Practice Tip of the Week | Take a Hike! Nature Versus Burnout

By Dr. Glenn A. Barnes, DNP, RN, EMT-P, NHDP-BC, FAWM LCDR, USN, NC, (Ret.)

Burnout is characterized by emotional and physical exhaustion due to extended exposure to demanding work and lack of recuperative rest and recovery. This exhaustion manifests itself as alterations in job performance, interpersonal skills, and psychological and physical health (WHO, 2019; ANA, 2023). We also understand the cause: too many patients with too many needs, with too few resources.

Before the pandemic, the nursing exodus from burnout was already at an alarming 31.5% , and since COVID we have lost over 100,000 members of our workforce, primarily from burnout (Shah, et al., 2021). We continue to need more nurses than we have, those at the bedside face higher patient-to-nurse ratios, more documentation, and the introduction of new technologies. All these produce stress which left unchecked leads to burnout.

As individual nurses, we cannot fix the lack of resources with any finality. All we can do is influence policy and perception in the hopes that we address resources before the need hits critical mass. This will take time. What is available to us now is our ability to deal with stress so we can alleviate the effects of burnout. Concepts of mindfulness, peer therapy, and professional therapy are all wonderful options for dealing with stress and you should use any options you feel are best for you.

Nature & Burnout

I have been a nurse for over 30 years including ICU and ED. I am a combat veteran and spent almost ten years in Iraq, Afghanistan, and Africa as a civilian. I am very familiar with stress and burnout. As an associate professor of nursing, and I created an elective called Nursing in Nontraditional Environments (NiNE). NiNE teaches undergrad nursing students basic wilderness survival and austere care including certifications in wilderness medicine.

The reports from students on stress reduction prompted me to begin investigating this officially and to start my own company, Crossed Arrows Training Site (CATS), to offer these courses publicly. I found that most research for nature therapy, being out in nature as a means of stress reduction, has been done overseas. In Japan, Ikei et al. (2016) looked at the available research at the time to coin the phrase ‘Shinrin-yoku’ (taking in the forest with all senses), or ‘forest bathing.’ Researchers found that time in nature decreased cortisol levels, heart rate variability sympathetic and parasympathetic responses, blood pressure, and other indicators of relaxation. Similar findings were found in Germany by Joschko, et. al (2023), and Abdullah et al. (2021) noted that these effects may even be replicated using virtual technology. Urban planners are now investing in green spaces in the city for these same reasons.

Safety First!

We must be smart about venturing out to remote locations away from disturbances, but also away from safety and security. These risks can easily be mitigated with a few simple steps:

Never go out alone. Have at least one person who can get help if needed. You may also use personal location beacons or at least make sure the GPS on your phone is turned on.

Pack a kit. Take a class or listen to experts on what to carry. It should cover your basics for survival but not be more than 10% of your body weight to start with.

Take a class. Knowledge is the single most important thing you can take to the woods. Plus, this type of learning is fun.

Walking outside with trees and fresh air, the sounds of nature— all the senses are engaged in the exact opposite of our normal stressors. You also appreciate the value of ‘smallness.’ Walking in the woods you are not the one in control. You do not have the stress of the lives of others on your shoulders; instead, you have the luxury of unimportance. This is key to your relaxation, so put down your electronics, get out of your normal working area, and take a hike.

REFERENCES

Abdullah, S., Sulaiman, S., Sulaiman, S., Alyan, E., Merienne, F., & Diyana, N. (2021). The Impact of virtual nature therapy on stress Responses: A Systematic Qualitative review. Forests, 12(12), 1776. https://doi.org/10.3390/f12121776

Ikei, H., Song, C., & Miyazaki, Y. (2016). Physiological effects of wood on humans: a review. Journal of Wood Science, 63(1), 1–23. https://doi.org/10.1007/s10086-016-1597-9

Joschko, L., Pálsdóttir, A. M., Grahn, P., & Hinse, M. (2023). Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature—A Pilot Study. International Journal of Environmental Research and Public Health, 20(3), 2167. https://doi.org/10.3390/ijerph20032167

Nurse burnout: What is it & how to prevent it | ANA. (2023, February 17). ANA. https://www.nursingworld.org/practice-policy/work-environment/health-safety/nurse-burnout-and-how-to-prevent-it/

Shah, M., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469

World Health Organization: WHO. (2019, May 28). Burn-out an “occupational phenomenon”: International Classification of Diseases. www.who.int. Retrieved January 6, 2024, from https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases