Gina Gessner
RN BSN CMSRN
Objectives
 The learner will be able to define
burnout and its relationship to
workplace stress.
 The learner will be able to
explain the effects of workplace
stress and burnout on the
healthcare professional.
 The learner will describe
different coping methods and
understand the difference
between problem based coping
methods, avoidance focused
coping and emotion based
coping methods.
 The learner will be able to
identify their personality type
and determine if it predisposes
one to workplace stress and
burnout.
 The learner will be able to
identify methods which are
proven to reduce workplace
stress and reduce burnout
among nurses and other
healthcare professionals.
Stress
Definition of Stress:
Stress is defined as “a dynamic and reciprocal relationship between the person
and the environment” however more emphasis is on how it is perceived by the
person experiencing it (Healy & McKay, 2000, p. 682).
-For example, getting two admissions at once may be perceived by a new graduate
nurse as extremely stressful when an experienced nurse may perceive it as only
mildly stressful.
Burnout
 Much research was done on burnout in the early
eighties by a predominant researcher, Christina
Maslach. Maslach defines burnout as, “a
syndrome of emotional exhaustion and cynicism
that occurs frequently among individuals who do
‘people-work’ of some kind” (1981, p.99).
3 components
Burnout
 Emotional Exhaustion:
Emotional resources have been “used up”
 The major component of burnout
 Synonymous with “compassion fatigue”
 Provider feels frustrated and irritable
 Give an example of someone who has experienced
emotional exhaustion
Burnout
 Depersonalization- “Workers may display a detached and
an emotional callousness, and they may be cynical toward
co-workers, clients, and the organization” (Cordes &
Doughtery, 1993, p. 623).
- Believe people are deserving of their health problems
- Highly correlated with emotional exhaustion
- These people commonly withdraw and take longer breaks
- Common in all human services professions
- Give example
Burnout
 Diminished Personal Accomplishment – This refers to
an individual’s feelings of decreased or insufficient
progress in accomplishing his or her job or in
interacting with others (Zenners, et. al., 2000).
 Can characterize the entire self negatively.
 Contemplates leaving their professional all together.
 Give an example
5 Stages of burnout. (Spinetta, et. al., 2000)
Why is Burnout so serious?
How is stress related to burnout?
 “Burnout is a prolonged response to chronic emotional
and interpersonal stressors on the job” (Maslach,
Shauflei & Leiter, 2003, p.323).
 “Burnout is a response to overload” (Maslach, Shauflei
& Leiter, 2003, p.409).
 Related to experienced work load, role ambiguity and
time constraints
The effects of workplace stress

Mental Disorders: The APA states stress has been
shown to cause irritability, anger, nervousness, and
lack of motivation. Stress exposure over time is linked
to feelings of anxiety, depression, subjective fatigue,
reduced confidence and self esteem (Burgess, 2010).

Physical Disorders: “fat storage, blood pressure
elevation, agitation, suppression of sex hormones,
accelerated blood clot formation, compromised
immune system, increased serum triglyceride and
cholesterol levels” (Antai-Otong, 2001). Research has
also shown that nurses who are exposed to continual
levels of stress are more likely to eat poorly, smoke
cigarettes and abuse alcohol and drugs (Burke, 2000).



Spiritual Disorders
- lack of meaning
- questioning life's purpose
- feeling empty inside
- diminished sense of faith
- less time spent praying or meditating
- less time spent in nature
- feeling isolated and disconnected from others
(Psychological Wellness Institute, 2009,
http://www.relaxingmoment.org/index.php?option=c
om_content&view=article&id=49&Itemid=59)

Decreased Work Productivity: Correlations
have been found between stress and error rates
(Sutherland and Cooper, 1990). Additionally,
less overall teamwork was seen in situations
where stress is prevalent as well as general
dissatisfaction (Burgess et al., 2010).

Absenteeism: Legitimate sickness and
absence rates of employees go up substantially
in stressful environments (Burgess, et. al.,
2010). Due to the evidence of stress and effects
on the body and mind, it is no surprise that
people experience more illness and there is
likely to be a factor of avoidance in
absenteeism. Stressful work situations also
made it more challenging to recruit
experienced staff and some people choose to
leave healthcare all together (Burgess, et. al.
2010).
Discuss with each other what methods
you use to cope with stress and
burnout and what you think is most
effective.
Table 3. Brief COPE description of coping
dimensions (Burgess, et. al., 2010)
Problem-focused
coping
Emotion Focused Coping
Avoidance Focused
Coping
Active coping– Take actions to make the
Religion– Finding comfort in spiritual beliefs.
situation better.
Self-distraction– Doing some other
activity to avoid thinking about the
situation.
Planning– Use of a strategy to solve the
Venting– Verbally expressing negative feelings
problem.
Substance use– Use of alcohol or drugs to
make self feel better.
Positive reframing– Trying to see things
Self blame– Blaming self for what has happened
in a different light
Behavioural disengagement– Giving up
trying to cope
Acceptance– Learn to live with the
situation
Using emotional support– Getting
comfort from someone else.
Using instrumental support– Seeking
information and advice
Humour– Making jokes about the situation.
Denial– Saying to self ‘This isn't
happening’
The Big Five trait factors and illustrative scales
From: Burgess, et. al, 2010, p. 133
Characteristics of the
high scorer
Trait Scales
Characteristics of the low
score
Worrying, nervous,
emotional insecure,
inadequate,
hypochondriacal

Neuroticism (N) Assess adjustment versus
emotional instability. Identifies individuals
prone to psychological distress, unrealistic
ideas, excessive cravings or urges and
maladaptive coping responses
Calm, relaxed, unemotional,
hardy, secure, self-satisfied
Sociable, active, talkative,
person-orientated,
optimistic, fun-loving,
affectionate
Extraversion (E) Assess quantity and
intensity of inter-personal interaction,
activity level; need
for stimulation and capacity for joy
Reserved, sober, unexuberant, aloof, taskorientated, retiring, quiet
Curious, broad interests,
creative, original,
imaginative, untraditional
Openness (O )Assess proactive seeking and
appreciation of experience for its own sake;
toleration for and exploration of the
unfamiliar
Conventional, down-toearth, narrow interests, unartistic, un-analytical
Soft-hearted, goodnatured, trusting, helpful,
forgiving, gullible,
straightforward
Agreeableness (A) Assess the quality of
one's inter-personal orientation along a
continuum from compassion to antagonism
in thoughts feelings and actions
Cynical, rude, suspicious,
uncooperative, vengeful,
ruthless, irritable,
manipulative
Organized, reliable,
hardworking, self
disciplined, punctual,
scrupulous, neat,
ambitious, persevering
Conscientiousness (c)Assess the
individual's degree of organizational
persistence, and motivation in goaldirected behavior, contrasts dependable,
fastidious people with those who are
lackadaisical and sloppy
Aimless, unreliable,
negligent, lazy le, lazy,
careless, le, weak-willed,
hedonistic
Are you neurotic?


Are you neurotic?
“‘Venting’, defined as the verbal expression of negative emotions and feelings, is considered to be an
emotion-focused coping strategy. The personality trait of neuroticism correlated positively with
venting, (rs = 0·36, p < 0·02) indicating that individuals who reported highly on the neuroticism scale
were more likely to verbally express their feelings” (Burgess, et. al., 2010, p.135).

“Our study revealed a significant association between neuroticism and venting; which is considered
to be an emotion-focused coping strategy. The positive effect of venting was revealed in a recent study
by Bosson et al. (2006). Using an experimental design which featured a mixed method survey of 120
participants, they concluded that sharing negative attitudes (venting) had a positive effect on interpersonal closeness. Venting may therefore be a strategy that ICU nurses should be encouraged to
develop as a means of coping and therefore avoiding excessive stress”

Neurotic personality types are more likely to experience stress by responding emotionally, this effect
is amplified if they are close to someone (Burgess, et. al., 2010). This makes problem based coping a
challenge for people with this personality type (Burgess, et. al., 2010). Research has also shown that,
“people who possess a neurotic trait do not lack the ability to choose an effective coping strategy; they
just appear to choose the wrong strategy” (Burgess, et. al., 2010, p.136). A study by Zellers, et. al.,
showed that those who had a neurotic personality type were far more likely to experience emotional
exhaustion (2000).
Are you extroverted?
 “Extraversion which is associated with assertiveness, and
enjoyment of social situations has also been described by Costa
and McCrae (1980) as psycho protective” (Burgess, et. al., p. 135).
 They report less workplace stress than pessimists, are often good
communicators and report more self accomplishments (Zenners,
et. al., ).
 Those who are highly extraverted are less likely to experience
depersonalization, due to their social nature they most likely get
to know their patients quite well and treat them as people
(Zenners, et. al., 2000).
 Extraverts commonly view things in a positive light and have an
optimistic point of view, which can be protective against burnout
(Zenners, et. al., 2000).
Are you open?
 Openness is also associated with use of problem based
coping methods such as reframing and planning which
are positive and effective (Burgess, et. al., 2010).
Are you both extroverted and
open?
 “Those who reported higher levels of openness and extraversion
also reported lower levels of stress when dealing with difficult
patients and relatives” (Burgess, et. al., p.133).
 Although extraversion and openness has mostly been shown to
be protective against burnout it may however have negative
effects. “Extraversion was associated with emotional exhaustion
and suggested that this was probably because of an excitementseeking subvariable, whereby individuals are willing to take risks
and have a greater tendency to emotional exhaustion and
ultimately burnout” (Burgess, et. al., p.136).
 Both open and extraverted personality types rate their personal
accomplishments higher than other personality types (Zellers,
et. al., 2000).
Are you conscientious?
 “A negative correlation was found between conscientiousness and the
two workplace stressors; that is workload 1, which is associated with
time pressures (rs = −0·34, p < 0·02) and workload 2, which is
associated with management stressors (rs = −0·47, p < 0·01). Both were
perceived to be less stressful by those who reported higher levels of
conscientiousness” (Burgess, et. al., 2010, p.134).
 In the study by Burgess, et. al., a positive correlation was found
between conscientiousness and active coping and planning which
indicates that these people create a plan to deal with the stressor and
therefore can control the stressor to some extent (2010).
 Also, those who where highly conscientious were less likely to perceive
themselves as incompetent and lack confidence in themselves, which
can be a source of stress (Burgess, et. al., 2010).
Are you agreeable?
 “Significant correlations were also found between
agreeableness and active coping, planning and reframing
indicating that individuals who reported higher levels of
agreeableness engage in more problem focused coping
strategies” (Burgess, et. al., 2010, p. 135).
 However, research has shown that overly agreeable and non
confrontational communicators are not likely to assert
their feelings and may experience high levels of job stress
(Wright, 2010).
 Those who are agreeable are less likely to experience
depersonalization in patient care (Zellars, et. al., 2000).
Buffers
Effective Coping Mechanisms
 Job Satisfaction: According to Healy & McKay, job satisfaction has been shown
to be negatively correlated with work stress. However, one does not know if
people are satisfied because their job is less stressful or satisfied in spite of
stress (2000).
 Humor: May or may not be considered effective; it has been positively
correlated with job satisfaction but not with stress reduction (Healy & McKay,
2000).
 Seeking Social Support & Self Control: These are examples of effective emotion
based problem solving methods, which may help nurses focus on tasks to be
done (Healy & McKay, 2000).
 Communication Competence: Organizational conflict is ubiquitous in
healthcare settings however positive conflict has been shown to be beneficial
and increase creativity (Wright, 2010). If you enter into a conflict with
someone who is a poor communicator they typically rely on aggression to
achieve their goals and this type of communication has been shown to
undermine personal relationships and increase dissatisfaction (Wright, 2010).
Ineffective Coping Mechanisms
 Avoidance: Research has shown that this method is highly
correlated with depressed mood and lower job
satisfaction (Healy & McKay, 2000).
 Poor Communication Styles: Less competent styles of
communication such as avoidance and confrontational
styles can produce negative outcomes in an organization
such as burnout and stress (Wright, 2010). The Learning
Network at Georgetown has classes on communication
and conflict resolution if you feel you or your staff could
benefit.
http://www.georgetownuniversityhospital.org/body.cfm?id
=264
Untraditional coping methods
 Reiki
 “Reiki has been shown to give a heightened state of





awareness, inner peace and calm” (Miles & True, 2003, p.
65)
Energy becomes free flowing and balanced causing
recipients to feel “jumpstarted” (Moore, 2005).
One can practice self Reiki
One can perform Reiki on their patients
Study saw a statistically significant decrease in workplace
stress for nurses who used Reiki (Cuneo, et. al., 2011).
http://www.reikinorthernvirginia.com/?alternative_healin
g_classes=oriental_medicine_training
Untraditional coping methods
 Knitting
 Knitting has shown to be very therapeutic for patients
and nurses in the literature
 Knitwell at Georgetown: a program that offers patients
and nurses knitting services.
 There is a knitting basket in the nurses lounge for your
use.
 www.stitchlinks.com - is a great website with tons of
stuff about the benefits of knitting
Untraditional coping methods
 Self Renewal (Antai-Otong, 2001).
 Utilize physical, mental and social well being activities for
example . . .
 Give yourself permission to fail without feeling guilty
 Reframing – changing your appraisal system and how you
view others
 Hanging out with positive people
 Gardening
 Finishes and Hospital Appearance
Ufer, M., & Gover, M. (2010). Caring for Caregivers: Selecting
optimal station finishes and furnishings. HMF Magazine,
27-30.
Employee Assistance Program
 Employee Assistance Program
 Can help with party planning, finding a summer camp
for your child, not just work related things
 Use it, you’re essentially paying for it!
Think about what may work
for you . . .
 Set a goal for yourself
 Consider something different
 Take the online personality test to learn more about
yourself
 The Big Five Personality Test – Free!
http://www.outofservice.com/bigfive/
References











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. Journal of the American Medical Association, 288 (16), 1987-1993.
American Psychological Association. Overwhelmed by workplace stress? you're not alone. Available at
http://apahelpcenter.org/articles/article.php?id=164. Last accessed July 8, 2011.
Burke, R. (2000). Workaholism in organizations: Psychological and physical well-being consequences. Stress and Health, 16(1), 11-16.
Burgess, L., Irvine, F. & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: a descriptive exploratory study.
Nurses in Critical Care, 15(3), 129-140.
Cordes, C. & Dougherty, T. (1993). A review and integration of research on job burnout. Academy of Management Review, 18, 621-659.
Cunco, C. L., Curtis Cooper, M. R., Drew, C. S., Naoum-Heffernan, C., Sherman, T. & Walz, K. (2011). The effect of Reiki on work-related stress
of the registered nurse. Journal of Holistic Nursing, 29(1), 33-43.
Healy, C. M. & McKay, M. F. (2000). Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses.
Journal of Advanced Nursing, 31(3), 681-688.
Marine, A., Routslainen, J. H., Serra, C., Verbeek, J. H. (2006). Preventing occupational stress in healthcare workers. Cochrane Database of
Systematic Reviews 2006, 4, Art. No.: CD002892. DOI: 10.1002/14651858.CD002892.pub2
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout.
Journal of Occupational Behavior, 2, 99- 113.
Millikens, T. F., Clement, P. T., Tillman. H. J. (2007), The Impact of Stress Management on Nurse Productivity and Retention: Consequences
of Stress. Nurse Econ, 25(4) 203-210.

Psychological Wellness Institute (2009) Spiritual effects of stress, Retrieved 7/10/11 from
http://www.relaxingmoment.org/index.php?option=com_content&view=article&id=49&Itemid=59)

Spinetta J. J., Jankovic, M. & Arush B. (2000). Guidelines for the recognition, prevention, and remediation of burnout in health care
professionals participating in the care of children with cancer: report of the SIOP Working Committee on Psychosocial Issues in Pediatric
Oncology. Med Pediatric Oncology, 35(2),122-125.
Srivastava, S. (2011). Measuring the Big Five Personality Factors. Retrieved 7/2/11 from http://www.uoregon.edu/~sanjay/bigfive.html.
Wright, K. B. (2010). A communication competence approach to healthcare worker conflict, job stress, job burnout and job satisfaction.
Journal for Healthcare Quality, 33(2), 7-14.
Zellars, K. L., Perrewe, P. L. & Hocharter, W. A. (2000). Burnout in Health Care: The Role of the Five Factors of Personality. Journal of Applied
Social Psychology, 30(8), 1570-1598.


