Part II: 1974 to the 1980s: What is Burnout?
The Continuing Discourse on How to Discuss & Solve U.S. Nursing Burnout: A Historical Perspective on the Issue, From 1974 to 2023
———————————————————————
1974 to the 1980s: What is Burnout? Nurses and Human Service Providers
The term “burnout” was first conceived by psychologist Dr. Herbert Freudenberger, PhD in his 1974 journal article “Staff Burn-Out”. In historian Matthew Hoffarth’s “The making of burnout: From social change to self-awareness in the postwar United States, 1970-82”, he describes how burnout manifested itself when a U.S. counterculture movement of idealist human service providers attempted to assist individuals at human service institutions and free clinics in the 1970s. “Human service providers” can be described as individuals who work in the “interdisciplinary practice of serving your fellow human beings”, which includes professions such as nurses, counselors, psychologists, probation officers, school social workers, etc. Specifically looking at the work of psychologist Herbert Freudenberger and social psychologist Christina Maslach, Hoffarth observed that human service providers were absorbing the issues of both their customers and the spaces they worked in. Freudenberger worked at free health clinics in San Francisco and New York City in the 1970s to create “spaces where young people could find medical and psychological care as well as a substitute family structure”. The over-commitment to serving these individuals is what led human service providers to develop physical and mental exhaustion.
Freudenberger was one of these human service providers, and he subsequently wrote about his experiences of “burn out” in the aforementioned 1974 journal article. His 1974 definition of burnout can be defined as when an individual experiences exhaustion due to extreme demands on energy, strength, and capitals that leads them to become ineffective in achieving their intents and purposes. As evident from my conversation with my CNA mother, nurses not only have a role to care for the health of their patients. They also have to care for their own sanity and health while also juggling their administrative responsibilities and acting as a second family member to their patients. In 1979, Dr. Frances Storlie, PhD, RN, former faculty administrator for the adult nurse practitioners programs at the University of Nevada and Arizona State University, wrote an article titled “Burnout: The Elaboration of a Concept”. Storlie describes burnout as the “collapse of the human spirit,” or the inability for a nurse’s ideals and beliefs to carry through into their work. She believes that a nurse’s burnout stems from: 1) nursing schools not preparing them for real-world hospital situations, 2) having to juggle both caring for a patient and completing their managerial responsibilities, and 3) not having their medical expertise and opinions being taken seriously. Some of Storlie’s solutions to burnout pertain to creating a workplace environment that encourages sharing and support without repercussions of losing their job. Storlie’s perspective is stark because the language of her article suggests the sentiment that nurses in the 1970s were more concerned about retaining their profession rather than worrying about their own wellbeing. Throughout history, women have been the main figures that individuals would think of donning white dresses in the makeshift hospital camps on the battlefield or early mental institutions and donning scrubs in the hospital setting. Considering that women have and still do dominate the field of nursing, Storlie’s remarks of nurses dealing with burnout to keep their job infers a possible worry that women in the workplace would be no more because of the inability to solve their burnout. A reason for this worry could be because of how heavily male-dominated every other field in the United States and around the world was at the time and is still true today. According to the Journalist’s Reserve historical statistics, “The percentage of women in the workforce has risen from 43.3% in 1970 to 58.6% in 2010 . . . [while] the percentage of men in the workforce fell from 79.7% to 71.2% [over the same period]”. If nurses already have a huge carving of the nursing profession and not many other fields, the last thing that U.S. nurses would want in the 1970s is to face more prejudice than they already do in work, salary earnings, and opinions.
The sentiments felt by both Dr. Freudenberger, PhD and Dr. Storlie, PhD, RN can best be visualized by looking at illustrations in Edwina A. McConnell’s 1982 published book “Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs”. These illustrations were drawn by nurses themselves when asked the question of how they would visualize the burnout that they are experiencing. First, Figure 1 depicts a droopy flower, inferring that nursing burnout can feel like you are down and have no energy to continue your day. Next, Figure 2 shows a nurse exploding at the seams of their scrub uniform, suggesting that nurses can also view burnout as a buildup of overwhelmed feelings to the point that you feel like you are about to explode. Lastly, Figure 3 shows a nurse not knowing how to respond to multiple requests that are being asked of them, which can be interpreted as the nurse never being asked if they need help to cope with their huge stack of responsibilities. These images and many more in McConnell’s book encompasses Freudenberger’s sentiments of being overcommitted to caring for others’ needs and Storlie’s feelings of the nurse’s body caving in and eventually giving up. These three scholars together show that nursing burnout is not just exhaustion and stress. It is also the feeling of being overwhelmed, stretched too thin, and no longer having anything within yourself to continue functioning.
In addition to the feelings of burnout, psychologist Wilmar Schaufeli attempts to understand the impact on the human service sector due to burnout in his book chapter “Burnout: A Short Socio-Cultural History”. He offers a handful of reasons that burnout emerged first amongst human service providers and then post-war industrial workers as a whole. Schaufeli believes that “rapid professionsation and bureaucratisation as a result of greater government and state influence” caused there to be a clash in a provider’s personal values and their institution’s organizational values.
Schaufeli’s description of bureaucracy and professionalization negatively impacting a nurse's health and well-being coincides with the complaints that my mother and her colleagues have described with hospital administrations. One financial complication of my mother’s long-COVID experience was not receiving worker’s compensation for her one month period of being bedridden due to her catching COVID from one of her patients in the makeshift COVID unit. Higher up administrators determined that going into the COVID unit meant that she was signing up for possibly getting COVID from the patients, meaning that she was left to deal with her partial salary time and further health complications alone. She described feeling “alone” and “uncared for”, despite her over 16 years of service to one of the most complicated and taxing telemetry units in a hospital.
As a partial tangent, a further health complication of my mother’s long-COVID was undergoing costly two surgeries, multiple oral medications, and injections to fix her frozen shoulder that she tore on the job after returning to work over Summer 2020. Because this complication was not considered a work injury but rather a complication from one of her “personal underlying health issues,” she had to pay out-of-pocket for all of her medical interventions, leaving her in extreme debt and sufficiently low outlooks on her future as a human. Burnout not only causes stress and exhaustion. Burnout can also cause financial ruin and poor mental health outcomes.
In order to combat burnout, Hoffarth discussed that social psychologist Dr. Christina Maslach, PhD wanted to focus on creating barriers to help service workers lessen their burnout. Maslach continued Freudenberger’s theory of burnout by making the term “burnout” more mainstream rather than the term just simply being an idea in his journal articles. As stated in Hoffarth’s journal article, “Maslach’s ‘social’ psychology focused on ways to protect service workers by erecting emotional and physical barriers between them and their clients. This type of ‘social change’ was, of course, quite different from the social change that counter-cultural figures had been calling for in the mid-1960s when they started the alternative health movement.” Maslach’s suggestion of creating barriers with your colleagues and environment emphasize how burnout can be caused by a toxic relationship with your work environment. In the field of nursing, the environment can be toxic because of all of the nurses’ responsibilities and their limitations set forth by their hospital administration.
———————————————————————
FOOTNOTES
Herbert J. Freudenberger, “Staff Burn-Out,” Journal of Social Issues, 30 (1974): 159, https://doi.org/10.1111/j.1540-4560.1974.tb00706.x
Matthew Hoffarth, “The making of burnout: From social change to self-awareness in the postwar United States, 1970-82,” History of the Human Sciences 30, no. 5 (Dec 2017): 32, https://doi.org/10.1177/0952695117724929.
“What is Human Services?” HumanServicesEdu.org, https://www.humanservicesedu.org/what-is-human-services/.
Anonymous-Named Individual (Author’s Mother), May 6, 2023.
Frances J. Storlie, “Burnout: The Elaboration of a Concept,” The American Journal of Nursing 79, no. 12 (1979): 2108–11. https://doi.org/10.2307/3469867.
Margaret Weigel, “Women in the Labor Force: A Databook,” The Journalist's Reserve, February 23, 2012, https://journalistsresource.org/economics/women-labor-force-data-longitudinal/.
Edwina A. McConnell, “Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs,” (St. Louis: C.V. Mosby Company, 1982), 104, 105, 212.
Wilmar B. Schaufeli, “Burnout: A Short Socio-Cultural History,” In Burnout, Fatigue, Exhaustion: an Interdisciplinary Perspective on a Modern Affliction (Cham, Switzerland: Palgrave Macmillan, 2017), 109.
———————————————————————
FIGURES
Figure 1: Drooping flower representing a nurse's visualization of burnout, from Edwina A. McConnell’s “Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs”, Page 105.
Figure 2: Exploding nurse representing a nurse's visualization of burnout, from Edwina A. McConnell’s “Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs”, Page 104.
Figure 3: Nurse being bombarded with requests, representing a nurse's visualization of burnout, from Edwina A. McConnell’s “Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs”, Page 212.
