Burnout is a psychological syndrome arising from prolonged exposure to chronic workplace stressors, widely recognised as a critical concern in nursing. Maslach and Jackson (1981) first defined it as a condition characterised by emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment. Although there is general agreement on the core components of burnout, debates persist regarding its precise definition and applicability across different professional contexts, including nursing (Maslach and Leiter, 2016). Nurses are particularly susceptible to burnout due to the physically and emotionally demanding nature of their roles, often exacerbated by long hours, high patient-to-staff ratios, and emotionally charged environments. The consequences of burnout extend beyond individual wellbeing, significantly impairing patient care quality (Babapour et al, 2022). This article explores the prevalence and indicators of burnout in nursing, highlighting effective strategies for its management, including organisational policies, resilience-building programmes, and fostering supportive workplace cultures.
Prevalence of burnout in nursing
A survey by the Royal College of Nursing (RCN) found that more than half of UK nurses reported significant work-related stress, with many symptoms of burnout (RCN, 2019). Contributing factors included the pressures of life-and-death situations, long working hours, high patient-to-nurse ratios, and administrative burdens. A systematic review by Gómez-Urquiza et al (2017) revealed that burnout rates among nurses vary but can reach up to 70% in specialties such as oncology and emergency nursing. The COVID-19 pandemic exacerbated this issue, increasing workloads, depleting resources, and increasing the emotional burden of caring for critically ill patients (Kisely et al, 2020).
Identifying burnout in nurses
Identifying burnout requires a collaborative approach due to its profound impact on both individual health and patient care. Early recognition of burnout is crucial for effective intervention and support. The Maslach Burnout Inventory (MBI), developed by Maslach and Jackson (1981), remains one of the most widely used tools for assessing burnout, offering a structured evaluation across the three critical dimensions of emotional exhaustion, depersonalisation, and reduced personal accomplishment. Evidence supporting the MBI's reliability and validity has been established in numerous studies, including that of Pérez-Mármol and Brown (2019); however, it is not without its critics. Some researchers have highlighted concerns about its cultural adaptability and its primary focus on emotional factors, suggesting that it may not fully capture the complexity of burnout in diverse nursing contexts (Dall'Ora et al, 2020).
Other tools, such as the Copenhagen Burnout Inventory (CBI) (Kristensen et al, 2005) and the Oldenburg Burnout Inventory (OLBI) (Demerouti et al, 2008), have been developed to address these limitations. The CBI includes a broader focus on personal, work-related and client-related burnout dimensions, demonstrating good reliability across international studies (Kristensen et al, 2005). Similarly, the OLBI measures burnout through two dimensions, exhaustion and disengagement, offering a more flexible structure and addressing some limitations of the MBI (Demerouti et al, 2008).
Emotional exhaustion, the initial dimension of the MBI, manifests as a state of chronic fatigue, persistent insomnia, and an overwhelming feeling of stress. Nurses experiencing emotional exhaustion often experience both physical and emotional exhaustion (Petersen et al, 2023) and can at times struggle to cope with the demands of their roles (Kelly, 2020).
Depersonalisation, the second dimension, involves developing a detached or callous approach towards patients and colleagues. This phenomenon can lead nurses to view patients as objects, not individuals, diminishing the empathetic connection crucial to effective caregiving (Kelly, 2020). Depersonalisation may also contribute to interpersonal conflicts within healthcare teams, exacerbating stress and burnout (De Hert, 2020).
The third dimension, reduced personal accomplishment, is characterised by a sense of inadequacy and self-doubt regarding one's ability to meet professional expectations (Maslach and Leiter, 2016). Nurses experiencing reduced personal accomplishment may feel disillusioned and disengaged from their work, resulting in decreased job satisfaction and motivation (Kinman et al, 2020).
Beyond the dimensions measured by tools such as the MBI, additional indicators of burnout in nurses include increased absenteeism, reduced productivity, interpersonal conflicts and physical symptoms such as headaches and gastrointestinal issues (Shanafelt et al, 2014). However, it is important to note that such symptoms can result from a variety of unrelated factors, such as underlying medical conditions, workplace bullying or personal stressors. Although Shanafelt et al (2014) focused on US doctors, the findings are still relevant to nursing. Both professions face similar emotional demands and high-pressure patient care environments that may contribute to burnout. Understanding the factors affecting physicians can provide valuable insights for managing burnout in nurses, who experience comparable stressors in their care-giving roles.
Causes of burnout in nursing
Burnout in nursing is a complex issue influenced by multiple inter-related factors that can significantly impact professional and personal wellbeing (Dall'Ora et al, 2020). Although not all nurses in every setting experience these challenges, certain conditions make some nursing roles and environments more vulnerable to burnout (Khatatbeh et al, 2022).
One primary cause of burnout is the workload and staffing conditions faced by nurses. High patient-to-nurse ratios and excessive workloads impose not only physical demands but also mental exhaustion (Babapour et al, 2022). Reduced staffing levels can overwhelm nurses with an unmanageable number of tasks, leaving them feeling depleted and unable to provide optimal patient care (RCN, 2019). However, the degree of impact may vary across nursing specialties, with intensive care units (ICUs), emergency departments and other high-acuity areas being particularly susceptible due to the complexity and urgency of the care required.
Emotional demands also contribute to burnout, particularly in roles where nurses are continuously exposed to traumatic situations, such as critical care, oncology and mental health nursing. This exposure may lead to compassion fatigue, where the emotional toll of witnessing pain, suffering and death erodes resilience and coping capacity (Figley, 2002; Nolte et al, 2017). Although Figley's (2002) work is focused on psychotherapists, it is relevant to nursing as it explores the broader concepts of emotional exhaustion and compassion fatigue. These issues, central to burnout, affect not only psychotherapists but also nurses, especially in environments with high emotional demands, such as intensive care and oncology. It is important to note that whereas some nurses thrive in emotionally challenging environments, others may find the cumulative effect overwhelming, highlighting the importance of individual and contextual differences (Kim and Chang, 2022).
A lack of organisational support further exacerbates burnout in nursing. Insufficient resources, limited professional development opportunities, and inadequate leadership leave nurses feeling isolated and unsupported. Nurses who perceive a lack of supportive mechanisms are more likely to experience frustration, diminished morale and reduced job satisfaction (Kelly, 2020; Kelly et al, 2021). This issue spans all nursing settings but is particularly pronounced in under-resourced healthcare facilities, where organisational constraints limit the availability of essential support systems.
Achieving a healthy work-life balance is another significant challenge. Nurses working frequent overtime, long shifts, or irregular hours often struggle to balance professional responsibilities with personal commitments, leading to chronic stress and dissatisfaction (Dall'Ora et al, 2023)). This challenge is particularly evident in acute inpatient settings, where the demands of care delivery frequently extend beyond scheduled shifts. Community and domiciliary nursing roles, while offering more flexibility, may still pose work-life balance challenges due to travel demands and unpredictable workloads.
Role ambiguity and conflict within healthcare settings are additional contributors to burnout, as they lead to uncertainty, frustration and stress. Unclear job descriptions, conflicting demands from multiple stakeholders, and vague expectations create an environment where nurses may feel overwhelmed and unsure about their priorities (Lambrou et al, 2010). These challenges are not uniform across all nursing specialties; they are often more pronounced in settings where interdisciplinary collaboration is critical, such as mental health or complex care environments. Although Lambrou et al's (2010) research on Cyprus healthcare is context-specific, it provides valuable insights into the common burnout challenges nurses face across various healthcare systems. The study's focus on role ambiguity and emotional demands in nursing is highly relevant to understanding similar issues within the UK context, especially in high-stress healthcare environments
It is essential to recognise that burnout in nursing arises not from a single cause but from a combination of workload pressures, emotional challenges, lack of support, work-life imbalance, and role ambiguity (Dall'Ora et al, 2020). These factors are experienced to varying degrees depending on the nursing specialty and work environment. Addressing burnout requires comprehensive strategies tailored to specific settings, such as improving staffing ratios in acute care, enhancing emotional support systems for trauma-exposed roles, implementing work-life balance initiatives, clarifying job roles, and fostering a supportive workplace culture that values nurses' wellbeing and contributions.
Strategies for identifying burnout
Early identification of burnout is essential for a timely intervention, ensuring that nurses receive the support they need before burnout severely impacts their health and performance. Recognising burnout requires a combination of individual, peer-level, and organisational strategies tailored to the healthcare environment (De Hert, 2020).
Role of ward/unit managers and peers in identifying burnout
Ward and unit managers play a pivotal role in recognising burnout among their teams. They are often in close contact with nurses and can observe changes in behaviour, performance, and wellbeing. Managers should be trained to identify early warning signs of burnout, such as reduced engagement, irritability, frequent errors, or withdrawal from team activities. Peer support also plays an essential role, as colleagues are often the first to notice subtle changes in mood or behaviour.
Encouraging a culture of openness and trust enables nurses to voice their concerns and seek support when experiencing stress (Kepplinger et al, 2024). Peers can engage in informal check-ins and foster an environment where discussing mental health and stress is normalised. Managers and peers can act as a first line of support by referring colleagues to appropriate resources, such as employee assistance programmes (EAPs) or counselling services, when needed.
Organisational strategies for identifying burnout
Although the responsibility of identifying burnout extends to individuals and teams, healthcare organisations play a critical role in implementing broader strategies to monitor and address burnout across departments.
Monitoring absenteeism and turnover rates
Tracking absenteeism and turnover rates can reveal trends indicating burnout (Kelly et al, 2021). High rates in specific units may signal issues that require further investigation (Lee et al, 2023). Although this strategy is effective in identifying problem areas, its success depends on the availability of resources to address the identified causes, such as adequate staffing or improved working conditions. However, during nurse shortages, organisations may face challenges in implementing such solutions.
Employee assistance programmes
EAPs offer confidential counselling and support services, allowing nurses to discuss their stressors and identify early signs of exhaustion (Doran, 2022). However, ensuring accessibility and raising awareness of these programmes is essential, as nurses may hesitate to use them due to stigma or lack of knowledge. Managers can help by actively promoting EAPs and creating an environment that destigmatises seeking help.
Feedback mechanisms
Anonymous surveys, suggestion boxes, and regular staff meetings provide opportunities for nurses to voice concerns about their work environment and stress levels (Frampton et al, 2017). These mechanisms can inform targeted interventions to address burnout causes, such as heavy workloads or insufficient resources. However, achieving meaningful outcomes from feedback requires strong leadership commitment and follow-through to implement changes.
Supervisory training
Equipping managers and supervisors with skills to recognise burnout and support their teams is a practical strategy to bridge the gap between organisational policies and day-to-day implementation. Supervisors trained in active listening and emotional intelligence can provide early interventions and reduce the stigma surrounding burnout discussions (Hammer et al, 2024).
Strategies for coping with and preventing burnout
Preventing and managing burnout requires practical, evidence-based strategies at both individual and organisational levels. By focusing on approaches directly applicable to nurses' daily practices and supported by research, healthcare organisations and individuals can take proactive steps to mitigate burnout effectively.
Organisational strategies
Schwartz Rounds
Schwartz Rounds are described as structured forums in which members of the multidisciplinary team, including nurses, can discuss the emotional and social aspects of their work. These sessions foster a sense of community and provide a supportive space to share experiences and challenges. Evidence from NHS trusts shows that Schwartz Rounds can enhance team cohesion, reduce stress, and improve overall wellbeing (Ng et al, 2023).
Clinical supervision and reflective practice
Clinical supervision, combined with reflective practice, allows nurses to process their work experiences in a structured environment. Supervision sessions provide a safe space for nurses to discuss challenges, seek advice, and develop coping strategies under the guidance of a trained supervisor (Scanlan and Hart, 2024).
Reflective practices, such as maintaining a reflective diary, can further support nurses by allowing them to process emotions and experiences systematically. Reflective writing has been linked to improved emotional regulation and job satisfaction (Lim et al, 2023).
Promoting a healthy work-life balance
Flexible scheduling and clear boundaries between work and personal life are essential to prevent chronic stress. Although achieving perfect staffing may be challenging due to ongoing shortages, organisations can adopt strategies such as shift rotation, job-sharing, or additional rest periods during long shifts (Suter et al, 2020).
Individual strategies
Stress management techniques
Practical stress management methods, including mindfulness, deep breathing, and progressive muscle relaxation, can help nurses manage stress during demanding shifts. Research has shown that mindfulness practices reduce anxiety and enhance emotional resilience (Oh et al, 2022).
Reflective writing
Writing in a reflective journal provides an outlet to explore challenges, celebrate successes, and track emotional wellbeing over time (Butler, 2024). Reflective writing has been linked to increased job satisfaction and resilience (Lim et al, 2023).
Conclusion
Burnout in nursing is a complex issue with significant implications for both nurses' wellbeing and patient care. However, it is possible to mitigate its impact through a proactive, comprehensive approach involving both organisational and individual strategies. Early identification of burnout is crucial, and nurses and nurse managers should actively monitor signs such as emotional exhaustion, absenteeism and high turnover. Tools such as the MBI can help identify burnout early, while regular feedback channels provide valuable insights into stressors that may lead to burnout.
Organisational support plays a key role, with effective workforce planning and adequate staffing being essential to prevent burnout. Nurse managers should prioritise creating a supportive work environment that promotes teamwork, mutual respect and open communication. Recognition programmes and opportunities for professional development can also enhance job satisfaction and reduce burnout. Ensuring staff can achieve a good work-life balance is another critical strategy, with flexibility in scheduling and encouraging nurses to take time off being vital. Nurse managers should consider offering part-time roles, job-sharing opportunities, and promote the use of leave entitlements to support nurses in balancing their personal and professional responsibilities.
Additionally, nurses should be encouraged to engage in self-care practices such as regular exercise, having adequate sleep, and stress management techniques such as mindfulness. Training in time management and stress-reduction strategies should be part of ongoing professional development to help nurses cope with the pressures of their roles. By integrating these strategies into daily practice, nurses and nurse managers can contribute to a healthier, more resilient workforce, ultimately improving the quality of care provided to patients and enhancing job satisfaction for nursing staff.