Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN®

Cancer Nursing Today

<p>Oncology nursing is stressful, even more so than working with other patient populations. Adding to oncology nurses’ stress is the emotional toll of working with blood cancer patients with life-threatening or debilitating complications such as graft-versus-host disease (GVHD) after allogeneic stem cell transplant (SCT).</p>
<p>Unsurprisingly, nurses working with this patient population are at high risk for burnout. Oncology nurses must define, identify the risk for, understand the reasons of, and recognize burnout. In addition, they must constantly build resilience to prevent and manage burnout, especially when caring for SCT patients with GVHD.</p>
<h2>Defining Burnout and Oncology Nursing Risk</h2>
<p><a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">Burnout</a> is “emotional, mental, and physical exhaustion caused by excessive and prolonged stress.” Workplace burnout is so prevalent that the <a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281" target="_blank" rel="noopener">World Health Organization</a> (WHO) made it an official medical diagnosis. The WHO describes it as “a syndrome resulting from chronic workplace stress that has not been successfully managed.” It often contains 3 dimensions:</p>
<ol>
<li>Energy depletion and emotional exhaustion</li>
<li>Depersonalization or mental distancing</li>
<li>Lower personal accomplishment or effectiveness</li>
</ol>
<p>Approximately <a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">38% of nurses</a>—or nearly 4 of 10—experience burnout across all specialties. In a <a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4632" target="_blank" rel="noopener">meta-analysis study</a> of almost 10,000 oncology nurses, more than one-third were at high risk for burnout from emotional exhaustion and low levels of personal accomplishment.</p>
<h2>Identifying Burnout Risk in SCT Nursing and GVHD Care</h2>
<p>Unfortunately, the specific burnout rates in SCT nurses, particularly those working with patients with GVHD, are unknown. However, oncology nurses caring for these patients are at high risk for developing burnout from the physical, emotional, and spiritual care demands. Ask any SCT manager, administrator, or leader, and they will likely concur that stress and burnout rates are high.</p>
<p>In addition, the <a href="https://www.nursingworld.org/foundation/programs/stress-first-aid-for-nurses/" target="_blank" rel="noopener">American Nurses Foundation’s Pulse on the National Nurse survey</a> found that Millennial and Generation Z (<a href="https://www.britannica.com/topic/Generation-Z" target="_blank" rel="noopener">Gen Z</a>) nurses report higher burnout levels than their older peers. <a href="https://cancernursingtoday.com/post/recruitment-strategies-for-nursing-students-to-care-for-patients-with-gvhd" rel="noopener">Recruiting nursing students</a> is just one strategy to assist with building the SCT workforce The typical nursing graduates working in inpatient SCT are Gen Z.</p>
<h2>Understanding Reasons for Burnout in GVHD Care</h2>
<p>Oncology nurses caring for patients with GVHD are at increased risk for burnout for many reasons, including:</p>
<ul>
<li>Compassion fatigue</li>
<li>Complex care</li>
<li>Moral distress</li>
<li>Patient acuity</li>
<li>Physical demands</li>
<li>Rapid medical or technological advances</li>
<li>Sickness and death</li>
<li>Working conditions (eg, staff-to-patient ratios, changing shifts, long hours)</li>
</ul>
<p>These nurses often witness the physical, emotional, and economic toll of GVHD on the patient and their family. Because of the nature of this highly specialized form of nursing, SCT nurses can experience high levels of stress leading to burnout.</p>
<h2>Recognizing Burnout Symptoms</h2>
<p>Burnout signs and symptoms fall into 3 categories: physical, emotional, and behavioral. Below are some examples you may experience or notice in your colleagues.</p>
<ul>
<li><strong>Physical signs and symptoms </strong>
<ul>
<li>Anxiety</li>
<li>Appetite changes (undereating or overeating)</li>
<li>Difficulty sleeping</li>
<li>Exhaustion</li>
<li>Frequent illnesses</li>
<li>Headaches, muscle pain, stomach aches</li>
</ul>
</li>
<li><strong>Emotional signs and symptoms</strong>
<ul>
<li>Career dissatisfaction</li>
<li>Critical or cynical mood</li>
<li>Detachment</li>
<li>Feelings of helplessness or hopelessness</li>
<li>Lack of motivation</li>
</ul>
</li>
<li><strong>Behavioral signs and symptoms</strong>
<ul>
<li>Frequently calling in sick</li>
<li>Frustration or lack of tolerance</li>
<li>Isolation and withdrawal</li>
<li>Poor judgment or medication errors</li>
<li>Substance abuse (eg, alcohol, drug, food)</li>
</ul>
</li>
</ul>
<p>A change in patient engagement may be one of the first signs of burnout. Peers may notice a difference in bedside or chairside manner. Their colleagues may seem short, rude, or uncaring. They may limit patient time, seem less sensitive, or show a lack of empathy. These are signs of depersonalization, detaching feelings, or emotionally disconnecting from people.</p>
<p>To successfully care for SCT patients, especially those with GVHD, oncology nurses must build resilience. Here are <a href="https://cancernursingtoday.com/post/the-importance-of-oncology-nursing-resiliency-in-gvhd-and-how-to-achieve-it">concrete ways nurses can achieve resilience</a> to get you started. If you recognize early signs and symptoms of burnout, act. Increase your self-care and talk with your manager. Your patients with GVHD deserve the best from you, so keep educating yourself on how to avoid burnout.</p>
<h3><strong>References</strong></h3>
<p><a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">Nurse Burnout</a></p>
<p><a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281" target="_blank" rel="noopener">World Health Organization: Burnout</a></p>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4632" target="_blank" rel="noopener">Prevalence of Burnout Syndrome in Oncology Nursing: A Meta-analytic Study</a></p>
<p><a href="https://www.nursingworld.org/foundation/programs/stress-first-aid-for-nurses/" target="_blank" rel="noopener">Stress &amp; Burnout Prevention Program</a></p>
<p><a href="https://cancernursingtoday.com/post/recruitment-strategies-for-nursing-students-to-care-for-patients-with-gvhd" rel="noopener">Recruitment Strategies for Nursing Students to Care for Patients With GVHD</a></p>
<p><a href="https://cancernursingtoday.com/post/the-importance-of-oncology-nursing-resiliency-in-gvhd-and-how-to-achieve-it" rel="noopener">The Importance of Oncology Nursing Resiliency in GVHD and How to Achieve It</a></p>


<p>Oncology nursing is stressful, even more so than working with other patient populations. Adding to oncology nurses’ stress is the emotional toll of working with blood cancer patients with life-threatening or debilitating complications such as graft-versus-host disease (GVHD) after allogeneic stem cell transplant (SCT).</p><p>Unsurprisingly, nurses working with this patient population are at high risk for burnout. Oncology nurses must define, identify the risk for, understand the reasons of, and recognize burnout. In addition, they must constantly build resilience to prevent and manage burnout, especially when caring for SCT patients with GVHD.</p><h2>Defining Burnout and Oncology Nursing Risk</h2><p><a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">Burnout</a> is “emotional, mental, and physical exhaustion caused by excessive and prolonged stress.” Workplace burnout is so prevalent that the <a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281" target="_blank" rel="noopener">World Health Organization</a> (WHO) made it an official medical diagnosis. The WHO describes it as “a syndrome resulting from chronic workplace stress that has not been successfully managed.” It often contains 3 dimensions:</p><ol>
<li>Energy depletion and emotional exhaustion</li>
<li>Depersonalization or mental distancing</li>
<li>Lower personal accomplishment or effectiveness</li>
</ol><p>Approximately <a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">38% of nurses</a>—or nearly 4 of 10—experience burnout across all specialties. In a <a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4632" target="_blank" rel="noopener">meta-analysis study</a> of almost 10,000 oncology nurses, more than one-third were at high risk for burnout from emotional exhaustion and low levels of personal accomplishment.</p><h2>Identifying Burnout Risk in SCT Nursing and GVHD Care</h2><p>Unfortunately, the specific burnout rates in SCT nurses, particularly those working with patients with GVHD, are unknown. However, oncology nurses caring for these patients are at high risk for developing burnout from the physical, emotional, and spiritual care demands. Ask any SCT manager, administrator, or leader, and they will likely concur that stress and burnout rates are high.</p><p>In addition, the <a href="https://www.nursingworld.org/foundation/programs/stress-first-aid-for-nurses/" target="_blank" rel="noopener">American Nurses Foundation’s Pulse on the National Nurse survey</a> found that Millennial and Generation Z (<a href="https://www.britannica.com/topic/Generation-Z" target="_blank" rel="noopener">Gen Z</a>) nurses report higher burnout levels than their older peers. <a href="https://cancernursingtoday.com/post/recruitment-strategies-for-nursing-students-to-care-for-patients-with-gvhd" rel="noopener">Recruiting nursing students</a> is just one strategy to assist with building the SCT workforce The typical nursing graduates working in inpatient SCT are Gen Z.</p><h2>Understanding Reasons for Burnout in GVHD Care</h2><p>Oncology nurses caring for patients with GVHD are at increased risk for burnout for many reasons, including:</p><ul>
<li>Compassion fatigue</li>
<li>Complex care</li>
<li>Moral distress</li>
<li>Patient acuity</li>
<li>Physical demands</li>
<li>Rapid medical or technological advances</li>
<li>Sickness and death</li>
<li>Working conditions (eg, staff-to-patient ratios, changing shifts, long hours)</li>
</ul><p>These nurses often witness the physical, emotional, and economic toll of GVHD on the patient and their family. Because of the nature of this highly specialized form of nursing, SCT nurses can experience high levels of stress leading to burnout.</p><h2>Recognizing Burnout Symptoms</h2><p>Burnout signs and symptoms fall into 3 categories: physical, emotional, and behavioral. Below are some examples you may experience or notice in your colleagues.</p><ul>
<li><strong>Physical signs and symptoms </strong>
<ul>
<li>Anxiety</li>
<li>Appetite changes (undereating or overeating)</li>
<li>Difficulty sleeping</li>
<li>Exhaustion</li>
<li>Frequent illnesses</li>
<li>Headaches, muscle pain, stomach aches</li>
</ul>
</li>
<li><strong>Emotional signs and symptoms</strong>
<ul>
<li>Career dissatisfaction</li>
<li>Critical or cynical mood</li>
<li>Detachment</li>
<li>Feelings of helplessness or hopelessness</li>
<li>Lack of motivation</li>
</ul>
</li>
<li><strong>Behavioral signs and symptoms</strong>
<ul>
<li>Frequently calling in sick</li>
<li>Frustration or lack of tolerance</li>
<li>Isolation and withdrawal</li>
<li>Poor judgment or medication errors</li>
<li>Substance abuse (eg, alcohol, drug, food)</li>
</ul>
</li>
</ul><p>A change in patient engagement may be one of the first signs of burnout. Peers may notice a difference in bedside or chairside manner. Their colleagues may seem short, rude, or uncaring. They may limit patient time, seem less sensitive, or show a lack of empathy. These are signs of depersonalization, detaching feelings, or emotionally disconnecting from people.</p><p>To successfully care for SCT patients, especially those with GVHD, oncology nurses must build resilience. Here are <a href="https://cancernursingtoday.com/post/the-importance-of-oncology-nursing-resiliency-in-gvhd-and-how-to-achieve-it">concrete ways nurses can achieve resilience</a> to get you started. If you recognize early signs and symptoms of burnout, act. Increase your self-care and talk with your manager. Your patients with GVHD deserve the best from you, so keep educating yourself on how to avoid burnout.</p><h3><strong>References</strong></h3><p><a href="https://www.mywellbeingindex.org/nurse-burnout" target="_blank" rel="noopener">Nurse Burnout</a></p><p><a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281" target="_blank" rel="noopener">World Health Organization: Burnout</a></p><p><a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4632" target="_blank" rel="noopener">Prevalence of Burnout Syndrome in Oncology Nursing: A Meta-analytic Study</a></p><p><a href="https://www.nursingworld.org/foundation/programs/stress-first-aid-for-nurses/" target="_blank" rel="noopener">Stress &amp; Burnout Prevention Program</a></p><p><a href="https://cancernursingtoday.com/post/recruitment-strategies-for-nursing-students-to-care-for-patients-with-gvhd" rel="noopener">Recruitment Strategies for Nursing Students to Care for Patients With GVHD</a></p><p><a href="https://cancernursingtoday.com/post/the-importance-of-oncology-nursing-resiliency-in-gvhd-and-how-to-achieve-it" rel="noopener">The Importance of Oncology Nursing Resiliency in GVHD and How to Achieve It</a></p>

How to Identify Oncology Nursing Burnout in SCT and GVHD Care

GVHD

Burnout is easy to spot if you know what to look for. This article discusses the signs and symptoms and offers some prevention tips. 