Seven signs you’re close to burnout– and what to do about it

Advice for nurses on spotting the signs of burnout early and the positive steps you can take to reduce your risk and cope with the stress of the job

• An NHS staff survey revealed four in ten nurses feel burned out, which is the result of chronic workplace stress
• According to UK research, burnout affects job performance, patient safety, medication errors and nurses’ intention to leave the profession
• Advice from experts on what burnout is, what to look out for in yourself and colleagues, and how to seek help

Four in ten nurses say that their job leaves them feeling burned out, according to the recent NHS staff survey, leaving no doubt that burnout is a huge problem for the nursing profession.

What is burnout?

Burnout is a syndrome that is an occupational phenomenon rather than a medical condition, says the World Health Organization. It is caused by chronic workplace stress that has not been successfully managed, which leads to energy depletion and exhaustion, increased mental distance from the job, feelings of negativity and reduced professional efficiency.

The NHS is under intense pressure and struggling with nursing vacancies, so perhaps it is little surprise that almost half of staff (48.6%) feel unwell due to work-related stress, according to the NHS staff survey. But burnout has a worrying impact on the quality of care.

Research in the UK has found that burnout leads to reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls and intention to leave.

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What signs of burnout should nurses be looking out for?

1. Feeling more exhausted than usual Nursing often comes with long, busy shifts, so feeling tired is not unusual. But feeling more exhausted than usual, both physically and emotionally, is often one of the first signs of burnout, says University of Southampton lecturer in nursing workforce Chiara Dall’Ora. This is not something that can be addressed by a few days off or an early night.

Cancelling plans that you may normally have undertaken could be a worrying sign. ‘It goes beyond normal tiredness,’ Dr Dall’Ora says. ‘If it feels like you are emptying yourself, and you feel unwilling to use the energy you do have, then that is a common sign, and often one of the first in burnout.’

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2. Being less chatty with colleagues Avoiding those ‘water-cooler conversations’ where colleagues have a quick catch-up can be a sign that something is amiss.

York St John University associate professor of psychology Daniel Madigan says: ‘When people start to experience burnout they often start to distance themselves from others and feel isolated, and there can be less communication with colleagues.’ This can potentially have consequences for patient safety, he says.

3. Having a short fuse When a nurse becomes emotionally exhausted, they can start to have more negative, cynical feelings, and this can lead to anger.

‘We can have a quicker emotional response to certain situations, and these can be negative, so a trigger to anger can become quicker,’ Dr Madigan says.

4. Not seeing patients as individuals Treating patients differently, with reduced communication and empathy, is a sign that burnout is taking hold. Looking at patients as just their condition or seeing only the task they need is a worrying signal, Dr Dall’Ora says.

‘If you are working in a setting with the opportunity to develop relationships with patients and that is not happening anymore because you are pulling back, that can be another sign’ she says. ‘You may not feel you have the energy to be empathetic.’

5. Taking more time off work sick Nurses who are feeling emotionally exhausted are more likely to have short-term absences, research has found. One study found that nurses were overworked, which led to burnout, which then led to sickness absence, in a worrying cycle that highlighted the harm of nurses working too hard.

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6. Feeling unhappy with the care delivered Nurses who are becoming burned out will perceive the care they are delivering as below the standard it should be, Dr Dall’Ora says. ‘It is hard to tell whether this is part of burnout or a consequence of burnout, but there is a negative perception about the quality of their work.’

7. Colleagues asking a nurse if they are struggling Research suggests that colleagues are good at picking up queues that someone is starting find things hard at work, Dr Madigan says. They will spot someone withdrawing. So when a colleague checks in, they may well have noticed something is amiss.

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Is it possible to stop burnout in its tracks?

While reports of burnout are alarmingly high among nurses, there are positive steps that can help reduce your risk.

York St John University associate professor of psychology Daniel Madigan says that steps that reduce stress have generally been found to be helpful when it comes to halting a slide towards burnout.

The NHS Better Health: Every Mind Matters website recommends these steps to help deal with stress in a positive way:

• Split up big tasks that can seem overwhelming
• Try self-help cognitive behavioural therapy techniques
• Talk to someone, such as trusted friends, colleagues or family members, or contact a helpline, if you are struggling
• Allow some positivity, by taking time to think about the good things in life
• Be more physically active
• Plan ahead – planning out stressful days or events can help

While steps like these are helpful – and great if they work – University of Southampton lecturer in nursing workforce Chiara Dall’Ora is clear that once a nurse has reached burnout, this is a serious state and they are likely to require support from occupational health or a GP, and probably a lengthy break from work.

‘We need to normalise talking to managers about burnout, as a lot of the changes that are needed are more systemic and can be out of a nurse’s control,’ she says. ‘So maybe a manager can make sure someone doesn’t have too many long shifts in a row, or gets their breaks – these kinds of things can help.’

• RELATED: Nurse burnout: the course helping staff to be advocates for self-care among colleagues

Where to get support

• Mental Health at Work – Our Frontline for Support Workers provides 24/7 emotional support for front-line staff on the phone or by text
• Samaritans is a confidential support helpline
• Nurse Lifeline (0808 801 0455) – speak to a nurse or midwife for confidential peer support
• The RCN provides advice and support, including access to a counselling service
• NHS Better Health: Every Mind Matters provides advice on burnout and stress

Erin Dean is a health journalist