Health employers must take preventative measures to avoid staff burnout, rather than treat it like a medical condition, a new report has said.
Professor Gail Kinman, co-author of a Society of Occupational Medicine (SOM) report into burnout, said employers needed to mitigate the “extreme” conditions nurses and other healthcare professionals are working under.
“Even the most resilient nurse or doctor cannot cope with conditions that are toxic without support”
Gail Kinman
The report, Burnout in Healthcare: Risk Factors and Solutions, called for a “new approach” for the heightening levels of burnout among healthcare staff in England.
It called for investment in preventative measures, better workplace conditions, and other interventions that would tackle the “root causes” of burnout, as opposed to treating burnout like a medical condition with a set of symptoms to be treated.
This preventative approach was categorised as “primary” intervention by SOM. It labelled measures improving people’s ability to cope, and reducing ill-health caused by exposure to conditions that might cause burnout as “secondary”, and those aiming to rehabilitate those who are burned out as “tertiary”.
Professor Gail Kinman from Birkbeck University of London
Professor Kinman said primary interventions were the most important, but that, currently, employers were focused on putting out the fires with secondary and tertiary ones.
“We can’t afford to lose anymore people [from the health workforce],” said Professor Kinman.
“Primary interventions are the very best way to improve staff wellbeing, tackling burnout at the source.
“We know that it’s an intrinsically stressful and demanding job, so people need resilience and those skills under their belt, but even the most resilient nurse or doctor cannot cope with conditions that are toxic without support.”
An example of a primary intervention, Professor Kinman said, would be including healthcare staff in decisions about their work which affect them.
She added: “We want to make organisations aware that primary interventions are not necessarily huge, great, ambitious things which are very costly.
“Involving employees in change, asking them to identify what is causing them difficulties… We can use things like the Effort, Reward and Balance model, where people become more stressed if they feel the effort they put in isn’t counterbalanced by reward; you can use it to talk with employees about how to increase their sense of reward, and it’s not just about money.”
Professor Anne Harriss, a contributor to the report, said an over-emphasis on treating burnout like a medical condition “victim blames” nurses who experience it.
She agreed that health employers focus too much on secondary and tertiary interventions, which can make on-the-ground staff like nurses feel as though burnout is something they must fix themselves.
“One thing which really annoys me is when an organisation says we’ll put on pilates classes on Wednesdays, mindfulness on Thursdays, tai chi on Tuesdays, and then on Friday we’ll give them fresh fruits, and expects them to go back to the same workplace the next week without stress,” Professor Harriss said.
Anne Harriss, former president of the Society of Occupational Medicine
“It’s victim blaming. If you stress your workers out Monday-Friday, then you can’t expect them to change.
“They feel like it’s their fault they can’t cope. I do some work on resilience, but things like mindfulness are the cherry on top, not the answer to burnout.”
Burnout, a long-standing nursing welfare issue, has become a focal point in the debates around working conditions for healthcare workers, and those in other industries as well, since the Covid-19 pandemic.
The report stated there is a “high prevalence of burnout among nurses”, quoting the 2022 NHS staff survey which suggested 39.7% of the nursing workforce felt often, or always, burned out.
“[Nursing] is a stressful profession; you’re dealing with, often, life and death situations,” Professor Harriss said.
“If someone has a cardiac arrest, how you perform could influence if that person lives or dies, and you often have to do things which are not pleasant.
“That’s the kind of work you do. Long hours, the shift patterns, often people feel a lack of control and that’s stressful.”
SOM, in its report, pointed to a “culture of self-sacrifice” within nursing which made staff feel as though putting their wellbeing first was “self-indulgent”, or required permission.
As a result, the report concluded, nurses have been made to feel burnout is an inevitability when caring for people.
This, Professor Harriss said, was then exacerbated by the Covid-19 pandemic: “We were, understandably, ill-prepared. Nurses and other healthcare professionals had to do the most awful things.
“There was an inadequate supply of PPE [personal protective equipment], nurses working 12-hour shifts every day, decked to the nines in PPE not able to go to the toilet.
“Spending time with patients who are dying, who normally would have their relatives to comfort. There was moral injury, having to do things like that which you don’t think are right but have no option.”
General surgical nurse Natasha, used as a case study in the report, told SOM that burnout had hit her hard, as a result of her working conditions during Covid-19.
The nurse had been redeployed into intensive care during the winter of 2020-21, when Covid-19 cases and deaths peaked.
The report read: “Although that role was challenging, at first it was also rewarding.
“The unrelenting and traumatic nature of the work, however, alongside the very limited opportunity for specialist ICU staff to mentor and support Natasha, made her feel emotionally drained.”
After three months, Natasha moved back to her original ward – but was told by her ward manager that staff had to “gear up” to deal with the growing backlog the pandemic had left.
This left her exhausted, struggling to sleep, and incredibly burned out and she reported this to her supervisor.
“It became quickly clear that her manager was not interested,” the report continued.
“Instead of listening, [the manager] started to tell Natasha how much pressure they were under to cut waiting lists and how important it was that Natasha did not let the team down – she was also asked whether she could put in some extra shifts.”
Another case study, of senior A&E staff nurse Andrew, also showed the impact of Covid-19 on the workforce.
Andrew was moved to an intensive therapy unit in the early days of the pandemic, but after just a few weeks he reported feeling overwhelmed, upset and pressured due to the nature of the work.
The report said: “During a ward meeting, the ward manager said: ‘We just need to mop it up and push on.’ Andrew tried to do this while providing the best care to his patients he was able to.
“Andrew felt increasingly exhausted, helpless and hopeless in his role, however, due to the nature of the pandemic, managing the workload and struggling to deliver the best care he could.”
Like Natasha, Andrew was missing out on meals, experiencing a broken sleeping pattern, fatigue and waking every morning “with a sense of dread” – culminating in him taking six months’ sick leave when it got too much.
At the end of this leave, he left his job and took a more junior role elsewhere, not feeling like he could return to his former position.
A third case study, this time not relating to Covid-19, was of staff nurse Scott, who was attempting to progress in his career to become a ward manager in the future.
A senior member of staff’s bullying led him to flag the matter to his current manager, who told him to “man up”, and that he was being overly-sensitive.
The report said: “Her parting comment to Scott was that he needed to “get a sense of humour and behave like an adult not a child in the school playground”.
“Scott was extremely disappointed at the lack of support from his line manager and felt she was not taking his experiences… seriously.
“He felt aggrieved as he had been a hard-working member of the ward team and had supported the ward at times of staffing crises by accepting additional shifts.”
This left Scott burned out, with a feeling that he no longer enjoyed his job – ending, again, with him leaving his post.
The SOM report concluded that a mixture of primary, secondary and tertiary interventions was needed, with further investment required to enact them.
Professor Kinman added: “Burnout is an extremely serious matter that impacts workplaces across Britain, but it is a particular problem in healthcare settings.
“We know that doctors, nurses, and other healthcare professionals are more likely than most to experience burnout and therefore it is vitally important that we take urgent action.
“There are compelling reasons for organisations to support the wellbeing of their employees.
“This report, which brings together a wealth of research and findings, recommends the real and practical steps that they can take in the fight against burnout to ensure healthcare staff remain healthy and motivated and that recruitment and retention are improved.”
