Nurses need to be prepared for every eventuality in patient care: they welcome life into the world, and hold patients’ hands as their lives come to an end. The core job duties are physically, emotionally, and spiritually taxing — and sometimes dangerous — so it’s no surprise that nurses experience burnout at an alarming rate.
In fact, the National Nursing Engagement Report for 2019 found that 15.6% of all nurses were feeling burned out at the time of reporting, with 41% of nurses who reported themselves as feeling unengaged also reporting feeling burned out. But many nurses also know they can’t leave — or even take time off — because the nursing shortage is so critical that every hour counts.
We’ve written before about how to combat nurse burnout, but it’s just as important to recognize the dangerous signs of burnout when it starts.
What Are the Signs of Burnout?
Between the long hours, the demands of the job, and just being human, most nurses will experience either the signs of burnout or full Burnout Syndrome (BOS) at some point during their careers. As the National Nursing Engagement Report showed, even fully-engaged nurses report these symptoms. The first step to combating BOS is to recognize the symptoms.
Perhaps the first sign and highest predictor of burnout is emotional exhaustion. Nurses know what it’s like to be tired, but emotional exhaustion leaves you feeling completely drained as a result of the stress of your job. In addition to feeling fatigued in every way, people who are emotionally exhausted often feel like they’ve lost control of their lives — they often report feeling trapped in their situation, whether it’s at work or in an outside relationship.
Another sign of burnout is depersonalization. When you become so exhausted that you have to detach from your surroundings to survive, then you are burnt out. Your outlook may be negative or even calloused, and it can express itself in unprofessional comments directed at colleagues, feeling nothing when a patient dies, or even blaming patients for their problems.
The final major predictor of burnout is a reduced feeling of personal accomplishment. You may not feel that you’re a good nurse or that you make any difference at all in patients’ lives. Nurses working in high-intensity settings, like the ICU or emergency room, may experience this more often as they receive a greater proportion of cases where little can be done for the patient.
Why Burnout is Dangerous for Nurses and Patients
Burnout is more than having a bad day; it’s an impaired outlook on nursing and life in general. Experiencing burnout doesn’t mean you don’t love your job, nor does it mean that you aren’t good at what you do. In fact, this reality makes it even more difficult for nurses who experience burnout because leaving is just another impossible choice.
At the same time, burnout is as dangerous for nurses as it is for their patients. A nurse in the throes of BOS is both less likely to have life satisfaction and more likely to provide a poorer standard of patient care. In a study published in Research in Nursing & Health, researchers explored the correlation between the quality of care and nurse burnout among 53,846 nurses from six countries. They found a strong correlation between higher levels of burnout and nurse-rated quality of care.
In other words, burnout can become a self-fulfilling prophecy. Burnout can result in lower standards of patient care, which further informs the reduced feelings of personal accomplishment. As nurses make mistakes, they feel even lower job satisfaction and an even greater intensity of burnout, which goes around again to manifest itself once again in patient care.
How Nurses and Nursing Leaders Can Combat Burnout
Nurses are caught between a rock and a hard place — the nature of the job is stressful, but if you love what you do, you can’t quit. Although almost all nurses will go through burnout at some point, there are things that both practitioners and health care organizations can do to stave it off and help re-engage burned-out nurses.
Education is one of the critical ways that nurses can empower themselves and avoid burnout. Pursuing further education can renew your passion for what you do and help you overcome roadblocks. It also puts you in a better position to provide the latest evidence-based care to patients, which correlates to better patient outcomes and increased job satisfaction.
Nursing leaders and administrators also have a strategic role to play, as the environment in which nurses practice needs to be a supportive one. Creating a positive work environment that limits unnecessary stress and allows nurses to care for themselves and recharge can do wonders in both reducing burnout and igniting engagement.
Those same leaders and administrators can also take notes from other industries’ workplace safety practices. You can’t just say you have a safety culture, you need to commit to it by formalizing the ways in which you intend to create and maintain the culture and creating avenues to accept employee input.
There’s Always More Work to Do to Prevent Burnout
Nurses can’t get rid of the high-stress, high-stakes environments they work in. They can’t wave a magic wand and save every patient no matter how severe their condition, and they can’t stop feeling to cope.
In other words, burnout is a given part of being a nurse. While these feelings are normal, nurses also need support in preventing the bad (and downright dangerous) days from outweighing the good ones. Nurses and administrators can and must work together to prevent burnout — and while the challenge is a significant one, it is achievable if we all listen to each other.
As 2019 winds to a close, several issues in the nursing industry remain prominently in the news and in the ongoing conversation around nursing as a profession.
What are some of the top issues of 2019 that will carry over into 2020?
80 Percent in 2020
The next year marks the end goal time period for the 2010 Future of Nursing report by the Institute of Medicine that called for 80 percent of registered nurses to have BSN credentials by 2020. According to the Campaign for Action, the ambitious goal won’t be met, but that doesn’t mean it hasn’t made a difference. The recap says that RNs with a BSN are at the highest percentage ever with 56 percent having the degree. That’s a seven percentage point increase since the initial report was issued. Even though the goal hasn’t been realized, there’s progress and that bodes well for the entire nursing industry.
Violence in the Workplace
The rate of violence against healthcare workers is skyrocketing. The thought of healthcare providers helping people and becoming targets of violent acts from patients and their social circles, disgruntled workers, or even random perpetrators is terrifying. Luckily, the government has recognized the problem and introduced H.R.1309 – Workplace Violence Prevention for Health Care and Social Service Workers Act to require organizations to develop and implement plans to protect workers. This bill passed in the House in November and is now under consideration by the Senate.
There is a lot of media attention on a projected nursing shortage over the next decade. As Baby Boomers continue to age and require more healthcare services, nurses will be a big part of that picture. According to the National Center for Biotechnology Information, U.S. National Library of Medicine (NCBI) the nursing workforce is also aging, spurring a shortage as it also provides a fantastic job market for nurses of almost any specialty. The issue will continue to attract attention.
Given the topics that are prominently in the news about nursing, it’s no surprise that nurses experience sometimes crippling job stress and burnout. When there aren’t enough nurses to care for a rising number of patients with increasingly complex conditions, the stage is set for nurses taking on too much. When that happens, their physical and mental health can suffer and that means patients aren’t getting the best care possible. This topic garners lots of attention by nurses themselves and by the organizations who recruit, hire, employ, and want to retain them.
Nursing as a Vibrant Profession
Nurses have professional pull. Routinely ranked as the most trusted profession, the nursing industry enjoys good salaries, opportunities for professional growth, respect, and increased independence. As an industry, nursing is committed to a more diverse, more educated, and more representative workforce and takes steps to meet those goals.
With 2020 on the doorstep, let’s see how these topics gains team in the next year.
Most of us know the benefits of being out in nature, but did you know there’s a difference between being in a green space and a blue space? Being in a green park or near blue water bring different feelings of peace that can supply mental and physical health benefits.
With the holiday season rush packing already busy schedules, nurses should take some time to decompress. Having a busy, engaging, and exhausting job is something nurses typically thrive on, but even the most energized nurse can get worn out during these next few weeks.
Maybe you need a little green or blue space to quiet your mind and energize your soul. If you suffer from depression, anxiety, or a general low mood in the winter, getting outside helps.
It’s obvious to just about anyone—being outside boosts your mood. But depending on where you live, you can’t always have access to green or blue space when you want it. Landlocked states don’t have the ocean’s coastline, but there are other ways you can reap the benefits of blue space—even if you’ve never seen the ocean. Green space is a little easier to find, and finding a new green space is always fun.
Green space can be as big as an open prairie or as small as a garden near your workplace—the important result is how it makes you feel. Urban green spaces are essential for city dwellers who may not have easy access to larger green areas.
A few minutes spent breathing in the fresh air, seeing the open sky, hearing birds or the wind in the trees, and feeling the green grass brings a sense of well-being and peace. Parks, open landscapes, and your own backyard all occupy the green space definition and bring a host of positive feelings.
Blue spaces are different. Open oceans, waterscapes, lakes, rivers, ponds, shorelines, even a fountain offer an interaction with water that is soothing. Even states hundreds of miles from the ocean will have bodies of water that offer similar benefits.
Blue spaces, with all their beautiful views, sounds, and positive ions from the water, also tend to encourage physical activity. Any kind of outdoor exercise is good for getting the heart rate up and bringing a sense of calm, and people tend to congregate around water to get moving. Walking, playing in the water, jogging along the shore, or swimming all help bring a sense of calm and lower blood pressure, reduce anxiety, and offer a protective benefit for mental health.
As a nurse, you can seek out green or blue spaces and see if it helps your stress levels or see if it boosts your feelings of well-being. Patients might find the correlation between green and blue spaces and better overall mental health interesting enough to ask for more information. And it’s fairly easy to incorporate into your routine. Walk through a park on your lunch break, take in a scenic vista whenever you can, take a trip to your local pond for a picnic. Even a visit to your local greenhouse or an indoor botanical garden can surround you with enough of a natural view that you’ll feel yourself relaxing.
During stressful or busy times, remember the benefits of green or blue space and make a point to get it on your schedule.
Nurses know all the reasons why heart health is so important. They don’t have to be a cardiac nurse to know that a healthy heart impacts everything from energy levels to brain health.
If you’re trying to take care of your heart by watching what you eat, getting enough exercise, and keeping your stress at a somewhat manageable level, you might be surprised to find your heart health is influenced by things you often just can’t control.
As a nurse, keeping some of these things in mind when talking with patients might be a flag for potential heart health trouble. Knowing a little more about those you treat can give you a broad picture of how events happening in their lives could impact their heart health.
People predisposed to heart disease because of their genetics can’t do anything about the genes they were born with. They can take steps to counter conditions such as high blood pressure or high cholesterol levels that are often handed down through generations. They should also be especially careful of their health, controlling the factors they can (diet and exercise are the big ones) and working with a health team to mitigate the ones they can’t.
Believe it or not, a recent American Heart Association report found that some jobs seem to increase a woman’s chances of poor heart health. According to this report, registered nurses are 14 percent more likely to have poor heart health, as do women in other health care roles such as a psychiatry, home health, or social work (36 percent more likely). Using data from approximately 65,000 postmenopausal women from the Women’s Health Initiative study, researchers found that women in some occupations show signs of poorer heart health than others.
Changing Economic Factors
Economic disparities have historically been linked with poorer health outcomes across regions, races, ages, and genders. But a recent report in the Journal of the American Medical Association showed a link between a significant drop in income and declines in heart health. Using data from the Atherosclerosis Risk In Communities (ARIC) study, the cohort showed that an income loss of 50 percent or more led to higher incident cardiovascular disease (CVD). Conversely, rising income levels resulted in decreased CVD.
Women lose the potentially heart-protective benefits of estrogen after menopause. Along with aging and the cumulative effects of other habits, this time in a woman’s life might increase her chances of heart disease. The American Heart Association recommends that women take stock of their health around this time and work to make changes that will be good for their hearts.
As you meet with patients and as you consider your own health, taking your heart into consideration is going to have on overall positive impact on your well-being. Understanding how other factors can have a significant impact on heart health is a great starting point for discussions about prevention, testing, monitoring, and lifestyle changes that will make the heart stronger and healthier.
Our health is something that we all have, and unfortunately, the condition of our health is not something that we have complete control over. We do, however, have the ability to enhance the quality of our health. We all have choices to make regarding our lifestyle and how we manage our health to make sure we ensure that our health never deteriorates and we can live a long, healthy, and fulfilling life. We can control our choices to improve the quality of our overall health, and a significant part of enhancing the quality of our overall health is making doctor’s visits a priority. Being inconvenienced with taking time off work or readjusting our schedules should become secondary to the need to seek medical attention when needed. The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.
The fragility of health became very real to me about 10 years ago when my persistence to my doctor, because I was not feeling well, finally resulted in an order for a CT of the lungs to reveal I had pneumonia. The previous x-rays of my lungs were always inconclusive. My health was in jeopardy, and I knew that I had to become intentional in my pursuit to get better. My persistence of seeking medical treatment reappeared with a vengeance in 2013 when my favorite uncle was diagnosed with stage 4 throat cancer. He was a mechanic who loved his family, and he was a very talented cook. He was one of those men who never had a lot to say, but he observed everything. It was easy to tell that he was not doing well, but I had to beg and plead with him to allow me to make him an appointment at a local clinic after we noticed that his health was declining. He was a proud man who did not like to admit when he needed some help. He was self-employed with no health insurance. His case was so difficult that most of his medical team did not want to take him as a patient. One of the wonderful physicians believed in him, and she advocated for him. He went through major surgery, and he lived another two and half years that gave me and my family more time to spend with him.
Two days before my uncle passed away, I softly spoke to him and told him that I would finish my doctoral program and make him proud of me. He nodded his head, and I was blessed to keep my promise. I believe that if my uncle would have been treated sooner, the outcome would have been different. I did not know when my uncle passed away that I would devote my research efforts to racial health disparities, or that I would have such a passion for educating the African American community on the importance of seeking health care services. Through my sorrow, I have made it a part of my mission to educate African Americans regarding the importance of seeking timely and routine medical treatment.
It is so important for African Americans to seek medical treatment because of the high incidences of health diseases and conditions that plague that population, such as high blood pressure, high cholesterol, diabetes, and heart disease. In my experience from working years as a certified pharmacy technician, too many people do not treat their health like the important commodity that it is. We sometimes feel that our health is something that we will always have, and that it will always be good. Unfortunately, I know firsthand that it simply is not true. Our bodies give us signs when things are not right, but it is up to us to pay attention. We sometimes shrug things off when we notice that variance in our health occurs in hopes that it will get better without us taking on more of an active role to ensure that it happens.
The goal of my research was to evaluate how the patient-provider relationship impacts the patient’s decision to access health services. Through my quantitative research, I wanted to delve into the rationale that African American patients have about how they make the decision about when they will visit the doctor. African American cultural norms, in addition to the historical aspects of discrimination coupled with provider biases, create a divide that can become evident during the patient’s visit. African Americans often feel as if they are not heard or a priority when they make medical visits. Chronic diseases and conditions often necessitate the need for medical visits as it pertains to African Americans, so African Americans between the ages of 40 and 65 were the target population that was studied. After reviewing the demographics within Shelby County, Tennessee, it was determined that the sample could be identified after evaluating the community right within my reach. It is apparent through observation as a former practicing certified pharmacy technician that African Americans are subjected to health disparities at an alarming rate. Those racial health disparities are prevalent because of the effects of the patient-provider relationship, limited access to health care resources, and health outcomes that are less than ideal.
A group of 56 participants were gathered through the help of alumni chapters of African American sororities and fraternities located throughout the greater Memphis area. All of the participants that were used to complete the analysis lived within Shelby County, had health insurance, had an English speaking primary care physician, and were African American. The findings evaluated the interactions that occur during the medical visits. The goal was to possibly uncover why African Americans do not go to the doctor in hopes of explaining why there is a prevalence of chronic diseases within that population. The findings did indicate that there is a significant relationship between the patient-provider relationship and the behaviors of the provider. Additionally, the behavior of the provider does contribute to the African American patient’s decision to seek health care services.
The participants that were evaluated stated that gender and assumptions that the provider makes about their education level and income did play a factor in how the provider interacted with them during the medical visit. The behavior that the staff exhibits during the medical visits of African American patients does impact the decision that is made to seek services, and the way that African American patients are made to feel during the medical visit does impact their decision to seek follow-up care and even their willingness to comply with medication compliance. It is important for the African American patient to be understood and treated with compassion, care, and concern. The historical component of the racial tension that African Americans have dealt with makes it pertinent for health care providers to treat the patient’s concerns as a priority.
In summary, there is a direct correlation between the relationship that the patient has with their provider and how the behavior of the provider is perceived during the interaction. It is important that African American patients receive ongoing education regarding the importance of seeking timely and routine health care. Providers need to be cognizant of how their mannerisms and responses affects their African American patients. African Americans do not consistently go to the doctor, which is evident by the staggering statistics of preventable and treatable conditions and diseases that plague that community. The goal for both parties within the relationship is to realize that it is impacted by both the actions and reactions of both sides.
Acknowledgment. The author would like to thank Cheryl Beers-Cullen, DHA, MPA, BSN, RN, CALA and Manoj Sharma, MBBS, PhD, MCHES for their contribution and mentorship.
Anyone working in a healthcare setting pays extra attention to infection prevention. With so many different people carrying infectious diseases in closed areas, infection control is a priority.
This week marks International Infection Prevention Week (October 13-19) and highlights the constant vigilance needed to keep infection control in the forefront. Sponsored by the Association for Professionals in Infection and Epidemiology (APIC), the week is a reminder to the crucial way infection control safeguards individuals and larger communities.
There’s more to stopping the spread of germs than simply washing your hands. Although hand washing is extremely important, nurses can also adopt other practices to help stop infections from spreading from person to person (and to avoid becoming a patient themselves). They are also a good resource for patients who can learn good infection control methods and also learn about other prevention methods including vaccinations.
Wash Your Hands
Nurses’ hands require near constant cleaning with soap and water or antibacterial gel. Because nurses touch everything from patients’ bodily fluids to medical devices to food, having clean hands is the top way of keeping infections in check. Nurses know this, but it’s also important for them to share this information with their patients and families. Whether it’s visitors to the nursery or family members who are taking care of wounds or stomach infections at home, this is one activity that cannot be stressed enough.
Protect Clean Surfaces
Everything a nurse touches has the potential to spread germs or infectious illness. Being mindful of the surfaces you touch, whether you are wearing gloves or not, helps you stay healthy and protects your patients.
Staying up-to-date on your own vaccinations helps protect you from preventable diseases and is a key to infection prevention. A flu shot every year, required by some healthcare organizations, is protective as are routine vaccinations to prevent tetanus or pneumonia (if you’re eligible). With the recent explosion of measles cases across the country, you can also help educate your patients on the safety and effectiveness of vaccines to keep serious and potentially deadly diseases out of their own homes and communities.
Know Proper Procedures and Protocol
Some nurses are exposed to extremely contagious and dangerous infectious diseases. Outbreaks of Ebola have caused infectious in the healthcare workers helping patients, for example. Knowing your organizations protocol for handling such cases or for handling outbreaks is essential. If you aren’t sure about the current protocol and process, keep asking until you find out or until a protocol is established. Flu outbreaks are common in the wintertime, but in our increasingly global world, outbreaks of other diseases that have primarily been in other countries can easily jump to any area. Nurses have to be ready to handle whatever might evolve.
As a nurse, infection control is a big part of your responsibility to your patients, but it’s also a responsibility to yourself. Remaining as healthy as possible lets you care for and protect your patients.