Chapter 26. Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions

Stress has been categorized as an antecedent or stimulus, as a consequence or response, and as an interaction. It has been studied from many different frameworks (or perspectives?). For example, Selye proposed a physiological assessment that supports considering the association between stress and illness. Conversely, Lazarus (p. 19) advocated a psychological view in which stress is “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being.” Stress is not inherently deleterious, however. Each individual’s cognitive appraisal, their perceptions and interpretations, gives meaning to events and determines whether events are viewed as threatening or positive. Personality traits also influence the stress equation because what may be overtaxing to one person may be exhilarating to another. Nevertheless, stress has been regarded as an occupational hazard since the mid-1950s. In fact, occupational stress has been cited as a significant health problem. Work stress in nursing was first assessed in 1960 when Menzies identified four sources of anxiety among nurses: patient care, decisionmaking, taking responsibility, and change. The nurse’s role has long been regarded as stress-filled based upon the physical labor, human suffering, work hours, staffing, and interpersonal relationships that are central to the work nurses do. Since the mid-1980s, however, nurses’ work stress may be escalating due to the increasing use of technology, continuing rises in health care costs, and turbulence within the work environment. In 1974, Freudenberger coined the term “burnout” to describe workers’ reactions to the chronic stress common in occupations involving numerous direct interactions with people. Burnout is typically conceptualized as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Work life, however, is not independent from family life; these domains may even be in conflict. 14 Stress may result from the combined responsibilities of work, marriage, and children. The effects of both work and nonwork stress among nurses have been studied infrequently. And yet, nonwork stress may be particularly salient to nursing, a predominantly female profession. Women continue to juggle multiple roles, including those roles related to the home and family, for which the women may have sole or major responsibility. Nevertheless, work stress and burnout remain significant concerns in nursing, affecting both individuals and organizations. For the individual nurse, regardless of whether stress is perceived positively or negatively, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness. In the health care organization, work stress may contribute to absenteeism and turnover, both of which detract from the quality of care. Hospitals in particular are facing a workforce crisis. The demand for acute care services is increasing concurrently with changing career expectations among potential health care workers and growing dissatisfaction among existing hospital staff. By turning toxic work environments into healthy workplaces, researchers and nurse leaders believe that improvements can be realized in recruitment and