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Burnout 1994; Grant, 1993; Hendrickson, Knickman, &
Finkler, 1994; Kovner-Malkin, 1993; Nakata &
Definition Saylor, 1994; Pines, 2004; Skubak, Earls, & Botos,
The ultimate result of unmediated job stress is 1994).
burnout.The term burnout became a favorite buzz-
Sharon had wanted to be a nurse for as long as she
word of the 1980s and continues to be part of
could remember. She married early, had three chil-
today’s vocabulary. Herbert Freudenberger formal-
dren, and put her dreams of being a nurse on hold.
ly identified it as a leadership concern in 1974.The
Now her children are grown, and she finally real-
literature on job stress and burnout continues to
ized her dream by graduating last year from the
grow as new books, articles, workshops, and videos
local community college with a nursing degree.
appear regularly. A useful definition of burnout is
However, she has been overwhelmed at work, criti-
the “progressive deterioration in work and other
cal of coworkers and patients, and argumentative
performance resulting from increasing difficulties
with supervisors. She is having difficulty adapting
in coping with high and continuing levels of job-
to the restructuring changes at her hospital and goes
related stress and professional frustration” (Paine,
home angry and frustrated every day. She cannot
1984, p. 1).
stop working for financial reasons but is seriously
More than 20 years of research on nursing work
thinking of quitting nursing and taking some
environments point to personal, job, and organiza-
computer classes. “I’m tired of dealing with people.
tional factors that contribute to dissatisfaction and
Maybe machines will be more friendly and
ultimately burnout (McLennan, 2005). Ultimately,
predictable.” Sharon is experiencing burnout.
nurse burnout affects patients’ satisfaction with
their nursing care. A survey of 820 nurses and
Aspects
621 patients in 20 hospitals across the United
Goliszek (1992) identified four stages of the
States (Vahey et al., 2004) showed that units char-
burnout syndrome:
acterized by nurses as having adequate staff, good
administrative support for nursing care, and good
1. High expectations and idealism. At the first
relations between physicians and nurses were twice
stage, the individual is enthusiastic, dedicated,
as likely as other units to report high satisfaction
and committed to the job and exhibits a high
with nursing care. The level of nurse burnout on
energy level and a positive attitude.
these units also affected patient satisfaction.
2. Pessimism and early job dissatisfaction. In the
Much of the burnout experienced by nurses has
second stage, frustration, disillusionment, or
been attributed to the frustration that arises because
boredom with the job develops, and the indi-
care cannot be delivered in the ideal manner nurses
vidual begins to exhibit the physical and psy-
learned in school. For those whose greatest satisfac-
chological symptoms of stress.
tion comes from caring for patients, anything that
3. Withdrawal and isolation. As the individual
interferes with providing the highest quality care
moves into the third stage, anger, hostility, and
causes work stress and feelings of failure.
negativism are exhibited.The physical and psy-
People who expect to derive a sense of signifi-
chological stress symptoms worsen.Through
cance from their work enter their professions with
stage three, simple changes in job goals, attitudes,
high hopes and motivation and relate to their
and behaviors may reverse the burnout process.
work as a calling. When they feel that they have
4. Irreversible detachment and loss of interest.
failed, that their work is meaningless, that they
As the physical and emotional stress symptoms
make no difference in the world, they start feeling
become severe, the individual exhibits low self-
helpless and hopeless and eventually burn out
esteem, chronic absenteeism, cynicism, and
(Pines, 2004, p. 67).
total negativism. Once the individual has
The often unrealistic and sometimes sexist
moved into this stage and remains there for any
image of nurses in the media adds to this frustra-
length of time, burnout is inevitable.
tion. Neither the school ideal nor the media image
is realistic, but either may make nurses feel dissat- Regardless of the cause, experiencing burnout
isfied with themselves and their jobs, keeping stress leaves an individual emotionally and physically
levels high (Corley et al., 1994; Fielding & Weaver, exhausted.