Understanding Burnout and How to Manage it for Healthcare Workers 

Systematic reviews suggest that the prevalence of burnout in the context of the COVID-19 pandemic was approximately half of all healthcare workers.

By Sonja Kram, Psychologist & Clinical Lead: Quality, Digital and Strategy, Logic Lounge

It is pertinent to our discussion here to note that the term burnout originated after the phenomenon was observed in Healthcare workers. The term was introduced in 1974 by psychologist Herbert Freudenberger, who used it to capture the exhaustion he and his colleagues experienced while volunteering at a free clinic for drug addicts. He noted a striking pattern: those who began with the greatest idealism and dedication were often the first to “burn out” when confronted with the relentless demands and scarce resources of their work environment. 

Burnout is a mix of emotional exhaustion, negativity, and reduced sense of personal accomplishment, especially in response to chronic stress (Ghahramani et al., 2021; Meredith et al., 2022). Symptoms of burnout include low energy, low motivation, irritability, feeling cynical, feeling disengaged, difficulty sleeping, procrastinating and low mood.  Whilst many of these symptoms overlap with mental health disorders, burnout has been identified as a separate cognitive, emotional and behavioural experience. Additionally, whilst is can be associated with compassion fatigue - a decreased ability to empathise with patients’ suffering - burnout and empathy are known to be two separate constructs, and it is important to distinguish between them (Wilkinson et al., 2017). 

The Maslach Burnout Inventory (Maslach & Jackson, 1981) is the most commonly used measure for assessing burnout in healthcare services (Wilkinson et al., 2017) although there are some concerns about negative language biasing of some of the questions, and that cognitive and physical aspects of exhaustion as well as physical) are not assessed. 

Systematic reviews suggest that the prevalence of burnout in the context of the covid-19 pandemic was approximately half of all healthcare workers (Galanis et al., 2021; Ghahramani et al., 2021). Increased burnout is also evident for healthcare workers in the face of other disasters such as natural crises and human catastrophes such as war and terrorist attacks(Alzailai et al., 2023). 

Workplace factors: High pressured work environments (long working hours, no breaks, high needs patients), lack of resources, a lack of recognition of success, or unrealistic expectations of managers are all risk factors for burnout at work, especially if home / personal life is also stressful 

Research exploring the predictors of burnout have explored various personal/professional and workplace factors. A systematic review by (Meredith et al., 2022) analysing burnout in American healthcare workers indicated that demographic factors did not have clear or strong associations with burnout, however factors such as workload, work / life balance, job autonomy and perceived support from leadership had strong associations with increased burnout, and social support had a protective effect. Additionally mental health and physical health factors are also thought to increase the risk, for example, personality factors such as perfectionism and difficulty saying no, and certain thinking styles, such as having rigid or unrealistic expectations of ourselves or others, can exacerbate the risk of burnout. 

The personal impacts of burnout include sleep difficulties, and increased risk of mental health difficulties such as PTSD, anxiety and depression  (Alzailai et al., 2023). From a professional perspective, burnout has been linked to low job satisfaction, turnover, absenteeism and early retirement (Meredith et al., 2022).  Of grave concern, research shows that suicide rates are higher in nurses and physicians than the general population, and that burnout (amongst other factors) is linked to an increased risk of suicide in healthcare workers (Melnyk, 2020).  

Burnout also has negative impacts on the safety and quality of patient care. A systematic review by (Hall et al., 2016) showed that moderate to high levels of burnout were associated with reduced patient safety in the majority of studies (eg medical errors), however further prospective research is required to help determine causality. Other studies have evidenced associations between burnout and adverse events such as patient falls, surgical wound infections, infusion or transfusion reactions and pressure ulcers (Alzailai et al., 2023). 

Strategies to reduce the risk of burnout encompass both individual and organisational levels. Organisational strategies include improving the culture of psychological safety and speaking up and inviting feedback from staff.  

At the individual level, psychoeducation, and positive coping strategies such as reflection and self care skills, and use of a pharmacological produce have been shown to be effective (Alzailai et al., 2023). Another study demonstrated that cognitive behaviour therapy, meditation, mindfulness, breathing and relaxation techniques have been shown to be beneficial interventions for reducing burnout, including via web and mobile app delivery (Pospos et al., 2018). Additionally, strategies to reduce workplace stress can mitigate burnout, such as managing time efficiently, asking for help, setting boundaries and sticking to them and problem solving for difficult work situations. When faced with work stress that can’t be reduced by individual factors, other psychological strategies are important, such as maintaining a positive mindset, practicing self-compassion, adapting self expectations to the circumstances, reminding that you can only do your best, and renewing your sense of purpose by reconnecting with your inner values and goals. 

The Resilience Collaborative offers a range of information and resources, including The Resilience Toolkit, which healthcare leaders can utilise to embed resilience strategies within organisational processes, and in partnership with Dimagi and Reach, other digital health interventions, including the WellMe app for healthcare workers. The BlackDog Institute in Australia provides a mental health self-assessment tool specifically designed for healthcare workers TEN Digital Mental Health Check-Up. If there is a concern about burnout impacting patient safety, or personal wellbeing, especially risk of suicide, it is essential to speak to a trusted manager, speak with your General Practitioner and let your family and friends know that you need support.  Some organisations are able to refer staff to counselling services via employee assistance programmes.  

References 

Alzailai, N., Barriball, K. L., & Xyrichis, A. (2023). Impact of and mitigation measures for burnout in frontline healthcare workers during disasters: A mixed-method systematic review. Worldviews on Evidence-Based Nursing, 20(2), 133–141. https://doi.org/10.1111/wvn.12633 

 

Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839 

 

Ghahramani, S., Lankarani, K. B., Yousefi, M., Heydari, K., Shahabi, S., & Azmand, S. (2021). A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.758849 

 

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLOS ONE, 11(7), e0159015. https://doi.org/10.1371/journal.pone.0159015 

Maslach, C., & Jackson, S. E. (1981). The Measurement of Experienced Burnout. Journal of Occupational Behaviour, 2(2), 99–113. 

 

Melnyk, B. M. (2020). Burnout, Depression and Suicide in Nurses/Clinicians and Learners: An Urgent Call for Action to Enhance Professional Well-being and Healthcare Safety. Worldviews on Evidence-Based Nursing, 17(1), 2–5. https://doi.org/10.1111/wvn.12416 

 

Meredith, L. S., Bouskill, K., Chang, J., Larkin, J., Motala, A., & Hempel, S. (2022). Predictors of burnout among US healthcare providers: A systematic review. https://doi.org/10.1136/bmjopen-2021-054243 

 

Pospos, S., Young, I. T., Downs, N., Iglewicz, A., Depp, C., Chen, J. Y., Newton, I., Lee, K., Light, G. A., & Zisook, S. (2018). Web-Based Tools and Mobile Applications To Mitigate Burnout, Depression, and Suicidality Among Healthcare Students and Professionals: A Systematic Review. Academic Psychiatry, 42(1), 109–120. https://doi.org/10.1007/s40596-017-0868-0 

 

Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research, 6, 18–29. https://doi.org/10.1016/j.burn.2017.06.003 

About the Author

Sonja holds master’s degrees in Health Leadership Management and Clinical Psychology, along with a Postgraduate Diploma in Systemic Therapy. She is a member of the College of Clinical Psychologists (APS), ACHSM, and AIDH and is Acting Convenor of the EPsychology Interest Group of the Australian Psychological Society and a Board Approved Supervisor (Psychology). With extensive clinical leadership experience across the EAP sector, private mental health, NSW public hospitals, and community services, Sonja brings a collaborative style focused on clinical governance, safety, and quality improvement. Her expertise spans health system transformation, digital integration, leadership development, workforce resilience, and change management. She is known for authenticity, integrity, and a strategic, solution‑focused approach.

Read more...