There are multiple factors that can contribute to nurse stress and burnout, including job frustration and overwork, poor work-life balance, substance use issues, emotional/family problems, and workplace bullying.

“What’s burnout for one person is not the same for someone else,” says Jan Allison, RN, CHSP, senior director of regulatory at AmSurg, based in Nashville, TN.

“Everyone’s needs are different. Our lives are different,” Allison says. “We have to do more with less. There are more new services coming into our facilities and greater financial restraints.”

Everyone who works in a surgery center has to wear multiple hats, and finding time to spend on their various responsibilities — outside of patient care — is challenging. For instance, nurses might have to complete audits and organize reports for the different roles, such as quality assurance/performance improvement, environmental safety, and infection control, she explains.

“That is a big struggle for those who wear those hats,” Allison says. “Some people don’t have the time they need to do the job well, and that’s a lot of frustration for people.”

For example, nurses with young families need time or help taking their children to various after-school activities. It can be difficult to schedule the day around these activities.

“You can’t always get out of the surgery center when you need to,” Allison notes. “It requires a balance to meet the needs of the personal life and work life, and that can lead to burnout.”

Efforts to prevent nursing burnout can begin with the hiring process. For instance, if an ASC quickly jumps into hiring someone to fill a nursing vacancy, that hire might be the wrong fit for the center. A nurse could present with a great resume and skill set, but a disruptive and bullying attitude, Allison says.

“It’s worth it to take more time to ensure that the person we’re hiring has the right values,” she notes. “You don’t want to create an environment that people don’t enjoy working in.”

Allison has learned from 21 years of working in surgery centers that there will always be ups and downs in the job. But the best experiences occur when the staff gets along and supports each other in teamwork.

“There is nothing that beats that,” she says.

Good leadership can provide the support that’s needed in creating a good team. The key is for ASC leaders to keep an open-door policy, allowing people to check in when they have a problem. Leaders also need to recognize the signs of burnout and job stress. (For more information, see story on preventing nurse/staff burnout in this issue.)

“Provide good recognition of jobs well done, and make sure everyone gets their breaks,” Allison says. “I just talked with someone the other day who said, ‘We don’t ever get a break at work,’ and I thought that was not good.”

Leadership best practices are when the leader can step in and fill in when the ASC is shorthanded. This should be temporary, as leaders need enough time to monitor staff for compliance, she notes.

“I provide support for regulatory compliance,” Allison explains. “People get rushed, lose focus, and skip steps. How will a leader know these things are happening if they’re not out there monitoring for this?”

When leaders miss regulatory noncompliance, they miss opportunities to teach and train staff.

“I feel like leaders need to find a balance to lead,” she says.

Identifying signs of staff stress and burnout and finding ways to prevent these events can affect an ASC’s quality of care, as well as efficiency and bottom line. Organizations with fatigued staff run the risk of employees losing focus and making errors.

“When people are burned out, it reflects in the care you give and reflects in the attitude of your patients,” Allison says. “If you’re feeling burned out and angry, you’re not focused in the same way or treating people in the same way.”

After experiencing such fatigue and burnout, Allison understands it. When she was a hospital nurse years ago, she found that she was just working to get the job done and was losing compassion for her patients. “I think it makes a difference and impacts patient satisfaction and safety,” she says.

One way to identify nursing and staff burnout is through a survey that asks questions about the employee’s fatigue, negativity, and empathy. For example, offers a burnout self-test that contains 15 questions (

Leaders also can discern signs of burnout through observing staff behavior. One sign would be an employee who calls in sick more frequently than usual, or who constantly asks to leave work early.