How can ED nurses spot the signs of burnout?
Advice for emergency department nurses on recognising physical or emotional burnout in themselves or colleagues and where to find help and support
Drawing on the evidence base, this article considers how emergency department (ED) nurses may be able to identify burnout in the ED and support themselves and others experiencing signs of it.
Around the world EDs are under pressure as patient need outstrips resource. The NHS is experiencing these challenges with demand for services at an all-time high (Nuffield Trust 2023).
'Signs of burnout often include a reduction in physical, emotional and psychological energy'
This has implications for staff tasked with delivering care, so it is no surprise that staff across the NHS are experiencing poor physical and mental well-being, including stress, burnout and absenteeism, compounded by the COVID-19 pandemic (King’s Fund 2021).
As reported by the Kings Fund, during June 2021-22 more than 34,000 NHS nurses left their role, 25% higher than the previous year (King’s Fund 2022).
Mudallal et al (2017) argue that burnout is a common psychological phenomenon among nurses and is a product of stress related to work. Burnout is linked to poor well-being and an intention to leave the profession (Bartram et al 2012).
Burnout can result in emotional exhaustion, negativity towards others and feelings of inadequacy
The signs of burnout often include a reduction in physical, emotional and psychological energy and can result in the following:
- Emotional exhaustion – this is when we feel physically and emotionally exhausted with work stress.
- Depersonalisation – when we feel negatively towards others. It can mean a lack of connection with those around us.
- Low personal accomplishment – labelling ourselves as incompetent and inadequate. Often this results in making less effort towards work (Mudallal et al 2017).
How might we recognise burnout in ourselves and others?
The likelihood of experiencing burnout is higher for ED staff than in many other areas of healthcare (Adriaenssens et al 2015). We also know that nurses who are newly qualified and less experienced can be more likely to experience burnout (Patrick and Lavery 2007).
Excessive workload, poor staffing, lack of resource and control/power over work, lack of support and moral challenges can all be triggers for burnout (Maslach 2003, Mudallal et al 2017, Dall’Ora et al 2020).
As ED nurses we hide and suppress emotion, known as emotional labour (Kirk 2022, Kirk et al 2021 and 2023) as part of our everyday practice. This is often ingrained and is often a subconscious process driven by the perceived need to be ‘superhuman’.
Sometimes feelings associated with burnout can be perceived as a sign of weakness, particularly in an ED, where stoicism and endurance are seen as the norm (Waddington 2022). Instead, it is critical that we notice and support these emotional experiences in ourselves and others – we are only human (Kirk 2022).
Likely indications of emotional burnout
Because the management of emotion is routine, it can also make emotional experiences, such as burnout, particularly difficult to spot in ourselves and others. However, we can draw on the evidence base inside and outside of nursing for likely indications (Nursing Standard 2023, Mental Health UK 2022):
- Low mood, tearfulness and other emotional outbursts (stress, aggression).
- Excessive and sustained tiredness.
- Feeling trapped and/or lonely (isolated, withdrawing from others, seeming distant and cold).
- Being cynical and pessimistic (resisting change or efforts to make things better at work).
- Not noticing suffering, becoming numb to trauma and pain.
- Doubting yourself and being self-deprecating.
- Unable to make choices and decisions, procrastinating and worrying.
- Feeling overwhelmed.
- Repeated sickness or sickness without explanation.
It is important to know that you are not on your own. We know from extensive research that the emotional complexities of healthcare are (unsurprisingly) incredibly challenging for nurses and other healthcare professionals. Please know you are not alone.
Accessing peer support from colleagues and line managers when possible can be hugely beneficial – leaders who show concern for their staff can help lessen burnout and associated emotional exhaustion (Mudallal et al 2017).
Where to go to get help – for yourself and others
Sometimes seeking support outside the team might feel a better fit. For example, NHS England has introduced a confidential text support service. Staff can access support by texting FRONTLINE to 85258, 24/7.
This service is available to all NHS colleagues who would like to talk, anyone who is feeling overwhelmed, has experienced a tough day or is worried.
NHS England also has an ‘emotional and mental well-being’ tool online that helps NHS staff access support based on need.
Outside of the NHS, RCN members can obtain free, confidential support and assistance for personal and work-related issues. The RCN counselling service is available 8.30am–8.30pm, seven days a week and 365 days a year, on 0345 772 6100.
The Samaritans charity is also available to talk about any stress, concerns of troubles, telephone 116 123.
Peer review
This article has been subject to external double-blind peer review and checked for plagiarism using automated software
References
- Adriaenssens J, De Gucht V, Maes S (2015) Causes and consequences of occupational stress in emergency nurses, a longitudinal study. Journal of Nursing Management. 23, 3, 346-358. doi: 10.1111/jonm.12138 (Last accessed: 18 March 2024.)
- Bartram T, Casimir G, Djurkovic N et al (2012) Do perceived high performance work systems influence the relationship between emotional labour, burnout and intention to leave? A study of Australian nurses. Journal of Advanced Nursing. 68, 7, 1567-1568. doi: 10.1111/j.1365-2648.2012.05968.x (Last accessed: 18 March 2024.)
- Dall’Ora C, Ball J, Reinius M et al (2020) Burnout in nursing: a theoretical review. Human Resources for Health. 18, 41. doi: 10.1186/s12960-020-00469-9 (Last accessed: 18 March 2024.)
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- The King’s Fund (2021) ‘Bitter irony’ that health and care staff are made ill by their work: The King’s Fund response to the Commons Committee report on workforce burnout and resilience (Last accessed: 18 March 2024.)
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