Nursing is one of the most demanding and emotionally taxing professions. Nurses are not only responsible for providing direct patient care but are also tasked with managing complex emotional and psychological challenges in an environment often characterized by high stress, long hours, and an overwhelming sense of responsibility. The American Nurses Association (ANA) reports that burnout is increasingly common among nurses and contributes to a feeling of diminished personal accomplishment (ANA, 2024). Theofanidis et al. (2022) refer to burnout among nurses as the “new pandemic” in an environment of physical and psychological demands, with a staggering 62% of nurses reporting feelings of burnout. Among those, 69% are nurses younger than the age of 25. This leads to increased turnover and early attrition from an already-taxed profession; in Missouri alone, there are 6,982 staff nurse vacancies (Missouri Hospital Association, 2023). The World Health Organization (2019) has classified “Burnout Syndrome” as an occupational hazard.

According to the ANA (2024), symptoms of burnout are many:

• Emotional exhaustion: feeling drained, fatigued, detached from work
• Depersonalization: a sense of cynicism, detachment, or negativity toward patients or colleagues
• Reduced personal accomplishment: a feeling of ineffectiveness or lack of achievement in one’s role

Emotional exhaustion and psychological injury are not just bad for the nurses who experience it. Decreased performance and loss of productivity leads to compromised quality of care for patients. A systematic review by Li et al. (2024) found that hospital acquired infections, patient falls, medication errors, and lower patient satisfaction are directly correlated with high levels of nurse burnout. Combined with personal life roles and demands in a largely female workforce, the risk of burnout is immense (APA, 2023).

Moral injury is a term used to describe frustration and powerlessness that nurses experience when they are repeatedly involved in situations where their own moral or ethical standards are violated (ANA, 2024). Burnout is a symptom of moral injury and the two often manifest together. Addressing both burnout and moral injury requires systemic changes at the organizational and policy levels to ensure long-term improvement in healthcare work environments (Dean et al., 2019; Li et al., 2024). In the current environment of limited resources and a challenging healthcare system, nurses must be proactive and learn strategies to protect themselves.

The Power of Mindset

Thought leader Cy Wakeman (2018) points out that burnout has a stronger correlation with how we respond to the work than the work itself. It is easy to blame our circumstances for feelings of burnout, but this leaves us feeling hopeless and helpless. Wakeman believes that by focusing on the pressures of the job, we are missing the opportunity to take responsibility for our own mindset. Nurses can protect themselves by actively cultivating a mindset that fosters resilience and well-being. This might mean:

• Letting go of the frustration over being understaffed or overworked.
• Avoiding emotional reactivity when facing difficult patients or coworkers.
• Stopping the cycle of complaining, which only amplifies feelings of helplessness.

Wakeman advocates for focusing on what is within our control to reduce the emotional drain. Instead of telling ourselves, “This job is too hard, and I’m overwhelmed”, reframe your thinking to “This job is difficult, but it is my personal goal, and I can manage my responses to the stress”. This shift moves us out of helplessness and into a growth mindset where challenges are viewed as opportunities to grow. Self-care is less about rituals like hot baths and chocolate and more about creating a mindset that allows you to thrive (Wakeman, 2018).

Three Good Things

One practical and effective tool that has garnered attention in recent years for its positive impact on mental health is the evidence-based Three Good Things (3GT) gratitude exercise. 3GT was popularized by psychologist Martin Seligman and involves reflecting on three positive things that happened during the day. Seligman found that those who engaged in mindful, intentional journaling experienced a significant improvement in happiness and depression. By actively focusing on positive experiences, no matter how small, individuals cultivate an attitude of gratitude that helps shift their attention away from negativity and stress (Adair et al., 2020).

Dr. Bryan Sexton, director of the Patient Safety Center at Duke University, is an advocate for mental health and he pioneered the use of 3GT in healthcare. He and his colleagues, Adair et al. (2020), conducted studies with nurses and other healthcare staff members to express three good things from their shift. At the end of each day, healthcare members could email, text, write down, or verbalize three good things from that day. Results showed staff eating more balanced meals, taking more breaks during their shifts, improved sleep, and improved personal life. Symptoms of burnout decreased by 22%. Participants experienced a 40% drop in depression, increased work-life balance, fewer conflicts with colleagues, and a self-reported increase in resilience from 49% to 71%. The study was conducted over two weeks and had lasting impacts for up to a year after it concluded.

In another study by Gold et al. (2023), the 3GT practice was implemented at an academic institution. Participants reported less emotional exhaustion, decreased depressive symptoms, improved work-life balance, and were less likely to leave their job. They also reported elevated happiness. While participants in this study returned to baseline at 3-6 months after the intervention, it was a low-cost intervention that highlights the need for further research and solutions.

Gratitude exercises like 3GT forces nurses to slow down, take stock of their day, and appreciate the small moments that may otherwise go unnoticed. This practice encourages a more intentional, present-moment awareness, which can help nurses feel more in control of their emotional responses to the challenges of their job. It also helps them recognize the value of their work, even on difficult days, reinforcing a sense of purpose and satisfaction (Adair et al., 2020). It can be started by anyone at any time with little to no cost using journaling, social support, or the digital version of the 3GT tool.

3GT is a simple yet powerful tool to improve individual well-being and workplace culture. Systemic problems affecting burnout must be addressed and when instituted on a larger scale, 3GT can result in improved teamwork, lower turnover, and increased engagement. It helps individuals, teams, and organizations focus on the positives, build resilience, and resist pervasive negativity. It can help nurses not only survive but thrive in a profession that demands so much of them.

References

Adair, K. C., Kennedy, L. A., & Sexton, J. B. (2020). Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions. The Journal of Positive Psychology, 15(5), 613–622. https://www.tandfonline.com/doi/full/10.1080/17439760.2020.1789707

American Psychological Association [APA] (2023, May 12). Employers need to focus on workplace burnout: Here’s why. https://www.apa.org/topics/healthy-workplaces/workplace-burnout

ANA. (2024, April 25). Nurse burnout: What is it & how to prevent it. https://www.nursingworld.org/content-hub/resources/workplace/what-is-nurse-burnout-how-to-prevent-it/

Dean, W., Talbot, S., & Dean, A. (2019). Reframing Clinician Distress: Moral Injury Not Burnout. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 36(9), 400–402. https://pmc.ncbi.nlm.nih.gov/articles/PMC6752815/

Gold, K. J., Dobson, M. L., & Sen, A. (2023). “Three Good Things” Digital Intervention Among Health Care Workers: A Randomized Controlled Trial. Annals of family medicine, 21(3), 220–226. https://doi.org/10.1370/afm.2963

Levine, D. (2022, October 5). Tackling Health Care Burnout. U.S. News & World Report. https://www.usnews.com/search?int=homepage-homepage-header&q=Tackling+Health+Care+Burnout.

Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB, Shanafelt T. (2024). Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis. JAMA Netw Open, 7(11):e2443059. doi:10.1001/jamanetworkopen.2024.43059 https://pubmed.ncbi.nlm.nih.gov/39499515/

Missouri Hospital Association (2024). 2023 workforce report – MHA. https://www.mhanet.com/mhaimages/Workforce/2023/2023_Workforce_Report.pdf

Theofanidis, D., Boukas, A., & Fountouki, A. (2022). A “New Pandemic” at Hand: Burnout of Nursing Staff. International Journal of Caring Sciences, 15(3), 2028–2035. https://www.internationaljournalofcaringsciences.org/docs/41.theofaidis.pdf

Wakeman, C. (2018). No ego: How leaders can cut the drama and transform the workplace. Portfolio.

World Health Organization. (2019). QD85 Burnout. In International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281