What Makes Nurses Vulnerable to Burnout and How It Impacts the Care They Provide

A federal study shows that last year, nearly half of healthcare workers reported they often feel burned out. Research suggests nurses are especially vulnerable and that can impact the care they provide. In collaboration with the Global Health Reporting Center and with support from the Pulitzer Center, Stephanie Sy reports from Columbus, Ohio, for our series, Critical Care: The Future of Nursing.

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Geoff Bennett: Last year, nearly half of all U.S. health workers reported they often feel burned out. That's according to a new federal study. Research suggests that nurses are especially vulnerable, and that can affect the care they provide.

In collaboration with the Global Health Reporting Center, with support from the Pulitzer Center, Stephanie Sy reports from Columbus, Ohio, for our series Critical Care: The Future of Nursing.

Stephanie Sy: It is a typical weeknight in Sarah Kincaid's home, rushing to find her daughter's soccer cleats, keeping her 4-year-old busy, policing the family's herd of ducks.

Kincaid is also a full-time nurse in Columbus, Ohio, a 40-minute drive away.

Sarah Kincaid, Family Nurse Practitioner: My patients know I celebrate with them. When we hit milestones, they have made a change with their diet, they have quit smoking, we hoot and holler and we dance around.

Stephanie Sy: But all that passion, along with obligations back at home and a lack of administrative support, can take a heavy emotional toll.

Sarah Kincaid: Nurses are especially vulnerable because of the caring role we play. I was experiencing extreme levels of stress and anxiety, went on maternity leave. And, during that time, I was like, I don't know that I want to go back.

Stephanie Sy: Research shows that nurses suffer disproportionately from mental health conditions.

Even before the pandemic, the risk of suicide among female nurses was nearly twice the risk in the general population and 70 percent higher than among female physicians.

Today, hospital nurses are much more likely to report burnout than their physician counterparts.

At Ohio State University, Bern Melnyk is sounding the alarm. She's a nurse herself and the first chief wellness officer of any U.S. university system.

Bernadette Melnyk, Chief Wellness Officer, Ohio State University: It is absolutely urgent. My studies have shown, the more depressed and burnt out you are, the more preventable medical errors that are made.

So not only is it unhealthy for our population, but it adversely impacts health care quality and patient safety.

Stephanie Sy: Melnyk says she's taking an evidence-based approach to creating a culture of wellness across Ohio State's hospitals and academic colleges.

Bernadette Melnyk: I have the philosophy, in God we trust, but everybody else better bring data to the table.

Stephanie Sy: You're a data person. OK.

Bernadette Melnyk: Absolutely.

Stephanie Sy: I like that.

Bernadette Melnyk: So nurses, for example, who believe their organization has a culture that invests in their well-being, there's much less burnout, much less depression and stress.

Stephanie Sy: A culture of wellness may sound intangible, but Melnyk says it leads to real measurable benefits, over three times the return on investment at OSU.

When is the best time to present that content and material?

Bernadette Melnyk: It must begin with our students. Self-care is a necessity, not a nicety.

Stephanie Sy: An urgent necessity. Nearly 18 percent of newly licensed registered nurses quit the profession within the first year.

Taylor Schwein, Student Instructor, Mindstrong: Another thing we talk a lot about is gratitude.

Stephanie Sy: Taylor Schwein is a psychiatric nurse practitioner in training. She teaches a cognitive skills building program for fellow OSU students called Mindstrong. Its benefits are backed up by 20 studies.

Taylor Schwein: We also measure levels of stress, anxiety and depression with validated survey tools. And we consistently see that those three levels decrease after taking Mindstrong.

Stephanie Sy: Mindstrong found Schwein's peer, Yang Du, at a critical juncture, questioning her success as a student nurse and struggling with what she calls passive suicidal thoughts.

Yang Du, College Student: Just doing self-statement really boosts your self-esteem, right? You keep giving yourself the positive influence. Yes, I'm good. I'm a good nurse. I'm caring. I'm making a difference. And that brings you — that reminds you of how great you are.

Stephanie Sy: There is an outsized need for support programs like this one. A national survey of 7,000 nurses earlier this year found two-thirds were not receiving any kind of mental health support.

Nurses' 24/7 schedules can be part of the problem.

Sarah Kincaid: I remember working night shift, and there were a lot of things that day shift would have access to, but, night shift, we didn't have those things. It has to be available for — to meet nurses where they are.

Stephanie Sy: Along with Mindstrong, Ohio State offers a peer-to-peer wellness counseling program.

Woman: I talk about wellness. I talk to students about wellness.

Bernadette Melnyk: These things work. Mindfulness that is evidence-based, really decreases stress and anxiety, cognitive behavior skills building, and that is all about teaching people to catch, check, and change automatic, unhelpful thoughts.

Stephanie Sy: Ohio State is also making some innovative new investments, including golden retriever Shiloh, one of 37 therapy dogs who visit Wexner Medical Center, not for patients, but clinicians.

Woman: Yes.

Stephanie Sy: One factor pushing nurses to the brink, the pressures of a profit-driven health care system.

Sarah Kincaid: That amount of time we're spending to get to know the patient, developing a plan of care that is patient-centered, that should be valued financially more than the number of people who are coming through that office.

Stephanie Sy: Kincaid says less time to see more patients and high drug costs, among other industry profit incentives, can run counter to a nurse's most sacred duty.

Sarah Kincaid: You have this moral obligation to assist patients in achieving their health and wellness.

When you can't do that because of systems that are in place, that's where that distress comes from. That's where that frustration, that burnout — there's only so many times it can hit your head against a wall.

Stephanie Sy: Researchers call this feeling moral injury and find it can lead clinicians to depression and even post-traumatic stress disorder.

Some stressors are hard to see, except for the people who deal with them every day. Ease-of-use issues with the Electronic Health Record, or EHR, systems have also been linked to higher rates of burnout. Nationally, more than a third of nurses surveyed say they spend excessive time working on inputting stats in a computer on breaks or after shifts.

Bernadette Melnyk: When you think about why people went into nursing, it's because they love people. But a lot of the joy in taking care of people has been taken away, in large part because of many tasks that need to be done.

Sarah Kincaid: If you find it's going to be longer, let me know. Give me a call. It should be in my chart.

While I think the conversation regarding wellness needs to continue, I think we need to go beyond just a conversation. We need to take care of our nurses. We need to take care of our health care providers.

Stephanie Sy: Taking care of nurses so they can take care of us.

For the "PBS NewsHour," I'm Stephanie Sy in Ohio.