I have a friend, Margaret, who confesses to being burned out. She’s in a state of panic and malaise, characterized by feeling weighed down by exhaustion, disengagement, and decreased productivity. With a faculty appointment as an associate professor in a public university, she balances teaching, mentoring graduate and undergraduate students, conducting research, and service to her school of nursing. She said to me,

It’s insidious, you know? Here I am, a 52-year-old woman, who received promotion with tenure five years ago, and I can’t seem to keep it going. You’re never off the grid or able to take a break. Emails, student grading and endless papers to review, committee work, always looking for that next grant funding – they never seem to end. You can’t get caught up. The thing that scares me the most is that I’m beginning to not care. The environment doesn’t help. We’ve had such tenuous leadership in our school for so long. Our culture isn’t where it needs to be. Faculty are siloed and split. I find myself being unkind and ashamed when I lash out. I know it’s because of how unfairly our so-called leaders operate. But still, that’s not who I am. I’m angry, can’t sleep, gained 10 pounds, and in general, I’m fed up. Should I leave? Probably. But I’m not sure I have the energy to…            

In two previous blogs, I wrote about the nurse as patient with an emphasis on the bedside nurse’s role (Nurse as Patient: June 28, 2022; Nurse as Patient Part 2: Anomalies in Normal Science: November 1, 2022). In this instance, I maintain that we need to position nurse faculty as individuals who need care, compassion, and competent leaders. Margaret, my friend, is a tenured faculty who maintains a research trajectory. However, clinical faculty are just as vulnerable to burnout. Consider the long hours spent supervising students, interacting with nurses who are watching to see if faculty skills are clinically up to date, keeping up with certifications, grading clinical work, debriefing after simulations and clinical hours, and preparing students for the NCLEX examination, with ever-changing curricula and standards. We hear of nurses’ burnout, compassion fatigue, secondary traumatic stress, and moral injuries. Concepts with overlapping attributes, each focusing on injuries to the soul with the potential for psychological traumas. In my middle-range theory of nurses’ psychological trauma (Foli, 2022; Foli & Thompsons, 2019), nurses are subjected to seven types of nurse-specific traumas (outlined below). I believe nursing faculty are exposed to these psychological traumas and vulnerable to their lasting effects:

1. Vicarious and Secondary trauma – Clinical instruction requires not only co-experiencing the suffering of patients, but also the students’ experiences and how their patient exposures affect them. When I was a psychiatric clinical instructor, I knew it was likely that my students’ own mental health issues would surface and need to be processed within their developmental stage. In one instance, a married student confessed to an abusive husband; another student realized her own childhood maltreatment and so forth. Co-living the students’ struggles also affected me. Another example of secondary trauma that I have experienced as a nursologist is in my current study of nurses who are in active recovery from substance use. I’ve collected one of the largest qualitative datasets in this area and interviewed nurses coast-to-coast over the past 14 months. Their stories have affected me. I listen to their narratives of suffering, courage, and fear, as well as them being subjected to intense stigma and ostracism. I’m left with a need to decompress, process internally what I’ve been told.
2. Historical trauma – Being in a collegiate setting may bring forth oppression of faculty in certain departments as universities favor those units that bring in the most funding. Gender is also a factor. In Margaret’s organization, only 30% of all full professors are women, fewer still of minority status – with representation that reflects these biases. The academic unit itself, the school of nursing, had experienced a rapid change in leadership with the new dean’s style causing several experienced faculty to leave. Margaret felt these losses personally and professionally as her teaching assignment increased due to faculty attrition.
3. Workplace violence – Students are becoming more demanding and may threaten lawsuits or display verbally aggressive behaviors. Defensive teaching and grading wear faculty down, which allows grade inflation to infuse courses. Parallel to secondary trauma, Margaret witnessed one of her students getting punched in the stomach by a patient experiencing a psychotic episode when the student was assigned to observe in the emergency department. My friend carried guilt and stress over being unable to protect her student.
4. System-induced trauma – The rigor and demands placed on faculty are forwarded by the academic organizations with little regard to work-life balance. As a female dominated profession, Margaret had seen several of her unhappy colleagues remain at the university because of partners’ jobs and children’s needs. Faculty going up for tenure and promotion seem to be almost hazed at times with politics and money supplanting science and objectivity. Seeing unsuccessful faculty struggle was difficult for Margaret, and she felt the system was unfair to many whose research didn’t align with funding opportunities. 
5. Insufficient resource trauma – The constant pressure of deadlines, ensuring active, funded research and/or current clinical skills to support a practice, all in addition to teaching, overwhelm faculty. The “golden ticket” of NIH funding seems elusive to many and older faculty have additional challenges to combat ageism and gender bias, especially as grant announcements encourage “new investigators” to apply. The endless barrage of emails, meetings, research responsibilities, class preparations and grading had worn Margaret down over the years. Discussions of workload calculations in Margaret’s school of nursing created conflict due to inaccurate perceptions of roles between clinical and research faculty. She wondered what the next step of her career would be and if “full professor” was something she wanted.
6. Second-victim trauma – Errors made by students may reflect unfairly on faculty competence and create tensions between academic and industry partnerships. Faculty oversee the instruction of several students at a time, with weaker students needing intense oversight in busy clinical areas. The cumulative nature and the enormity of these responsibilities can be exhausting and unsustainable.
7. Trauma from disasters – The COVID-19 pandemic dramatically altered what faculty “presence” means. In many respects, we’re still trying to figure that out. The mix of online and on-site presence, and deciding which is best, can be confusing. Margaret’s dean believes that only those with a physical presence “really work hard.” Rapid changes to online learning, as well as providing additional emotional support to students, created faculty stress that may continue to be felt (Sacco & Kelly, 2021).

The effects of these traumas should be seriously considered by organizations. Evidence supports such consideration. When we analyze “burnout,” we know there are associations with psychological distress (Watson, 2023), which can diminish our well-being and how we are able to do our jobs. Doctorate faculty (n=146) who held PhDs or DNPs with four or less years of teaching experience were surveyed by Aquino et al. (2018). The authors found that those with PhDs and who had experienced the “emotional exhaustion and depersonalization in burnout” were predictors of intention to leave academia (p. 35). And we, as a discipline, can’t afford to lose faculty. According to the American Association of Colleges of Nursing (AACN; 2022), faculty shortages effect the pipeline of registered nurses in the workforce. In the AACN’s report, “The 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing,” U.S. nursing schools were unable to admit 91,938 qualified applicants in baccalaureate and graduate nursing programs due to the lack of nursing faculty, clinical space, and other resources.

In the 2022 survey, the “Special Survey on Vacant Faculty Positions,” the AACN identified 2,166 full-time faculty vacancies across 909 nursing schools. These are compelling statistics, but the link to the daily realities of nursing faculty members needs to be emphasized. As asserted in my middle-range theory of nurses’ psychological trauma, the organization’s leadership should examine itself for culpability. My friend Margaret shared:

It’s difficult to maintain motivation when you can’t come up for air. And leaders think we’re easily replaceable. I’ve worked hard on not only my research, but my pedagogy. I used to look forward to every semester starting. Now I dread it. My advanced practice students’ salaries far outpace mine, and they can elect to work part-time. In my current position, that’s not an option. But I guess the thing that would make a difference would be more attention paid to promoting a healthy work culture, real faculty governance, acknowledgement from my academic leadership team for what I do for the organization and respect for my contributions.

The enormity of the problem seems to have grown over the years; in a 2023 study with 3,556 survey responses, Zangaro et al. found that 85.2% of faculty reported moderate/high levels of overall burnout. So, what can be done? Thomas et al. (2019) suggest several “tips for avoiding burnout” and include setting limits to the number of hours worked in a day, learning to say “no,” building communities through mentors, and writing groups, and even “seek a change in employment” (Table 2; p. 115). While helpful, there is a subtext of the faculty member making changes, not the organization or leaders. Also needed is acknowledgement of how difficult it can be to feel a sense of belonging for faculty based on age or minority status. I know of committed, fair, and humble deans and nursing leaders. They make a difference, and it’s not hard to prove their success when one examines retention of faculty, licensure and certification pass rates, and strategic plans that are operationalized by faculty, students, and other stakeholders.

I hope Margaret continues as a nursologist and teacher, and I encourage her to reach out to me as I want to help her as her friend and peer. Part of this is selfish on my part: we can’t afford to lose nursing faculty, and we can’t afford to turn aspiring nurses away because of such losses.  

References

American Association of Colleges of Nursing. (2022). Fact sheet: Nursing faculty shortage. https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Faculty-Shortage-Factsheet.pdf

Aquino E., Me Lee Y., Spawn N., Bishop-Royse J. (2018). The impact of burnout on doctorate nursing faculty’s intent to leave their academic position: A descriptive survey research design. Nurse Education Today, 69, 35–40. 10.1016/j.nedt.2018.06.027

Foli, K. J. (2022). A middle-range theory of nurses’ psychological trauma. Advances in Nursing Science, 45(1), 86-98. doi: 10.1097/ANS.0000000000000388

Foli, K. J. (2022, June 28). Nurse as patient. Nursology.net. https://nursology.net/2022/06/28/nurse-as-patient/ Foli, K. J. (2022, November 1).

Nurse as patient part 2: Anomalies in normal science. Nursology.net. https://nursology.net/2022/11/01/nurse-as-patient-part-2-anomalies-in-normal-science/

Sacco T., & Kelly M. (2021). Nursing faculty experiences during the COVID-19 pandemic response. Nursing Education Perspectives, 45(4), 285–290. 10.1097/01.NEP.0000000000000843 

Thomas C., Bantz D., & McIntosh C. (2019). Nurse faculty burnout and strategies to avoid it. Teaching and Learning,14, 111–116. 10.1016/j.teln.2018.12.005

Watson, M. F. (2023). The relationship between psychological distress of nursing faculty with burnout. SAGE Open Nursing, 9, 1-8. doi: 10.1177/23779608231181203.

Zangaro, G. A., Rosseter, R., Trautman, D., & Leaver, C. (2023). Burnout among academic nursing faculty. Journal of Professional Nursing, 48, 54-59. https://doi.org/10.1016/j.profnurs.2023.06.001.