Gina Gessner

RN BSN CMSRN

Objectives The learner will be able to define

burnout and its relationship to workplace stress.

The learner will be able to explain the effects of workplace stress and burnout on the healthcare professional.

The learner will describe different coping methods and understand the difference between problem based coping methods, avoidance focused coping and emotion based coping methods.

The learner will be able to identify their personality type and determine if it predisposes one to workplace stress and burnout.

The learner will be able to identify methods which are proven to reduce workplace stress and reduce burnout among nurses and other healthcare professionals.

StressDefinition of Stress:Stress is defined as “a dynamic and reciprocal relationship between the person and the environment” however more emphasis is on how it is perceived by the person experiencing it (Healy & McKay, 2000, p. 682).

-For example, getting two admissions at once may be perceived by a new graduate nurse as extremely stressful when an experienced nurse may perceive it as only mildly stressful.

BurnoutMuch research was done on burnout in the early

eighties by a predominant researcher, Christina Maslach. Maslach defines burnout as, “a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do ‘people-work’ of some kind” (1981, p.99).

3 components

Burnout Emotional Exhaustion:

Emotional resources have been “used up”

The major component of burnout

Synonymous with “compassion fatigue”

Provider feels frustrated and irritable

Give an example of someone who has experienced emotional exhaustion

Burnout Depersonalization- “Workers may display a detached and

an emotional callousness, and they may be cynical toward co-workers, clients, and the organization” (Cordes & Doughtery, 1993, p. 623).

- Believe people are deserving of their health problems

- Highly correlated with emotional exhaustion

- These people commonly withdraw and take longer breaks

- Common in all human services professions

- Give example

Burnout Diminished Personal Accomplishment – This refers to

an individual’s feelings of decreased or insufficient progress in accomplishing his or her job or in interacting with others (Zenners, et. al., 2000).

Can characterize the entire self negatively.

Contemplates leaving their professional all together.

Give an example

5 Stages of burnout. (Spinetta, et. al., 2000)

Why is Burnout so serious?

How is stress related to burnout? “Burnout is a prolonged response to chronic emotional

and interpersonal stressors on the job” (Maslach, Shauflei & Leiter, 2003, p.323).

“Burnout is a response to overload” (Maslach, Shauflei& Leiter, 2003, p.409).

Related to experienced work load, role ambiguity and time constraints

The effects of workplace stress Mental Disorders: The APA states stress has been

shown to cause irritability, anger, nervousness, and lack of motivation. Stress exposure over time is linked to feelings of anxiety, depression, subjective fatigue, reduced confidence and self esteem (Burgess, 2010).

Physical Disorders: “fat storage, blood pressure elevation, agitation, suppression of sex hormones, accelerated blood clot formation, compromised immune system, increased serum triglyceride and cholesterol levels” (Antai-Otong, 2001). Research has also shown that nurses who are exposed to continual levels of stress are more likely to eat poorly, smoke cigarettes and abuse alcohol and drugs (Burke, 2000).

Spiritual Disorders - lack of meaning

- questioning life's purpose - feeling empty inside - diminished sense of faith- less time spent praying or meditating- less time spent in nature - feeling isolated and disconnected from others

(Psychological Wellness Institute, 2009, http://www.relaxingmoment.org/index.php?option=com_content&view=article&id=49&Itemid=59)

Decreased Work Productivity: Correlations have been found between stress and error rates (Sutherland and Cooper, 1990). Additionally, less overall teamwork was seen in situations where stress is prevalent as well as general dissatisfaction (Burgess et al., 2010).

Absenteeism: Legitimate sickness and absence rates of employees go up substantially in stressful environments (Burgess, et. al., 2010). Due to the evidence of stress and effects on the body and mind, it is no surprise that people experience more illness and there is likely to be a factor of avoidance in absenteeism. Stressful work situations also made it more challenging to recruit experienced staff and some people choose to leave healthcare all together (Burgess, et. al. 2010).

Discuss with each other what methods you use to cope with stress and burnout and what you think is most effective.

Table 3. Brief COPE description of coping dimensions (Burgess, et. al., 2010)Problem-focused

coping

Emotion Focused Coping Avoidance Focused Coping

Active coping– Take actions to make the

situation better.Religion– Finding comfort in spiritual beliefs.

Self-distraction– Doing some other

activity to avoid thinking about the

situation.

Planning– Use of a strategy to solve the

problem.Venting– Verbally expressing negative feelings

Substance use– Use of alcohol or drugs to

make self feel better.

Positive reframing– Trying to see things

in a different lightSelf blame– Blaming self for what has happened

Behavioural disengagement– Giving up

trying to cope

Acceptance– Learn to live with the

situation

Humour– Making jokes about the situation. Denial– Saying to self ‘This isn't

happening’

Using emotional support– Getting

comfort from someone else.

Using instrumental support– Seeking

information and advice

The Big Five trait factors and illustrative scales From: Burgess, et. al, 2010, p. 133

Characteristics of the high scorer

Trait Scales Characteristics of the low score

Worrying, nervous, emotional insecure, inadequate, hypochondriacal

Neuroticism (N) Assess adjustment versus emotional instability. Identifies individuals prone to psychological distress, unrealistic ideas, excessive cravings or urges and maladaptive coping responses

Calm, relaxed, unemotional, hardy, secure, self-satisfied

Sociable, active, talkative, person-orientated, optimistic, fun-loving, affectionate

Extraversion (E) Assess quantity and intensity of inter-personal interaction, activity level; need for stimulation and capacity for joy

Reserved, sober, un-exuberant, aloof, task-orientated, retiring, quiet

Curious, broad interests, creative, original, imaginative, untraditional

Openness (O )Assess proactive seeking and appreciation of experience for its own sake; toleration for and exploration of the unfamiliar

Conventional, down-to-earth, narrow interests, un-artistic, un-analytical

Soft-hearted, good-natured, trusting, helpful, forgiving, gullible, straightforward

Agreeableness (A) Assess the quality of one's inter-personal orientation along a continuum from compassion to antagonism in thoughts feelings and actions

Cynical, rude, suspicious, uncooperative, vengeful, ruthless, irritable, manipulative

Organized, reliable, hardworking, self disciplined, punctual, scrupulous, neat, ambitious, persevering

Conscientiousness (c)Assess the individual's degree of organizational persistence, and motivation in goal-directed behavior, contrasts dependable, fastidious people with those who are lackadaisical and sloppy

Aimless, unreliable, negligent, lazy le, lazy, careless, le, weak-willed, hedonistic

Are you neurotic? Are you neurotic? “‘Venting’, defined as the verbal expression of negative emotions and feelings, is considered to be an

emotion-focused coping strategy. The personality trait of neuroticism correlated positively with venting, (rs = 0·36, p < 0·02) indicating that individuals who reported highly on the neuroticism scale were more likely to verbally express their feelings” (Burgess, et. al., 2010, p.135).

“Our study revealed a significant association between neuroticism and venting; which is considered to be an emotion-focused coping strategy. The positive effect of venting was revealed in a recent study by Bosson et al. (2006). Using an experimental design which featured a mixed method survey of 120 participants, they concluded that sharing negative attitudes (venting) had a positive effect on inter-personal closeness. Venting may therefore be a strategy that ICU nurses should be encouraged to develop as a means of coping and therefore avoiding excessive stress”

Neurotic personality types are more likely to experience stress by responding emotionally, this effect is amplified if they are close to someone (Burgess, et. al., 2010). This makes problem based coping a challenge for people with this personality type (Burgess, et. al., 2010). Research has also shown that, “people who possess a neurotic trait do not lack the ability to choose an effective coping strategy; they just appear to choose the wrong strategy” (Burgess, et. al., 2010, p.136). A study by Zellers, et. al., showed that those who had a neurotic personality type were far more likely to experience emotional exhaustion (2000).

Are you extroverted? “Extraversion which is associated with assertiveness, and

enjoyment of social situations has also been described by Costa and McCrae (1980) as psycho protective” (Burgess, et. al., p. 135).

They report less workplace stress than pessimists, are often good communicators and report more self accomplishments (Zenners, et. al., ).

Those who are highly extraverted are less likely to experience depersonalization, due to their social nature they most likely get to know their patients quite well and treat them as people (Zenners, et. al., 2000).

Extraverts commonly view things in a positive light and have an optimistic point of view, which can be protective against burnout (Zenners, et. al., 2000).

Are you open? Openness is also associated with use of problem based

coping methods such as reframing and planning which are positive and effective (Burgess, et. al., 2010).

Are you both extroverted and open? “Those who reported higher levels of openness and extraversion

also reported lower levels of stress when dealing with difficult patients and relatives” (Burgess, et. al., p.133).

Although extraversion and openness has mostly been shown to be protective against burnout it may however have negative effects. “Extraversion was associated with emotional exhaustion and suggested that this was probably because of an excitement-seeking subvariable, whereby individuals are willing to take risks and have a greater tendency to emotional exhaustion and ultimately burnout” (Burgess, et. al., p.136).

Both open and extraverted personality types rate their personal accomplishments higher than other personality types (Zellers, et. al., 2000).

Are you conscientious? “A negative correlation was found between conscientiousness and the

two workplace stressors; that is workload 1, which is associated with time pressures (rs = −0·34, p < 0·02) and workload 2, which is associated with management stressors (rs = −0·47, p < 0·01). Both were perceived to be less stressful by those who reported higher levels of conscientiousness” (Burgess, et. al., 2010, p.134).

In the study by Burgess, et. al., a positive correlation was found between conscientiousness and active coping and planning which indicates that these people create a plan to deal with the stressor and therefore can control the stressor to some extent (2010).

Also, those who where highly conscientious were less likely to perceive themselves as incompetent and lack confidence in themselves, which can be a source of stress (Burgess, et. al., 2010).

Are you agreeable? “Significant correlations were also found between

agreeableness and active coping, planning and reframing indicating that individuals who reported higher levels of agreeableness engage in more problem focused coping strategies” (Burgess, et. al., 2010, p. 135).

However, research has shown that overly agreeable and non confrontational communicators are not likely to assert their feelings and may experience high levels of job stress (Wright, 2010).

Those who are agreeable are less likely to experience depersonalization in patient care (Zellars, et. al., 2000).

Buffers

Effective Coping Mechanisms Job Satisfaction: According to Healy & McKay, job satisfaction has been shown

to be negatively correlated with work stress. However, one does not know if people are satisfied because their job is less stressful or satisfied in spite of stress (2000).

Humor: May or may not be considered effective; it has been positively correlated with job satisfaction but not with stress reduction (Healy & McKay, 2000).

Seeking Social Support & Self Control: These are examples of effective emotion based problem solving methods, which may help nurses focus on tasks to be done (Healy & McKay, 2000).

Communication Competence: Organizational conflict is ubiquitous in healthcare settings however positive conflict has been shown to be beneficial and increase creativity (Wright, 2010). If you enter into a conflict with someone who is a poor communicator they typically rely on aggression to achieve their goals and this type of communication has been shown to undermine personal relationships and increase dissatisfaction (Wright, 2010).

Ineffective Coping Mechanisms Avoidance: Research has shown that this method is highly

correlated with depressed mood and lower job satisfaction (Healy & McKay, 2000).

Poor Communication Styles: Less competent styles of communication such as avoidance and confrontational styles can produce negative outcomes in an organization such as burnout and stress (Wright, 2010). The Learning Network at Georgetown has classes on communication and conflict resolution if you feel you or your staff could benefit. http://www.georgetownuniversityhospital.org/body.cfm?id=264

Untraditional coping methods Reiki “Reiki has been shown to give a heightened state of

awareness, inner peace and calm” (Miles & True, 2003, p. 65)

Energy becomes free flowing and balanced causing recipients to feel “jumpstarted” (Moore, 2005).

One can practice self Reiki One can perform Reiki on their patients Study saw a statistically significant decrease in workplace

stress for nurses who used Reiki (Cuneo, et. al., 2011). http://www.reikinorthernvirginia.com/?alternative_healin

g_classes=oriental_medicine_training

Untraditional coping methods Knitting

Knitting has shown to be very therapeutic for patients and nurses in the literature

Knitwell at Georgetown: a program that offers patients and nurses knitting services.

There is a knitting basket in the nurses lounge for your use.

www.stitchlinks.com - is a great website with tons of stuff about the benefits of knitting

Untraditional coping methods Self Renewal (Antai-Otong, 2001). Utilize physical, mental and social well being activities for

example . . . Give yourself permission to fail without feeling guilty Reframing – changing your appraisal system and how you

view others Hanging out with positive people Gardening Finishes and Hospital AppearanceUfer, M., & Gover, M. (2010). Caring for Caregivers: Selecting

optimal station finishes and furnishings. HMF Magazine, 27-30.

Employee Assistance Program Employee Assistance Program

Can help with party planning, finding a summer camp for your child, not just work related things

Use it, you’re essentially paying for it!

Think about what may workfor you . . . Set a goal for yourself

Consider something different

Take the online personality test to learn more about yourself

The Big Five Personality Test – Free! http://www.outofservice.com/bigfive/

References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and

job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987-1993. American Psychological Association. Overwhelmed by workplace stress? you're not alone. Available at

http://apahelpcenter.org/articles/article.php?id=164. Last accessed July 8, 2011. Burke, R. (2000). Workaholism in organizations: Psychological and physical well-being consequences. Stress and Health, 16(1), 11-16. Burgess, L., Irvine, F. & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: a descriptive exploratory study.

Nurses in Critical Care, 15(3), 129-140. Cordes, C. & Dougherty, T. (1993). A review and integration of research on job burnout. Academy of Management Review, 18, 621-659. Cunco, C. L., Curtis Cooper, M. R., Drew, C. S., Naoum-Heffernan, C., Sherman, T. & Walz, K. (2011). The effect of Reiki on work-related stress

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Spinetta J. J., Jankovic, M. & Arush B. (2000). Guidelines for the recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer: report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Med Pediatric Oncology, 35(2),122-125.

Srivastava, S. (2011). Measuring the Big Five Personality Factors. Retrieved 7/2/11 from http://www.uoregon.edu/~sanjay/bigfive.html. Wright, K. B. (2010). A communication competence approach to healthcare worker conflict, job stress, job burnout and job satisfaction.

Journal for Healthcare Quality, 33(2), 7-14. Zellars, K. L., Perrewe, P. L. & Hocharter, W. A. (2000). Burnout in Health Care: The Role of the Five Factors of Personality. Journal of Applied

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