Burnout in Millennial Nurses
“Registered nurses under age 30 reported experiencing significantly higher rates of the most intense levels of frustration, anger, and irritation (i.e., agitation) than those over 30.” (Erickson & Grove, 2007)
Jessica is always tired. Even after a good night’s sleep, she never fully recovers from her three twelve-hour shifts a week. She doesn’t enjoy her hobbies as much as she used to and certainly does not enjoy her job in a chaotic ED.
Not too long ago, she was a new grad in love with the idea of being a new nurse. Now she dreads going to work and counts the hours until the end of her shift. She avoids co coworkers and struggles to conceal her irritability from her patients.
Evidence shows an alarming trend of younger nurses both leaving their first positions within the first year of nursing and leaving the profession altogether. Leaving nursing, a job that required so much time and training, signals profound dissatisfaction.
Research shows that nurses in the millennial generation (ages 21-33) have:
- higher levels of compassion fatigue
- lower levels of compassion satisfaction
as compared to their counterpart Baby Boomers (ages 50-65) and Generation Xers (ages 34-49) (Kelly, et. al)
Compassion fatigue and secondary trauma lead to burnout. Why are younger (presumably enthusiastic) nurses at risk?
It is well-known that new grad nurses do not feel prepared for their new jobs.
The role is not at all what they thought. They experience self-doubt. “Should I really be a nurse?” The chaos and stress are too intense. The sheer pressure, workload, and demands are overwhelming and they either quit or stay on the job and shut down.
Ashley is often overwhelmed by her complex patients and the constant admitting and discharging. She feels inadequate and is terrified she’ll make a mistake. Almost daily she feels the urge to cry at work. More than once she has dashed into the employee bathroom to compose herself. See Nurse’s Dirty Little Secret
Ironically, highly committed and idealistic nurses are more at risk. Some are unable to translate their school values to the real world. They feel they are compromising their values when they are expected to perform a focused assessment in a matter of minutes because an assessment should be thorough and take thirty minutes.
Another type at risk for burnout is the nurse who is strong on compassion and caring but low on prioritizing and efficiency.
Unable to transition from student to staff, they are at risk for leaving.
Eager to impress, Mark in ICU volunteered to lead the unit based council and soon was heading up a Quiet at Night performance improvement project to reduce noise at night. He made flyers and spreadsheets from home. He also planned the unit holiday party and was soon precepting new nurses.
Also at risk for burnout is the competitive person who strives to make a name for themselves Gandi, et. al, (2011) calls him or her a “show-off”. Driven, in school they had to get all “A’s and at work they have to be Employee of the Month. Failing is a never event and their self-esteem is performance-based.
Asking for help is a weakness. They may secretly believe their co workers don’t work as hard as they do. Over achievers are at risk of burnout because others do not meet their expectations,they have to do everything, and they become resentful.
Lack of Self-Care
Working too much overtime is a sure-fire way to burn out. Enamored by their new earning potential, new nurses sign up for overtime. Some nurse managers even exploit the willingness of new nurses and use it to staff their units.
Severely out of balance, they do not exercise regularly. They may intend to eat correctly but don’t take the time for meal planning and prep. They may justify this by saying they are making more money or helping out the nursing unit.
Jackie could not believe the big paychecks she got from overtime. She began to seek out opportunities to earn double time and night shifts and weekend differentials. Soon she bought a new car and then realized she could qualify for a home loan. Now her lifestyle depends on making a lot of money and she got a second job to supplement her income.
According to Gandi et al. (2011), over time, working too much changes the core values of the person. An example is the nurse who prefers to work holidays than to be with family and friends.
Burnout is composed of three constructs: emotional exhaustion, depersonalization, and diminishing one’s personal accomplishments (Maslach, Schaufeli, & Leiter, 2001).
Symptoms may include being chronically fatigued, irritability, lack of joy, numbness. The burned out nurse may feel bad for feeling bad, resulting in guilt.
Emotional exhaustion refers to the feeling of being emotionally overextended, exhausted and depleted at work.
- The emotionally depleted nurse feels empty and fake. They may suffer from impostor syndrome.
- Covering or masking feelings and pretending to have feelings (“surface acting”) both represent emotional labor. The nurse must fake responses which takes even more energy.
- The burned out nurse loses feelings of authenticity. Even simple social interactions are dreaded, such as “Hi, how are you?”
Cynthia used to take joy from every birth she attended in L&D and rejoiced in watching new mothers and babies. Now she feels nothing, mocks mothers who come in with “birth plans” and is callous towards frightened teenage mothers.
Often described as “going through the motions” depersonalization (also termed cynicism) refers to negative, cynical or excessively detached responses to other people at work
The burned out nurse is cynical and detached. Being increasingly sarcastic can signal depersonalization.
Low Personal Accomplishment
The burned out nurse has feelings of lack of achievement at work. In truth, they may be performing at a low level, doing the minimum required, and then feeling guilty about it. They are not engaged or motivated.
Not finding personal meaning makes work exhausting.
Chronic work stress leads to the response of burnout. Many environmental factors contribute to burnout.
- workload and staffing (nurse:patient ratios)
- unit morale- burnout is contagious
- insufficient time allocation for duties
- lack of meaningful recognition
Bethany is new to the ICU and still on orientation. She is assigned to a 42 year old stroke victim who has been bed bound for several days. One day she decides to shave her patient’s legs. She gets a lot of satisfaction from it and her patient is grateful for her smooth, moisturized legs.
Her preceptor remarks “Well, that’s special. I guess our newbie nurse here thinks we’re all going to be shaving our patient’s legs from now on!”
Not too long after that, Bethany decides she is not cut out for the ICU and transfers to a Med Surg unit. A year later, she no longer works at the hospital and has returned to school to pursue a different career.
The first three years are critical. Employers must provide a sense of belonging through social onboarding. Everyone wants to belong.- it’s one of our deepest needs. Peek inside a classroom during an inservice. Observe that nurses from the same floor/unit sit together.
New nurses who do not belong will not stay. By contrast, new nurses who belong and make accomplishments feel rewarded and are likely to stay.
All nurses, including millennials, need a manageable workload, meaningfulness, and meaningful recognition.
- Resilience is the capacity to handle stress. Resiliency comes with experience and perspective.
- Cultivate a spirit of gratitude
- Reinvent your career start fresh to combat burnout
- Challenge yourself Awaken your curiosity and love for learning. Pick a topic and go on to be an expert.
- Give back. Teach a class, do an inservice, volunteer
- Avoid perfectionism. Lower your expectations- first of yourself, then of others.
Employee engagement is vital. Nurses need empowerment and control over practice.
Millennials may think the grass is greener elsewhere, but it’s only because they do not have a context for reference. To a millennial, six months to a year is a long time.
Wise managers watch their new employees closely for signs of dissatisfaction, not just for the first three months, but for a good year to two years. New grads and millennials need to be seen as the valuable resources they are and be supported.
Until next time,
Come visit me at Ask Nurse Beth career column at allnurses.com for all kinds of entertaining and informative career questions and answers, and to submit your own question Or visit me at nursecode.com and StaffGarden where I also blog. Buzzzzzz…I’m a busy little bee !
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993.
Erickson, R., Grove, W., (October 29, 2007). “Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses” Online Journal of Issues in Nursing. Vol. 13, No. 1.
Gandi, J. C., Wai, P. S., Karick, H., & Dagona, Z. K. (2011). The role of stress and level of burnout in job performance among nurses. Mental health in family medicine, 8(3), 181.
Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal of Nursing Scholarship, 47(6), 522-528.
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52(1), 397-422.