Nurses face increased likelihood of burnout during COVID-19, reports study

Reviewed by Emily Henderson, B.Sc.Jul 22 2021

Early in the COVID-19 pandemic, more than 40 percent of nurses and other health care workers had risks associated with an increased likelihood of burnout, reports a survey study in the August issue of the American Journal of Nursing (AJN). The journal is published in the Lippincott portfolio by Wolters Kluwer.

The study identifies risk factors for poor well-being as well as factors associated with greater resilience - which may reduce the risk of burnout for hands-on care providers, according to the new research by Lindsay Thompson Munn, RN, PhD, and colleagues of a North Carolina healthcare system. They write, "The insights gained from this study can help health care leaders to target these risk factors and develop strategies that allow organizations to better support well-being and resilience among clinicians."

New evidence of pandemic's impact on well-being in health care workers

The researchers conducted an online survey of nurses and other non-physician health care workers (HCWs), and received responses from 2,459 participants who provided direct patient care. The survey focused on risk factors for decreased well-being: a key contributor to the epidemic of burnout among health care professionals.

The survey also evaluated aspects of resilience. Defined as the ability to cope with and adapt positively to adversity, resilience is an important contributor to well-being. Data were collected in June and July 2020, providing a snapshot of well-being and resilience among HCWs a few months into the pandemic.

At that time, 44 percent of HCWs surveyed had "at risk" well-being, which is associated with increased risk of burnout, fatigue, and patient care errors. Analysis of the responses identified several factors associated with increased odds of poor well-being, including:

• Having low scores on a measure of resilience
• Believing that supplies of personal protective equipment (PPE) were insufficient
• Feeling that the organization did not understand health care workers' emotional support needs during the pandemic
• Believing that workload had increased
• Believing that staffing was inadequate to safely care for patients
• Having a lower degree of psychological safety (feeling that the work environment was conducive to vulnerability and interpersonal risk-taking)

In contrast, opposite levels of some of the same factors were associated with higher scores for resilience:

• Feeling that the organization did understand emotional support needs
• Believing that staff were being redeployed to areas of critical need
• Having a higher degree of psychological safety

Less than one-fourth of health care workers had used available resources to support their well-being and resilience (such as meditation apps, employee assistance programs, and counseling). Perhaps reflecting high levels of stress early in the COVID-19 pandemic, those who used such resources were more likely to have "at risk" well-being.

Dr. Munn and coauthors believe their study has practical implications for health care leaders to promote well-being and resilience among health care workers, during the COVID-19 pandemic and beyond.

While it may seem obvious that nurses and other HCWs would sustain burnout and poor well-being after dealing with providing care under arduous circumstances, it's important to establish the contributing factors and to learn how some were able to mitigate the effects of the stressors. We're in serious need of successful strategies to support frontline caregivers."

Maureen Shawn Kennedy, MA, RN, FAAN, Editor in Chief of AJN

The researchers discuss steps that may help to support resilience while addressing modifiable factors that negatively affect well-being in the health care work environment. "[L]eaders can take crucial steps toward optimizing workers' well-being by paying careful attention to workload and staffing, creating a culture of psychological safety within teams and units, and recognizing and actively addressing the unique challenges posed by the pandemic," Dr. Munn and colleagues conclude.