Credentials of Corresponding Author
MSN, RN
Name of Faculty Advisor
Elizabeth Burkhart
Problem
Burnout, the end result of chronic organizational stress, is a syndrome characterized by exhaustion, depersonalization, and inefficacy in one’s professional life (Maslach, 2016). •Effects 48.9-66% of nurses (Dyrbye et al., 2019) •Burnout leads to an increase in turnover intention (Van der Heijden et. al, 2019) •Burnout increases work absences and decreases general health in nurses (Dall’Ora et al., 2020; Khamisa et al., 2015 ) •Burnout increases the use of alcohol and drugs use in HCPs (Van Gerven et al., 2016) •Nurses who score high in burnout provide a lower quality of care with an increase in adverse events, infections, patient falls, and mediation errors (Cimiotti et al., 2012; Dall’Ora et al., 2020, Dwyer, 2019; Montgomery et al., 2020; White et al., 2019)
Purpose
The purpose of this review is to collect, review, and synthesize the literature on burnout in the nursing population.
Search strategy
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
Results of literature search
The literature for burnout fell into three categories - The Individual, The Unit, and the Organization.
What is known about individuals, units, and organizations that are likely to score higher in burnout measures. What interventions have been used at the individual, unit, and organizational level in order to decrease burnout levels in nurses.
A majority of what is known about burnout has occurred at The individual level, both in correlations related to developing burnout and what interventions have been used to mitigate or reduce levels of burnout.
Synthesis of evidence
Individuals who are: Male, Single, Younger than 40, A Narcissistic Personality Type, Ruminating Personality Types, Less than 3 years experience are more likely to experience burnout.
Units with: A higher instance of experiencing moral distress, trauma, bullying, patient death. Units with higher nurse/patient ratios. Units where nurses are assigned working permanent night shift. Units with a lower perception of social support are all more likely to experience burnout.
Organizations using Authentic Leadership and Structural Empowerment are less likely to have nurses scoring high in burnout measures. Nurses working in government hospitals are more likely to experience burnout. Nurses who have higher organizational level social capital are half as likely to experience burnout.
Implications for practice
Further research should be completed at the Unit level to further develop what is known about how interpersonal relationships develop burnout in nurses.
Burnout - A Review of the Literature