The Wellbeing of the Nursing Workforce

May 11, 2016

This blog post was originally published on the OUPBlog at

By Mary Koithan and Mary Jo Kreitzer

In an op-ed published in the New York Times titled “Why You Hate Work”, Schwartz and Porath highlighted Gallup data that revealed that only 30% of employees in the US and 13% across 142 countries feel engaged at work. Noting the high rate of burnout, they declared that for most of us, work is a depleting, dispiriting experience that is getting worse.

Within health care, stress and burnout are very significant issues. In an article published by the Journal of Organizational Behavior, Maslach et al. associate burnout, with a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Burnout is associated with early retirement, alcohol use, and suicidal ideationA 2014 survey found that 68% of family physicians and 73% of internists would not chose the same specialty if they could start their careers anew. While the rate of burnout in nursing is not as high as in medicine, it is still significant. McHugh et al. found that 34% of hospital nurses and 37% of nursing home nurses report burnout.

Compassion fatigue, a related but distinct phenomenon, has recently emerged as a growing concern, particularly among nurses. Defined as the emotional residue or strain when exposed to suffering and repeated traumatic events, compassion fatigue has been linked to beliefs of the unfairness of life, feeling saturated by emotions, an inability to disconnect from work, and inability to accept support. While often accompanied by burnout, compassion fatigue emerges more suddenly and appears to affect a much greater proportion of nurses who bear witness to trauma on a daily basis without an opportunity for adequate resolution. Current literature suggests more than 80% of nursing staff will experience some degree of compassion fatigue during their career. Compassion fatigue has been associated with low morale, physical and emotional exhaustion, impaired job performance, absenteeism, and turnover. Some nurses who have left the profession prematurely described their departure as the only viable means to escape this unremitting stress.

As health care scrambles to respond to patient needs and fiscal realities, the concept of the triple aim has been introduced as a way to optimize performance. The focus of the triple aim is on improving the health of the population, improving patient experience, and reducing costs. Bodenheimer and Sinsky have proposed that the triple aim be expanded to a quadruple aim, adding the goal of improving the work life of health care providers, including clinicians and staff. Their point–care of the patient requires care of the provider. They make a strong case that chronic stress among the health care workforce threatens patient care and that organizations should be focusing on care team wellbeing.

Nursing requires the delivery of humane, empathetic, culturally sensitive, proficient, and moral care in working environments with limited resources and increasing responsibilities. When nurses experience burnout or compassion fatigue, it impacts their personal wellbeing as well as the quality and efficacy of patient care. Nurses experiencing ongoing stress are more likely to eat poorly, smoke cigarettes, and abuse alcohol and drugs. Lack of self-care is a pervasive issue that adversely impacts personal health and wellbeing, patient care and the organization as a whole.

We believe that integrative nursing provides a set of principles and practices that focus on whole person and whole system care and healing that is transforming care across clinical settings and patient populations globally. Integrative nursing is relationship-based, person-centered, and focuses on improving the health and wellbeing of caregivers as well as those they serve. The principles of integrative nursing offer clear and specific guidance that can shape and impact patient care in all clinical settings and improve the health and wellbeing of nurses.

  • Human beings are whole systems inseparable from their environments.
  • Human beings have the capacity for health and wellbeing across all dimensions (body, mind, spirit).
  • Nature has healing and restorative properties that contribute to health and wellbeing.
  • Integrative nursing is patient-centered and relationship-based.
  • Integrative nursing is informed by evidence and uses the full range of therapeutic modalities, moving from least intensive and invasive to more, depending on the need.
  • Integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve.

Recognizing the toll that chronic, unresolved stress and burnout has on nurses and the adverse impact on patient care, we are seeing more and more organizations looking for ways to increase the health, wellbeing, and resiliency of the staff. From respite rooms to stress reduction programs and wellbeing retreats, healthcare organizations are engaging nurses, physicians, therapists, and others to proactively identify and then address early symptoms that signal compassion fatigue and burnout. The American Nurses Association has recently launched the “Healthy Nurse, Healthy Workplace,” providing tips, tools, and techniques that support wellbeing and self-care across our profession.

As we celebrate Nursing Week, we invite you to take the time to invest in your own wellbeing, the most precious resource in health care today. As Janet Quinn reminds us, the journey to wellbeing begins with one degree of change. Ask yourself, “what is the one-degree change that I can make today that would bring me into a better relationships with myself?”


Mary Koithan, PhD, CNS-BC, FAAN, is the Anne Furrow Professor of Integrative Nursing and Associate Dean for Professional and Community Engagement at the University of Arizona College of Nursing. She is director of Community Cancer Connections, an online resource that promotes integrative approaches to wellbeing for those affected by cancer as well as the Integrative Nursing Faculty Fellowship that prepares nursing faculty to transform curricula and nursing education programs.

Mary Jo Kreitzer, PhD, RN, FAAN, is the founder and director of the Center for Spirituality & Healing at the University of Minnesota, and a tenured professor in the School of Nursing. She has more than 40 years of leadership and expertise in healthcare. In addition to her roles as nurse, teacher, healthcare administrator, and researcher, she is also an internationally recognized innovator in the field of integrative health and wellbeing. She has authored more than 100 publications.

Mary Koithan and Mary Jo Kreitzer are also co-editors of Integrative Nursing.