involves intense fear, helplessness or horror
  • Compassion fatigue: a type of secondary traumatic stress emanating from frontline professionals' "cost of caring" for those suffering psychological pain; feeling a loss of meaning and hope

The question remains what we can do for each other and ourselves. When discussing burnout, we often fall into the trap of taking a binary viewpoint: individual or systemic. However, work is more integrated into one's life than a daily to-do item, especially for nurses and other healthcare professionals. The professional identity of a nurse can become a part of self-identify. Thus, the approaches to burnout must be comprehensive at multi-levels: individual, group, organization and society.

The individual-directed approach aims to care for oneself through various stress-managing activities that bring joy to each person. These measures range from yoga and mindfulness to reading or exercise. In addition to these activities, it is also important to consider the impact of one's mindset on one's perception and reactivity to stressors, including work.

One of the ways to promote a positive mindset is through the group-directed approach. Nursing is a social profession that values connection, not just with patients but also with colleagues. Even though each person feels different degrees of burnout, it is also an emotion that can transfer among the members in the same group — “burnout contagion.” Thus, burnout can also be a collective experience, which requires the members of the same group to influence each other positively through support, kindness and trust.

For the organizational-directed approach, burnout must be reframed as a hazardous occupational phenomenon that requires safe physical and psychological work environments. Furthermore, nurses' work and contributions must be recognized in meaningful ways through equitable compensation and autonomy.

Lastly, from a societal perspective, increased funding to develop programs and research – and the standardization of the data on burnout and its outcomes – are much needed to enhance the epidemiology of burnout.

No one approach alone is sufficient to address the complex and deeply-embedded burnout phenomenon for nurses with so many different complex causes. We live in a complicated and risky world; the risks for burnout are increasing for nurses, and even our students are developing anticipated career burnout. The status quo is not an option, given the widespread impact of burnout on the largest healthcare profession. To achieve real change, we must reframe how we view burnout among nurses. Recognizing the contagious etiology of burnout in nurses and the significance of the occupational environment is the first step in addressing this rampant issue.

Jin Jun, PhD, RN, is an assistant professor at The Ohio State University College of Nursing.

 

Research cited:

  1. Sexton JB, Adair KC, Proulx J, et al. Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open. 2022;5(9):e2232748. Published 2022 Sep 1. doi:10.1001/jamanetworkopen.2022.32748
May 07, 2021

OHIO-Nurses are up against major obstacles every day: workplace violence; burnout; unsafe staffing; COVID-19; and other traumatic events. Many of these have a lasting impact that go beyond the bedside, leading to moral injury within the profession. Moral injury, often described as a consequence of continual acts that go against one’s morality, is a phenomenon sweeping the profession, which is why the Ohio Nurses Foundation announced today the winners of a $100,000 award to support important research on moral injury in nursing. The research will be conducted by a team of researchers spanning multiple universities.

“After months of preparation, the Ohio Nurses Foundation is pleased to announce the recipients of the $100,000 Moral Injury Research Award. This exemplary team of researchers includes Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, Case Western Reserve University, Minjin Kim, Ph.D., RN, University of Cincinnati, Sharon Tucker, PhD, APRN-CNS, PMHCNS-BC, NC-BC, FNAP, FAAN, The Ohio State University, Dónal O’Mathúna, B.Sc.(Pharm), MA, PhD, The Ohio State University, Jin Jun, PhD, RN, The Ohio State University, and Grant A. Pignatiello, PhD, RN, Case Western Reserve University. When selecting the research group, it was important to the Foundation for the research team to be from Ohio and focused on how registered nurses in all practice settings across the state are experiencing moral injury, especially after Covid-19,” said Dr. Susan Stocker, chair of the Ohio Nurses Foundation.

The research team, who call themselves “Ohio’s Moral Injury Team,” are composed primarily of registered nurse investigators prepared at the doctoral level. The research will focus on how registered nurses in all practice settings across the state of Ohio are experiencing moral injury in the workplace.

“Nursing is a hazardous occupation. Nurses’ health and well-being have been negatively affected by the work environment and their personal lives for decades. Known to be self-sacrificing, nurses’ put their own needs last, which has been clearly demonstrated during the Covid-19 pandemic. Moral injury is one outcome of the self-sacrificing that deeply impacts nurses’ well-being,” explained Dr. Sharon Tucker, Ohio State University, member of the research team.

The research will not only collect data on moral injury in nursing, but will also encourage nurses to share their story. As Dr. Joyce Fitzpatrick, of Case Western University explained, “Narrative Nursing is a unique intervention that empowers nurses to share their collective experiences, building a strong professional bond among participants. We will use this intervention to help Ohio nurses who cared for patients and families during the COVID-19 pandemic toward the goal of enhancing nurses’ wellbeing and resilience.”

Dr. Minjin Kim, University of Cincinnati, continued, “Narrative nursing is a promising approach to foster healing and well-being of nurses who suffered mental stress and trauma during the COVID-19 pandemic. We believe our intervention can create cohesion, solidarity, and resilience by allowing nurses to share and reflect their individual experiences during the pandemic while engaging in other nurses’ collective struggles.”

If you are an Ohio registered nurse and would like to participate in the study, please contact Michelle Donovan, mdonovan@ohnurses.org, Ohio Nurses Foundation. To listen to today’s announcement, visit the Ohio Nurses Foundation’s Facebook page.

 

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The Ohio Nurses Foundation, the philanthropic arm of the Ohio Nurses Association, is a 501(c)(3) charity founded in 2002. ONF’s mission is to provide funding to advance nursing as a learned profession through education, research, and scholarship.

October 20, 2020

All-virtual summit hosted by The Ohio State University to focus on promoting and protecting the well-being of healthcare professionals and students

VADM Jerome M. Adams, MD, MPH, Surgeon General of the United States, will deliver remarks Thursday morning to kick off the second biennial Summit on Promoting Well-Being and Resilience in Healthcare Professionals hosted by The Ohio State University. Nearly 400 participants from 35 states, the District of Columbia, Canada, St. Martin and Sint Maarteen are expected to attend the all-virtual event on October 21-23.

The summit shines a spotlight on clinician burnout, a public health crisis that has spiked during the COVID-19 pandemic. National experts and practitioners from across the country will join together to share evidence-based strategies and programs designed to promote clinician well-being and build resilience in the face of hardship.

“Clinician burnout and its major impacts – stress, anxiety, depression and suicidal ideation – have become a pandemic within the pandemic,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing at Ohio State. “Burnout does not only affect the well-being of healthcare professionals and health science students, but it also threatens the quality and safety of patient care. Investment in building a wellness culture and providing programs that support and sustain clinician well-being is not a nicety; it is a necessity.

“Our summit will feature some of the best evidence-based actions available. We want to help create a movement centered on evidence and inspiration that protects our clinicians so they can deliver optimal care to patients in every setting.”

The summit is hosted by Ohio State’s seven health science colleges (Dentistry, Medicine, Nursing, Optometry, Pharmacy, Public Health and Veterinary Medicine), the College of Social Work, The Ohio State University Wexner Medical Center and the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience.

September 16, 2020

Clinician burnout was a public health epidemic before COVID-19. Now, there is a clinician mental health pandemic within the pandemic. Burnout involves a sense of ineffectiveness, presenteeism, overwhelming emotional exhaustion and depersonalization,1 and is associated with rising rates of anxiety, depression and suicide.2 The Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health notes that, while nurses and physicians overall have higher proportionate mortality rates from suicide than the general population, Black nurses and physicians experience higher rates than their White counterparts. Findings from a recent rapid systematic review and meta-analysis indicated that viral epidemics result in an almost 30% prevalence of acute stress disorder, anxiety, burnout and depression.3 As of June 2020, the prevalence of anxiety disorders in the U.S. had risen as high as three times those observed in Quarter 2 of 2019, while depression had risen fourfold. Essential workers experienced worse mental health outcomes than the general population.4

Burnout among clinicians not only adversely impacts their own health and well-being, but also threatens the quality and safety of healthcare. A recent national study of nearly 1,800 nurses from 19 healthcare systems across the U.S. showed that nurses in poor mental and physical health reported making more medical errors, with depression being their strongest predictor. Nurses who perceived that their organizations supported their well-being had better mental and physical health outcomes.5 Burnout also results in declines in patient satisfaction, absenteeism, presenteeism and turnover, which are very costly to the healthcare system.6

Healthcare system issues, including long shifts, inadequate patient-staffing ratios, problems with the electronic health record, high acuity patients and personal protective equipment shortages contribute to burnout. To improve clinician health and well-being outcomes, organizations must address system failures, invest in building and sustaining a wellness culture led by a chief wellness officer, and implement evidence-based interventions known to promote the mental health and well-being of their clinicians.

Although clinicians strive to take great care of others, they often do not prioritize their own self-care. As one out of two Americans have a chronic disease and 80% of chronic disease is preventable with healthy lifestyle behaviors,7 clinicians need to engage in regular physical activity, eat healthy, not smoke, limit alcohol if they drink, sleep at least seven hours a night and practice regular stress reduction strategies so that they can be in optimal health and well-being. These self-care behaviors and wellness cultures also need to be established in health sciences colleges to ensure a healthier generation of clinicians.

The Ohio State University is recognized as a national leader in this movement, promoting a sustained wellness culture through a comprehensive, multi-component approach that targets leaders, managers/supervisors, the grassroots and the system, led by a chief wellness officer. The University regularly tracks health and well-being outcomes of clinicians, faculty, staff and students that informs strategies to accomplish its wellness strategic plan. Evidence-based interventions such as Mindfulness in Motion, Health Athlete and MINDSTRONG™ are regularly offered to clinicians, and special partnerships promote health and well-being in areas including staying calm and well in the pandemic, wellness support for front-line nurses and aiding clinicians who experience or survive trauma. In fact, the University’s Safe Campus and Scientific Advisory group formed in response to the COVID-19 pandemic has prioritized the mental health and well-being of its population and, next month, Ohio State will host its second National Summit on Promoting Well-Being and Resilience in Healthcare Professionals with national leaders and practitioners sharing evidence and best practices to battle clinician burnout.

Other stakeholders listed below are sharing leadership to demand changes in practice, public policy and academic institutions that prioritize clinician and student well-being. We have been a sick care and crisis-oriented healthcare system for way too long; a paradigm shift must occur that emphasizes prevention and early intervention. With an emphasis on prevention, not only would the health and well-being of clinicians be enhanced, patient outcomes would improve and healthcare costs would decline.

How many more clinicians have to die from suicide because of rising depression associated with burnout? How many more medical errors, the third leading cause of death in America,8 will be made by outstanding, well-meaning clinicians suffering from burnout? How many more clinicians will the American healthcare system lose, which will continue to jeopardize the quality and safety of care because it does not invest in supporting their health and well-being? It is time to stop just describing and talking about the problem. Urgent action is needed!

April 23, 2020

Health and well-being hub represents an innovative first step towards addressing burnout and associated mental health issues among nurses nationwide

Trusted Health, the career platform for the modern nurse, and The Ohio State University College of Nursing today announced a new initiative to promote mental health and well-being among nurses on the front lines of the COVID-19 pandemic. The program will be piloted with nurses in New York and Michigan -- two of the states hit hardest by the pandemic -- and rolled out nationwide in the coming weeks. 

Even before the current crisis hit, burnout among nurses has been at an all-time high, with some studies estimating that up to 63 percent of nurses exhibit symptoms such as job-induced stress, anxiety and depression. In addition, nurses are at increased risk of suicide. More than half report being in suboptimal mental or physical health, which research shows can lead to more errors in caring for patients. The COVID-19 pandemic has only exacerbated this issue, as frontline nurses find themselves delivering care for a high volume of acutely ill patients, often in situations with limited crisis response training or supplies of personal protective equipment (PPE). 

Trusted and The Ohio State University have come together to help address this issue through a partnership that will provide access to wellness support and evidence-based strategies from nursing faculty and advanced practice nursing (APN) students from The Ohio State University College of Nursing. Nurses employed by Trusted who are working in facilities with COVID-19 patients will be able to access an emotional support line staffed by seasoned nurse practitioner faculty, including mental health experts, and supervised students. Those faculty and students will review stressors with callers and offer coping strategies and stress-reduction techniques.

Nurses who call the emotional support line may then opt to participate in a wellness support partnership program supported by the College of Nursing for a period of four or eight weeks. This will include cognitive-behavioral skills building, motivational interviewing, mindfulness and therapeutic communication aimed at finding sustainable solutions to enhance the nurses’ health and well-being, both during the pandemic and for life.

“Our healthcare professionals on the front lines of this pandemic deserve not only our highest regards for their selfless service, but also our support to handle what they are feeling and experiencing because of this crisis,” said Bernadette Mazurek Melnyk, PhD, APRN-CNP, EBP-C, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing at Ohio State. “Our college’s faculty, staff and students participating in this effort are well-versed in evidence-based interventions that will not only help these nurses survive, but thrive and build the resilience needed to continue to provide high-quality care and save lives.”

“As a nurses-first company, Trusted was founded on a simple idea: Nurses are the backbone of our healthcare system, and we must do more to support them,” said Dan Weberg, PhD, RN, head of clinical innovation at Trusted. “The COVID-19 crisis has pushed this issue into the national consciousness, and we are committed to using this moment to advocate for and identify new ways to support the mental well-being of nurses not just on the front lines, but everywhere.” 

Since the onset of COVID-19, Trusted has been focused on meeting the unprecedented demand for healthcare workers by matching nurses who have raised their hands to help with hospitals battling the pandemic. As a nurses-first company, Trusted was among the first to offer guaranteed quarantine pay for all of their nurses, and has made their Nurse Advocate team -- former bedside nurses who offer guidance throughout the job search process -- available 24/7 to support the needs of Trusted nurses working on the front lines. Over the last several weeks, nearly 40,000 nurses have signed up via Trusted to work on the front lines of the crisis. 

About Trusted Health

Trusted is where modern nurses go to build their careers. Nurses are the backbone of our healthcare system and yet their options for finding new roles are cumbersome and outdated. Trusted is on a mission to change this by matching the nurses on our platform with a range of flexible jobs that meet their preferences and career goals. With support from a dedicated Nurse Advocate and unmatched insight into compensation and contract details, Trusted makes it easy for nurses to navigate the job search process and manage their careers with confidence. 

Trusted supports hiring in all 50 states and has connected the nurses on its platform with thousands of opportunities. Based in San Francisco, CA, Trusted has raised $25 million in funding from Craft Ventures, Felicis Ventures, and Founder Collective, as well as healthcare innovators like Texas Medical Center and Healthbox. For more information, visit trustedhealth.com.

About The Ohio State University College of Nursing

The Ohio State University College of Nursing exists to transform health and improve lives through top-tier teaching, research and innovation, grounded in evidence-based practice and a powerful culture and support system to foster optimal personal well-being.

The college’s nationally-ranked academic programs taught by world-class faculty offer top-notch programs for future and current nurses and healthcare leaders. U.S. News & World Report highly ranks our university-wide online bachelor’s including RN to BSN (#1), online master’s (#4), traditional master’s (#6) and online Doctor of Nursing Practice (#8). Majors include both nursing and programs in healthcare and wellness innovation, along with certificates that range from school nurse and primary care to nurse education and nurse/health coaching.

The college’s two research centers – the Martha S. Pitzer Center for Women, Children and Youth and the Center for Healthy Aging, Self-Management and Complex Care – seek innovative solutions to real-world healthcare issues. The college received approximately $10.7 million in research awards in FY2019, including $4.3 million in NIH funding – #6 among public institutions and #13 overall. Its Helene Fuld Health Trust National Institute for Evidence-based Practice (EBP) in Nursing and Healthcare promotes EBP worldwide and offers the first globally-recognized certificate of added qualification in EBP.

July 31, 2019

The National Academy of Medicine’s (NAM) Action Collaborative on Clinician Well-Being and Resilience released a comprehensive and groundbreaking case study today about how The Ohio State University is working to stem the growing epidemic of clinician burnout in healthcare settings.