Research Paper-Final Copy!

Krystal Yost

English 132

Burnout Syndrome

Since I was a young girl I wanted to be just like my mom who was a nurse. A career in the medical field was always what I knew would be a part of my life in one way or another. This topic is not only important to me but also the people who are already working in the medical field as doctors, nurses, medical assistants, etc. These people would more than likely agree that finding more research on health issues would be relevant. Not only health care professionals but also the ones that are suffering from health problems would find this topic important. People are always looking for new ways on improving someone’s health. This would include the patient and the caregiver. The overall health of our country is important. Problems that are going on around the world are what is seen on the news. In general, people care about the well being of others. However, what is extremely important to me is people who are dealing with some sort of cancer While being in school trying to earn a degree in nursing I want to know more of what it actually takes. A lot of nurses in the Oncology department experience what is called the “Burnout Syndrome.” This is where they become physically and mentally exhausted because of their work. My research question is; How can we improve job burnout in the nursing field? I will begin with researching this topic online, looking at educational articles, and even talking to someone who works in the field or a patient who has some form of cancer. This topic hit home a lot to me because my mom passed away from cancer so I already have a lot of background knowledge that will help improve my paper. This paper will allow readers to know what steps need to be taken in order to earn a nursing degree. It will allow them to find out what true strength is needed with working in the oncology department. As a prediction I hope to find some answers to the questions that have come up. I will find out more about education, schooling, and what it is like working with a patient with a serious illness. There are so many demands that nurses have and I need to find out just what those are. A lot of nurses get attached to the patients and have to watch them suffer. It can be both an emotional and physical strain on a person, which is related to the burnout syndrome. I want to know what it is like taking care of people as a career and going through all of the stress. Having gone with my mom to chemo I’d like to find out how people with cancer have positive outlooks. If only people could be as strong as someone fighting for their life would truly inspire everyone to have a better outlook.

            It takes a great deal of schooling in order to become a registered nurse. Long hours in the classroom, practical’s, exams, and so much more goes into earning a degree in the medical field. Working long hours in the hospital or at the patients home can cause a great deal of problems. One big problem would be considered a nurse burnout. “Burnout was first recognized as a psychological concept in the 1970’s. The Maslach Burnout Inventory defines burnout according to three characteristics: emotional exhaustion, depersonalization, and a reduction in perceived personal accomplishment” (Christina Fearon). When a person is emotionally exhausted they feel drained and down 24/7. Then when they try to protect themselves more it would be considered depersonalization and a lowered satisfaction in achievement results in a decrease of work productivity. This would cause a reduction in perceived personal accomplishment.

            The nurse burnout is known because it shows a pattern of emotional and subsequent emotional exhaustion. A person gets too involved emotionally, and may overextend him or herself, and feels overwhelmed by the demands imposed by other people. (Christina Maslach) It is a condition that some registered nurses experience that shows itself as being fatigued all the time, readily irritable, insomnia and poor performance. Physical manifestations can be chronic headaches, back pain, weight gain, and Gastrointestinal problems. (Nursing Profession Education)

            The range of health care professionals is so wide. It can range from becoming a medical assistant, registered nurse, or a doctor to one of those three who specializes in something specific such as oncology. “Professional burnout has been recognized in the nursing field for decades. Research in the area has examined personality characteristics, working conditions, shift length, support networks, and various other risk factors associated with burnout in nurses in many specialty areas, including oncology” (Marcella Williams). Oncology specializes in the treatments of cancer. This field of study has such a high chance of experiencing the burnout syndrome. Much of the research done has shown that nurses in the oncology department experience burnout much more than other professions. However, one author completely disagreed. Burnout can occur in any profession and it’s the end result of stress.

            A survey was completed by 589 people showing so many results. 60% returned the survey before the cut-off date. 56% of the respondents reported experiencing burnout in their professional life. There was no significance found between the burnout and specialty within oncology. Significance was found between the type of practice and the incidence of burnout. (Journal of Clinical Oncology) That piece of evidence seems to go against all of the data previously found.

            Another article stated, “There is a great level of stress among people who work with the vulnerable groups of society” (Harm Reduction Network). This would include nurses and oncologists, along with several others. When working in this type of environment stress is a huge factor. Once stress comes in so many other things could happen. “Frequent depressions, anxiety, emotional exhaustion, depersonalization, low level of work satisfaction, etc. All this is a widely spread reaction on a permanent emotional stress related to work with other people who are in a difficult situation and often face hardships. A burnout syndrome is very painful problem for individuals and leads to work efficiency and labor drain in an organization” (Harm Reduction Nerwork).

            When someone experiences the burnout syndrome it may be like there is no getting back on track. It has been shown and proven that there are specific techniques and things that can be done. A person may experience the burnout syndrome, take some time for themselves, and then get back on track. Much research has justified that sentence.

            “Nurses can experience burnout in all aspects of life, from work to family time” (Karen Hochberg). Karen Hochberg found several ways to prevent this syndrome from occurring. The first step would be to identify your purpose. This would mean figure out exactly what should be learned from the meeting, specifically would be a meeting that could be emotionally draining. Secondly, your attitude is everything. Honestly, have a positive outlook on the situation. Don’t focus on the negatives. Thirdly, would be to listen and the fourth is to take notes. This would mean complete focus and determination. Lastly would be to learn by watching. Instead of just jumping in take the time to watch your co-workers. This would not mean not doing your job but just taking enough time for yourself to deal with the burnout syndrome.

            Another author believes there are other ways to deal and cope with this syndrome. According to a study of physicians from the Journal of the American Medical Association they stated, “Guided meditation and sharing of experiences has been shown to improve mood and decrease feelings of burnout” (Morgan Lewis Jr.).

            When it comes to doctors and nurses the level of burnout is high. The authors from the South African Medical Journal have found a significantly high degree of emotional exhaustion and depersonalization experienced by doctors. “Burnout resulting from high levels of stress at work can contribute to the exodus of health care workers.” Recruitment, improved management and planning, increased support, mentorship, and a more empathetic administration were some of the factors suggested to mitigate the burnout experienced by doctors” (South African Medical Journal).                                                           Stress

                                                                        Burnout

                                                            Depressive Indications

                                                                Clinical Depression

         My Viewpoint on the Issue

            The burnout syndrome is such a hard thing to get rid of. From knowing several people who work in the medical field I have had a pretty good insight into that sort of thing. The burnout syndrome is from physical and emotional exhaustion in the work place. The oncology department hit home to me because of my mom. I went with my mom every Monday to chemotherapy and was able to see what it is like working with such ill patients. I also see what it is like being the patients with the terminal illness of cancer, however, I truly do not understand. For professionals in the health care field the burnout syndrome is always a worry, which I have seen and completely agree with. How can we improve job burnout in the nursing field?

            Oncologists are professionals who are there to track a person’s health. They are also there to watch over chemotherapy and radiation and to make sure that everything is working properly. From going with my mom every Monday I have seen how nurses get attached to their patients. These nurses care for people like they are their best friend. They have to watch them sit there, knowing they have some form of cancer. Taking care of these patients is such an emotional strain which can be connected to the burnout syndrome. The burnout syndrome can be alleviated by being aware of the lifestyle and coping, knowing risk factors, and finding true meaning within the work place.

            The burnout syndrome is such a problem that so many nurses are facing. “Burnout is defined as the syndrome of emotional exhaustion, depersonalization, and a reduced personal accomplishment” (South African Medical Journal). Burnout can also cause so many health problems. Things such as: depression, iron and vitamin deficiency, diabetes, and much more. (http://www.dzip.de/en/health/burnout/causes-of-burnout) With knowing several of the health problems there are also ways to prevent it.

            Being aware of the lifestyle and coping skills is a huge component of being able to overcome issues in the workplace. There are a wide variety of coping skills that need to be known. Problem focused and emotional focused coping is so important for nurses. That would be finding the problem and aligning emotions so that they are not off balance. Authors Fearon and Nicol brought up the point, “The promotion of a healthier lifestyle to improve wellbeing and protect against burnout is a common topic in burnout literature, with advice on diet, exercise, relaxation, and decompression routines (such as exercising after leaving work or changing into different clothes)” (Fearon and Nicol). Honestly, all it is would be to take care of yourself and don’t let the stress at work get to you too much, to the point it would cause burnout. If not allowing yourself the time to take care of your body then chronic fatigue could set in. Along with being aware of the lifestyle and coping skills another way to prevent burnout is by knowing the risk factors.

            The list of risk factors is absolutely huge. Being aware of what could happen while working in the oncology department is another way to prevent the burnout syndrome. People in general care about one another. They want what is best, and that is especially true to those who work with patients suffering from a life threatening illness. According to Komatsu and Yagasaki, “Symbolic interactionism theory assumes that people create meaning through social interaction” (Komatsu and Yagasaki). This is true when someone is taking care of another person. Putting 100% of your time and effort into the care of one person allows you to get attached. From a personal experience, I know my mom loved one of her nurses and would have done absolutely anything for her. It would have gone the other way also. However, being attached to someone puts the person at a higher chance of developing risk factors. In order to veer away from problems make sure to take good physical and emotional care of yourself. Know what values you possess, and set professional goals. Know that in the oncology department things are going to happen because the patient is suffering from a serious illness and the chances of them making it are not that high. Even with knowing the risk factors, meditation is also another possibility.

            Meditation is something that many people believe to be a positive aspect of coping. In other words Morgan Lewis Jr. states, “Guided meditation and sharing of experiences has been shown to improve mood and decrease feelings of burnout, according to a study of primary care physicians from the Journal of the American Medical Association” (Lewis). This is where 70 physicians participated in a study in Rochester, New York. While taking the survey physicians experienced decreased feelings of emotional exhaustion and depersonalization. They felt more accomplished and had patient empathy. (Lewis) Better health within the health care field was related to patient trust, lower health care costs, and improved mood.

            Even though there are ways to get around or deal with the burnout syndrome the health care professional must know what is to come. When taking care of a patient with some form of cancer a routine needs to be set in place. By this I mean, along with Natalie Scott that, “Care plans should be more holistic and oncology based, and the process for completing care plans should not be too time-consuming for staff” (Scott). This would mean not to overwhelm the staff. However, you shouldn’t give too much leeway. That is when the caregiver and patient get attached. Yes, it could be such a positive thing but getting too attached to the patient with cancer can lead to a high risk of burnout. Even though there are always ways to prevent burnout some would strongly disagree.

            I believe that one of the careers more susceptible to the burnout syndrome would be that of oncology. However, authors Whippen and Canellos strongly disagree by saying, “No significance was found between the incidence of burnout and specialty within oncology” (Whippen and Canellos) They believe that all careers experience burnout and oncology doesn’t qualify for being any higher. How does that seem right? In the oncology department people are getting connected. Patients with cancer who are there for treatment have no guarantee that a cure will be found. It amazes me that people with cancer are the ones with the positive outlooks on life. An example of this is with my mom. Every Monday her and another gentleman with  lung cancer went to the same place at the same time. They talked for the few hours they were there and really got to know one another. When he passed away my mom was devastated. She knew what was coming and was able to cope with it. My mom was the patient, she wasn’t the nurse. Nurses are there most days with so many different patients really getting to know them. I do not understand how people can say that oncology is not at a higher risk than other careers.

            Another rebuttal is that the burnout syndrome is to be expected. Staff is working with patients of terminal illnesses. They experience frequent depression, anxiety, emotional exhaustion, and a low level of satisfaction. (Harm Reduction Network) When this happens how do they overcome it? Yes, there are always coping skills, meditation, etc but who is to say that it won’t come back.

            Once a person experiences the burnout syndrome there are so many things to do but will that ever guarantee that it won’t come back? The whole process will have to keep repeating. Things that will have to constantly be at the forefront are: relaxation, exercise, balancing life, and managing all of lifes challenges. (http://www.dzip.de/en/health/burnout/causes-of-burnout)

            Taking care of another person makes someone so strong. They have such a kind heart to be doing the type of work done to oncology patients. Of course fatigue and burnout are going to set in but that does not mean that you cannot overcome it. So the questions still stands, how do we improve job burnout in the nursing field? The answer is pretty simple. The health care provider must possess the right coping skills, have an eye for risk factors, and know that the work being performed is changing someone’s life. That should truly inspire you to make a different. If only we all had viewpoints like patients with cancer do the world would be such a better place.

During this process I decided I would talk with my uncle who is a Critical Care Nurse. I was able to ask him several questions and in summary this was his response:

            My uncle works as a Critical Care nurse in Detroit, Michigan. He has worked there for over 20 years. While my mom was sick, he moved in with my family and found a job near my house as a nurse. Since he has taken care of sick people his whole life he has learned so much from it. Living with my family for over two years was hard on him. He watched his sister in law every day, who was sick with cancer. However, he was the biggest help to my family. I couldn’t have asked for anyone better to explain to my family the ins and outs that were to come. He got us prepared. This would be especially true for me and my brother. My brother is 14 years old. My uncle explained to my brother in the best way that he could what was going on inside my mom’s body and what it was doing to her. He is still so young that I’m not sure if he fully understands it but because my uncle has had so much experience he thought it would be best to let my brother know.

            After my mom passed he helped both of us through the grieving process which still has not stopped. I am not to the point where I’ve accepted what has happened. I’m still in shock and angry but with my uncles help he taught me that it is normal and everything will take time.

            When it comes to my uncle working in the ICU he experiences a lot of burnout. Along with workings nights he is always tired and fatigued. He has great coping skills because if it weren’t for them he wouldn’t be alive today. Working with such ill patients is an emotional strain. He takes frequent vacations but those only help for so long. He has learned to accept the fact that everything does happen for a reason. The people he takes care of were put in front of him for one reason or another. He has learned from some and some have learned from him.

            Because of my mom, who was also a nurse, and my uncle I know exactly what I want to do with my life. It’s going to be hard but with those two by my side I’m sure I’ll get through anything. 

Maslach, C. (1982). Burnout-the cost of caring. (pp. 1-155). Englewood Cliffs, New Jersey:

            Prentice-Hall, Inc…

                        Christina Maslach’s book, Burnout-The Cost Of Caring is important to many people in the    medical field. There are several chapters within the book, all deal with several different problems that nurses can face and how they can overcome them. The main issue that nurses face is called the “burnout syndrome.” This means that health care professionals become drained and exhausted from the work they perform each day. This is specifically true with Oncologists. Oncologists specialize in the study of cancer. These nurses may get attached to their patient and have to watch them go downhill due to their illness. This book was extremely helpful with writing the paper. It lead me step by step with each chapter. Each chapter gave me a lot of    information on the topic that I needed. 

Lavrova, K., & Levin, A. (2006). Handbook for workers of harm reduction programs. In Burnout Syndrome: Prevention and Management (pp. 1-57). Retrieved from http://www.harm-reduction.org/ru/images/stories/library/burnout_syndrome_06_en.pdf

                       Two authors, Lavrova and Levin, both worked together with several other authors in order to come up with a handbook titled, Burnout Syndrome: Prevention and Management. This handbook was able to inform several students who are going into the nursing field. It gave an in depth definition of the burnout syndrome along with reasons to why it comes up, symptoms, and ways of prevention. The Central and Eastern European Harm Reduction Network (CEEHRN) worked with the International Harm Reduction Development Program (IHRD) in order to conduct a grant program. It was aimed to explore and create activities for employees in the health care field. I did find this handbook very beneficial. I found it helpful because it gave so many definitions to many of the questions that came up while writing my paper.

Whippen, D. A., & Canellos, G. P. (1991). Journal of Clinical Oncology. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists, 9(10), 1916-1920. Retrieved from http://jco.ascopubs.org/content/9/10/1916.short
                       D A Whippen and G P Canellos teamed together in writing, Burnout Syndrome in the practice of oncology: results of a random survey 1,000 oncologists. This article provided a questionnaire. Five hundred ninety-eight people completed the survey that asked about whether or not they experienced the burnout syndrome. I was able to use this information in my research paper which made it beneficial. Surveys and questionnaires only improve the paper.

Williams, M. (2007, April). ONS Connect. Follow these tips to prevent professional burnout, 1-26. Retrieved from http://www.thefreelibrary.com/Follow these tips to prevent professional burnout.-a0187772806
                      The article, Follow these tips to prevent professional burnout, was written by Marcella Williams. Williams was able to provide me, along with people in the health care field, information on how spring brings daylight hours and the relationship between that and stress for nurses. Even though spring is a time for cheer and happiness it doesn't let stress leave the hospital environment. Then it listed several tips for oncologists. This was a helpful article for me because I plan on going into the oncology department because of my mom. It helped me get a heads up as to what could possibly come in my future.

Komatsu, H. & Yagasaki, K. (2011, November 08). BMC Nursing. Preconditions of successful guideline implementation: perceptions of oncology nurses, 1-23. Retrieved from http://www.biomedcentral.com/1472-6955/10/23
                     Komatsu and Yagasaki wrote about the Grounded theory and Symbolic interactionism theory. They wrote the article, Preconditions for successful guideline implementation: perceptions of oncology nurses. The Symbolic interactionism theory assumes that people create meaning by socially interacting. Grounded theory describes terms of phenomenons. By this I mean you collect data on the behavior of oncology nurses through interviews, and certain goals. This was a helpful article because it provided a couple theories that were able to go into my paper.

Stott, N. (2011, June 22). Nursing Standard. Improving care planning in oncology nursing practice, 25(42), 1-33. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21826869

                   Improving care planning in oncology nursing practice, was written by Natalie Scott. This article described a 27 bed oncology unit in Scotland. It evaluated the units care plans and identified where improvements could be made. This could be useful to bosses and managers who work in hospitals to see if there are any implementations that could be incorporated into their working environment. This was another article that was helpful because it listed out ways to improve the health care setting. 

N/A. (2011). South African Medical Journal. Junior doctors: burnout and skills retention , 101(2), 1-84. Retrieved from http://www.biomedsearch.com/article/Junior-doctors-burnout-skills-retention/262037415.html

                     In the South African Medical Journal there was an article titled, Junior doctor: burnout and skills retention. This article was based on the Red Cross War Memorial Children's Hospital and whether or not nurses experience burnout there. There was a significantly high level of emotional exhaustion. Depersonalisation is related to reduced personal experience. This article was extremely helpful. It gave one example of burnout and several factors that lead into that. It made it very easy to relate with. This article would be helpful for really anymore, particularly those going into the medical field.  

Lewis, M. (2009). Medical Economics. Meditation, sharing help prevent burnout, 86(20), 1-12. Retrieved from http://www.mastermeditation.com/meditation/meditation-and-how-to-avoid-burn-out/

                    Morgan Lewis, Jr wrote, Meditation, sharing help prevent burnout. If someone experiences burnout this article gave several ways in order to overcome it. Seventy physicians in Rochester, NY participated in a year long study. The study consisted of eight weekly 150 minute sessions and 10 monthly 150 minute sessions. There they were able to express emotions and talk about ways of prevention. This would be helpful to nurses who are already experiencing the burnout syndrome. I don't think these sessions would be that beneficial to those who haven't experience burnout yet. However, this article was helpful for me. It showed a real life example of a way to cope.

Hochberg, K. (2008). ONS Connect. Consider these remedies for mastering meeting burnout, 23(4), 1-18. Retrieved from http://www.thefreelibrary.com/Consider these remedies for mastering meeting burnout.-a0187772829

                     Consider these remedies for mastering meeting burnout, written by Karen Hochberg described ways to avoid experiencing the burnout syndrome. Nurses can experience burnout in so many different settings. All nurses must go through what seems to be an endless line of meetings which can cause burnout. Meeting burnout can be dealt with by identifying the purpose, adjusting attitude, listening, taking notes, and to learn by watching. Each of those point is explained in more detail. This paper was helpful because of the list it provided with coping. I was able to incorporate part of this article into my paper. 

Fearon, C., & Nicol, M. (2011). Nursing Standard. Strategies to assist prevention of burnout in nursing staff, 26(14), 1-35. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22259967

                     Strategies to assist prevention of burnout in nursing staff, written by Fearon and Nicol talks about how burnout was first recognised. It is a psychological concept that was introduced in the 1970's. It lists out three characteristics: emotional exhaustion, depersonalisation, and a reduction in perceived personal accomplishment. Definitions were given to each of those three characteristics. This article was extremely helpful. It was helpful because it talked about where the burnout syndrome originated and gave several definitions of several terms.