Exploring and Conceptualizing Brownout among Nurses: A Sequential Qualitative Study Using Grounded Theory and Cognitive Interviewing

Abstract

In recent years, a less-known form of work-related stress has been recognized by career coaches and organizational psychologists alike: “brownout.” The phenomenon is assumed to pose a significant threat to nurses, as it leads to predictable consequences such as fatigue and burnout. Despite its critical impact, the concept of brownout remains undefined in existing literature, highlighting the need for a clear theory. Lebanon, ranked among the lowest country in nursing density in the Eastern Mediterranean Region, faces numerous challenges, including excessive nurse migration, low job satisfaction, poor retention, and high turnover rates. While studies in Lebanon and globally have primarily focused on burnout among nurses, there is a clear gap in exploring brownout. This study addresses this gap by investigating, conceptualizing, and characterizing brownout among nurses, offering a distinction between brownout and burnout.

Using a sequential qualitative design, this study began with developing a grounded theory, guided by Charmaz’s framework, to explore nurses’ experiences, perceptions, and the meaning of the brownout phenomenon. Findings identified core domains of brownout—job distancing, exertion, psychosomatic indicators, and lifestyle and social disturbances—alongside its antecedents, barriers, and consequences. A substantive theory of brownout emerged, highlighting its attributes and dimensions, supported by participant excerpts. Building upon this theory, the study employed the DeVellis guidelines to develop an instrument measuring brownout, followed by cognitive interviewing to validate its content and structure. Feedback from cognitive interviews led to refinement, enhancing the instrument’s clarity, relevance, and applicability. The final instrument consists of 32 items targeting brownout and 16 demographic questions.

This study contributes a robust theoretical and empirical foundation for understanding brownout, distinguishing it from burnout, and developing an operational definition for its measurement. It lays the groundwork for future research to test the instrument's psychometric properties, explore predictors and outcomes of brownout, and design interventions aimed at mitigating its impact. The findings hold significant implications for addressing nurse retention, fostering a healthier healthcare workforce, and ensuring sustainable community care, particularly in Lebanon’s challenging healthcare environment.