Nurse Practitioner Burnout: How to Recognize, Manage, & Prevent It

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Burnout is an enormous topic that has never been more relevant to the general public, let alone the health care field. Prepandemic, there was more stigma attached to mental health in health care settings. But now, over two years into the pandemic, burnout seems ubiquitous and an assumed aspect of many workplaces. You may catch a whiff of it as equally from your local ED clinician as from your area pharmacist.

A colleague recently told me, “We are all in the frying pan now. Some of us just have the heat turned up a little higher and longer.” Preventing and addressing burnout feels like another form of PPE that we all must know how to identify and use.

After working in health care for more than 10 years, I’ve gained my own perspective and advice about nurse practitioner burnout. Based on my experience, here’s how you can identify, manage, and prevent burnout as a nurse practitioner.

What is burnout?

As defined by the World Health Organization, burnout is a phenomenon isolated to the workplace:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”

Although burnout as a term dates back to the 1970s, it remains a somewhat contentious concept. One place to start in conceptualizing burnout is by identifying what it is not. Burnout is not a medical condition, “a bad attitude,” or depression, though there can always be some combination of the three. It is not an end state, but rather a dynamic and multidimensional experience.

It’s common to experience the dimensions of burnout regularly in health care, as the work can be physically and emotionally exhausting. Clinicians often use “gallows humor” to cope with the daily grind and a sense of their work being at odds with health determinants or, at times, public will.

The related concept of “moral injury” is also common in health care, though it’s distinct from burnout. Moral injury stems from constraints beyond one’s control (i.e. distress from not being able to provide what patients need), while burnout stems from demands on one’s energy or strength.

There is still no unifying “gold standard” approach to addressing burnout in health care settings. While there are calls to assess burnout among individuals, correctly interpreting and assessing this data is a bit more nebulous.

What does burnout look like as a nurse practitioner?

Before the pandemic, there was a common notion in health care that self-identifying with burnout was admitting to failure. The idea was that successfully managing stress was an individual issue, and the solution was to “do more yoga” or “reach out to a friend.”

Now, most health care institutions recognize the chronicity of pandemic stressors, moral injury, and the need to assess for burnout. Some institutions are also leading the way in addressing the culture change needed within health care to prevent burnout. These initiatives can be in the form of “engagement” surveys, but (speaking from personal experience) it’s often hard to discern the direct impact or outcomes.

As a trainee and new grad, you will likely be a clear mirror to reflecting burnout, whether you see it during your clinicals or in your future workplace. It may be your preceptor or their colleague. It may look like the loss of clinical curiosity, hope, or a sense of contribution. More extreme versions can come in the form of using substances or withdrawing socially.

Whether burnout is already in your midst or soon to be, it’s important to be proactive and realistic to minimize your risk of burnout as a nurse practitioner.

How do I lower my risk for nurse practitioner burnout?

Beyond the incalculable value of your support people (a healthy team, peers, “work-wife/spouse,” and mentors), the structures that undergird your work experience are essential for mitigating the flames that can lead to burnout.

When it comes to lowering your risk for burnout, there are a few preventative steps to take before entering a potentially unsustainable work situation.

Choose your workplace wisely

When researching workplaces, I think “real talk” on how a team or institution deals with burnout is a telling signal. It reflects leadership’s engagement and investment with clinical staff and their realities. This inevitably is reflected in how fulfilled someone claims to be with their job and employer.

There are many progressive institutions that have programming to support and prevent burnout. A few examples include coaching services, committees, work groups, sabbaticals for staff, and unlimited PTO. From my experience, the greater the transparency on the subject, the healthier the organization.

Grow your people

Remember when you were little and were paired with another kid during field trips? I highly recommend investing time and energy to connect with and get to know your colleagues. Not only does this make work more fun, you’ll also have a way to better monitor your mental health. You may even find a new best friend or simply someone with whom you can share clinical experiences. Over time, as you encounter risk factors for burnout, this person may serve as an accountability partner.

Next, prioritize identifying your mentors. These are the people who you may admire from their teaching or leadership style. More than once, I have approached someone at work and been direct about identifying them as a mentor. If you find yourself in a place where you no longer recognize yourself or are out of alignment with your professional goals, having one or even a handful of mentors throughout your career goes a long way.

How do I minimize the effects of burnout?

If you’re currently experiencing burnout, consider what it is about your situation that’s unsustainable for you. Some building blocks for this are considering your schedule, your ongoing development and leadership, and your counterbalance in life outside of work. In short, think through the aspects of work you can control versus what you cannot.

Modify your schedule

Perhaps one of the most overlooked contributors to burnout is your commitment to a schedule. Maybe you know that you can’t work the third shift, ever. Perhaps you’ve found the restorative value of a long weekend every few months if your PTO allows it, or you know that you have to be out the clinic door by 4 PM every day. Going back to our frying pan and marshmallow analogies, your schedule largely determines your protection from the effects of burnout.

Seek ongoing professional development

As in many fields, the health care field highly values ongoing education. Investing in your professional development is essential for maintaining your license and credentialing. Your employers may even reimburse your efforts with additional time or money. Take advantage of this opportunity and sign up for that conference in a location where you can tag on a mini vacation at its end.

If there is a specific training you want to earn, see how it can tie into your team or organization’s goals or needs. If you participate in an (ideally semi) annual review process, this is a great space to float some ways that perhaps your own goals can align with your workplace. Even if you end up participating in a given training or professional development experience that is not facilitated or supported by your employer directly, your increased expertise and engagement will serve that setting or the next job you lead yourself to.

Identify your counterforces to work

Again, many more employers are evolving beyond the notion of “work/life balance” and promoting more flexibility in schedules, PTO, and the idea of one’s work role being a subset of their overall lifestyle. If you are working there already, lucky you!

For the rest of us, it can require some attention and intention to create space for activities we want to engage with that do not result in a paycheck. The investment in that aikido or pottery class, more time with your kids or dog, or that 10k race this year will inevitably serve as a counterbalance to work demands.

I think one of the most successful antidotes for at least a serious case of burnout is supporting yourself to identify and invest in activities you love. Whether it’s channeling the stress of the work through some high-intensity exercise or keeping your mind limber in learning a new language, the activities we enjoy help temper the threats or effects of burnout.

While much of the world has experienced some level of disillusion, fatigue, and perhaps even hopelessness due to the pandemic, I would argue that for those of us in direct and consistent service to others as health care workers, burnout can have more significant consequences for our patients and society as a whole.

Depending on your career trajectory, it may not be possible to completely inoculate yourself from nurse practitioner burnout. Hopefully, however, there is an idea or two here that will serve you as you navigate your journey ahead.

Rosh Review is a board review company offering Qbanks and online educational resources to physicians, PAs, and nurse practitioners around the world. Find more free NP content on the Rosh Review blog or start a free trial.

By Alana Rose, FNP

Alana Rose, BSN, CNP, ACHPN, is a nurse practitioner currently working in rural Maine. She completed an undergraduate degree in cultural anthropology at the University of Pennsylvania, and was inspired to pursue a BSN/MSN through the University of Southern Maine after living abroad in rural Tanzania. For over a decade she has worked in healthcare, from mobile health clinics in service of migrant farmworkers to a bustling FQHC as a primary care provider and more recently in palliative care. She is a lifelong learner and has also spent a decade in leadership coaching (www.primary-intention.com). Alana believes that empowered learners/trainees become valuable agents of change needed in our healthcare systems. You can find Alana on Twitter @alanarosenp!