1. ABSTRACT

Stress is a subjective feeling, based on an individual perspective. What one individual finds stressful, another may not. Burnout is not simply excessive stress; rather, it is a complex human reaction to stress. Some of the professionals are having some sort of stress, ie good for their professional development, but it is moderate to severe it may affect all activities of the individual. If you have any types of stress please ventilate with your closed ones, otherwise it may lead to the development of burnout syndrome. Through this article the author aimed to prevent stress and burnout among nursing professionals. So the nurses can work efficiently and effectively in their profession.

2. INTRODUCTION

Without work, all life goes rotten,
But when work is soulless, life stifles and dies.

3. SIGNIFICANCE OF THIS TOPIC

1. Research shows 1 in 5 nurses will experience burnout in their nursing career and consequently leave the profession (Wharton, 2004).
2. More than 40% of hospital nurses reported being dissatisfied with their jobs.
3. Graduate nurses are more susceptible to burnout because theoretical experience far outweighs practical experience.
4. Problems at work are more strongly associated with health complaints than any other life stressor

4. WHAT IS BURN OUT SYNDROME?
Burnout is "a syndrome of depersonalization, emotional exhaustion and a sense of low personal accomplishment that leads to decreased effectiveness at work" (Shanafelt002).
A state of mental and / or physical, exhaustion caused by excessive and prolonged stress (AIHW, 2002).

5. STAGES OF BURNOUT

Stage 1: Acceptance
Initial belief that new position or job will satisfy your expectations. You have boundless energy and enthusiasm. You have a positive outlook on your new position and believe that anything is possible and achievable.

Stage 2: Depression
Awareness that expectations were unrealistic. Needs are not satisfied. Rewards and recognition are scarce. Disillusionment and disappointment grow.

Stage 3: Bargaining
Early enthusiasm and energy give way to chronic fatigue, irritability and other burnout symptoms (Physical ,Psychological and Social).

Stage 4: Anger
Despair is dominant. Life seems pointless and Pessimistic attitude
Exhaustion both physical and mental. Possibility of suicide, stroke or heart failure

Stage 5: Denial and Isolation
Overcoming symptoms of burnout

6. PHASES OF BURNOUT

1. A compulsion to prove oneself.
2. Working harder.
3. Neglecting one's own.
4. Displacement of conflicts.
5. Revision of values.
6. Denial of emerging problems.
7. Withdrawal.
8. Behavioral changes become obvious to others.
9. Inner emptiness.
10. Depression

7. STRESS VS BURNOUT

Stress
• Characterized by over engagement.
• Emotions are overactive.
• Produces urgency and hyperactivity.
• Loss of energy.
• Leads to anxiety disorders.
• Primary damage is physical.
• May kill you prematurely

Burnout
• Characterized by disengagement.
• Emotions are blunted.
• Produces helplessness.
• Loss of motivation, ideas and hope.
• Leads to detachment and depress.
• Primary damage is emotions.
• May make life seem not worth living

8. RISK FACTORS OF BURNOUT

• Burn out is very high in creative, committed, ambitious individuals
• Perfectionist tendencies.
• Pessimistic view of yourself and the world.
• The need to be in control: reluctance to delegate to others.
• Often women between 35-50 years of age
• High achieving, type 'A' personality.
• Conflict between your personal values and the organizational values

9. WORK RELATED CAUSES OF BURN OUT

• Feeling like you have little or no control over your work.
• Lack of recognitions or rewards for good work.
• Unclear or overly demanding job expectations.
• Doing work that's monotonous or unchallenged.
• Inadequate pay.
• Under employment
• Lack of support on the part of the supervisor and colleagues.
• Lack of job satisfaction

10. SIGNS and SYMPTOMS OF BURNOUT SYNDROME

Physical:
Feeling tired, lowered immunity, feeling sick a lot, headache, backache, high B.P.
teeth grinding, fatigue, digestive problems, difficulty in sleeping, increased smoking or drinking alcohol, rapid breathing or pounding of the heart.

Emotional:
Sense of failure and self doubt, feeling helpless, detachment, feeling alone in the world,
apathy, negativism, low morale, depression, boredom, anxiety, anger/irritability, frustration, physical problems, absenteeism, loss of initiative, efficiency and interest, reduced work performance, insomnia.

11. HOW TO IDENTIFY THE STAFF HAVE BURNOUT?

• Negative outlooks (work and personal life)
• Inability to express sympathy / empathy towards patients or staff
• Physical and emotional exhaustion
• Excessive mistakes (medication, documentation etc)
• Excessive amounts of sick leave /workers compensation claims.
• Substance and alcohol abuse.
• Becoming detached from colleagues
• Aggressive behavior towards staff as well as patients.

12. DO YOU WANT TO KNOW WEATHER YOU SUFFER FROM THE BURNOUT SYNDROME?

1. Tiredness over weeks and months no matter how many hours you sleep at night.
2. Very depressive feeling and thinking.
3. Sleeplessness.
4. Your chest feels pressed together.
5. Your heart beats really hard and fast all the time.
6. Your appetite drives down to nearly zero.
7. Every day is a bad day.
8. Caring about your work or home life seems like a total waste of energy.
9. You are exhausted all the time.
10. The majority of your day is spent on tasks you find either mind-numb.
11. You feel like nothing you do makes a difference or is appreciated.

13. HOW TO AVOID NURSING BURNOUT?

1. Build in decompression time between the end of your shift and jumping into family activities. Sit quietly or write in a journal (Reflective Journal).
2. Enjoy your time off.
3. Relieve stress with relaxation and aerobic exercise.
4. Involve yourself in a good support system.
5. Take advantage of in-service opportunities and CNE.
6. Change of shift or specialty can renew the feeling.
7. Recognize your limits.
8. Distance yourself from symptoms which can not be changed.
9. Enter the patient in a self care management.
10. Seek support from positive minded caretakers who share common challenges.
11. Engage in a hobby or passion that is compatible with your caregiver role.
12. Recharge your batteries regularly.

14. STRESS MANAGEMENT

Preventive strategies:

NATURAL SPEED
• Sleep
• Priorities.
• Empathy
• Exercise.
• Diet

Organizational Level
• Ask your employer to establish a weekly or monthly support group.
• Find out solutions for the exact problem.
• Organize individual or group counseling
• Initiate some expressive activity such as dancing, yoga, painting, writing, or drawing to get your feelings out.
• Proper communication with all categories of staff. If any changes inform them in advance.
• Get periodical feedback.

For the Manager
Some of the activities the manager can do to prevent burnout among staff
• Implement a weekly plan,
• Be aware of subtle changes to your staff's attitude and performance
• Rotate tasks throughout the departments.
• Create incentives that reward good work.
• Demonstrate that you have confidence on them.
• Keep your staff informed about changes
• Engage them in team building activities.

15. TIME MANAGEMENT

Take time to work, it is the price of success
Take time to think, it is the source of power
Take time to play, it is the source of youth
Take time to read, it is the source of wisdom
Take time to love, it is the privilege of Gods
Take time to serve, it is the purpose of life
Take time to laugh, it is the music of soul

16. TIPS TO COME OUT FROM BURNOUT

1. Put in perspective.
2. Cultivate allies at work.
3. Modify your job situation.
4. Find humor in the situation.
5. Get time away.
6. Have realistic expectations.
7. Fight through the clutter.
8. Nobody is perfect.
9. Talk it out.
10. Maintain a positive attitude.

17. CONCLUSION

The professional nurses have to identify their causes of stress (work related or personal) and try to overcome the stress by proper stress management techniques. So we can prevent burn out among nurses.

BIBLIOGRAPHY
1. www.helpguide.org
2. www.ncbi.hlm.nih.gov
3. Bakker AB, Killmer CH, Siegriest J, Schaufeli WB. Effort-reward imbalance and burnout among nurses. Journal of Advanced Nursing.2000;31:884-891.
4. Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Rochard F, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175(7):698-704.

About Author / Additional Info:
Bindu Bharathi, Lecturer, Faculty of Nursing, Northern Border University, Saudi Arabia.

I have interest in research, social activities and women empowerment.