Burnout In Nursing

Burnout within healthcare has been a prevalent topic of discussion and research for numerous years. Although the link between burnout rates and nursing as a whole has been well established; most studies do not distinguish the burnout rates within the specific branches of nursing. Among these branches is psychiatric nursing, specifically forensic psychiatric nursing; where studies regarding this topic is extremely limited. According to Pompili et al. (2006), psychiatric nurses were found to have higher levels of burnout than nurses of other speciality. More research regarding psychiatric nursing burnout rates within forensic will not only expand the knowledge of the nurses and the employers regarding the key stressors that are causing these

burnouts; but rather the findings can also be utilized and incorporated within the psychiatric nursing curriculum by professors, in order to decrease the number of future burnouts within the profession.

In order to find relevant articles regarding, burnout rates among forensic psychiatric nurses, we utilized several keywords when searching the various research databases. We began our search by examining ‘burnout out in nursing’ articles. We then narrowed our search specifically focusing on articles that included the term ‘forensics.’ Unfortunately due to our topic focusing on a specific population group, we were able to find 10 articles in total in the following two databases: EBSCO and The Cochrane Library. In order to expand our search but remain within the field of psychiatry, we replaced the term ‘forensics’ with ‘mental health’ which in turn allowed us to examine more articles on more databases.

Dickinson and Wright (2008) stipulate that working in mental health has been noted as a particularly stressful area of nursing but there is not a lot of research on the subject.

Happell, Martin, and Pinikahana (2007) also argue in their research that “despite the strength of discourse and debate in relation to stress and burnout in psychiatric nursing, limited research has been conducted in this area” (p. 40). Although a handful of studies (Cañadas et al., 2013, Dickinson and Wright, 2008; Happell, Martin, and Pinikahana, 2007, Ewers et al., 2001) agree that burnout reduces employee effectiveness which can compromise quality of care provided for the patient, there is still little research and support in this

area.

Most articles agree (Blau, Tatum, & Goldberg, 2013; Cañadas et al., 2013, ) that the most widely accepted definition of burnout was crafted by Maslach, Jackson, and Leiter (1997), who claim that burnout has three dimensions: emotional exhaustion, depersonalization, and decreased personal accomplishment. Emotional exhaustion can be defined as a physical and emotional depletion; one may feel they lack energy or feel fatigued and that emotionally, all their resources are exhausted (Blau, Tatum, & Goldberg, 2013; Cañadas et al., 2013; Maslach, Jackson, & Leiter, 1997). Depersonalization can be defined as having a general apathy and cynicism towards a patient or work and viewing the patient as an object or task to complete rather than a person (Blau, Tatum, Goldberg, 2013; Cañadas et al., 2013; Maslach, Jackson, & Leiter, 1997). Finally, decreased personal accomplishment can be defined as feelings of inadequacy or ineffectiveness at one’s job and the tendency to view themselves negatively in light of their work (Blau, Tatum, & Goldberg, 2013; Cañadas et al., 2013; Maslach, Jackson, & Leiter, 1997). Cañadas et al. (2013) further list how these three dimensions can manifest physically, emotionally, and psychologically, and identify insomnia, apathy, depression, and irritability as some of the issues that may arise as a result of burnout. Dickinson and Wright (2008) claim that burnout is an experience that results from occupational stress that nurses experience from working directly with their patients on a day to day basis. It is a negative experience that arises from interaction between the individual and the environment (Dickinson and Wright, 2008; Happell, Martin, and Pinikahana, 2007). Both studies agree that burnout is first and foremost an adverse experience and second, it is a process that people go through rather than an instantaneous state of being (Dickinson and Wright, 2008; Happell, Martin, and Pinikahana, 2007). Evidently, all these factors can cause job dissatisfaction which may lead to increased absenteeism, sick days, and decreased job performance (Cañadas et al., 2013). This, in turn, can lead to compromised patient care which can affect people who need to access health care services (2013).

Burnout does not just manifest itself within the workplace; nurses are often affected even in their own personal lives. Goalder and Schultz (2008) suggest that, despite having a knowledge base on healthy ways of coping with stress due to education provided by most nursing schools, nurses may turn to alcohol or drugs and develop a dependence on it. They may also develop coronary artery disease and diabetes, among other health challenges (2008). Other studies suggest that relationships can deteriorate or be negatively affected due to

Although the articles that have been discussed pertains to psychiatric nursing or mental health as whole, they are highly relevant when discussing burnout within forensic psychiatry.

According to Tabor 2011, vicarious trauma is one of the leading contributor of burnout within forensic health care professionals. The term vicarious trauma was first utilized by McCann and Pearlman in 1990, when they used it to describe “the therapist’s reaction to a client’s traumatic events” (Tabor, 2011, p. 203). The study also suggests that nurse’s are at a risk of suffering from vicarious trauma due to the increased levels of mental exhaustion from prolonged exposure to high levels of traumatic stressor (2011). This is in turn may result in changes in the nurse’s beliefs, cognition, memory, sense of safety, trust and self-esteem (2011). The combination of the above mentioned effect and vicarious trauma may potentially result in the nurse developing post traumatic stress disorder (2011). The consequences for this would not only be detrimental to the health of the nurses but also for their family and

friends.