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Bad Childhood Experiences Increase Burnout Among Student Nurses

Analysis  |  By Jennifer Thew RN  
   November 01, 2018

Nursing students who were exposed to more Adverse Childhood Experiences have higher rates of burnout and depression.

Adverse Childhood Experiences, which include abuse, neglect, and family/household challenges, are common. Two-thirds of over 17,000 participants in the Kaiser-CDC ACE study, one of the largest studies on childhood neglect and abuse and later-life health and well-being, reported experiencing at least one ACE, and one in five reported experiencing three or more ACEs. Adverse Childhood Experiences are known to increase sensitivity to stress and negative physical and mental health outcomes.

Nurses are not immune from the effects of ACEs. The recently released study, "The Relationship of Childhood Adversity on Burnout and Depression Among BSN Students," by researchers at The University of Texas at El Paso School of Nursing found that undergraduate nursing students who were exposed to a higher number of ACEs had higher levels of burnout and depression.

The study included over 200 UTEP junior students enrolled in the first semester of upper division courses in the Bachelor of Science in Nursing program during the fall of 2016 and the spring and summer of 2017.

Participants completed the ACE questionnaire, the Maslach Burnout Inventory, and the PHQ-9 depression questionnaire.

Of the 211 respondents, 179 completed the ACE questionnaire. 72% reported at least one ACE, and 23% reported an ACE score of four or greater.

The most frequent ACEs reported were:

  • Divorced parents (32.7%)
  •  Substance abuse within the household (31.3%)
  •  Physical abuse (24.6%).

Of the 159 respondents who completed the MBI questionnaire:

  • 22% reported moderate to high-level burnout on subscale A, which measures exhaustion
  • 24% of participants scored moderate to high-level burnout on subscale B, which measures depersonalization
  • 37% scored moderate to high level burnout under subscale C, which measures personal achievement

Of the 164 respondents who completed the PHQ-9 questionnaire:

  • 62% reported no symptoms of depression
  • 25% reported minimal depression
  • 8% reported minor depression
  • 3% reported major-moderate depression
  • 2% major severe depression

Based on the study's results, nursing faculty should be educated on the frequency and range of ACEs experienced by students, and that these past experiences can influence students' present and future health and well-being, write the authors.

Seeing as these students will someday be present in the workforce, the influence ACEs may have on their ability to process stress and their risk for burnout is something nurse leaders should consider.

Both nursing faculty and nurse leaders can help students and nurses by intentionally educating them about available support services and making those services easily accessible.

Another intervention leaders can provide is educating students and staff on risks for and signs of depression and burnout.

Providing resources and formal training on building resilience is another tactic nurse leaders can take to combat burnout.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


Adverse Childhood Experiences are common.

More ACEs increase a student nurse's risk for burnout and depression.

Nurse leaders should educate nurses on the availability of support services.

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