All of the academics have been buzzing about nurse “burnout” this year. Richard S. Lazarus PhD, defined stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being.” (His article on nurse burnout is here). For a bedside nurse in a high-stress environment, this is almost an inevitable course.
This year and for the first time in my life, I experienced a full on breakdown. Life happened to me as it does to many and with the added stress of my job as a CVSICU nurse and rotating shift work, my body could not sustain health. Due to the rotating shifts, I suffered from severe insomnia, which contributed to relentless infections and eventually emotional exhaustion as well. After it took nearly nine weeks to recover from my collapse, I have taken a self-oath that I can never let this happen again. Achieving a work/school/life balance is tough, especially as a nurse, but it is possible.
So here are some reasons nurses experience burnout and preventative tactics to avoid it. These are from my own experience because the academics do not have any surefire ways to reduce burnout, so take what you can and leave the irrelevant.
Reason #1: Nurses are the INVISIBLE captains, pilots and execs of patient care
I operate under the belief that the bedside nurse has the toughest job (physically, mentally and emotionally) and is the most important person involved in patient care and outcomes. The obligations of the bedside nurse are endless. Despite the fact that administration and the general public do not necessarily understand this, we (the bedside nurses) get this. The stress of this responsibility is astronomical for many reasons.
- The decisions we make can mean the difference of life or death (seriously).
- We not only have to continuously monitor, assess, implement and multi-task with a smile and chart it twice, but we have to protect our critically ill patients from other people. We are the downstream person who has to take the responsibility of every person before us. (Ex: If a med is given that should have been held, even if the doctor has ordered it, the nurse is to blame. Or if a baby doctor tries to do something stupid, with his/her chest puffed out in white coat armor, we have to have the confidence to stand up to them for the sake of the patient. This can attribute to a stress overload situation.)
- Our emotional intelligence is just as important as our technical intelligence and we have to be on our game in both areas all of the time. While we may be coding a patient in one room, we have to pretend like everything is peachy to our patient next door (We say: I’m so sorry you had to wait for your cup of ice (smile) We think: Your cup of ice is miniscule compared to the chest I’m pounding on next door #kthxbye). This ability to emotionally compartmentalize is a skill that is unique and essential to be a great nurse (just be sure to deal with these emotions later). If your hospital has great HCAHP scores, thank your nurses who can emotionally compartmentalize.
- Amongst other things, the fact that many nurses are not recognized and respected for these talents makes the job even more difficult. Societally, the public does not understand what even happens in a hospital until they are admitted, and then, they sometimes still do not understand. NEWSFLASH! This isn’t Greys Anatomy folks. Also, emotional intelligence and the ability to “know” people (mind, body and spirit) is not as culturally respected as a perfect score on a math exam. It’s incredibly stressful to not be appreciated and understood for a job you literally have to empty your soul into.
What can you do?: This issue is the nature of the beast and is a constant love/hate struggle. Ideally, this would require and extreme culture shift to cure. However, if you feel you are nearing burnout related to this issue (the responsibility is too much and the recognition is too little), you need to COMMUNICATE this with your manager and other nurses. I don’t mean whining and gossiping, I mean effectively communicate. Talk to your trustworthy mentors, form a group where you can take action and get ideas. Do not be destructive. Recognize the power of nurses who ban together. Your unit may be able to put a “Band-Aid” on the issue to help.
As for the NOW, take a day of PTO with zero apologies. Use 12 hours out of your bank and take the day for yourself and only yourself. I am a huge proponent of nurses getting one month (12 shifts) of paid vacation per year to be taken in any increment and any time. People think I’m crazy for suggesting this, but it would keep nurses happy and fresh and make them want to stay in their jobs. Then nurses could keep their PTO for emergencies, maternity leave, and extra money if they wanted to cash it out. Other companies offer their employees two weeks off at Christmas as well as other holiday time, so I don’t believe I’m overstretching here. Happy nurses = better patient outcomes and there is no doubt in my mind this would help with nurse burnout (this idea isn’t officially researched, but it is a Nurse Abnormalities University prediction).
Reason #2: You work in an ICU, 12-hour shifts, night shift and/or rotating shifts
If you hit all three of these, you MUST beware of eventual burnout. ICU nurses get the double whammy here because they typically have a dedicated, over-committed personality. They tend to report a high level of emotional exhaustion and depersonalization with a low level of personal accomplishment. After working in such an intense environment with no clear goals for achievement, a feeling of powerlessness when it comes to changing something important and forcing oneself to accomplish the impossible, burnout will eventually be on the horizon with this distinct personality type.
Throw in the stress of working a 12-hour shift (which most of the time is more like 13 hours plus commute) and the lack of sleep associated with night and rotating shifts, you are playing with fire. Keep in mind, working in an ICU and working nightshift is exceedingly difficult for a perfectly healthy nurse with few other life commitments, therefore asking any normal person to endlessly excel in this environment is nearly impossible. I cannot emphasize enough the importance of sleep. Without sleep, every single one of these issues is magnified.
What can you do? Recognize the symptoms and pay attention to them. The most important part of this sentence is “pay attention.” I am plagued with the “I can do everything” syndrome like many other nurses. Looking back, before my burnout, there were many red flags. However, at the time, I did not realize this and I did not pay attention to the symptoms. I felt like a failure for admitting exhaustion and needing a break. I also did not want to be perceived as lazy by my peers. It’s so difficult to make yourself vulnerable in our profession, but we NEED to do this. If I had recognized the early burnout signs like chronic fatigue and exhaustion, anger, self-criticism, feelings of helplessness and overall negativity, perhaps this would not have happened.
In the short term, if you can’t take time off, ask the charge nurse for a less tasky assignment. If you are the nurse who is always admitting or getting the train wreck patient, you need to ask for a chill assignment to renew yourself. Once again, DO NOT JUST BEND OVER AND TAKE IT…be vulnerable and ask. If you start the trend, other nurses will follow. We are humans, not machines.
Another idea I think would be great to tackle nurse burnout is the addition of a “helper” nurse on the unit. This nurse would help admit new patients, lend an extra hand to transport patients to CT or MRI, assist in emergencies or crashing patient situations and simply be there to help and support, even with the dirty work. Some would say their unit would never pay for this, but once again, in my perfect world, this would help with nurse burnout and retention (another Nurse Abnormalities University prediction… and no folks, I don’t have a PhD).
Reason #3: You are female, have a poor relationship with your nurse manager and/or you unit is short staffed
By this point, I’m pretty sure every nurse who ever lived is at risk of burnout. The typical female personality is directly related to the typical nurse personality. The work and stress is continuously piled on and the nurse just deals with it because she is simply so tired that advocating for a change is the last thing on her mind. Many times, the wife/mother/daughter/nurse not only deals with her insane job, but is responsible for caring for a husband, kids, pets and/or ill family members. Studies have shown that if female healthcare professionals could work the hours they request, their stress level decreases immensely.
To continue a vicious cycle, almost half of nurses have poor nurse/manager relationships. While some bosses are just terrible, nurse managers are being pulled in so many directions and report poor job satisfaction themselves. Misery creates misery in this situation.
Finally, the nurse to patient ratio is an issue that MUST be tackled not only for patient health, but for nurse health. Track the progress of national nurse to patient ratios bill here: https://www.congress.gov/bill/114th-congress/house-bill/1602 Please, rally and share this link.
What can you do: In the long term, you can take part in your state’s nurses’ association and the ANA. You can also write and share your thoughts on your nurse blog (wink). In addition, you can raise your concerns to management and even your hospital CNO. Be careful when doing this and communicate intelligently. This is not an issue that will be solved overnight, but it needs attention.
In the short term, you can ask for a schedule change to help you balance all of your obligations. Perhaps you will need one lower stress job to balance the high stress of your bedside job. Also, consider talking to your friends or even a professional on how to deal with your high stress situations. Remember, your health is the most important thing. The healthier you are, the better you can care for your patients and families.
Wrapping it up
The common denominator in all of these is to communicate with management and other nurses and take time off if at all possible. Do not be afraid to verbalize your concerns with frustration and exhaustion. Yes, this will make you vulnerable, but talking about this issue is the only way to make it change. Listen to your body and acknowledge your exhaustion, believe that feeling this way is NOT normal.
It is important to know that the academics don’t have the answer to combat nurse burnout. However, here at Nurse Abnormalities U, I’m fairly certain our ideas would help the issue and we didn’t even have to form a committee, hire a consulting firm or send out a survey. I desperately would love to apply for a government grant to get a university hospital the money to give their nurses 36 hour work weeks on day OR night shift, every third weekend, a month (12 shifts) of paid vacation, plus PTO acquisition, lower patient to nurse ratios and free coffee. Then the academics can record employee satisfaction/retention before and after, as well as patient satisfaction and outcomes.
Some may say I’m being too simplistic, but I think I’m just using common sense and proposing what is morally right. If companies would value nurses for their talents and help give them a better work/life balance, more nurses would stay at the bedside and burnout would decrease. END. OF. STORY. Remember, just because things are the way they are, even if they have been that way for a long time, does not mean it is how they should be.
Anyway, I know this was a long one, but I know you get me…So, while I’m trying to take over the nurse world and combat these issues, take care of yourselves. You are all so stinking amazing, I can’t even.