A Manager's Guide-Seven visible signs your nurses may be suffering from burnout & how to prevent it at your hospital.

1. A MANAGER’S GUIDE
SEVEN VISIBLE SIGNS
THAT YOUR NURSES
MAY BE SUFFERING
FROM BURNOUT &
HOW TO PREVENT IT
AT YOUR HOSPITAL.

2. NURSING BURNOUT signs include no longer finding enjoyment in areas of the job the nurse once really
liked, becoming cynical or bitter about the job, and starting to experience problems in relationships with co-workers,
friends or family, as a result of the conflicts of with their job. As a Nurse Manager, other signs to watch out for are
nurses who frequently find excuses to not go to work, calling off or asking to go home early on a regular basis. Also “You don’t have that same spark that
be aware if your nurses are becoming easily annoyed with co-workers and envious of those who do enjoy their work, you used to have... You feel overwhelmed.
and not caring if they do a good job or not. Physical and emotional exhaustion are not uncommon in burnout. Burnout
I knew I had to do things for myself to
can create incredible havoc on a nurse’s personal life as well. 1
continue to stay in nursing.”
- Janine Mazabob, RN
1 cALLING IN SIck TO WORk FREqUENTLY. from Even Keel, by Rebecca Ray
2 cHRONIcALLY LATE GETTING TO WORk.
3 DEADLINES ARE NOT MET.
4 PROBLEMS WITH RELATIONSHIPS.
5 REGULARLY ASkING TO GO HOME EARLY.
6 SUDDEN FLUcTUATION IN WEIGHT.
7 FREqUENT cOLDS OR ILLNESS.

3. HELP YOUR NURSE BATTLE BURNOUT
If you ask your nurses what keeps them in nursing, most will say it is going home knowing that they did a good job
and made a difference for their patients. It’s not about salary. Mostly it is about having control over what they do
as nurses and how they do it. Lack of control is really what drives nursing satisfaction down and burnout up.
Burnout is a term nobody wants to hear, see, or experience, but it’s real. Burnout happens for a variety of reasons,
but ultimately it communicates a situation where “caring for others has become a chore.”The art of nursing
becomes a burden of all sorts. Nursing becomes nothing but eight or 12 hours of tasks that, when completed, will
allow the nurse to go home. 2
Here is a list of some ways in which you as Nurse Manager can help your nurses reduce stress and take back
control of their working lives:
STOP DENYING. Tell your nurses to take a minute and listen to the wisdom of their body. Have them start
to admit the stresses and pressures which have manifested physically, mentally, or emotionally.
AVOIDING ISOLATION. Don’t do everything alone! Encourage them to develop or renew intimacies
It’s not about salary. with friends and loved ones. Closeness not only brings new insights, but also is anathema to agitation and
depression.
cHANGING cIRcUMSTANcES. If their job, relationship, a situation, or a person is dragging them under,
have the nurse try to alter their circumstance, or if necessary, leave it entirely.
DIMINISH INTENSITY. Have the nurse pinpoint those areas or aspects which summon up the most
concentrated intensity and work toward alleviating that pressure.
STOP OVER NURTURING. If a nurse routinely takes on other people’s problems and responsibilities,
teach them to gracefully disengage. Have them try to get some nurturing for themselves.
LEARN TO SAY “NO”. Nurses can diminish intensity by speaking up for themselves. This means refusing
additional requests or demands on their time or emotions.
BEGIN TO BAck OFF AND DETAcH. Instruct the nurse to delegate, not only at work, but also at home
and with friends. In this case, detachment means rescuing themselves for themselves.
REASSESS THEIR VALUES. Help them sort out the meaningful values from the temporary and fleeting,
the essential from the nonessential. They’ll conserve energy and time, and begin to feel more centered.
LEARN TO PAcE. Try to take life in moderation. You only have so much energy available. Ascertain what is
wanted and needed in their life, then they can begin to balance work with love, pleasure and relaxation.
TAkE cARE OF BODY. Nurses should not skip meals, abuse themselves with rigid diets, disregard their
need for sleep, or break the doctor appointments. It is important they take care of themselves nutritionally.
DIMINISH WORRY AND ANXIETY. Try to keep superstitious worrying to a minimum - it changes nothing.
They’ll have a better grip on the situation if they spend less time worrying and more time taking care of
their real needs.
kEEP YOUR SENSE OF HUMOR. Suggest to your nurses to begin bringing job and happy moments into
their lives. Very few people suffer burnout when they’re having fun.

4. PROTEcTING YOUR STAFF FROM BURNOUT
Nurses are rarely thought of as needing help, but only as the care givers, which makes applying some
techniques for nursing stress burnout prevention more important than we ever thought.
A new research study, published in the March/April issue of the journal Nursing Economics, has determined
what factors can help keep new nurses from leaving their jobs and – in doing so – save health systems money.
When nurses leave for another position or retire early, it dramatically affects a hospital’s bottom line – as much
Lack of recognition
as 5 percent of a hospital’s budget may go to paying for nursing turnover costs. 4 is the #1 reason
employees quit.
Below are some ways in which you can help your staff understand the effects of burnout and ways to prevent
losing important staff to stress and ultimately, burnout.
YOU’RE A SUPERSTAR. Lack of recognition is the #1 reason employees leave a job. It has been proven
that a 2 minute positive and specific detailed recognition of an employees performance once a month will
dramatically increase a person’s job satisfaction. Create a monthly newsletter with updates, celebrations and
kudos from the month past.
APPREcIATION GOES A LONG WAY. Giving your staff simple tokens of appreciation once a month for
a job or task well done has the ability to relieve stress by 25%. For example tickets to a movie, Subway gift
card, car wash token, massage.
IT’S A cELEBRATION. Celebrate individual birthdays / anniversaries / education / graduation.
FREE LUNcH. Take a group or person to lunch once a quarter and ask them for their ideas.
ALL FOR ONE. Build group cohesiveness through encouraged peer support, regular training, discussions and
in-services. Ask staff to suggest topics.
SWITcH IT UP Vary professional responsibilities.
.
TAkE A BREAk. Let staff know it is all right to ask for a “stress break.”
REcOGNIZE AND AckNOWLEDGE. Watch for signs of significant stress in staff, and offer them help. Often
times, simply stating the obvious provides a sense of support and validation. (See page 2- Seven Visible Signs)
WE ALL cAN USE A HAND. Make asking for and accepting help part of the hospitals culture. Providers
who admit to feeling stressed must be accepted and not viewed as weak. It takes time to build the attitudes
required for this level of openness.

5. WHAT cAUSES A NURSE TO BURNOUT?
What causes burnout in the first place? Burnout on the job can be a direct result of inadequate staffing,
according to E. Carol Polifroni, RN, EdD, CNAA, associate professor of nursing, University of Connecticut,
Storrs, CT, and a recognized expert on workforce issues. If hospital administrations don’t work with
employees to ensure adequate staffing ratios, nurses need to speak with their feet, says Polifroni. “I’m not
suggesting job-hopping. But a nurse does not have to stay in a job because it’s the only game in town,” she
adds. 5
Besides poor staffing, the lack of autonomy in making decisions on care can also contribute to burnout.
When a nurse has to call in a resident or intern to the bedside to make a decision that the nurse is
capable of making, the nurse’s knowledge and skills are ignored and diminished. 5 Hospital nurse work
environments that devolve greater autonomy and control to nurses at the bedside, provide administrative
support for nursing care, have adequate staff, and facilitate good relationships between nurses and
physicians are associated with lower risk-adjusted Medicare mortality7; higher patient satisfaction8, 9;
lower nurse burnout10; and lower rates of needlestick injuries to nurses. 11-13
Do you In addition to poor staffing and autonomy, lack of recognition of the professional nurse also contributes to
remember why burnout. Burnout can be avoided by rewarding the current staff with bonuses and incentives for the great
work they do instead using that money to attract new staff. Again, the lack of recognition is the number
you became a one reason people leave their jobs.
nurse?
Before you start losing your permanent staff to burnout, try supplementing your current team with
temporary healthcare staff (i.e. Traveling Nurse or Contract, Per Diem). The difference between the types
of temporary staffing is based on the duration of the assignment; Per Diem is typically short in length
while a traveling assignment can last up to an average of 13 weeks. Temp staff can come as a big relief to
the current members of your team. Travelers are able to jump right in and fill the necessary hours needed
to keep nurse to patient ratios at their optimum and keep your current staff refreshed.
In closing, nurse burnout can be costly to hospitals. The average visible and invisible costs associated with
nurse turnover is approximately $50,000 or more. Instead of spending more money on overtime hours, it
would be better spent on reducing nurse-patient ratios. This would have the desired effects of improving
patient outcomes and reducing nurse work pressure. 14
Nursing may not be for everyone. It takes dedication and a tenacious attitude. There are stressful aspects
of being a nurse, but the good news is that the same experiences that cause stress can also give the nurse a
greater sense of gratification. Nursing is a highly emotional and sometimes strenuous job, and a nurse can
learn to focus that energy into positivity. 6
Everyone is prone to some sort of emotional disengagement - feeling stressed and unable to cope with
their job. With knowledge about recognizing the problem, causes, symptoms and ways to change your
enviornment to reduce stressful situations, nursing burnout within your staff can be avoided. Your staff
looks to you as a leader and it is your obligation to provide them with a positive working enviornment. By
implementing some of the tactics into your unit, you’ll soon have the nurses working for you, not against.

6. MEDIcAL SOLUTIONS was one of the first travel nurse and allied healthcare staffing companies to be
certified by the Joint Commission and has been continuously certified since 2004. Its focus is on meeting the urgent and short-
term staffing needs of its clients with highly skilled allied health professionals, nurses and technologists. A nationwide network
of travelers allows Medical Solutions to help its client hospitals continue to provide excellent patient care amidst a nursing and
allied health shortage. Medical Solutions has contracts with nearly 1100 client hospitals nationwide and is one of the fastest
growing companies in the travel nursing and allied health industry. This eBook is a free public service from Medical Solutions,
please share this with fellow collegues!
By visiting Staffing.MedicalSolutions.com/knowledge/one-minute-whitepaper/ you can learn more about the ways you can
save money with alternative staffing measures and more importantly, save your nurses from being burned out. Together we can
keep our nurses healthy, happy and more importantly, taking care of those who need it.
REFERENCES & RESOURCES
1. More Thoughts on Dealing with Nursing Burnout
http://medscapenursing.blogs.com/medscape_nursing/2008/02/more-thoughts-o.html
quality
2. In the mix: Avoid Burnout by Caring for Yourself
http://www.hcpro.com/NRS-228578-4931/In-the-mix-Avoid-burnout-by-caring-for-yourself.html
experience
3. 15 Useful Techniques for Nursing Stress Burnout
http://www.stressreductionbasics.com/techniquesfornursingstressburnout.html
4. Keeping Nurses On the Job: Retention is Part of the Answer to the Nursing Shortage
http://www.eurekalert.org/pub_releases/2009-03/nyu-kno033009.php
5. Fired Up or Burnt Out
http://nsweb.nursingspectrum.com/Articles/FiredUpCF2003.htm
commitment
6. How Nurses Are Avoiding Burnout
http://www.nursinglink.com/careers/articles/3716
7. Aiken LH, Smith HL, Lake ET. Lower Medicare mortality among a set of hospitals known
for good nursing care. Med Care. 1994;32:771–787
8. Aiken LH, Sloane DM, Lake ET. Satisfaction with inpatient AIDS care: a national comparison
of dedicated units and scattered beds. Med Care. 1997;35:948–962.
value
9. Aiken LH, Sloane DM, Lake ET, et al. Organization and outcomes of inpatient AIDS care.
Med Care. 1999;37:760–772
10. Aiken LH, Sloane DM. Effects of organizational innovations in AIDS care on
burnout among urban hospital nurses. Work Occup. 1997;24: 453–477
11. Aiken LH, Sloane DM, Klocinski JL. Hospital nurses’ risk of occupational exposure to blood:
prospective, retrospective, and institutional reports. Am J Public Health. 1997;87:103–107.
12. Clarke SP, Rockett JL, Sloane DM, et al. Organizational climate, staffing, and safety equipment as predictors
of needlestick injuries and near-misses in hospital nurses. Am J Infect Control. 2002;30:207–216.
13. Clarke SP, Sloane DM, Aiken LH. Effects of hospital staffing and organizational climate on needlestick injuries to nurses.
Am J Public Health. 2002;92:1115–1119.
14. Bonnie L. Atencio; Jayne Cohen; Bobbye Gorenberg. Nurse Retention: Is it Worth It?
Nurs Econ 21(6):262-268, 299, 2003. © 2003 Jannetti Publications, Inc.
Phone: 1-866-633-3548 Fax: 1-866-688-5929 Staffing.MedicalSolutions.com