It’s concerning that mental illness among healthcare professionals is exceptionally high compared to the national average1. A study of suicides over 12 years found female nurses and midwives had a suicide rate almost triple that of women in non-health professions.

These statistics are alarming. However, it’s not surprising that the physical and emotional demands of nursing and midwifery can lead to occupational burnout.

Burnout depletes energy, leads to feelings of hopelessness and, at its worst, is a precursor to mental health problems like anxiety and depression.

Marcela Slepica, Clinical Services Director, AccessEAP, a leading employee assistance provider, says the unique challenges that affect the mental wellbeing of health professionals includes exposure to trauma, threats of aggression and violence, shiftwork, dealing with grief and loss, allegations and complaints, compassion fatigue and mental health stigma.

In the latest survey, What Nurses & Midwives Want: Findings from the National Survey on Workplace Climate and Well-being, almost a third of nurses and midwives have considered leaving the profession due to rising work demands and burnout.

According to the report, increasing workloads, work intensification and budget cuts leading to unrealistic nurse to patient ratios underscore leading triggers.

Data also revealed 71% of nurses and midwives feel they often have to do more work than they can do properly while 67% listed work intensification as a major issue. Alarmingly, 54% of nurses and midwives were apprehensive about reporting their concerns to management due to fear of negative consequences.

A Psychologist’s Perspective

Peter Charleston, a former psychologist in one of Australia’s largest tertiary hospitals, said nurses and midwives are at risk of burnout because they are altruistic and notoriously poor at self-care.

“They work hard, for long hours, in emotionally intense environments. I constantly had a long wait list of staff seeking therapy for their own distress and personal and professional issues.”

“Midwives have stressful jobs in that they regularly deal with people with high anxiety. They are emotionally involved in the birth process.  Their job also involves showing a lot of compassion, warmth and understanding, which can be emotionally taxing,” he said.

Healthcare professionals are trained not to show vulnerability and being emotional is seen as a weakness in some workplaces. It is this bottling up of one’s emotions that leads to stress if there’s no outlet, according to Charleston.

“Midwives are particularly at risk of burnout from the cumulative effect of dealing with people’s anxieties and distress during the birth process. And the stakes are high; all midwives know what could go wrong. The potential death of a newborn baby is ever present.”

Charleston advocates self-care in healthcare, including regular debriefing, time for rest and relaxation, and a conscious effort to satisfy one’s own practical and emotional needs.

“Many healthcare workers, midwives included, don’t give themselves adequate time for these activities because they care more for others than for themselves. The common element is low self-worth. If you don’t feel good enough, you won’t invest enough time to take care of yourself.”

“Helping others can be a legitimate way of avoiding yourself. So valuing yourself, and your needs, is a crucial aspect of improving the way you take care of yourself.”

The combination of a stressful, high-pressure work environment and lack of self-care can lead to burnout, and is best prevented, as treatment is difficult, said Charleston.

“Burnout involves complete physical and emotional shutdown. You cannot function, feel disconnected from your job, not unlike a machine going through the motions, and this is the result of accumulated stress over time,” he said.

Burnout: A Midwife’s Story

Andrea Fallon, a practicing midwife of 12 years, says burnout is an occupational hazard in her profession, and one she endured in her graduate year in a large public hospital.

“I believe a combination of factors contributed. Firstly, full-time shift work is physically exhausting, and as a new practitioner trying to manage workload, on top of physical exhaustion, it’s difficult.”

While support for graduates is generally good, within the birthing suite, the conflict between midwives trying to keep low-risk births normal and doctors wanting to intervene is difficult for many midwives, said Fallon.

“New midwives graduate with the training to manage the care of low-risk birthing women; the reality of practice in a hospital setting is vastly different and many graduate midwives struggle with this and, in my group, many left the profession.”

“We are also trained that best practice is continuity of care, seeing women from pregnancy through to postpartum, but the reality is a fragmented system.”

“The signs of burnout for me were: dreading going to work, anxiety when I arrived at work, feeling shaky, nauseous and generally like I didn’t have much to give emotionally.”

“I made the decision to become a child health nurse while continuing part time in midwifery.”

“This dramatically improved things for me. I enjoyed the continuity of care in child health while still caring for mums as a midwife. I believe women should be able to access all the information on health for themselves and their baby.”

Fallon said she strongly encourages midwives to learn at the major hospitals and then get out into the low-risk settings.

“Get involved with a professional colleague who will support you, and know that it takes a long time for the system to change but do what you can for each individual woman and family in your care.”

Beating the Burn: Nurse & Midwife Support

Mark Aitken, Registered Nurse and Consultant for Nurse & Midwife Support: a national support service for nurses and midwives, said common issues include stress, compassion fatigue, depression and anxiety.

“Midwives may be exposed to particularly challenging and stressful situations. One moment you are sharing a family’s joy with the birth of a healthy baby. However, on the same shift, you might be providing support to a mother with a stillborn baby. Managing that range of emotions can be difficult,” he said.

“It is important to identify the signs of burnout early, so preventative measures can be put in place. Both your physical and mental health is of great importance,” he said.

Professor Anne Williams, School of Health Professions, Murdoch University, has counselled nurses on how to manage stress and burnout for many years. She said the nature of the work is rarely mentioned when it comes to stress and burnout.

“It is workload and environmental factors, such as lack of equipment and resources, challenging behaviours of patients, relatives and staff, workload, parking, and insufficient time because of a lack of qualified staff.”

“Worldwide research in this area supports these local findings. In addition, factors such as nursing team relationship issues and difficulties interacting with medical staff are apparent,” she said. 

“Nurses and midwives can minimise the risk of burnout by reducing stress, both at home and at work, and by removing prolonged causes of stress. This isn’t always possible, so focusing on what can be controlled is essential,” said Prof. Williams.

“Nurses and midwives have limited control over many aspects of the work environment. Most nurses have no control over staffing levels.”

A staff shortage on shift is stressful but might be minimised by consciously modifying their thinking about this challenging situation.

This might be achieved by thinking, ‘Well I can’t do everything today because we are short of staff, so I’m going to do the best that I can with the time that I have, prioritising patient safety,’ said Prof. Williams.

Nurses and midwives can maintain physical and mental health by eating healthy, exercising regularly, getting adequate sleep, and finding ways to relax, she said. “Try deep breathing, meditation, mindfulness, laughter, singing, listening to music, reading a book, or spending time with friends or family,” she said.

However, the prevention of burnout should not be the sole responsibility of nurses and midwives. Hospital managers need to be constantly aware of sources of environmental stress and implement strategies to address concerns, said Prof. Williams. 

“The provision of resources to support staff, such as educational courses about various aspects of wellbeing, and counselling services are essential.”

Slepica agreed, saying “Healthcare organisations need to tackle the unique challenges their employees face, including patient care and mortality, workplace stress and worryingly, a stigma around asking for support with their mental wellbeing.”

“It makes sense for healthcare organisations to invest in the mental health of their staff, as the benefits are seen in reduced absenteeism, sick leave, and work related psychological injuries,” said Slepica.

Burnout is a serious and debilitating condition that needs treatment, warned Prof. Williams.

“It’s essential that nurses are aware of the signs and know where to get help for themselves and their colleagues. Sources of help include: General Practitioners, Beyond Blue, Headspace and Black Dog. In addition, most healthcare workplaces offer free counselling services,” said Prof. Williams.