May 13 2020
Article by Whitney M. Jacobson, Advocate Aurora Health Research Institute
Burnout is a syndrome originally described in the early 1970s by psychologist Herbert Freudenberger. In the 1980s, Christina Maslach and Susan E. Jackson defined burnout as, “…a three-dimensional syndrome in which the affected person presents depersonalization (D) or cynicism in dealing with patients, emotional exhaustion (EE) and lower personal accomplishment (PA)” (De la Fuente Solana 2017). Although not classified as a medical condition, burnout was included in the 10th revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD) as an occupational phenomenon and is included in ICD-11 with a more comprehensive definition (WHO 2019).
The signs and symptoms of burnout can be diverse and may include physical and emotional exhaustion, insomnia, gastrointestinal complaints, chronic fatigue, negativity, detachment, depression, anger, low sense of personal accomplishment, and low productivity (Hlubocky 2016). Burnout can be formally assessed and measured by validated instruments including the Maslach Burnout Inventory (MBI) and Copenhagen Burnout Inventory. The MBI has been used since the 1990s and is the most widely utilized instrument to assess burnout syndrome (Russel 2016). The MBI-Human Services Survey (MBI-HSS) version is a 22-item assessment tool for self-reported symptoms of burnout in professionals who work with people. The MBI-HSS scale covers emotional exhaustion, depersonalization, and personal accomplishment.
In addition to its personal consequences, burnout can negatively affect the workspace. Professional consequences may include increased rates of absenteeism and sick leave, decreased staff retention, decreased quality of care provided, and an increase in errors (De la Fuente Solana 2017). In the context of oncology clinical trials, it is prudent to have an awareness of burnout so early recognition and mitigation strategies can be deployed to ensure successful trial operations and patient safety.
Research has identified multiple risk factors that may cause burnout among oncology professionals. Some studies have classified these variables into sociodemographic (e.g., age, marital status), occupational (e.g., professional experience, workload, shift), and psychological (e.g., depression) groups (Gómez-Urquiza 2016). Risk factors of burnout can include personality characteristics (e.g., compulsiveness, type A behaviors), advances in technology and disease management, increased time in direct patient care, limited decision making, unclear job expectations (Hlubocky 2016), long-term connections with patients and families, lack of communication skills (Wittenberg 2019), advanced age, a heavy workload, and caring for patients with a terminal illness (Gómez-Urquiza 2016).
The literature on burnout discusses various individual and organizational strategies to address burnout, prioritize self-care, and build resilience. Supportive and team-centered work environments (Wu 2016), communication skills training, mindfulness, cognitive-behavioral techniques, and experience sharing have been identified as strategies to reduce burnout (Murali 2018).
In May 2020 we will celebrate Clinical Trials Day and Oncology Nursing Month. Pause and take a moment to celebrate and focus on self-care and teamwork by sharing your stories, greatest professional accomplishments, and recognizing your colleagues.
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Gómez-Urquiza JL, Aneas-López AB, De la Fuente-Solana .I, Albendín-García L, Díaz-Rodríguez L, Cañadas-De la Fuente GAPrevalence, risk factors, and levels of burnout among oncology nurses: A systematic review. . 2016; 43(3): E104-E120. doi: 10.1188/16.ONF.E104-E120
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Russell K. Perceptions of burnout, its prevention, and its effect on patient care as described by oncology nurses in the hospital setting. Oncology Nursing Forum. 2016; 43(1): 103-109. doi: 10.1188/16.ONF.103-109
Wells-English D, Giese J, Price J. Compassion fatigue and satisfaction. Clinical Journal of Oncology Nursing. 2019; 23(5): 487-493. doi:10.1188/19.CJON.487-493
Wittenberg, E., Goldsmith, J., Buller, H., Ragan, S., & Ferrell, B. (2019). Communication training: needs among oncology nurses across the cancer continuum. Clinical Journal of Oncology Nursing, 23(1), 82-91. doi:10.1188/19.CJON.82-91
World Health Organization (2019, May 28). Burn-out an “occupational phenomenon”: International classification of diseases. https://www.who.int/mental_health/evidence/burn-out/en/
Wu, S., Singh-Carlson, S., Odell, A., Reynolds, G., & Su, Y. (2016). Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncology Nursing Forum, 43(4), E161-E169. doi:10.1188/16.ONF.E161-E169