By Ibironke Taiwo. Freelance Health Writer, with medical review and editorial support from The DLHA Team
A gathering of Nigerian nurses and midwives at a conference
Burnout is a response to overwhelming work demands that are not successfully managed. It could be a state of emotional, physical, and mental exhaustion.
Burnout occurs in various professions, including the nursing profession. And it can affect people at different stages of their careers.
It can lead to a decreased quality of life and productivity with consequences on the individual's physical, social, and mental well-being.
This is why it is very important to address burnout early by seeking support, setting boundaries, practicing self-care, and making changes to reduce stress levels.
Burnout among Nigerian nurses is a serious concern facing the nursing profession as it has significant impact on the nurse, the quality of care given to the patient, and the overall healthcare system in the country.
In Nigeria, nurse burnout is mostly a result of limited healthcare resources and unsatisfactory working conditions, which in turn affect healthcare delivery.
Although data on the prevalence of burnout in Nigerian nurses is still limited, it may well be a major driver of the “japa” phenomenon (a local ubarn term for emigrating to seek employment abroad) in this population of Nigerian professionals.
Keep reading as this content promises to shed light on the causes, effects, and potential solutions to burnout among Nigerian nurses.
The Nigerian nursing profession is said to have been in existence as early as human existence. Before modernization came into play people have always fallen sick and there were ways that they were taken care of that makes nursing the foremost caring profession.
As time went by, nursing became modernized (in Europe) with Florence Nightingale who provided care to injured soldiers in the Crimean War in the 1850s. She campaigned against poor hygiene standards which often led to fatal infection in the injured and advocated for improved hygiene standards while attending to the wounded soldiers. This brought about the outcome of the reduced number of deaths from infection. [1]
Florence Nightingale changed nursing to a respectful profession via the establishment of the first nursing school in London in 1860. [1]
The Nigerian nursing profession under the administrative regulation of the Nursing and Midwifery Council of Nigeria, came to Nigeria through the British colonial masters who provided medical care for wounded soldiers. The first nursing home in Nigeria was established 5 December, 1927 by the British colonialists in Jericho, Ibadan. It was supported by the missionaries and their wives by setting up mission homes and dispensaries.
With the above in place, the training of nurses began earnestly in Nigeria. Although no formal training occurred, the skills and practical aspects of nursing were rendered at the nursing home.
To enhance the nursing profession in Nigeria, the School of Nursing, Eleyele in Ibadan, currently Oyo State, Nigeria, was established in 1949. Later in 1952, the University College Hospital Ibadan started the training of nurses to a higher standard and a degree program was introduced in nursing in 1965 at the University of Ibadan. Ibadan, Nigeria
The Nursing and Midwifery Council of Nigeria started as two separate bodies firstly with the establishment of the Midwives Ordinance in 1930 to regulate Midwifery education and practice in Nigeria. Later on, the Nursing Council of Nigeria was established in 1947 by the registration of the Nurses Ordinance of August 1947 to regulate and control the education and practice of Nursing in Nigeria. After several amendments and acts the two bodies were merged into one nursing and midwifery regulatory agency of the Federal Government of Nigeria by the enabling decree 89 of 1979, which later transformed into Act Cap. No 143 Laws of the Federation of Nigeria 2004. Since then the body has grown and developed in status, functions, and responsibilities as well as in influence and authority. [2]
As of March 2020, the total number of registered nurses in Nigeria was 180,709, with 126,863 midwives. The number of registered nurses has reduced drastically to 125,000 by the year 2022 and serves the health needs of the country of over 200 million population. Given these figures, Nigeria presently has an average of 13 nurses per 10,000 population . This is less than the minimum recommended by the World Health Organization.
The fact above has brought nothing less than a series of shortcomings to the profession, one of which is burnout.
Over the years burnout has been a major occupational hazard in the nursing profession. According to a 2016 publication, "Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job". [3] Burnout is often associated with emotional exhaustion, depersonalisation and reduced feeling of personal achievement. These result in being negative, cynical, and cold in interaction with family & patients, and a sense of low self-esteem and accomplishment.
The prevalence of burnout in Nigerian nurses is still a matter of continuing research. Two studies with small sample participants from Southwestern [8] and Southeastern Nigeria [9] reported very high levels ranging between 29 to 40% and 43 to 54% respectively between the three domains of Maslach Burnout Inventory studied.
Burnout in a nurse never provides a favorable outcome for patients as it reduces the quality of care thereby causing a decrease in patient satisfaction
What are the Signs of Burnout in Nigerian Nurses?
Look out for these signs and symptoms that may indicate that you are experiencing burnout:
The following are the major factors that contribute to the burnout of nurses in Nigeria.
Burnout in Nigerian Nurses can be measured using certain tools and methods that include: [4]
1. Malachi Burnout Inventory: This is used to measure burnout in individuals who work with people for instance medical professionals. It deals with the 3 major components of burnout: Exhaustion, Depersonalization, and Reduced Personal Accomplishment.
2. Oldenburg Burnout Inventory: This looks into the exhaustion and disengagement behaviors that come out of burnout.
3. Single Burnout Measure: It helps to measure burnout in any occupational group. It has to do with responses based on your perspective of burnout such as "I enjoy my work, no symptoms of burnout", "I am burning out with one or more symptoms of burnout", "Occasionally I am under stress, but I don't feel burned out" etc.
4. Copenhagen Burnout Inventory: This is also used to measure burnout in any occupational group with a focus on personal work and client-related burnout.
According to a research published in Biomed Central using all the three scales of the Maslach Burnout Inventory to measure burnout, it was deduced that high workload, value in congruence, low control over the job, low decision attitude, poor social support, low reward and low/inadequate nurse staffing level, and greater than 12 hours shift are all predictors of burnout among nurses generally. The available limited research [8. 9] suggest that these same factors may well apply to Nigerian nurses too. More research is needed for confirmation.
Burnout not only affects Nigerian Nurses but it has consequences for patients, the society, and the profession at large.
III. Consequences of Nurse Burnout on the Society
To address burnout in nurses the first thing that needs to be done is to undertake comprehensive scoping research to identify the prevalence and causal factors of the burnout. These could include stress, poor work environment, etc.
Nigerian nurses should be encouraged to practice self-care and be supported institutionally to obtain a balance between work and life. [6]
An adequate working environment with appropriate facilities and reward should be put in place.
Resources should be put in place to achieve conducive nurse staffing levels in the country though policy adoption of the WHO standard of one nurse to five patients.
Burnout among Nigerian nurses is a complex issue that calls for robust nd concerted action. The causes include excessive workload, inadequate staffing, limited resources, poor reward, and poor working conditions all of which contribute to increased emotional vulnerability in nurses and inability to carry out their duties adequately and with personal satisfaction.
The consequences of burnout among nurses not only affect their well-being and job satisfaction but also have serious effects on the outcome of care of patients and the overall effectiveness of the healthcare system in the country.
Curbing burnout among Nigerian nurses requires several approaches that include organizational support, improved working conditions, adequate staffing levels, access to mental health resources, and ongoing education and training on stress management and self-care.
Also, the well-being of nurses should be prioritized with an adequate and supportive work environment and reward.
Awareness should be raised among nurses about the importance of self-care to prevent and address burnout.
1. Karimi H, Masoudi Alavi N. Florence Nightingale: The Mother of Nursing. 2015 Jun;4(2):e29475. doi: 10.17795/nmsjournal29475. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/.
2. Nursing and Midwifery Council of Nigeria (NMCN). Origin of Nursing in Nigeria. [Internet n.d]. Accessed March 12, 2024. Available from: https://www.nmcn.gov.ng/history.html.
3. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016 Jun;15(2):103-11. doi: 10.1002/wps.20311. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911781
4. National Academy of Medicine. Valid and Reliable Survey Instruments to Measure Burnout, Well-Being, and Other Work-Related Dimensions. [Internet n.d]. Accessed March 12, 2024. Available from: https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-related-dimensions/
5. Leving H. How Inadequate Hospital Staffing Continues to Burn Out Nurses and Threaten Patients. Penn Leonard Davis Institute. [January 9, 2023]. Accessed March 12, 2024. Available from: https://ldi.upenn.edu/our-work/research-updates/how-inadequate-hospital-staffing-continues-to-burn-out-nurses-and-threaten-patients/
6. St. Catherine University. Tips for Preventing Nurses Burnout. [Internet. April 15, 2021]. Accessed March 13, 2024. Available from: https://www.stkate.edu/academics/healthcare-degrees/nurse-burnout.
7. Onoh, A. Nigeria’s Health Workforce Crisis And Future Of Healthcare Delivery. Daily Trust. [Internet. 12 Jan. 2023} Accessed March 17, 2024. Available from: https://dailytrust.com/nigerias-health-workforce-crisis-and-future-of-healthcare-delivery
8. Lasebikan VO, Oyetunde MO. Burnout among Nurses in a Nigerian General Hospital: Prevalence and Associated Factors. ISRN Nurs. 2012;2012:402157. doi: 10.5402/2012/402157. Available from: https://pubmed.ncbi.nlm.nih.gov/22619733/. (Abstract)
9. Okwaraji FE, Aguwa EN. Burnout and psychological distress among nurses in a Nigerian tertiary health institution. Afr Health Sci. 2014 Mar;14(1):237-45. doi: 10.4314/ahs.v14i1.37. Available from: https://pubmed.ncbi.nlm.nih.gov/26060486/. (Abstract)
Published: March 19. 2024
Updated with more prevaence data: March 20, 2014
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