Shedding Light on Nursing Burnout
The pandemic accelerated the nursing profession’s concern about burnout on the clinical front lines. Columbia Nursing’s Allison Norful, PhD ’17, and her colleagues are studying the problem and seeking solutions.
“Recent studies suggest that upward of 60% of the healthcare workforce reported some level of burnout or adverse psychological health during the COVID-19 pandemic.” That introductory statement in a recent paper by Columbia Nursing’s Allison Norful, PhD ’17, and colleagues is no surprise. Nor is the fact that nurses—who arguably bore the biggest frontline burden of caring for COVID patients—experienced higher levels of burnout than other clinical disciplines.
What IS surprising is that there’s been so little study of such a widespread problem. “No studies have examined professional role differences in the course of burnout during the pandemic, nor do we know concrete solutions to help prevent such burnout,” Norful notes. She set out to rectify that lapse.
Norful joined Columbia Nursing as an assistant professor in 2019, after completing her doctorate at Columbia and a postdoctoral fellowship at Columbia University Irving Medical Center’s Irving Institute for Clinical and Translational Research. In recent months, she has co-authored several high-profile studies on burnout in the nursing profession. The paper noted above, published February 8, 2023, in the International Journal of Environmental Research and Public Health, assessed the trajectory of clinician burnout over the first year of the pandemic. Another study published on the same day in the Journal of Emergency Nursing looked specifically at burnout’s effect on job turnover in the emergency nursing workforce.
Other recently published research led by Norful includes a study of the relationship between burnout and the effectiveness of RN-physician co-management pairs (Journal of Interprofessional Care, January 23, 2023); an assessment of sleep health and frontline nurses’ well-being during the pandemic (Sleep Advances, December 16, 2022); and a summary of nurses’ perspectives on gaps in the public health response during the pandemic (Journal of Nursing Scholarship, January 2023).
Norful’s research interests encompass interdisciplinary care delivery models and the impact of stress in work environments on nurses’ wellbeing. She is widely known for developing several measurement instruments, including the Provider Co-Management Index, which is now used worldwide in both research and clinical settings.
Stress levels, recovery vary among clinicians
The study assessing the trajectory of burnout was developed on the fly, during the turmoil of the pandemic’s earliest weeks, initially as a way to aid in hospital planning. The team collected data from clinicians at a busy hospital in Queens, surveying the hospital-wide health care workforce online every five days on patient caseloads, burnout symptoms, and resource availability; the process continued in real time throughout the entire first year of the pandemic. Survey completion was high (20% on the first survey) and did not seem to be affected by burnout. All three measures showed variation over the course of the year, with burnout levels rising during the city’s first and second waves of COVID. The surveys also revealed subtle differences in stress levels and stress recovery between nurses, physicians, and physician trainees.
In a finding that may prove significant for developing burnout prevention programs, lower levels of burnout were associated with clinicians’ feelings of self-efficacy, perceptions of support from the hospital administration, and sense of professional development. The authors also concluded that the use of regular online surveys during a health crisis is an effective way to conduct real-time burnout surveillance.
The study of the emergency nursing workforce found no difference in burnout levels between emergency nurses and nurses in other disciplines. But it went deeper than previous research by examining their reasons for leaving their positions. The study analyzed responses from 19,855 nurses, 1,266 of whom identified as emergency nurses, to the 2018 National Sample Survey for Registered Nurses.
The paper on the findings, for which Norful was the lead author, reported that emergency nurses were more likely than nurses in other disciplines to leave their positions—either entirely or for a position in another field—due to insufficient staffing, the job’s physical demands, the patient population, better pay, career advancement, the length of their commute, and/or the need to relocate. The data was gathered before the pandemic, but even so the findings may help guide administrators on how to most effectively address burnout in the emergency medicine workforce.
At the height of the pandemic, New York City became famous for its nightly salute to health care workers. City residents opened their windows every evening at 7 p.m. to whistle, cheer, and bang pots and pans in honor of the frontline clinicians risking their lives to care for COVID patients.
Norful and her Columbia Nursing colleagues are hoping their research will provide longer-lasting moral support for nurses by clarifying why burnout is so common in the profession, and finding effective ways to address it.