It breaks my heart when I hear that nurses are so incredibly stressed out that they leave the profession. We can’t afford to lose great people through burnout.

Clearly, burnout comes at a heavy price…for individuals AND systems, alike.  Three out of four nurses cited the effects of stress and overwork as a top health concern in a 2011 survey by the American Nurses Association.

Burnout: Advice for Individuals

First and foremost, nurses have to take care of themselves. We have to make sure that we eat right, that we exercise and take care of our bodies and our own mental health.

Taking care of ourselves also means speaking up when work assignments are placing us in a state of constant overwhelm. This isn’t whining. Make it evidence-based: “I can only be my best, if I give up ‘x’.” Don’t be afraid of delegating.

Burnout: Advice for Organizations

Burnout is viewed by many as something wrong within the practitioner exclusively.  Misguided thinking may include: “Maybe they cannot handle heavy workloads. Maybe there are other stresses in their lives. Maybe they have a hard time dealing with organizational rules.”

While individual factors can contribute, I often find the core of the problem is actually within the culture of the organization itself.

Here are a few signs of a dysfunctional organization:



The higher-ups know things that others do not — things that the employees feel the effects of but cannot clearly identify. So a sense of mistrust develops followed by a sense of unfairness. Those in on the secret always have more power and flexibility than those out.

Crazy rules

One’s performance evaluation is based on the curve. That means that some people must get a lower performance rating regardless of their actual performance. And some will get a higher rating (if they have been part of the system long enough) simply because it is their turn.

The white wall of silence

It is not often that one professional will confront another professional who has done something seriously wrong or unethical. So less capable or less ethical employees are allowed to function and not be corrected.

A high degree of responsibility but a lower degree of power

Nurses, for example, are on the front lines more than doctors. They have a great deal of responsibility but often lack the final power.  They are sandwiched in between the MDs and the patients. They get the bulk of the complaints from each side. They need more support rather than being told, “You knew what you were getting into when you became a nurse.”

Innovation is not rewarded

Publications and professional accomplishments are not rewarded in many settings as they might be in other settings. It might be expected and thus not seen as an extra effort, or more often it is viewed as not that relevant to the system as a whole.


It can happen anywhere. But in a healthy system, the productive staff, those who get things done and are often valued more by patients, are seen as role models for others to emulate. In an unhealthy system, jealousy is allowed to flourish because administrators are either jealous themselves, or it allows them to manipulate the situation to whatever purpose it might serve.


Sometimes, addressing a problem requires more paperwork and meetings than an administrator wants to deal with. It’s easier to deny a problem exists or pretend it is not that big a deal and therefore not worth fixing.

Fixing a dysfunctional system requires buy-in from senior leadership.

As the saying goes:  change really does begin at the top.   Here are the strategies I often suggest when consulting with organizations:

  • Consistently reward high performance.
  • Take employees’ thoughts and feelings seriously. Don’t make quick judgments if you haven’t really heard from the employee.
  • Penalize bad-mouthing, gossip, and obvious signs of jealousy. Reward cooperation and reward those who praise their colleagues for a job well done.
  • Make sure the organization’s stated values are actually lived up to — and that they dovetail with the employees’ values.

Burnout among healthcare professionals isn’t easily solved. But savvy organizations can make the commitment to employ strategies which support employee engagement for this industry that impacts all of us. 


Renee Thompson


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Dr. Renee Thompson works with healthcare organizations that want to overcome the leadership and clinical challenges their people face every day.

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