Neurocognitive and sleep dysfunction common

A prospective long-term study of nurses that followed them from nursing school to as long as 15 years after graduation found that burnout strikes nurses early in their careers and can have a long-lasting impact on their job performance.

Ann Rudman, RN, PhD, of the Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute in Stockholm, and colleagues recruited nurses from 26 nurse training programs in Sweden and followed a cohort of 2,474 RNs (62% of the total sample) for 11 to 15 years with annual assessments. They measured burnout symptoms delineated in the Oldenburg Burnout Inventory using a “study specific instrument” to measure cognitive function, the Major Depression Inventory to measure depressive symptoms, and the Karolinska Sleep Questionnaire to measure sleep disturbances, including insomnia.

The results of their study were published in EClinicalMedicine.

“The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12.3%),” they wrote.

Rudman and colleagues recorded the following symptoms at follow-up (controlling for age, gender and cohort):

  • 275 (11.4%) of the nurses reported that they often had four or more cognitive problems. Having at least four different cognitive problems was nearly three and a half times more common in nurses who had experienced early career burnout (ECB) than in nurses with no history of ECB.
  • 138 (5.7%) of nurses fulfilled the criteria for depression. Almost three times as many nurses with a history of ECB got this diagnosis than the controls.
  • 1,020 (42.2%) of the nurses reported symptoms of insomnia at follow-up. Significantly more nurses with an episode of ECB reported insomnia symptoms than the controls, even after controlling for an ongoing episode of burnout.

There were 2,225 participants in the follow-up sample, of which 90% were women and more than half (57%) were specialty-trained nurses. Other characteristics:

  • 1,014 (41%) were 39 or younger.
  • 865 (35%) were ages 40-49.
  • 643 (26%) were ages 50 or older.
  • 73% were parents with children living at home.

Because burnout symptoms such as cognitive function difficulties, depression, and insomnia are often “linked together,” Rudman and colleagues worked out odds ratios for each symptom while controlling for the other two.

In that analysis, both cognitive function and insomnia risks remained significant among those who experienced ECB, but “after controlling for age, gender, cohort, and current symptoms of burnout, cognitive problems, and insomnia, nurses with a history of ECB did not report higher levels of depression than controls at follow-up.”

That finding was unexpected, as previous studies of burnout reported a strong association with depression.

They noted that “previous longitudinal and diagnostic studies have consistently found depression to be a probable consequence of burnout. However, our results show that neurocognitive problems and insomnia, but not depressive symptoms, were unique consequences of ECB. Previous longitudinal research finding a temporal link between burnout and depression has been interpreted to point to an association between burnout and the core symptoms of depression (i.e. low mood, sadness, and loss of initiative). However, the results presented here indicate that such an association might not exist… Thus, the present study points to sleep and neurocognitive problems as being unique consequences of ECB and that the previously published longitudinal findings might also be interpreted as reflecting these associations. The question is then if the present results uncover an association between burnout and a subtype of depression (dominated by neurocognitive and sleep dysfunctions) or if the results should be interpreted as reflecting unique consequences not associated with depression at all (although symptoms are included in depression inventories). We propose that it might be fruitful to think about neurocognitive and sleep dysfunctions as unique consequences of burnout.”

The authors cited a large sample size and meticulous data collection as strengths of their study but also noted several limitations.

“One major limitation was the lack of information on what happened in burnout levels and outcomes during the time between follow-up years and the lack of knowledge when the consequences occurred. Another limitation of the study was that all data were self-reported and that the assessment of, for example, cognition can therefore be biased by perceptive insufficiency and/or the subject of socially desirable answers,” they wrote.

That said, Rudman and colleagues concluded that their findings make a convincing case for initiating measures to prevent burnout and to initiate those measures early, which means starting in nursing school and on boarding programs at hospitals.

“By identifying when stress-related ill health occurs and the long-term consequences of it, effective timing of interventions can be identified,” they wrote. “To avoid negative long-term consequences for nurses’ health, employers need to limit stress levels in the workplace and develop methods to ensure sufficient recovery from stress-related ill health in order to facilitate a sustainable working life. The consequences of burnout will lead to a further increase in the growing nurse shortage seen worldwide.”

  1. Early career symptoms of burnout in nurses were shown to have long-term consequences on psychological health with respect to cognitive functions and sleep; however but experiencing early career burnout was not associated with greater risk for depression later in life.

  2. To avoid negative long-term consequences for nurses’ health, the employer needs to limit stress levels in the workplace and develop methods to ensure sufficient recovery in order to facilitate a sustainable working life.

Peggy Peck, Editor-in-Chief, BreakingMED™

AFA Insurance funded the research.

Rudman and co-authors reported no competing interests.

Cat ID: 730

Topic ID: 729,730,728,791,730,192,925