Compassionate, caring and empathetic are just a few attributes that make up a great nurse. Everyday nurses dedicate themselves to provide quality care to their patients, constantly being confronted with their patients’ needs and suffering, and often nurses place their clients well-being before their own (Kanste, Kyngas & Nikkila, 2007). These very things that make nursing rewarding can also negatively impact their own health. Nursing is one of the most emotionally demanding areas of work, and prolonged exposure to stressful situations can lead to a decline in mental health and ultimately healthcare worker related burnout. There are two types of variables that can be the cause of burnout, the organizational demands such as increased work load and long hours, or there can be interpersonal factors such as personality characteristics that place certain healthcare workers at an increased risk for developing burnout. Within this paper the dimensions of burnout will be discussed and the five personality traits that predict burnout with a focus on the relevance to clinical practice and the preventative measures needed to support mental health in nurses.
The most widely accepted definition of burnout was proposed by Maslach and Jackson (1981), who defined burnout as a condition that incorporates three dimensions: “emotional exhaustion, depersonalization, and reduced personal accomplishment” (Canadas-De la Fuente, Vargas, San Luis, Garcia, Canadas, De la Fuente, 2015). Firstly, emotional exhaustion refers to the mental and physical toll that can occur when working in the challenging healthcare field (Canadas-De la Fuente et al., 2015). Secondly, depersonalization is the development of cynicism towards others through an impersonal attitude towards co-workers and patients (Geuens, Bogaert & Franck, 2017). And lastly, reduced personal accomplishment refers to developing a negative self-concept with feelings of incompetence due to the emotional demands of nurses (Canadas-De la Fuente et al., 2015). The combination of these three dimensions can lead to high stress within the individual and negatively impact their overall wellbeing.
Burnout can be viewed as an individual experience and can develop from the varying levels of stress nurses are subjected to. Burnout manifestations include psychosomatic and emotional problems and may begin with insomnia and further develop into anxiety and depression (Adriaenssens et al., 2012; Janson-Frojmark and Lindblom, 2011; Leape et al., 2012, as cited in Canadas-De la Fuente et al., 2015). Attitude problems may also occur in which the nurse appears hostile and apathetic, or rather may withdraw from their work environment and isolate themselves (Adriaenssens et al., 2012; Janson-Frojmark and Lindblom, 2011; Leape et al., 2012, as cited in Canadas-De la Fuente et al., 2015). The effects of burnout not only affect the individual nurse on a personal level, but also affects the workplace as a whole as burnout causes more absenteeism, diminished work effectiveness and increased sick days (Canadas-De la Fuente et al., 2015). Reports of decreased patient satisfaction are also revealed with the deteriorating quality of healthcare reflected by the three dimensions of burnout.
There are two causes of healthcare related burnout: organizational which pertain to the work environment, and these stressors could be triggered from an overwhelming patient workload, long overtime shifts due to not enough staffed nurses, and poor support from co-workers (Canadas-De la Fuente et al., 2015) The second cause of healthcare related burnout and the focus of this paper are personality variables.
Some nurses are more at risk for developing burnout due to their specific personality characteristics compared to others (Canadas-De la Fuente et al., 2015). Research reveals that “certain personality traits could be conductive to the advent of the syndrome or, on the contrary, may protect against the development of the disorder” (Fornes-Vives et al., 2012; Hudek-Knezevic et al., 2011; Narumoto et al., 2008, as cited in Canadas-De la Fuente et al., 2015). Personality affects an individual’s interpretation to their environment and in other words healthcare related burnout is predictive of their personality traits (Geuens, Bogaert & Franck, 2017).
The five-factor model identifies the five personality traits that can predict the development of burnout within an individual. The five personality traits are: neuroticism, agreeableness, conscientiousness, extraversion, and openness to experience (Geuens, Bogaert & Franck, 2017). Neuroticism refers to negatively interpreting events and reflecting emotional instability in certain situations such as anxiety, depression and fear (Geuens, Bogaert & Franch, 2017). Neurotic individuals tend to over-think problems and dwell on negative aspects of a situation rather than focusing on the positives and effectively coping with difficult events. Neuroticism is linked to increased feelings of “emotional exhaustion and depersonalization along with a lower sense of personal accomplishment” (Canadas-De la Fuente et al., 2015). Individuals who score highly on agreeableness are more co-operative, trusting and altruistic and work well with others (Canadas-De la Fuente et al., 2015). Studies reveal that agreeableness and burnout are negatively associated as individuals are more likely to experience burnout due to focusing on their own personal interests rather than the better interest of a group and may feel very alone when dealing with certain stressful situations (Bakker, Van Der Zee, Lewig & Dollard, 2002). Conscientiousness refers to being thoughtful and aware of one’s actions and the consequences of their behaviour, these individuals are “reliable, well-disciplined, collected and cautious” (Hoekstra et al., 2012, as cited in Geuens, Bogaert & Franch, 2017). Studies show a positive correlation between conscientiousness and personal accomplishment. Other studies reveal that there is a negative association between conscientiousness and emotional exhaustion (Lepine, LePine, & Jackson, 2004, as cited in Bakker, Van Der Zee, Lewig & Dollard, 2002). Extraversion is characterized as those who are social and enjoy being in the company of others and have a higher need for stimulation. Extraverts tend to look at problems with a positive lens and utilize rational, problem-solving strategies and seek affirmative appraisal (Dorn & Matthews, 1992; Watson & Hubbard, 1996, as cited in Bakker, Van Der Zee, Lewig & Dollard, 2002). Research suggests that extraversion is negatively associated with burnout (Bakker, Van Der Zee, Lewig & Dollard, 2002). The final personality trait predictive of burnout is an individuals openness to experience or their willingness to try new activities. Individuals who display this trait are more likely to “tolerate ambiguity and accept values that deviate from their own willingly and with curiosity” (Geuens, Bogaert & Franch, 2017). People who are more openminded often use humour as a way to cope with stressful situations (McCrae & Costa, 1986, as cited in Bakker, Van Der Zee, Lewig & Dollard, 2002). Studies revealed a positive relationship between openness and personal accomplishment and a negative relationship between openness and depersonalization (Deary et al., 1996; Zellars et al., 2000 as cited in Bakker, Van Der Zee, Lewig & Dollard, 2002). Furthermore, studies revealed that nurses who are more open minded tend to be more emotionally exhausted (Deary et al., 1996 as cited in Bakker, Van Der Zee, Lewig & Dollard, 2002). Many studies have revealed that when emotional exhaustion increases, neuroticism also increases, though agreeableness, conscientiousness, extraversion and openness to experience decreases (McManus et al., 2011; Biaggi et al., 2003; Hudek-Knezevic et al., 2011, McManus et al., 2011; Gustafsson et al., 2009, as cited in Canadas-De la Fuente et al., 2015) In essence, certain personality traits can serve as a protection against burnout and on the contrary, other personality traits play an important predictor of the individuals who may need extra support to promote mental well-being….I wanna put this somewhere incorporated near the end of this paragraph“the use of the most effective coping strategies, which is characteristic of people with the positive personality factors of emotional stability, agreeableness, conscientiousness, extraversion, and openness to experience, can led to lower levels of emotional exhaustion and depersonalization as well as a higher level of personal accomplishment” (Canadas-De la Fuente et al., 2015)
Stopping the occurrence of burnout is needed for nurses by promoting their mental wellbeing and increasing their job satisfaction. Work environments where there are low levels of burnout are those where “nurses have good support and feedback, job clarity, autonomy and low levels of complexity in their work, as well as managers with a social leadership style which covers the relational aspect of work” (Melchior et al. 1997, as cited in Kanste, Kyngas & Nikkila, 2007). From an organizational standpoint, it is important that leaders are able to identify those who are at risk of burnout and implement strategies to prevent the progression. Having support from the management is shown to decrease the incidence of burnout (Bakker et al. 2000; Demerouti et al., 2000; Leiter & Laschinger 2006, as cited in Kanste, Kyngas & Nikkila, 2007). Studies revealed that transformational leadership style has been linked to decreased levels of depersonalization and emotional exhaustion among nursing staff (Webster & Hackett, 1999, as cited in Kanste, Kyngas & Nikkila, 2007). The transformational leader is ideal in a stressful hospital setting as change is adopted through actively inspiring and motivating fellow followers. On the contrary, laissez-faire leadership where they utilize a hands-off approach were related to high burnout levels (Corrigan et al. 2002., as cited in Kanste, Kyngas & Nikkila, 2007). The laissez-faire leadership provides little guidance and support their followers and rather allows them to make their own decisions which increases the demands and stress on the followers and ultimately leads to higher levels of emotional exhaustion. It is important for managers to support their staff and not have too high of expectations, as high expectations can increase levels of emotional exhaustion as the employee is constantly trying to rise to those expectations (Kanste, Kyngas & Nikkila, 2007). By being an active leader, it shows the staff that they care about their employees and respects the work they are doing (Kanste, Kyngas & Nikkila, 2007). Great leaders create a safe place for their employees with increased job satisfaction and ultimately, they will strive to perform better as nurses.
Prevention programs should be implemented by the managers on each unit which will promote overall well-being within the work environment. Anyone can join this program, but an emphasis should be on the most at-risk personality types. Geuens, Bogaert and Franck (2017) suggest that these programs incorporate discussion on creating self-awareness and changing the way individuals think to incorporate a more positive outlook on life and ways to manage stressful situations. Furthermore, these programs can create a safe place for collaborative interactions between leaders and followers and discuss changes that may need to take place within the work environment in order to decrease emotional exhaustion and depersonalization and increase personal accomplishment among nurses. Research also suggests that individuals may be “more tolerant of a greater workload if their work is valued, if they feel well-rewarded, if they are treated fairly, and if they feel energized within a supportive community” (Shirey, 2006). Upon nurses being hired onto a unit, managers could utilize personality assessment instruments which will identify the individuals who may need extra supports to help manage stress more effectively and decrease the likelihood of developing burnout (Geuens, Bogaert and Franck, 2017). It is easier to prevent burnout from occurring by utilizing health promotion techniques, compared to addressing burnout once it has already affected the individual and hindered the work place environment.
On an individual level, employees may wish to participate in ways to promote health in their body, mind and spirit. Nurses dedicate themselves every day to provide quality care to their patients, but it is important that they take care of their own health first. Nurses may wish to participate in cognitive behavioural therapy which allows them to work towards changing the way they think and act in certain situations and promote more effective problem-solving techniques (Geuens, Bogaert and Franck, 2017). Mental and physical relaxation may also be beneficial to the at-risk personality as a way to set aside time for yourself during your busy day and let go of tension and stress that may have developed throughout the day (Geuens, Bogaert and Franck, 2017). Talking with a manager about how they are feeling or adjusting to the demands of nursing on that unit may also be beneficial and together they can create a plan to promote success within the work organization.
By caring for the at-risk for burnout individual it will increase the overall job satisfaction of the other employees on the unit. Patient satisfaction will also increase as the nurse is better able to provide quality care to each individual patient (Geuens, Bogaert and Franck, 2017). By utilizing effective supports within the organization and promoting individual self-care there will be a decline in absenteeism and job turnover and enhanced positive team-work on the unit (Geuens, Bogaert and Franck, 2017).
Nursing leadership is an important component of being a great nurse. Nursing leadership promotes positive interactions with fellow co-workers and improves patient outcomes and overall success within the work environment. Since the beginning of the nursing program we were taught how to be successful leaders. In my community nursing class, we led a seminar directed at school-aged children on the importance of hand washing, we had to ensure that we created an interactive presentation that encouraged our audience to believe in what we were saying to adopt the vision we had created. Another example of nurse leadership within my nursing program is our fourth-year project where we will be leading a seminar with our intended audience being nursing and social work students. We will be educating the population on what Adverse Childhood Events (ACE’s) are, and how healthcare professionals can implement the screening of ACES into their own practice. It is imperative that before we lead this seminar we have completed thorough research on the topic, including completing a certification that ensures we are knowledgeable and credible to teach this topic. We must know the information thoroughly in order to promote this population to adopt our vision and create a change. I believe that each leadership project that we have completed within the nursing program has influenced the type of leader I am today.
In our second year of the program we attended a workshop called ‘True Colour’ where we explored our values and were able to identify our personality styles. My primary colour is a blue with a secondary colour of gold. Blue represents relationship oriented, which they feel on a deep level and value and care about people’s feelings (Weber, 2015). Blues are often compassionate and empathetic and emotionally driven (Weber, 2015). I do seek meaningful relationships in my life and look for ways to help and motivate others to lead significant lives. I feel like being a blue is an important personality to have in the nursing profession as I am able to interact with my clients on a meaningful level and provide them with client-focused care. On the contrary, being an emotional person may lead me to being more at risk for developing burnout as I feel very deeply for my clients and empathize with their health struggles. It is important that I work on identifying my own needs and be aware when I am becoming too emotionally invested in my clients care. My secondary colour is a gold and that is structure oriented. Golds value organization and are known to be “loyal, dependable, and prepared” (Weber, 2015). As a gold I am able to manage my time well and prioritize my clients care. I work hard in all situations that I am in and strive to succeed. As a gold I have to be cognisant that I am not too uptight and rigid when implementing change as followers may not want to conform to the change I am trying to implement. I believe a combination of a blue and gold personality with a transformational leadership style will be able to support my nursing career.
I believe that I embody a transformational leadership style and incoorporate it within my nursing practice. A transformational leader is one who empowers others to collectively pursue and achieve a vision (Whitireia, 2012). New graduate nursing leadership may look different than more experienced nurse leadership. As a new graduate I will be a leader by being able to delegate tasks and supervise other employees. As a transformational leader I will build relationships and trust within my work environment. The foundation of being a leader I believe begins with trust from others, they must see that I am an authentic value driven nurse that wants to promote a successful work environment. I will ensure that I seek opportunities to broaden my own knowledge that will support the development of my professional practice and continuously review information with a critical inquiry lens and utilize evidenced based practice. As a transformational leader it is important I am able to effectively communicate and provide my followers with the insight needed for them to join the change movement (Whitireia, 2012).
As a transformational leader in a work environment where nurses are at-risk for developing burnout it will be important that I actively provide them with the supports needed and motivate them to participate in self-care techniques. As mentioned earlier on in this paper, transformational leaders are protecting the nursing staff from depersonalization and emotional exhaustion and promoting an increased sense of personal accomplishment (Kanste, Kyngas & Nikkila, 2007). I will encourage the staff to participate in a work huddle on a regular basis that will allow open communication and ultimately inspire the nursing staff to work towards a mentally healthy work environment. It will also be important that I identify the staff members who may require more support than others and discuss ways in which I can effectively support them when they are feeling mentally unwell. I do feel like I am a transformational leader but it is also important that I modify my leadership style accordingly to better promote conformity to the vision of mentally healthy nurses.
As a nurse leader I must support the nursing staff and influence a healthy work environment. As a new graduate nurse my nursing leadership will look differently compared to when I am a more experienced nurse but it is still important for me to promote change and lead by example. Nursing burnout is a significant concern, it not only affects the individual nurse, but also the organization as a whole as well as the clients as the quality of care declines. It is important that leaders utilize health promotion and burnout prevention techniques before the stress has become too much for them. As leaders we need to care for the nursing staff in order for them to effectively care for their clients.