Commentary on Van Bogaert P Commentary on Kowalski C, Ommen O, Driller E, Ernstmann N, Wirtz M, Koehler T & Pfaff H (2010) Burnout in nurses – the relationship between social capital in hospitals and emotional exhaustion. Journal of Clinical Nursing 19, 1654–1663. Journal of Clinical Nursing20, 913–914

Abstract

High rates of burnout are a persistent problem in the nursing profession as well as in the helping professions generally. As yet, there have been few attempts to systematically reduce its prevalence by means of systematically implemented (organisational) interventions in (quasi-) experimental designs – even though a large amount of research on burnout and its associated factors exists. Van Bogaert, in his commentary (Van Bogaert 2011) on our paper (Kowalski et al. 2010), stressed the relevance of the nursing unit teams as the multidisciplinary core of a clinical microsystem. This, in the context of searching for effective strategies against burnout within the nursing profession, provides a promising framework and leverage for prevention. From our perspective it is important, as Van Bogaert (2011) did, to emphasise the existence of different levels to encounter and reduce the challenge of burnout in nurses in particular and in the helping professions in general. In contemporary discussions – both in mainstream media and some scholar-led discourses – the focus for reducing the prevalence of burnout is still the effective treatment of individual patients/employees that are already sick, i.e. a curative point of view. Existing research, however, persistently shows associations between the prevalence of burnout and organisational/workplace/group conditions, pointed out by Shanafelt (2009) using the example of physicians. We argue, in line with Van Bogaert (2011), for a more active involvement of health care workers encouraged by nurse and hospital leaders to achieve effective organisational and workplace interventions. These interventions are intended to prevent the development of burnout. We would like to add a third aspect that should help reduce the persistent problem of high turnover rates in the nursing profession: effective return to work, i.e. a rehabilitative perspective. Although research is still needed that investigates the mediating factors between burnout and permanently leaving nursing, sick leave follow-up meetings have proved to be effective in assisting formerly sick employees and might also be effective in helping nurses return to work after suffering from burnout. To implement the findings from existing research, we suggest tackling the burnout challenge by intervening at three stages in the course of the disease: first, to prevent its occurrence, particularly taking into account the workplace environment, the organisational culture within the hospital, and the nursing unit teams; second, to cure those suffering from burnout by paying attention to both individual and workplace causes and by strengthening personal and workplace resources; third, to effectively facilitate the return to work of those affected by burnout within a climate of encouraging co-workers and superiors. Those who have successfully returned to work might serve as facilitators/role models to prevent stigmatisation. The workplace environment and factors associated with it are central to interventions at all three stages. Assessing the workplace environment and its associated factors either within a framework of an organizational culture, climate or systems theory approach is of great importance. Equally, using the existing research as groundwork to realise interventions that fight burnout for the good of nurses, patients, and the health care system, is a vital issue in this area. The authors did not receive any support in the form of grants, equipment or anything else. None.