Essentials of Nursing Leadership and Management, 5th Edition

chapter 13 | Work-Related Stress and Burnout 205

Stressors Leading to Burnout

Personal Factors

Some of the personal factors influencing job stress
and burnout are age, gender, number of children,
education, experience, and favored coping style. For
example, the fact that many nurses are single par-
ents raising families alone adds to the demands of
already difficult days at work. Married nurses may
have the additional stress of dual-career homes,
causing even more stress in coordinating work and
vacation schedules as well as day-care problems.
Baby boomers are finding they need to care for el-
derly parents along with their children (DeFrank &
Ivancevich, 1998). Competitive, impatient, and
hostile personality traits have also been associated
with emotional exhaustion and subsequent burnout
(Borman, 1993). Most experienced nurses state
that they separate their home from work when
dealing with work-related stressors and that they
try but usually fail to leave their work-related stres-
sors in the workplace (Hall, 2004).

Job-Related Conditions

Job-related stress is broadly defined by the
National Institute for Occupational Safety and
Health as the “harmful physical and emotional
responses that occur when the requirements of the
job do not match the capabilities, resources, or
needs of the worker” (http://www.cdc.gov/niosh/
homepage.html). Since the prior edition of this
text, the threat of terrorism has been added to the
list of job-related conditions that contribute to job-
related stress. Box 13-1 lists some of these condi-
tions, which were discussed in Chapter 12.

Human Service Occupations

People who work in human service organizations
consistently report lower levels of job satisfaction
than do people working in other types of organiza-
tions. Much of the stress experienced by nurses is
related to the nature of their work: continued
intensive, intimate contact with people who often
have serious and sometimes fatal physical, mental,
emotional, and/or social problems. Efforts to save
patients or help them achieve a peaceful ending to
their lives are not always successful. Despite nurses’
best efforts, many patients get worse, not better.
Some return to their destructive behaviors; others
do not recover and die. The continued loss of
patients alone can lead to burnout. Even exposure

to medicinal and antiseptic substances, unpleasant

sights, and high noise levels can cause stress for

some people. Health-care providers experiencing

burnout may become cynical and even hostile

toward their coworkers and colleagues (Carr &

Kazanowski, 1994; Dionne-Proulx & Pepin, 1993;

Goodell & Van Ess Coeling, 1994; Stechmiller &

Yarandi, 1993; Tumulty, Jernigan, & Kohut, 1994).

In some instances, human service professionals

also experience lower pay, longer hours, and more

extensive regulation than do professionals in other

fields. Inadequate advancement opportunities for

women and minorities in lower-status, lower-paid

positions are apparent in many health-care areas.

Conflicting Demands

Meeting work-related responsibilities and main-

taining a family and personal life can increase stress

when there is insufficient time or energy for all of

these. As mentioned in the section on personal fac-

tors, both the single and the married parent are at

risk because of the conflicting demands of their

personal and work lives. The perception of balance

in one’s life is a personal one.

There appear to be some differences in the way

that men and women find a comfortable balance.

box 13-1

Five Sources of Job Stress That Can Lead

to Burnout

1. Intrinsic factors.Characteristics of the job itself, such as
   the multiple aspects of complex patient care that many
   nurses provide; lack of autonomy


2. Organizational variables.Characteristics of the
   organization, such as limited financial resources, staffing,
   workload, models of care delivery


3. Reward system.The way in which employees are
   rewarded or punished, particularly if these are obviously
   unfair


4. Human resources system.In particular, the number
   and availability of opportunities for staff development,
   salary and benefits, organizational policies


5. Leadership.The way in which managers relate to their
   staff, particularly if they are unrealistic, uncaring, or
   unfair; communication patterns with supervisors and
   coworkers
   Adapted from Carr, K., & Kazanowski, M. (1994). Factors affecting job satisfac-
   tion of nurses who work in long-term care. Journal of Advanced Nursing,19,
   878–883; Crawford, S. (1993). Job stress and occupational health nursing.
   American Association of Occupational Health Nurses Journal,41, 522–529;
   Duquette, A., Sandhu, B., & Beaudet, L. (1994). Factors related to nursing
   burnout: A review of empirical knowledge. Issues in Mental Health Nursing,
   15, 337–358; and Best, M., & Thurston, N. (2004). Measuring nurse job
   satisfaction, Journal of Nursing Administration,34(6), 283–290.