Mental Health UK's Burnout Report (2024) revealed that nearly one in four adults in the UK felt unable to cope with the stress and pressure of daily life. A further 35% reported feeling uncomfortable openly talking about their mental health with their employer (Mental Health UK, 2024).
In healthcare systems in high- and middle-income countries, there has been growing recognition of the burden associated with burnout among healthcare professionals, which has increased exponentially since the COVID-19 pandemic and is associated with high levels of morbidity and even mortality (Dall'Ora et al, 2020). The following reflections focus on the impact of healthcare worker burnout within the health service and considers ways that leaders and clinicians can foster practices which work towards improved wellbeing.
The NHS 2022 staff survey reported a greater risk of burnout amongst healthcare professionals with around 35% of staff reporting signs of burnout in the UK (The King's Fund, 2023). Nurses form the largest clinical group within the NHS, with 372 000 practitioners employed in England alone, suggesting that burnout in nurses is associated with significant burden to the NHS (NHS England, 2024). In 2024, the NHS recognised the need to implement evidence-based initiatives to reduce the incidence of burnout while protecting both patients and staff (Cohen et al, 2023).
Burnout in nurses has been associated with the concept of ‘moral distress’, which often occurs with prolonged working in challenging circumstances that conflict with their professional values or beliefs (Salari et al, 2022). For example, a community nurse might experience trauma after repeatedly not being able to provide the highest level of care for patients because of consistent unachievable workloads and expectations. When considering how to prevent burnout related to moral distress in nurses, there is evidence that having an employer who is focussed on employee wellbeing is associated with reduced staff burnout (Hofmeyer et al, 2020). This requires employers who role model compassionate leadership traits. These include:
- Being present with employees and asking about difficulties and challenges
- Taking the time to understand the experience of employees
- Having the ability to empathise with employees
- Focussing efforts towards helping to improve the experience of employees (Papadopoulos et al, 2022).
‘Burnout in nurses has been associated with the concept of ‘moral distress’, which often occurs with prolonged working in challenging circumstances that conflict with their professional values or beliefs (Salari et al, 2022). For example, a community nurse might experience trauma after repeatedly not being able to provide the highest level of care for patients because of consistent unachievable workloads and expectations.’
Application of compassionate leadership for nurses within the healthcare setting includes maintaining safe staffing levels, providing adequate rest facilities and rest periods, monitoring shift patterns and encouraging the use of annual leave across the year (Papadopoulos et al, 2022). In a mixed methods systematic review evaluating the impact of compassionate leadership in healthcare, there was consistent agreement that compassionate leadership positively impacted on rates of healthcare practitioner burnout, staff turnover and patient safety (Östergård et al, 2023).
Embedded psychological wellbeing initiatives to support healthcare professionals has become more available in many NHS clinical settings, and these have been recognised to reduce burnout associated with compassion fatigue (Cohen et al, 2023). Compassion fatigue can be seen in nurses and is described as the intense physical and psychological exhaustion that is linked to caring for patients through traumatic experiences (Cocker and Joss, 2016).
Restorative clinical supervision is an evidence-informed intervention that focuses on supporting staff with their wellbeing, personal and professional development and is delivered by a professional nurse advocate who has completed an approved higher education level 7 programme (Wade, 2023). Ernawati et al (2022) undertook a systematic review of the international evidence base for clinical supervision interventions for nurses, which identified associated improvements in the care quality and patient safety. Further staff benefits included measurable improvements in stress relief, burnout rates, professional accountability and greater job satisfaction (Ernawati et al, 2022). Despite these measurable benefits, the current finance deficit in the NHS has impacted on consistent implementation across many clinical areas (Beckwith, 2022). There is a need to support nurse managers to establish restorative clinical supervision within a cash-strapped health service (Smythe et al, 2023).
‘There is epidemiological evidence that burnout rates among healthcare professionals, including nurses, have grown substantially since the COVID-19 pandemic. This affects staff in all clinical areas and is associated with workload and other factors that affect individuals’ perception of work satisfaction. It is recognised that interventions are needed to minimise the impact of psychological stress in healthcare professionals. Implemented interventions need to be impactful and cost-effective and underpinned with scientific evidence.’
Similarly, rapid access to an embedded clinical psychologist is recognised as an alternative or supplemental intervention to restorative clinical supervision, which has been established in some clinical settings (O'Ferrell Beacham et al, 2023). The aim of having a routinely available clinical psychologist for healthcare professionals is to reduce psychological distress and improve psychological wellbeing (Vincent et al, 2019). It is suggested that early access to occupational ‘talking therapies’ will reduce the incidence of burnout and psychological stress amongst healthcare professionals (O'Ferrell Beacham et al, 2023). This has had increasing popularity in emergency and critical care areas since the COVID-19 pandemic and would have utility in the other specialist areas such as community nursing (Collett et al, 2024). Despite many anecdotal examples of success in the NHS, there remains limited evidence to support this intervention, particularly in relation to cost-effectiveness (O'Ferrell Beacham et al, 2023; Collett et al, 2024).
‘Wellbeing hubs’ were established for staff within many healthcare organisations during the COVID-19 pandemic and in many cases, these have remained active in the post-pandemic period in the secondary care setting (Blake et al, 2024). While it is unclear if and how wellbeing hubs have been applied within primary and community-based care, this intervention has the potential for application in all clinical settings. Wellbeing hubs are central physical spaces within healthcare organisations that offer a calm, quiet space for rest and reflection during working hours. The use of these hubs has been associated with higher levels of wellbeing among healthcare professionals, including nurses (Keyworth et al, 2022). In a large survey study (Blake et al, 2024), age was a significant predictive variable, with a higher proportion of younger healthcare professionals affected by burnout. This study concluded that healthcare organisations require strategies, including wellbeing hubs, as part of a system-wide approach to reducing the incidence of burnout (Blake et al, 2024).
Alongside these focussed interventions, specifically for healthcare professionals including nurses, there are several mindfulness interventions that have been developed for use by the public which may have use for nurses working in a wide range of clinical specialties (eg Headspace) (Reyes, 2020). There is a body of evidence that has evaluated the efficacy of these self-directed interventions amongst the healthcare professional population (Keng et al, 2022). In a randomised control trial (Taylor et al, 2022), there was a measurable reduction in stress among participants. While the authors concluded that there was a place for self-directed interventions, they highlighted the fact that face-to-face interventions had greater potential for effectiveness (Taylor et al, 2022).
There is epidemiological evidence that burnout rates amongst healthcare professionals, including nurses, have grown substantially since the COVID-19 pandemic. This affects staff in all clinical areas and is associated with workload and other factors that affect individuals’ perception of work satisfaction. It is recognised that interventions are needed to minimise the impact of psychological stress in healthcare professionals. Implemented interventions need to be impactful and cost-effective and underpinned with scientific evidence.