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October 25, 2021

‘Self-care and resilience’ — UW’s Elaine Walsh discusses burnout among nurses

The pandemic has left nurses around the country feeling burned out. Their top four feelings, according to a recent survey? Exhausted, overwhelmed, irritable and anxious or unable to relax.

UW News spoke with Elaine Walsh, a UW School of Nursing associate professor and a Nurse Scientist in Resiliency at Seattle Children’s Hospital, to learn more about the conditions that lead to burnout and solutions.

Walsh explains burnout is characterized by physical, mental and emotional exhaustion and can involve a feeling of disconnection or depersonalization.

“People who experience burnout can have physical symptoms such as headaches, GI problems and difficulty with sleep,” Walsh said. “A general way to characterize job burnout among nurses is that demands exceed personal resources. There are many reasons for this — working with complex patients and families, witnessing emotional and physical suffering and death, staffing shortages and being asked to do more with less time and fewer resources.”

How has the COVID-19 pandemic exacerbated the conditions that lead to burnout? 

EW: COVID-19 has put a tremendous stress on health care systems. In hospitals, nurses are responsible for round-the-clock care of patients. In community settings, nurses do everything from mounting a public health response to triaging questions about symptoms and about vaccinations. The fact that concerns and consequences of COVID-19 are part of nurses’ lives at and away from work is an added stressor. In other words, the issues and worries related to the pandemic do not end at work. Concerns about what is and is not safe away from work, exposing family members and friends, and in some cases needing to isolate from family and friends, are an additional stress.

How do you approach the problem of burnout in nursing?

It is very important to address the causes of burnout, but many of these are at a system, or even societal, level. Providing adequate staffing, breaks and support is important at an organizational level. Increasing self-care and resilience is an individual strategy, and this often involves what might sometimes feel “selfish” — taking time away, prioritizing one’s own needs, saying no — but it is in fact critically important to decreasing burnout and increasing resilience.

What are your basic tips for improving resilience?

Resilience requires space to engage in self-care, planned strategies that can be used during stressful times and ways to recharge physically and emotionally. What works for one person might not work for another person. We talk about having strategies for in the moment, at the end of the day and for the longer term. Having the strategies is a good start, but it is important for individuals, teams and organizations to commit to engaging in these strategies and providing space for people to engage in these strategies.

What are the key “self-care” points you make to nurses, or really anyone experiencing burnout or high stress?

Self-care is a mindset and takes commitment. The time and energy required for self-care are difficult to muster when a person experiences burnout or stress. That is where having a plan, having support from colleagues and commitment on the part of an organization is critical.

We know that those who take care of themselves take better care of others. Research is clear that those who are burned out or experiencing a great deal of stress do not provide optimal patient care, are more prone to mistakes and are at risk for leaving a job or even leaving the profession. It is also important to be able to ask for help and support, which means there need to be adequate support resources and a culture in the organization that normalizes taking breaks, asking for help, noticing when others are beginning to struggle and lowering the bar for what counts as a difficult situation.

There appears to be a growing awareness of mental health as an important factor in not only personal health but the health of populations. How do mental health issues in the general population affect nurses on the job?

When we work with nursing students, we discuss the fact that every nurse, regardless of setting or population with which they work, needs mental health skills. We cannot treat the mind and the body in isolation. This is true for patients and for nurses. We know that the pandemic has challenged the mental health of everyone, and those who already struggle with mental health issues are at additional risk. So, nurses are working with more people who have mental health challenges, and they themselves are not immune to those challenges. The notion of caring for the caregiver is not new. There are organizations and centers dedicated to supporting nurses and our health care colleagues, and this is encouraging.

What can we as citizens and policymakers do to help nurses?

Nurses need to be paid adequately for the work they do. Some would argue that it is impossible to put a value on the work nurses do, but it is clear that some organizations and locations pay less than average. That makes it difficult to hire and retain people. We also need more nurses in most settings, and that begins with having faculty to teach and clinical sites for training. We, and many other nursing schools, do not have the faculty resources or clinical placements needed to train all who are qualified. In addition, patients need to be cared for by nurses who represent the diversity of our patient populations. This requires outreach, support for individuals from underrepresented populations to attend school, and assistance so that education is affordable.

Ways to do this include funding colleges and universities to expand nursing programs, providing funding to support student scholarships and recruiting students who will help us develop a more diverse workforce. We know that a more diverse workforce also supports more innovative problem solving, which benefits patients, healthcare organizations, communities and society in general.

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To speak with Professor Walsh, contact emwalsh@uw.edu.

Tag(s): Elaine Walsh • School of Nursing • Seattle Children's Hospital

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