The Journal of Continuing Education in Nursing

Leadership and Development 

Burnout 3.0

Jan Jones-Schenk, DHSc, RN, NE-BC

Abstract

Although burnout has long been discussed and recognized in nurses, the fact that it is now classified in the World Health Organization's International Classification of Diseases brings it back into the forefront. Dismissal of burnout as a generational construct or a lack of resilience carries significant risks for individuals, organizations, and the clients they serve. Purpose-driven work actually may exacerbate the rise of burnout. [J Contin Educ Nurs. 2019;50(8):345–346.]

Abstract

Although burnout has long been discussed and recognized in nurses, the fact that it is now classified in the World Health Organization's International Classification of Diseases brings it back into the forefront. Dismissal of burnout as a generational construct or a lack of resilience carries significant risks for individuals, organizations, and the clients they serve. Purpose-driven work actually may exacerbate the rise of burnout. [J Contin Educ Nurs. 2019;50(8):345–346.]

Nursing burnout was a discussion topic over 20 years ago, and during that time detractors were prone to blame unengaging and monotonous work, understaffing, and generational differences in work–life expectations. With the rise of writings and research about purpose-driven work and the passion and love that follow it, there is a revival of defining burnout as a phenomenon with significant impacts and strong evidence. Somehow, individuals drawn to mission-focused work, work related to helping others, and work associated with deep passion are the most vulnerable to burnout and it is an important dichotomy to consider. In her recent article “When Passion Leads to Burnout,” Moss (2019) claimed:

While burnout can affect anyone, at any age, in any industry, it's important to note that there are certain sectors and roles that are at increased risk, and purpose-driven work—that is work people love and feel passionately about—is one of them.

This claim and an assortment of studies with supporting data help to explain why the World Health Organization (WHO, 2018) recently included burnout in the International Classification of Diseases. While stopping short of characterizing burnout as a disease, this designation as a syndrome takes a big step forward in recognizing symptoms and raising awareness about the insidious nature of burnout as an occupational phenomenon. Prior discussions about burnout had an air of personal opinion that tended to dismiss burnout as a legitimate issue, resulting in less attention or validation of the problem. WHO did not jump to a conclusion about burnout but took the classification step after consultation with a variety of global workforce experts who wanted to bring greater clarity and visibility to the effects of burnout on the global health workforce and refine the definition with an eye toward improving recognition, treatment, and support.

The WHO (2019) definition includes three characteristics:

  • Feelings of energy depletion or exhaustion.
  • Increased mental distance from one's job, or feelings of negativism or cynicism related to one's job.
  • Reduced professional efficacy.

Who Is at Risk?

While feeling connected to one's work and enjoying the passion of its pursuit has many benefits, a recent study also revealed the dark side of purpose-driven work. According to Whiteside (2019), “results indicated that purpose-driven employees are significantly more stressed than non-purpose driven employees, and reported significantly lower levels of general well-being, resilience, and self-efficacy” (section 4). These findings are especially significant in health care, and particularly for physicians and nurses who are strongly, emotionally attached to their work. This attachment manifests as higher levels of engagement, inspiration, and willingness to go above and beyond. It also carries the darker side of insufficient boundaries between self and work and a significantly higher risk for the symptoms of burnout. The weight of the purpose can drive higher levels of stress, reduced resilience, and self-efficacy. This seems somewhat counterintuitive as we consider the value and benefit of engaging in work that has meaning. The perceived value of meaning is so great that leaders of organizations may be more inclined to dismiss the implicit dangers in this risk factor and may tend to assume that highly engaged and effective purpose-driven employees can figure out the problems of their growing stress on their own—a dangerous and potentially costly mistake resulting in losses of talent, overall culture, and recognition of the leader's role in workforce well-being.

What Is a Professional Development Leader to Do?

A culture of support, empathy, and recognition is essential to counteract the dangers described in this article. Surprisingly, the study by Whiteside (2019) found that purpose-driven employees reported significantly lower levels of recognition than employees who reported working in nonpurpose-driven environments. Is this a manifestation of a mindset that doing good work is its own reward, or is it potentially related to outcome-focused environments where recognition is based on results and not effort? Whatever the cause, the cure is within reach and begins with greater awareness of the reality of burnout, the greater susceptibility of the purpose-driven employee, and a willingness of all leaders to focus more intensely on this problem. Supporting employees in setting boundaries within their work is another strategy that can help to mitigate the growing challenge of employees feeling that they must be available at all times. Technology is a factor, and fears about being out of contact contribute to the inability for employees to feel safe in creating boundaries and pushing for greater balance. In the presence of significant burnout, leaders must be able to recognize the symptoms and be more proactive in providing quantifiable support, guidance on limits, and prioritization advice. Finally, the engaged and purpose-driven employee is a valued asset. Losing impassioned employees to a preventable phenomenon is unwarranted. Good leaders know their most important role is to ensure the health and well-being of their employees.

References

Authors

Dr. Jones-Schenk is Academic Vice President, College of Health Professions, Western Governors University, Salt Lake City, Utah.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Jan Jones-Schenk, DHSc, RN, NE-BC, Academic Vice President, College of Health Professions, Western Governors University, 4001 S. 799 E., Salt Lake City, UT 84107; e-mail: jan.jonesschenk@wgu.edu.

10.3928/00220124-20190717-03

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