MSN, RN, CCRP
Remote work has become much more normalized since 2020. While previously almost unthought of for a nurse, many initiated remote work at that time, whether by choice or mandate.
Remote nursing options are as diverse as care management; remotely observing patients to assist floor staff in higher-acuity areas; handling insurance claims or preauthorization; or even healthcare technology. While several reasons have led nurses to pursue remote work, one is burnout in the direct-care setting.
I previously worked in direct patient care as a clinical research nurse in adult oncology, so I’m no stranger to burnout. Now working remotely for a healthcare technology company, I realized that remote work is not immune from this issue.
Merriam-Webster defines burnout as “exhaustion of physical or emotional strength or motivation, usually due to prolonged stress or frustration.” Almost anyone who has worked as a nurse can describe a time when they felt burned out. This might have occurred after several difficult shifts, low staffing, or poor treatment from management or physicians.
It’s so prevalent that the World Health Organization (WHO) has classified it as a diagnosis.
While burnout isn’t a surprise in the hospital or clinic, many move to a remote environment to avoid feeling emotionally exhausted, frustrated, cynical, and unable to complete tasks to their satisfaction
But why do these feelings occur in a remote environment? Are there factors that cause this to occur more frequently than you might expect? And most importantly, what can you do to prevent or alleviate burnout in a remote environment?
While some factors that lead to burnout occur remotely and on-site, others are unique to the remote setting.
Of course, there are obvious causative factors in either environment. These include insufficient support from management or other staff members, working through difficult situations, and short staffing in proportion to the workload.
However, variables unique to remote work — like “feeling chained to the desk,” an inability to disconnect from work, an increased level of disconnect with other team members, and feelings of isolation — also are likely to cause burnout.
The biggest contributor is an increased workload beyond reasonable expectations. According to a “Frontiers in Psychology” article, heavy workloads and enforced work decrease productivity, engagement, satisfaction, and feelings of trust from the employer. In addition to increased work stress, this also hurts the employee’s personal life.
In an in-person setting, the manager is usually near the central hub of activity, or at least in the same building or campus. This allows staff to voice concerns or describe challenges to their manager in a face-to-face conversation
But when staff could be scattered all over the country or world, those conversations can be more challenging.
Navigating schedules in different time zones, not being aware of your coworkers’ availability, or never having a true face-to-face meeting with team members can lead to feelings of insufficient support. Back-and-forth conversations via email, messaging, or phone calls about required tasks can leave you feeling lost, frustrated, or inadequate.
This problem is not easily solved, but literature supports that strong organizational systems, specifically adapted to the remote environment, can be helpful. Giving employees control over their work day and employer’s requirements has been shown to reduce psychological stress and burnout.
The key to strong support and leadership in remote settings is directly related to the emotional intelligence (EI) of management, according to a study published in “Healthcare.”
“EI can adjust the behaviors and attitudes of employees in a workplace environment, reducing the levels of work stress and burnout and increasing overall job performance,” the authors stated.
Strong leadership should help employees cope better to reduce burnout and improve well-being. The “Healthcare” study also found that virtual leadership strongly influences their team’s success, or lack thereof.
Heavier than reasonable workloads can lead to burnout in both work environments. However, it may be easier to find someone to assist with the work in an in-person setting.
Typically, in a clinic or bedside setting, the staff performs routine tasks for patients with a usual list of diagnoses or presentations. In the remote setting, individuals may be tasked with different jobs for different clients and there may be little overlap between employees even in the same role.
Sometimes, it comes down to “too much work” and too few people. This can frustrate staff, leadership, and other external and internal stakeholders.
A major factor leading to burnout in the remote setting is the inability to disconnect from the “office.” This occurs because the office is almost always at home, and most employers expect employees to always be accessible. Working with colleagues and clients in another time zone also requires employees to be available outside the normal “9-5.” This can impinge on family or personal time and cause stress and anxiety about work outside of working hours.
Working in a virtual world can promote feelings of loneliness and isolation, especially if the team does not use communication tools or meet regularly. There is no opportunity to walk down the hall to talk with the manager or other staff to clarify or obtain assistance on issues.
According to myhours.com, a more individualized factor leading to burnout is the inability to create a routine. This can cause you to feel disorganized and lead to low productivity
These feelings, when felt in tandem with overload, the inability to disconnect, and insufficient support frequently lead to emotional exhaustion, cynicism, and a reduced sense of personal achievement. According to Nurse Fern, scope creep, which is also becoming more pronounced in the remote setting, places more work on remaining employees in the aftermath of layoffs.
Employees should be open and honest with their leadership about realistic expectations. But keep in mind this discussion may not alter anything related to your responsibilities. The remote nurse must be aware of both the symptoms of burnout and what can be done to prevent or mitigate them.
Burnout symptoms, according to myhours.com, include physical, emotional, and behavioral manifestations.
There is a new self-care trend on social media almost every day, which can be both encouraging and discouraging. So it’s best to start with the basics. From a work perspective, you must inform leadership of your emotional state. This is a good point to set realistic expectations about availability
While it’s reasonable for an employee to be accessible during typical business hours, they should not be expected to be available all the time. Another easy task an employee can perform is to prepare for the next day at the end of the day so a mental disconnect is easier. This allows the employee to focus on their life outside of work.
The nurse must set clear boundaries between work and life as much as possible. A space in the house devoted strictly to work can help, along with muting notifications on cell phones for work-related items outside of business hours. Participating in self-care activities such as yoga, other forms of exercise, mindfulness, or other hobbies can also help quite a bit.
Remote work has become much more prevalent in recent years. Previously, nurses were unlikely to work remotely but now have taken on more remote work. However, the remote environment does not necessarily eliminate nurse burnout. A remote nurse must be aware of what causes burnout, the symptoms, and, most importantly, tactics to reduce feelings of burnout. As remote work continues to occur, nurses need to remember to first and foremost care for themselves if they want to be able to care for others.
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