Consequences of Early Career Nurse Burnout: A Prospective Long-Term Follow-Up on Cognitive Functions, Depressive Symptoms, and Insomnia

Abstract

Background: Burnout is common among nurses and midwifes. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation. Methods: Symptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden’s nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2472 nurses (62%) consented to participate at follow-up. Burnout was measured using the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used multivariable logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up. Findings: The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression. Interpretation: The results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses’ careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs). Funding: AFA Insurance Grant [number 150284]. Declaration of Interests: All authors report no competing interests. Ethics Approval Statement: Ethical permission was given by the Regional Research Ethics Committee at Karolinska Institutet, Stockholm, Sweden (Dnr 01-045), and the Regional Ethics Review Board in Stockholm, Sweden (Dnr 04-587 and for the long-term follow-up Dnr 2016 / 793-32).