Breaking Burnout: Nurses on the Bleeding Edge
Robin Kirby
Owner, Gracion Group - Executive Assessment, Search & Development | CHRO | Author of The Sparkle
In June 2019, I was hospitalized with a large DVT (deep vein thrombosis, i.e., blood clot) in my leg and multiple pulmonary embolisms in my lungs and near my heart.?
I was immobilized and put into the ICU for 2 days.?
I was 40 years old, and it was the first time I had been in the hospital since I was a child. I was afraid, confined to my bed, and unable to do anything for myself. Needless to say, I have an entirely new appreciation for healthcare workers, especially nurses. My nurses were quite literally lifesavers.?
They meticulously measured and double-checked the dosage levels of the risky medication they were giving me, as either too much or too little could be fatal. They fed me, bathed me, and everything in between so I could remain still, and they did it with a smile on their face and a kindness in their heart, all while managing multiple other patients who also needed intensive attention.
The hospital, and especially the ICU, is a place you never want to visit. If you must go, be comforted that it is home to some of the most caring and selfless individuals on the planet, hospital nurses.?
I grew to know and love my incredible nurses that called that 5th-floor, left-wing part of the hospital home. The HR practitioner in me couldn't help but ask them about how they became nurses, what their day was like, and if they enjoyed it.?
Below is what I learned in those vulnerable and honest conversations.?
The Path
For most, the path to nursing starts after high school and comes from a deep desire to help others. Sure, there are benefits like job stability and career mobility, but that's not why they sign up. They become nurses because they have a stirring compassion for others that pulls them into a life dedicated to serving others and saving lives. For these brave men and women, this is a higher calling.
That calling then quickly gets put to the test in nursing school, where they spend 2-4 years working hard and studying harder. They are learning an entirely new language, the language of life, and the stakes are high. These aren't your typical college classes where you can sleep in the back and learn enough just to pass the test. Nurses will graduate into high-pressure, complex, and exhausting environments where their knowledge will be put to the test, and lives will hang in the balance daily.?
Nursing school is where their mental and emotional muscles are built for the job. There are lab skills to master, veins to stick, volumes of knowledge to gain, rotations to complete, and competing priorities to juggle. There are grueling exams to pass, all-nighters to survive, and reservoirs of confidence to build. They will be pushed well past their comfort zone, and 20% of nurses will eventually opt out before graduation.
The Life
For those that remain, a career filled with purpose, fulfillment, stability, and impact awaits. Decades of saving lives, comforting fear, hand-holding confusion, holding back tragedy and keeping their finger constantly on the scale of survival lay before them. A deep sense of meaning and personal satisfaction are waiting and theirs for the taking.
Unfortunately, also waiting in the shadows for many nurses, especially hospital-based nurses, are physical and emotional exhaustion, seasons of unending stress, and unpreventable deaths. There are difficult patient family members, dismissive physicians, poor organizational communication practices, and regular 12-hour shifts of not eating, drinking, or bathroom breaks.??
Nursing is truly a labor of love and is one of the most important yet often most undervalued roles in our economy. They are often understaffed, overworked, under-appreciated, and overlooked. It's no surprise that half of nurses quit within the first five years, and a whopping 56% of those quit in the first two years. For most, their will was strong, and their intention was pure, but their physical and emotional lives couldn't cash the check.?
That said, while some quit the field altogether, many thankfully stay in the nursing field but go into different environments (ex., schools, education, etc.).?They are still helping and serving others in critically needed areas.
For those that remain in the hospital setting, it's often out of an unshakeable desire to help others despite the personal toll. I recently spoke to a friend who is an ICU nurse about burnout, and she said, "I have given my life to serve others seven days a week, both at work and at home. I enjoy helping people and seeing them progress to go back home. Although the job can be mentally and physically challenging, I love what I do." My friend wouldn't change a thing, and I am beyond grateful for her and countless others just like her who fight the good fight on the frontlines of life every day.
The Impact
If you are a nurse, statements like these below that I've heard and read as they have described their situation may feel familiar.?According to Zippia, 95% of nurses surveyed say they have experienced burnout in the last three years. NINETY-five percent. Below is how many describe their feelings:
"Grueling," "Pushed to the limit," "At a breaking point." "I love what I do and my patients, but I'm only human. I don't know how much longer I can do this."
Excerpt from an account of one nurse's night in the ER in a recent Yahoo News report:
"I rush from one end of the emergency room to the other, dialing the pharmacy for some antibiotics that I have been waiting several hours for. I have just finished unsuccessfully coding one patient, while another decides to forgo her call light and, instead, unsteadily walk out of her room to get me while I'm signing the other patient's death paperwork. The patient who left her bed to get me falls and hits her head." The nurse continues in the story to tell of one impossible situation after another that she encountered over the course of her shift.
There are thousands more stories just like this one and it can seem disheartening but there is a path forward.
Yes, the system may be broken, and so many things are out of your control, but it's time to take the frustration out and put the power in. There are critical components of your situation that you CAN control.?
None of them are magic bullets, and none of these are going to make it completely better.
But what they can do is give you back some control. They can give you back energy, give you back life, and your smile.?
First things first, though, let's do a gut check on your level of burnout.?
The Symptoms
As we launch into symptoms and causes, please read these closely and study yourself like a science project. Use these to diagnose yourself just like you diagnose your patients.
Get up on the balcony of your life and look down at yourself through these lenses. You may also want to ask those closest to you if they see these in you. It may be hard to recognize them in ourselves.
Below are the most common symptoms of burnout in nurses. If you are experiencing a large number of these consistently and increasingly, it is a good sign you may be in the chokehold of burnout, and you need to address it.
Top Burnout Symptoms for Nurses
Physical Exhaustion
This is not just tired. This is a kind of tired you can't shake. You feel it deep in your bones and in your soul. You go to bed tired, and you wake up tired. If you are a reader (and I hope you are!), there is a book called Sacred Rest by Dr. Saundra Dalton-Smith that I think is fantastic and dives deep into the topic of rest. I read it one sitting and you may find it helpful.
Emotional Detachment/"Compassion Fatigue"
You are losing the empathy and compassionate heart that pulled you into a life of nursing. You are shorter with patients and see them as yet another number in a bed or another problem to deal with. This is a glaring red flag.?
Feelings of Dread or Panic
This is much more than the Monday blues. These are daily and, at times, debilitating. You may have trouble falling asleep or waking up because of the constant stream of anxiety coursing through your brain.
Emotional Exhaustion?
You are not yourself anymore, and the people in your life are likely noticing. You are snippy and cranky most of the time, may have little patience, and find yourself blowing up or reacting poorly to the smallest of triggers.
PTSD Symptoms/Moral Injury
Counselors have found that nurses are increasingly suffering from symptoms of PTSD as they are unable to care for patients as they feel they should due to a lack of staffing or other resources. For example, if you lose a patient, you may feel what is called "moral injury."?
The VA defines it this way: "moral injury can occur when someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs." You believe you should have been able to save the patient, but the situation prevented you from doing so. As a result, you take on feelings of guilt and trauma that have a debilitating effect on you. It's important to seek help from professionally trained counselors to help you work through these feelings.?
Other Symptoms
Loss of Appetite, Unexplained Illnesses, Heart Palpitations, Increase in Mistakes, Inability to Focus, Increased Anxiety or Depression
The Causes
At a high level, burnout happens when our jobs physically, emotionally, and mentally require too much of us for too long, and our well runs dry.?
Tactically, there are specific triggers for burnout, and while every situation is unique, the hit list of causes below will likely sound familiar. I have starred those you have control over that we'll discuss next.
Common Causes of Burnout in Nurses
There may be other unique symptoms to you but these are a good indicator list that something needs to change and that you need to do something to help change your situation.
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What Can Help
I should say upfront that I am not a nurse and have no medical background other than being a self-professed hypochondriac and having been a patient more times than I'd like.?
Burnout is a serious challenge, and the consequences for you, particularly as a nurse, are even more severe. Not only will it take a heavy toll on you personally, but it can result in an increasing number of mistakes and impacts on your patients, which I know you don't want.?
Only you know the source and cause of your burnout, and only know what techniques will best work for you. I can't write you a prescription. You have to pull together a formula that works for your specific situation but this should give you a good list to draw from.
What Can Help You Beat Burnout
Catch it early.?
As with most challenges, catching it early does less damage and allows you to up your odds of beating it. Don't suffer in silence and keep grinding it out because you think it's just the way it is. Yes, nursing is, without a doubt, one of the most difficult jobs on the planet, but there are ways to manage it and thrive.
Check your beliefs.?
Jen Barnes from the American Association of Critical Care Nurses says this one much better than I can.
"It is a deep-seated belief you likely hold that as a nurse, as a true caretaker, you need to put everyone else ahead of you and your own needs — and the system you work in is taking advantage of that belief.?
The truth is you are not responsible for everyone and everything. The more you work extra shifts and accept too many responsibilities, the longer it will take your organization to see the need for change. Your organization — not you — is responsible for appropriate staffing, treating nurses well, and optimizing patient outcomes as a whole.
Hospital administrations consider documented metrics when making decisions. For example, if the data shows that all nursing shifts are covered, they will likely assume staffing is fine. So, when you take on too many extra shifts thinking it will help patients in the short term, it can actually exacerbate the problem in the long term for both you and your patients."
Take care of yourself as much as you would an at-risk patient.
Like above, you have to know when you need to say no, and importantly you have to let the guilt of saying no go. Just as the airline attendants tell passengers to put on their oxygen masks first, so must you. If you need to say no to the help needed call from your nurse manager, then do it. You are not obligated to work a 12-16 hour shift on your day off. Just by virtue of your job profession, you are an at-risk patient for burnout. Take every precaution and treatment you need to protect yourself.?
Take care of yourself during your shift and after your shift.
I know it's hard to step away from the floor. Your patient may fall, they may need something or something may happen. It's hard to grab a bite to eat or drink or just a few minutes off your feet, but prioritize it for the sake of your patients. If you can, try to take a walk outside.
After work, turn your brain and phone off. Find ways to unplug from the streams of anxiety and stress that have just filled your day.?
Take an intermission.
I have a friend who had a very stressful job, and she got to a point where she had to take what she calls an 'intermission.' I love that. When I asked her what was exciting about it, she said, "what is exciting me is my couch, my jammies, and my cat." :-) Bravo, my friend. We ALL have a moment where we just have to call a time-out. When life and work have brought us to our physical, emotional, and mental knees.?
If this is you, my friend, you know you are no good to anyone in this state, especially your patients. You may need to take a week, a month, or even longer off. Financially that may not be easy, but it may be the best investment you'll ever make.?
Reignite your passion.
Think about why you became a nurse to start with. Revisit those old feelings and memories. Find some friends to talk with, maybe some old nursing school friends, and give them a call. Find the spark that has grown so dim.?
Keep healthy boundaries with your patients.
You care deeply about your patients. You wouldn't be there if you didn't. You have to walk a fine line, though. You want your patient to know you care, but you cannot become personally attached to every patient. The reality of losses over time will start to take a toll on you.?
Get a change of scenery.
Many nurses have found a potent cure for their burnout is to exploring other ways to use their nursing skills. If you think the entirety of your current working circumstances, and there are multiple challenges with very few bright spots, this may be the path for you.
The good news is you have options to make a change. This may include working as a school nurse, being a nurse educator, going into home health, working in the hospital administration team, being a traveling nurse, or perhaps even going back to school to be a nurse leader where you can support and empower your peers. It could be shifting to nursing in a different kind of practice (ex-hospital to family practice) or a different part of the hospital. Nurses are in high demand, and the options are plentiful.
Plan for the future.
Research shows having something to look forward to lessens present stress levels. It's a buffer and a hedge that moves our eyes forward. Find a vacation to plan, buy a concert ticket, find a local community event you are interested in, or plan your retirement. Just do something that moves your focus forward.?
Find an outlet.
Don't let your work take over your identity. Our jobs were never meant to become the center of us. They were never meant to take over our world. Find hobbies you like, creative outlets, or friends that give you joy. Just don't lose yourself in your job.
Ask for help.
If tactical and specific challenges within your job could be addressed, raise your hand and talk to your manager about your concerns. Be honest about how you are feeling.
If you don't feel they are listening and need more help, then talk to your HR team (yes, I hear your groan from here, but I promise you they want nothing more than to help you work through this). It could be a schedule change, or you need more techs on the floor. You don't know if you don't ask.
If you have deeper challenges, you may need to plug into confidential professional counseling through your employer's EAP (employee assistance program). You may also want to consider finding a support group to help you realize you are not alone and that you have other shoulders to lean on besides your own.
Whatever you do, don't suffer in silence, and don't fight this alone. Fighting burnout is a team sport.
If you have read this far in this article, first, thank you (and sorry, it went way longer than I expected, but this is a serious topic, so I wanted to be thorough).??
Second, you likely know it is time for you to make a change. It may be small changes or radical changes, but you know deep in your soul that something has to give, and something has to change.
If you need a place to start, grab my book, The Sparkle . It's not a magic bullet, but it will go deeper into many things we spoke about here and can help give you the inspiration you need to take your next steps.?
You have helped save our lives. Let us now help you save your smile.
?We need you. We appreciate you. Thank you.?
??, Robin
Sources
www.dailynurse.com
www.nursingjournal.com
www.ptsd.va.gov/professional/treat/cooccurring/moral_injury_hcw.asp
https://sg.style.yahoo.com/er-nurse-10-years-nightmare-140008218.html
https://www.aacn.org/blog/nursing-burnout-the-solvable-problem-within-your-control