Transforming the Work Environment: A Different Approach to Combating Nurse Burnout

The urgent need to prioritize the health and well-being of nurses has come to the forefront of the health care agenda due to the COVID-19 pandemic, which compounded the existing burnout problem and exposed the flaws and vulnerabilities in the public health system. The effect of COVID-19 on burnout among health care workers has gained the attention of legislative and regulatory bodies, leading to the enactment of the Dr Lorna Breen Health Care Provider Protection Act,1 a bipartisan legislation supported by The Joint Commission to address serious health problems impacting health care workers, such as burnout, suicide, and mental and behavioral health conditions.2 Prioritizing the health and well-being of nurses is critical because burnout not only impacts nurses, it impacts the delivery of care to patients.3 Hence, nurses need to be well themselves to provide competent, compassionate, and empathetic care to patients.4 Burnout remains a challenge to health care professionals despite decades of research and interventions,5 indicating a need for a different approach in addressing the problem of burnout. One approach involves thinking of and viewing stressors in a way that highlights how perception and interpretation of these stressors can contribute to nurse burnout; this approach focuses on positive thinking and positive practices in the workplace.Burnout affects all health care professionals but is highly prevalent among critical care nurses.6 Burnout occurs due to prolonged exposure to work-related stress and has 3 dimensions: emotional exhaustion, depersonalization or cynicism, and a reduced feeling of personal accomplishment.7 Burnout is a significant concern among nurses due to its prevalence and serious consequences on patient safety and nurses’ well-being.8 The prevalence rate of burnout among critical care nurses is higher than among other nurse specialties, with one-third of critical care nurses reporting symptoms of burnout.9 The high prevalence rate of burnout among critical care nurses has been attributed to their highly stressful work environment, which is fast-paced, with ongoing exposure to traumatic injured, critically ill, and dying patients,3 which can lead to emotional exhaustion. Unsurprisingly, a study on burnout showed that emotional exhaustion was the most negatively impacted dimension of burnout, with more than 70% of critical care nurses experiencing moderate to high levels of emotional exhaustion.10 Emotional exhaustion manifests as fatigue, feeling emotionally drained and depleted, and loss of energy,7 and its presence in nurses has been associated with adverse patient and organizational outcomes.3Depersonalization is defined as detachment, treating others as objects, irritability, and negative attitude (cynicism) toward other people.7 Cynicism contributes to poor relationships with patients and colleagues7 and is associated with incivility, workplace violence, and turnover.11 Workplace relationships with colleagues are important because they significantly affect a nurse’s psychological health, job performance, and productivity.12 A reduced sense of personal accomplishment is another dimension of burnout, and it manifests as reduced productivity or low morale and inability to cope, which may lead to staff disengagement.7Positive thinking is a subfield of positive psychology, which has been gaining momentum as a potential approach to address the issue of burnout and well-being among health care workers.13 The pattern of individual thinking is important, as a person with positive thinking can overcome challenges more effectively14 than a person with negative thinking. The positive approach focuses on identifying resources and strategies that lead to well-being, happiness, and increased life satisfaction.14 Positive thinking centers on the favorable aspects of situations rather than the unfavorable and is associated with positive emotions and other constructs such as optimism, hope, joy, and well-being.15 Positive thinking enables a person to approach situations differently, with hopeful expectation, thus appraising a stressful situation as less threatening and manageable.16 By contrast, negative thinking is associated with hopelessness, which leads to ineffective coping strategies17 and contributes to burnout. Stress in itself may not be significant, but the meaning given to the event determines the intensity of the response.18 Hence, it is considered beneficial to approach situations in a positive way. Positive thinking boosts a person’s confidence and motivation to actively explore options for a situation.19A research study on burnout and positive thinking among critical care nurses showed a statistically significant (P < .001) negative correlation between positive thinking and emotional exhaustion and between positive thinking and depersonalization, as well as a statistically significant (P < .001) positive correlation between positive thinking and personal accomplishment.10 This means that positive thinking is associated with decreased burnout, while the lack of positive thinking is associated with increased burnout, thus suggesting positive thinking may be a promising tool for combating burnout.It is crucial to create awareness of individual nurses’ responsibility in creating a positive work environment. The time has come for nurses to focus on their own individual responsibility in creating and maintaining a healthy work environment, rather than focusing on what others can do.20 Perception and interpretation of work stressors contribute significantly to nurse burnout but have been overlooked in research, which has focused mostly on factors in the nurses’ work environment.21 A positive perception of work has been linked with decreased burnout rates, and a negative perception of work has been linked with increased burnout rates.21 This evidence encourages nurses to view and interpret work stressors in a positive, rather than negative, way to combat burnout. It is also empowering for nurses to become aware of the positive influence they can have on their work environment, and that they can hold themselves accountable by making daily positive contributions to their teams and organization.The findings in a quantitative study suggest that promoting positivity in the workplace can foster team member engagement and performance through actions that show appreciation, affirmation, and respect.22 The following positive practices could help to transform the workplace22: focusing on the positives by looking for what is good, celebrating wins, highlighting team member accomplishments, telling success stories, being solution-driven rather than focusing on problems, thinking in optimistic versus pessimistic terms, and reframing challenges and obstacles as opportunities and growth. Research supports that positive practices not only benefit the receiver but the giver as well4,23 through generating positive emotions, which promotes overall well-being. Frequent experiences of positive emotions and positive attitudes toward life have been linked to quality of life across one’s lifespan.24 It has been found that engaging frequently in situations that generate positive emotions can lead to experiences of high levels of positive emotion, promoting overall well-being.25 No wonder there has been increasing momentum among health care experts on promoting joy in work to reduce burnout. The Institute for Healthcare Improvement has been at the forefront of the efforts on finding joy in work,26 aimed at combating burnout.Creating a positive work environment is everyone’s responsibility and encompasses all aspects of behavior, from thoughts to actions. Small changes at a time may eventually lead to significant positive changes in the work environment. Positive thoughts lead to positive actions, thus impacting every aspect of behavior, attitude, and relationships. The stressful work environment of nurses may not change; therefore, we need to educate critical care nurses on the skills that will enable them to think differently about their work as an effective way of coping with stress.27 This may help to reverse the worrisome trend of burnout. A positive work environment promotes health and well-being and is characterized by openness, friendship, collaboration, encouragement, and trust.22 A healthy workforce is associated with the well-being of the patient.28 Transforming the workplace into a positive work environment can be dauting, and nurse leaders need to partner with frontline nurses to achieve success and sustainability.