The Toll of Accountability: Burnout in The Nursing Profession

Nursing is a profession that relies on critical thinking, background knowledge and relieving the pain and suffering of patients (Stacey, Singh-Carlson, Odell, Reynolds, & Yuhua, 2016). The ANA’s Scope and Standards of practice recommends that nurses have “an ethical responsibility to report to work…prepared to give safe, quality patient care” (ANA, 2015). While nurses are guided by a code of ethics, their work entails being patient advocates, communicators and educators. With autonomy comes an increased level of accountability that can lead to burnout, a feeling of “hopelessness” and an “inability to perform [their] job well” (Hunsaker, Chen, Maughan, & Heaston, 2015). Burnout affects professional accountability because if a nurse is not in the proper mindset, a nurse cannot adequately perform their duties. The purpose of this paper is to highlight the high-stress work environment that can often cause a higher susceptibility of mistakes, decreased work performance and compassion fatigue due to unfavorable environmental pressures (Bamonti et al., 2019).

Accountability and Burnout

Burnout was first coined by psychologist Herbert Freudenberger who saw evidence of psychological depletion caused by environmental stressors (Hunsaker, et al., 2015). Burnout is a state of emotional, mental and physical exhaustion that is defined in three stages: emotional exhaustion, depersonalization and low personal accomplishment (Bamonti et al., 2017). These stages affect the nursing profession due to the level of emotional control that is required from nurses (Bamonti et al., 2017). Bamonti et al., (2017) results indicate that long term care facilities experience high levels of turn over due to the symptoms of emotional distress caused by burnout. More specifically, dysfunctional coping mechanisms, like emotion-focused coping, are correlated with an increased level of burnout as a result of unhealthy suppression of emotions. Oppositely, problem-focused coping aims to solve the issue at hand that is causing complications and was found to have an inverse relationship with burnout (Bamonti, et al., 2017). Because nurses care for a multitude of people at one time, compassion fatigue can also negatively affect the workplace. The distinction between burnout and compassion fatigue is that burnout is environmentally driven while compassion fatigue is caused by emotional second-hand exhaustion from witnessing the pain of others (Bamonti, et al., 2017). For instance, a study focused on oncology nurses found that although building a close relationship with a patient is vital in knowing a patient, when traumatic events happen such as death, there is an increased risk for burnout by cause of the personal ties that were built (Stacey et al., 2016).

Factors that Worsen Burnout

The environmental determinants that raise the likelihood of burnout include job turnover, management problems, staff shortages and patient workload (Hunsaker et al., 2015). These factors are magnified by certain specialties of nursing such as working in long-term care facilities, geriatrics, intensive care unit and the emergency department (Monsalve-Reyes et al., 2018). These jobs tend to have a frequent rate of turnover that is primarily caused by low personal accomplishment, a feeling of inadequacy in their role that causes a decreased job performance (Monsalve-Reyes et al., 2018). According to Hunsaker et al., (2015), a study on ED nurses found a lower level of burnout effects in nurses that are experienced, have an adequate support system, and shorter shifts. The significance of this issue is that every nurse has to start somewhere with slim experience, but they still have the same amount of pressure put on them, in comparison to experienced nurses, to properly take care of patients and themselves. This demanding adjustment would take a while to get acclimated to as they learn healthy coping mechanisms and develop a self-care routine. However, the implications of burn out for the hospitals are where professional accountability can falter. According to Blouin and Podjasek (2019), an inappropriate amount of nurse to patient ratio can have a chain reaction that extends past emotional exhaustion. When nurses are overworked and understaffed, the consequences lead to absenteeism and low work productivity (Bamonti et al., 2017). Patient-centered care is not transpiring with emotional exhaustion considering their mind is preoccupied with other matters.

How to Alleviate Burnout

Although stress is an inevitable part of this profession, there are ways to reduce burnout and increase morale. Promoting positivity, focusing on nurses’ strengths and encouraging self-care is a monumental way to implement a beneficial change for every nurse (Wei, Roberts, Strickler, & Corbett, 2019). Encouraging nurses’ to maintain their usual self-care ritual is crucial because being kind to oneself will increase the capacity to be kind to patients, therefore increasing patient satisfaction and the nurses’ ability to perform their job. Partnering up experienced nurses with new graduates can build relationships, decrease negative work experiences and foster increased teamwork (Wei et al., 2019) These things can benefit accountability by putting the focus back on the work performance and on the patients.

In conclusion, the nursing profession maintains accountability for oneself, patients and colleagues (Stacey et al., 2016). Having autonomy enables nurses to have control over certain patient aspects, but carrying that responsibility can be a heavy burden to carry. Professional accountability and burnout go hand in hand due to their inevitable relationship effects that can impair the health care system and its health care workers (Monsalve-Reyes et al., 2018). To prevent nurses from acquiring burn out, it is imperative to foster connections, encourage growth and gain a deeper understanding as to where these burnout symptoms originate from (Wei et al., 2019).