The impact of burnout, exhaustion, and stress

Burnout is associated with reductions in the physical and psychological well-being of nursing staff (Dulko & Kohal, 2022), and can result from prolonged emotional exhaustion at work (Botha et al., 2015). In recent years, the nursing profession has raised alarm about the cumulative negative impacts of work-related stress and burnout (Kelly & Tyson, 2016).

Have you ever considered how emotional exhaustion affects your motivation to listen to a patient’s suffering?

You don’t need to personally witness trauma to be impacted by it.

As you have likely experienced at some point in your career, simply listening to a patient’s story can negatively impact your psychological well-being (Sinclair & Hamill, 2007). This can cause something called compassion fatigue, where it becomes harder to empathize with the patient’s experience (Raab, 2014). One solution is to focus on tasks, minimizing the emotional demands inherent in nursing work (Botha et al., 2015).

Did You Know?!? Maintaining empathic concern is an important protective factor for burnout at work. In one study of medical students over a three year period, it was found that higher levels of empathic concern were negatively associated with burnout and personal distress (von Harscher et al., 2018). Additionally, nurses exposed to toxic workplace environments appeared to benefit from intentional self-care practices (Monroe et al., 2021). For example, nurses who insist upon completing mindful self-care activities at work show reduced rates of burnout and patient satisfaction (Monroe et al., 2021).

Distancing is common in the nursing assessment of pain. Beliefs about pain vary considerably between nurses, and absence may actually prevent burdening the nurse with the patient’s experience of suffering (Walsh et al., 2019). Empathy and rapport carries some risk that the nurse may vicariously experience pain (Cheng et al., 2017). This may result in some nurses maintaining a comfortable distance from the patient’s pain experience by limiting their exploration of it (Sinclair & Hamill, 2007).

Let’s consider the example of Jack once more, but this time in an environment where the nurse is experiencing emotional exhaustion at work.

Within a high stress environment, the initial nurse-patient interaction in the emergency department might look more like this:

Shortly after arrival at the emergency department, the triage nurse told Jack: “No one is going to see you for quite some time… it’s a 6-8 hour wait today.”

In the above example, the triage nurse shared objective information with the patient; however, the nurse also distanced themself from the patient’s experience.

How might distancing impact the therapeutic relationship?
Although the nurse may assume that the lack of emotional connection lowers the work of care, many patients will perceive distancing behaviors as rejection (Derksen et al., 2017) which may provoke feelings of frustration or disappointment (Dulko & Kohal, 2022). Patients who feel disregarded or overlooked are also more likely to perceive having received a lower quality of care (Aiken et al., 2021). As a result, distancing by the nurse may increase the amount of patient criticism and increase legal liability associated with routine care activities.