Many people feel called into nursing careers. Nurses get the
unique opportunity to directly serve people in achieving better health. But
while nursing offers many rewards, the stress of the job can also lead to
burnout. Left unchecked, career burnout can drive even the most dedicated
nurses to leave the profession altogether.
Anyone considering a nursing career should start by having realistic expectations of what day-to-day life is like as a nurse—especially in acute care settings.
Ingrid Flanders, RN, BSN, MN, FNP-C, a visiting assistant professor at the Linfield-Good Samaritan School of Nursing in Portland, Oregon, says sometimes the job is different from what a nurse might expect. “Maybe they don’t have a full understanding of the role and the responsibilities that go with it,” says Flanders. “Then they’re surprised at the level and intensity of the workload. Maybe they haven’t prepared themselves physically, mentally, and emotionally for the work involved; because a nursing role, regardless of what setting you’re in, is really demanding.”
Flanders notes that patients have high expectations of nurses’ proficiency, which can create pressure. There’s also the pressure that many nurses put on themselves. “Generally, the people who are drawn to be nurses have high expectations of ourselves and so we try to give it all away and we don’t always have enough left for ourselves,” explains Flanders.
What starts out as a passion for helping people can soon lead to chronic job stress or what Vicki S. Good, DNP, RN, CPHQ, CPPS, vice president of quality and safety at Mercy Hospital Springfield Communities in Springfield, Missouri, calls burnout syndrome (BOS)—work-related stress that remains unresolved. “BOS has three elements: exhaustion, depersonalization, and perception of decreased personal and professional accomplishment. BOS is directly related to stress at work and not related to stresses outside of work, although outside stresses may impact the stress at work,” explains Good.
Good says that nurses in high-risk, high-stress work environments (such as critical care nursing) are at especially high risk for developing BOS, where they are asked to care for patients during a vulnerable time in the patient’s life, and often at the end of life, with the accompanying ethical issues.
“Nurses are engaged in high-stakes decision making on a daily basis,” says Good. “The nurse is the clinician who is constantly at the bedside of the patient, giving their entire physical and emotional self to care for their patient and their family. Combine this with one of the most challenging workforce shortages in nursing and nurses have rates of BOS equal and often higher than their physician colleagues.”
One extreme consequence of nursing job burnout is nurses deciding to leave the profession—a choice that nurses are making in unprecedented numbers according to Good.
“By raising awareness and educating nurses on how to respond and mitigate symptoms of BOS we hope to prevent nurses from leaving the profession. BOS has been called a ‘silent epidemic’ because nurses and other clinicians have been afraid to speak up about their feelings, and instead the nurse ‘votes with their feet’ by leaving the unit and/or profession,” says Good.
Warning Signs of
Because nurses invest vast amounts of time, education, and money into entering the field and growing their careers, it’s important that they practice good self-care and watch out for the warning signs of chronic stress and burnout.
Nursing career burnout can be sneaky, warns Anna Rodriguez, BSN, RN, CCRN, PCCN, a critical care nurse who launched TheBurnoutBook.com to help nurses combat burnout. “It comes on so gradually, one bad shift at a time, and before you know it, you dread clocking in to work,” says Rodriguez. “Early recognition is key. You need to pause and assess yourself frequently for signs of fatigue, depression, or feeling cynical or apathetic toward your work. You might go home feeling emotionally or physically drained more days than not. You might feel anxious and find your mind racing, thinking about work. These are all unhealthy signs that the work is getting to you and, if it continues, will lead to full-blown burnout.”
Good says that unfortunately, most nurses do not realize when they are developing the signs and symptoms of BOS. “This is one reason that raising awareness of this syndrome is so important to our profession. As a professional nurse, it is critical to be able to recognize the warning symptoms so that one can then take action to mitigate the potential outcomes of the syndrome,” says Good.
So, what do nurses need to watch out for as they go about their daily work?
“As a nurse, the first thing to become keenly aware of are any changes in energy levels related to work—both physical and emotional. Exhaustion is one of the key symptoms. If the thought of going to work makes you exhausted, pay attention, ask questions, and seek intervention,” Good advises.
Flanders agrees that nurses should watch out for fatigue. Another common symptom is a lack of resilience or tolerance for challenging situations where you feel more impatient or more irritable than usual.
This lack of resilience may cause nurses to become disengaged in their work and interactions with coworkers and patients. “If a nurse was previously highly engaged in social events and activities on the unit and stops participating, this may be a sign of BOS development,” says Good.
Finally, watch out for the general feeling that you’re not making a difference as a nurse for your patients/community. Good notes that this lack of a personal and professional sense of accomplishment is a warning that burnout has set in.
How to Avoid Burnout—or Nip
it in the Bud
What can a nurse do if they are on the road to burnout or to prevent burnout from developing? Here are some expert tips from seasoned nurses.
Practice Self-Care. Flanders says it all starts with prioritizing
self-care. This includes reading for pleasure for a few minutes every day,
maintaining a healthy diet, getting regular exercise to reduce stress, and
making sure you get adequate rest. “Even if you’re a nurse working on a night
shift, it’s important to make sure your sleep pattern is one that’s
sustainable,” says Flanders.
Develop Resiliency Skills. “Resiliency is the antidote to burnout,” says Rodriguez. “It’s the ability to bounce back after feeling that emotional, physical, and psychological exhaustion that burnout creates. It’s finding a way to balance the energy you give to others and recharging yourself so that you can continue to care for others effectively.”
Rodriguez suggests the following tips to build resiliency as a
- Be intentional on your days off to regroup and rest so that you can come back a better nurse on your next shift. Don’t say yes to extra shifts if you need to rest.
- Take breaks during your shifts (and practice self-care strategies during your break, such as eating a healthy meal or reading for pleasure).
- Plan unit-bonding activities. Getting together with coworkers outside of work is a great way to fight off burnout.
Talk It Out. Having a support network is vital for nurses. Nurses need to ensure they have other nurses to turn to vent about a bad day, a troublesome patient, or frustrations. Having nursing friends at work and/or joining a professional nursing association dedicated to your specialty, such as the American Association of Critical-Care Nurses, can be an excellent outlet.
“We need a way to talk about the things we see every day,”
says Rodriguez. “There’s a lot of doom and gloom. There are morally distressing
moments. There are times when we’ve given so much of our energy to others that
we develop compassion fatigue and go into survival mode, shutting down our
empathetic side as a coping mechanism. The ability to vent in a healthy way
with our peers is essential to dealing with all of that and maintaining our
empathy. No one understands what you go through better than another nurse.”
Explore Your Options
If you feel that you are already in burnout mode, take some time to explore your career options. Some nurses who experience burnout leave the profession altogether. But that may not be necessary.
Start off by exploring ways you can remain in the field by taking some time off, changing units, or finding a new job in a less stressful environment.
“A sabbatical or some time off may help, but it’s generally not a
long-term fix,” says Paula Davis-Laack, JD, MAPP, owner of Davis-Laack Stress
& Resilience Institute. “Remember that burnout is more about work
systems, cultures, and values creating an environment that breeds burnout, so
until the workplace changes, burnout will likely remain a possibility. You may
just be in an environment that’s a disconnect for you. Can you switch teams,
organizations, or practice settings?”
If a change in work environment or position doesn’t help, then
it’s time to look at nontraditional career tracks such as becoming a health
coach, nurse entrepreneur, or nurse educator.
“One of the things I’ve enjoyed about being a
nurse now for almost 35 years is that there’s a variety of nursing roles within
the profession, and it’s important for young nurses to know that if they’re
getting to the point that they feel like they can’t do it anymore, there are other
options and other roles that might be a better fit for them at that point in
their lives,” says Flanders. “It’s important not to feel like you’re stuck in a
corner and that you don’t have the power or ability to make it different if it
needs to be different. Because when you’re in the role of taking care of other
people, if you’re not doing well, then how can we possibly do our jobs as
Students across the country say they have been shamed by for-profit colleges promising a great education and career prospects. Here’s what nursing students should know before enrolling in any degree program to ensure it is a wise investment.
Imagine spending years in nursing school only to learn that a degree from the college you’re attending won’t actually qualify you for the nursing job of your dreams. Unfortunately, this can be a devastating reality for many students across the United States who attend for-profit colleges.
For-profit colleges have received a lot of negative headlines in recent years. There have been several cases of for-profit colleges shutting down without notice to enrolled students—leaving them without options for continuing their education. Others have faced lawsuits by students claiming they were shamed and their degrees are worthless in the job market.
Many for-profit college programs advertise flexible class schedules, accelerated learning, and high job placement. However, with so much controversy surrounding these colleges, it’s smart to thoroughly investigate if the college you are considering will provide you with the education and job prospects you seek.
A growing number of nursing students have found out the hard way the true cost of some for-profit colleges. They are left with massive student loan debt and useless degrees that won’t get them a job. And to make matters worse, traditional colleges and universities won’t accept their transfer credits.
A November 2017 study published by The Century Foundation found that for-profit college students accounted for a staggering 99% of applications for student “loan relief from students who maintain that they have been defrauded or misled by federally approved colleges and universities.”
Like many students, you may be enticed by what some for-profit colleges offer in terms of flexible class schedules, online learning options, accelerated degree programs, and less competitive admissions requirements. Public colleges and universities are more competitive, and a for-profit program can seem like an easier path.
For-profit colleges are known for targeting nontraditional students who desire more flexible education programs and want to enter into a certain field or industry such as nursing. But some college advisors steer students away from such colleges.
“Our general advice about for-profit colleges is to avoid them if at all possible,” says Evelyn Alexander, founder/owner of Magellan College Counseling, an independent service that helps students with the college admissions process.
The first step to a successful nursing career is to do your research for any degree program you are considering prior to enrolling. It’s smart to do due diligence to ensure you are making a wise investment of time and money in your education.
Here are some tips to help you determine if the college you’re considering is a good choice for a successful nursing career.
Know the Status
You should always know upfront the status of the college you’re considering. Colleges and universities can be state, nonprofit, or for-profit. This is the first thing to know when deciding on a nursing program.
“I started poking around several college websites, and it’s very difficult to determine if a college is for-profit, because they generally don’t announce it,” Alexander says. “I think the best way to deal with this is to ask, upfront, immediately, if the college is nonprofit. Just come out and ask, and if it is not nonprofit, see if there are other options available to you.”
Alexander notes that a private college can be either for-profit or nonprofit, while public colleges/universities are publicly owned and always nonprofit. Alexander almost exclusively guides her clients toward nonprofit colleges and universities.
Seek Out Accredited Programs
One of the major problems that many for-profit students encounter is that their college program doesn’t have the industry-recognized accreditation that employers want. Many students find this out only after they have spent time and money on a degree and begin job hunting.
While most for-profit colleges do have accreditations, they may not be the specific accreditations employers look for in nursing job candidates. In addition, without the right accreditations, your credits won’t transfer to another school.
For nursing programs, look specifically for schools with Accreditation Commission for Education in Nursing (ACEN) accreditation. Also, look for nursing school programs that are regionally accredited (e.g., accredited by a state board of nursing), as this is an indication that other colleges/universities are more likely to accept transfer credits. Beware of nursing programs that don’t meet these criteria.
You can also contact other nonprofit/state colleges/universities in your area and ask if they accept transfer credits from the college in question. You want to keep your options open for transferring to another college in case it is necessary. So, it’s best to know from the start if your credits will transfer.
Don’t Fall for Pressure Tactics
One common complaint about for-profit colleges is that admissions staff pressure potential students into enrolling or don’t offer sound admissions and financial aid guidance. If the admissions reps are using pressure tactics or making big promises about job prospects, beware. Admissions reps should be enthusiastic about what their school has to offer, but they shouldn’t be like a pushy car salesman.
For-profit colleges usually have an easier admissions process than nonprofit/state colleges and often do not require test scores such as the SAT/ACT, a certain GPA, or the like. This makes enrollment easy; especially for nontraditional students or those working full-time. However, nursing programs with the proper accreditation will likely have a more competitive admissions process—and that’s a good thing.
Do graduates of the nursing program you’re considering actually get nursing jobs in your area? An easy way to start researching actual job placement success for a college is to utilize online resources such as LinkedIn to search for graduates of the program you’re considering and take note of their job history. Are graduates working for reputable health care organizations in your area? Or do they have non-nursing jobs? While this is anecdotal research, it’s a good way to get an idea of job prospects.
While you’re online, do a Google search for the school and read student reviews and ratings. Are there a lot of complaints or low ratings? Your online search may also bring up news articles that mention the college, which could provide information about pending lawsuits filed by previous students. You don’t want to enroll in a college in legal or financial jeopardy.
If there are no red flags from your online research, pick up the phone and call large employers, such as hospitals and clinics in your area, to speak with an HR representative to see if they consider graduates from the college for job openings. Or attend a local job fair and make a point to speak directly with health care recruiters to ask if they regularly recruit or hire graduates from the college you’re considering. Don’t just take the college admissions advisor’s word that employers hire their graduates.
Already Enrolled in a For-Profit Nursing Program?
What if you are already enrolled in a for-profit program? If you’ve already started a program it’s not too late to check on the school’s accreditation and reputation among employers. You may discover that your school meets the industry-recognized criteria for nursing education such as ACEN and has solid regional accreditations.
If you do find some red flags with your current college, first assess what exactly is causing you alarm. For instance, is the only red flag some negative student reviews online? That in itself should not be cause for much concern. However, if you find your college isn’t ACEN and regionally accredited or there are rumors about the school closing or facing legal action, you should reconsider what your realistic job prospects are going to be if you continue with the
Alexander says if one of her clients was enrolled in for-profit institution she would likely advise them to start looking for another program. “They may run into a problem ensuring that all of their credits transfer to another institution; but I would say it’s probably better to get out in the middle than to wait until they finish, when they may hit a barrier in finding a job.”
Choosing a good nursing school is vitally important to your nursing career. All students should be knowledgeable about industry education standards and not rely on admissions representatives who have enrollment quotas to meet and don’t always have your best interest at heart. And if a program sounds too good to be true, it may lead to major disappointment down the
“What seems like a good idea for certain reasons may be overshadowed by much larger drawbacks,” Alexander warns. “This is why we advise against for-profits. It’s not really a good investment if your degree doesn’t get you a job or if you end up owing money on student loans, you haven’t finished your degree, and the next school you attend doesn’t recognize your credits.”
This month, New York University (NYU) Rory Meyers College of Nursing welcomed Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, as the inaugural Vernice D. Ferguson Professor in Health Equity.
Taylor has already had a notable career. In January 2017, she was awarded the Presidential Early Career Award for Scientists and Engineers by President Barack Obama, the highest honor awarded by the federal government to scientists and engineers, where she will examine next-generation sequencing-environment interactions on cardiovascular outcomes among African Americans.
Vernice D. Ferguson (1928-2012) was a distinguished nurse leader, educator, and executive who championed the health of all people throughout her career. Ferguson, who received a baccalaureate in nursing from NYU, pioneered leadership positions for nurses and elevated the nursing profession through advocating for increased opportunities, respect, and wages, as well as fostering nursing research.
Taylor says it’s a tremendous honor to be selected to serve as the inaugural Vernice D. Ferguson Professor in Health Equity. “It is my sincere hope that the research I lead is as beneficial to the public as the work of the iconic Vernice D. Ferguson.”
Over the course of Taylor’s career her work has focused on health equity in Black populations for common and chronic diseases such as hypertension, both in the United States and in Africa.
“African Americans have the highest incidence and prevalence of hypertension than any other ethnic group in the U.S.,” says Taylor. “In particular, African American women have the highest incidence and prevalence of hypertension than any ethnicity or gender. Understanding the genomic underpinnings and social factors that contribute to this disparity can help providers to intervene early in life to eliminate such disparities. On a personal level, my father had hypertension and had a stroke, and my mother had cardiovascular complications as well. I would like for the work that I do to help others to avoid these complications.”
Another primary goal for Taylor is to study the genomics of lead poising in Flint, Michigan. She says the purpose of this project is to better understand the harmful effects of chronic lead exposure, the psychosocial insults of the Flint water crisis, and the underlying omic mechanisms involved that may contribute to increases in blood pressure in this already at-risk African American population in Flint.
“An intergenerational, multi-omic (genetic and epigenetic), and psychosocial approach will be utilized to understand one of the major symptoms of chronic lead exposure—high blood pressure—among African American families in Flint,” Taylor explains. “This research will provide critical insights that will add a layer of functional outcomes for health providers to best understand, assess, and intervene with tailored treatments based on an individual’s unique environmental, omic, and psychosocial profile and will help in mitigating long-term cardiovascular and other health risks.”
Taylor says her primary goal during her professorship is to continue to build on the work she has done in omic-environment interaction studies among minority populations by utilizing multiple advanced genomic techniques and expanding to more minority populations across the USA and abroad.
“I would also like to expand my reach as a leader in nursing science by taking on a more key administrative role that will aid in building up the next cadre of minority nurse scientists.”
Keondra Rustan, RN, MSN, PhD(c), visiting assistant professor at Linfield College in Portland, OR, has overcome many challenges in her decade-long career as a nurse and nurse educator. Raised in a single-parent home with limited resources, she discovered how she could channel her interest in science into a nursing career by reaching out to mentors along the way.
Today, she shares her story and offers advice to other minority nursing students and nurses who may face similar challenges in their education and careers.
How long have you been in the nursing field and what has been your career history until now?
I have been a nurse for nine and a half years. I started out working in cardiac health care in Virginia. I did cardiac stepdown, some cath lab work, and I floated to some cardiac ICUs. I then went to the ICU where I learned a great deal and developed some professionalism and leadership traits. I then went on to become an assistant manager of an ICU and IMCU. I finished my master’s degree and became a professor at a private college where I rediscovered simulation and developed a great love for it. I became the simulation lab coordinator and for a time was the interim director of the LPN program, and went on to become the assistant director of the LPN program so that I could make more time for my doctoral schooling.
I am currently working in the dissertation phase of my doctoral program and enjoying my work at Linfield College as a visiting assistant professor working in simulation as lead faculty.
What inspired you to enter the nursing profession?
At first I didn’t want to be a nurse. I went through all of my primary schooling without having the decision of wanting to be a nurse. I wanted to be a scientist at first like those scientists in Jurassic Park.
Later on in high school I decided that I wanted to be a scientist that could help cure diseases and study microbes. However, I lost my grandmother when I was in high school and some of the care that she received wasn’t the best and lacked empathy. I decided that I wanted to help people more directly and show them that they aren’t just a room number but a thriving person who was deserving of care. I wanted to be a person who made a difference in the lives of others.
As nurses we often aren’t remembered individually; but if a patient has less exacerbations and starts feeling better because of your care and the education that you provided, it is very rewarding.
What inspired you to become a nurse educator?
I discovered that I liked teaching by precepting new nurses and nursing students. I enjoyed seeing the potential in them. I loved teaching them how to do things based on evidence and why it was so important for it to be done that way. I wanted to show them how to provide holistic care to patients and help them grow into future leaders.
I also enjoyed telling them stories so they could directly apply the teachings to their practice. Most importantly, I wanted them to have things I did not have prior to becoming a nurse: resources and a mentor. I wanted to apply these principles on a broader and larger scale so I went into the field of nurse education.
I would say the first year or so I was not very good at it. Or at least I did not feel as though I was a good teacher. I did not have a mentor or anyone to show me the ropes so I just taught them the way I was thought, which did not work.
What challenges have you faced in your career and how have you overcome them?
In my career my biggest challenges have come from lack of resources and lack of mentors. I grew up in a low-income single parent home with no vehicle. We did not have the funding or access to resources to get informed about career programs while in high school or even most scholarships. I wasn’t aggressive enough in thinking of my future and did not have enough drive when I was younger to seek those resources.
Once I decided to become a nurse, I didn’t really know how to become one, what nurses actually did, and what type of nurse I wanted to be (even when I graduated I still did not know that part). I had a lot of ideas, but I did not know how to bring them into fruition.
I overcame the lack of resources and lack of mentoring by joining organizations (good old-fashion Google search) based on my interests. When I was obtaining my BSN I got accepted into Sigma Theta Tau (the nursing honor society). Going to those conferences really opened a lot of doors for me. I am so grateful for the aid of the nurses and educators that I have met throughout my nursing career. They were able to point me into a lot of great directions. I am still growing and have a great deal more that I want to accomplish.
What challenges do you see minority nursing students face and what is your advice for them?
I see lack of resources as a big one and lack of mentors. Minority students (and I include males in this) have a high risk of falling through the cracks in nursing school. There seems to be a reluctance to seek aid when dealing with difficulties. It is hard to get over, because typically it is culturally ingrained.
My advice is to seek help right away when you are having trouble. If your school does not assign faculty mentors, seek out an instructor that you feel you can connect with. Shadow a nurse if you are not experienced with the duties of a nurse, so you have an idea of if it is right for you. Don’t be afraid to ask for help; if you do not understand, seek help (think of the patient’s safety).
Most nursing schools have scholarships, open labs, writing labs, and tutors available for their students; make use of these resources and give yourself support. View any setback as a learning opportunity and grow from the experience. Never stop learning even after you are licensed and working on the floor. Google search some nursing organizations (you can even join some as a student for a cheaper price) and they can lead you down some interesting paths. Also, once you obtain your knowledge, pass it on. You never know who you will be helping with your expertise and experience.
Where do you see yourself in 5-10 years?
I see myself with at least 10 articles published and maybe a book, of course having obtained my PhD. I want to still be educating nursing students and maybe have obtained my NP. I want to continue to learn and grow each day to become the best educator that I can be. I want to do more in community and be a greater help to those in need.
Marygrace Colucci (center) along with her supervisor/nurse manager Louise Esposito (right) and Marianna Vazquez, CNO (left)
Imagine moving to the United States from the Philippines and building a nursing and military career. That’s what Marygrace Colucci, RN, BSN, MSN, did when she migrated to the U.S. in 1995. Today, Colucci is living her lifelong dream as a staff RN in the ophthalmology operating room at Northwell Health at Syosset Hospital in New Hyde Park, New York.
In May, Colucci was honored with the Zuckerberg Nursing Excellence Award during National Nurses Week. The award recognizes exceptional nurses at Northwell Health.
“Ever since I was a little girl, I wanted to be a nurse,” Colucci says. “I have seven siblings, so my parents could only send me to a two-year midwifery program due to the financial constraint to support a four-year BSN program. I graduated at 18, passed the midwifery board but couldn’t get my license until I was 21 years old. I started working as a midwife in the hospital with just a permit, and I remember having so much fun delivering babies, and assisting in C-section procedures.”
Colucci says that when she first arrived in the U.S., it was a huge culture shock. “I missed my family and friends. I was homesick, but eventually got over it,” she says. “I was afraid to talk to people because of the language barrier; not because I didn’t know how to speak the language, but more because I was shy of my English and my accent.”
Colucci was inspired by her cousin who served in the U.S. Army as a nurse. “He was sort of my role model, and that is why I joined the Army Reserve in 1998,” Colucci says. “Joining the Army helped me overcome most of the challenges I had to face back then such as the language barrier, being shy, and lacking self-confidence. The Army taught me how to face all kinds of adversity. I’d have to say the Army really turned me into the kind of person I am today.”
Another supportive influence for Colucci has been her husband. “When I graduated with my associate’s degree in nursing, he told me I should go back to school, which I intended to do anyway. I went on to finish my BSN, and he told me again that I should go for my master’s, which I intended on doing. But him pushing me to go further was really a good motivator. And now that I’m done with my NP, he said go for your doctorate, which I’m still considering.”
Colucci says for now she is focusing on her military career. She hopes to be promoted to major in the future. “I also want to focus on helping soldiers from my unit, which I am currently commanding,” she says. “I try to motivate my soldiers and tell them that they can do so much with their skills, and that there are so many opportunities available if they’ll just work hard for everything that they want to achieve.”
“I also tell my fellow Filipino coworkers to advance their education by going back to school,” she says. “I told them that if I can do it, so can they. I’m not really smart; I just happen to be disciplined and really put a lot of time and effort into everything I set my mind on achieving.”
Colucci sees herself working in emergency medicine in the future. “I had a great time when I was doing my clinical at the urgent care centers. I told myself I will embark in that field if given the chance. I think emergency medicine is a very good and rewarding field to practice. I would like to be promoted to major in the next two years; and eventually to lieutenant colonel in the Army Nurse Corps.”