Nurses—especially in the last year during the pandemic—have been experiencing burnout. Often, articles focus on what they can do to make themselves feel better. But what can their workplaces do?
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health Learning, Research & Practice, a Critical Care Nurse Practitioner at Penn Medicine Chester County Hospital, and a Clinical Adjunct Faculty member at Drexel University. She’s also authored and presented on many clinical and professional topics including a recently published eBook, COVID-19: Transforming the Nursing Workforce in the New Paradigm of Care.
She took time to answer our questions about what hospital leadership can do to prevent nurse burnout.
From a hospital leadership standpoint, what are some of the steps they can take to help prevent nurses from burning out?
Health care systems need to recognize that their most valuable commodity is their workforce. For years, health care systems have focused on patient well-being, but now many of those institutions are beginning to see the importance of focusing on workforce well-being too. Hospitals need to provide a safe environment for their workers, recognizing when they’re exhausted, burnt out and/or experiencing moral distress on the job. Safe environments should include the assurance of personal as well as patient safety and having adequate personal protective equipment, clinical decision support resources, and adequate staff to appropriately care for patients.
Staffing needs must be based on clinical acuity and severity of illness, not just on the number of patients. And having an agile workforce that can work in a variety of units as well as be shifted to other units when and where they are needed the most, is also a new essential, thanks to COVID. What we want, and need, are multispecialty nurses who can work across multiple units, not just single-specialty nurses working only with one patient population. Cross-training and upskilling staff to care for patients in a variety of units with a variety of care needs brings flexibility and efficacy to the workforce so managers will not need to overwork staff and can provide necessary time off.
Health care systems need to recognize when a member of their workforce is experiencing burnout and moral distress by having leadership and those trained in recognizing emotional distress available and on the unit to assess for it. Social workers and mental health workers are excellent resources to utilize for this kind of assessment. Taking the time to debrief and discuss what went right and what could have gone better in emergencies is a great opportunity to decompress after stressful situations. Many hospitals have instituted a moment of silence after a death where everyone in the room stops to acknowledge the life that was just lost.
Employee assistance programs (EAP) are good, but only if they can be easily accessed by those who need them. Too often EAP programs are difficult to find on the health care system website, and once they are found, the paperwork and or searching for an available care provider is incredibly challenging. EAP programs need to be made readily accessible and usable.
What should they do first?
The most important first step is to recognize that there is a problem with burnout. If staff are quitting, retiring early, or are becoming less engaged, there is a real problem. Be present! The leaders within the organization must be up on the units to experience what is going on firsthand. You need to find out if staff able to take breaks and leave the unit to have a meal. Are they able to sit down or are they constantly moving and up on their feet? Are they working as a team or as individuals? Health care is a team activity. It takes an interdisciplinary approach to provide the highest quality care and facilitate the best outcomes. If patient outcomes are not where they need to be, the first place to look is at your caregivers to see if they are exhausted, burned out, or experiencing moral distress.
What action steps should leaders recommend that nurses take? How can they get this information to them?
The question should not be what steps leaders should recommend to nurses to combat burnout, but how can health care organizations facilitate workforce well-being and prevent burnout? It is the obligation of leaders to assess the situation, make a plan, implement it, and then evaluate if the plan and interventions are working.
Start meeting with the staff, watch and listen to what they have to say, and start implementing these 10 steps:
Assess if the staff are burned out or experiencing moral distress.
Make employee assistance programs easy to access and utilize.
Adequately staff the patient care units with the right staff for the right patient populations.
Cross-train the workforce so they are more agile and can go when and where they are needed.
Provide adequate support systems, unit coordinators, unlicensed assistive personnel, and transporters.
Make sure the workforce takes their breaks and mealtimes.
Offer healthy food. Get a cart and take healthy options to the unit if the staff is too busy to get to the cafeteria at mealtime.
Give the staff time to debrief and collect themselves after a challenging situation.
Decrease documentation burden and make sure nurses have input on what is added to required documentation in the electronic health record.
Offer continuing professional development activities and career ladders to meet the staff’s professional needs.
Remember, nurses have family and financial concerns; offer care alternatives and financial counseling if and when it’s needed.
If nurses are already experiencing burnout, what should hospital leaders do? How can they help? And how can they let nurses know that their jobs aren’t in jeopardy if they need to take time off for their mental health because of burnout?
Take the time to see, hear, and experience what nurses are experiencing. You can’t do that from an office, so get up on the patient care units and look around. If the workforce doesn’t feel valued by the organization, they will leave, and there will be fewer caregivers left to care for the patients. Develop a “care without judgement model,” meaning that to whomever is in need of care—a patient, a nurse, or another employee—care will be delivered, without judgment. No one’s job should be at risk if they need to take time to step away and focus on self-care. You cannot be a good clinician unless you care for yourself first. Again, make it easy to access employee assistance and mental and physical health resources.
What should hospital leaders absolutely *not do when trying to prevent their nurses from burning out? What are the biggest mistakes they can make?
The biggest mistake health care leaders make is not recognizing that the health care workers are the most important commodity within their organization. Patient outcomes are optimized only if the staff feels valued, have adequate resources, are properly trained, and feel safe in their work environment—both physically and emotionally. Everyone on the health care team needs time to be able to take a moment to step away and recharge.
During COVID-19, what have been the biggest challenges that nurses are facing in terms of burnout? Is there anything that hospital leadership can do to help?
The biggest challenges have been fear and uncertainty. Fear that we initially didn’t know enough about the COVID-19 virus, and we might bring it home to our families or become infected ourselves, and fear that the death we experienced day after day wouldn’t stop. And uncertainty that we wouldn’t be strong enough to keep delivering care to our patients as we fought this seemingly unending pandemic. Yet we did. We looked fear and uncertainty in the face and said—”we will not be daunted!” That’s who we are—we are nurses, and our passion is to care for those in need.
Health care systems need to invest in workforce well-being, retaining the talent they have and recruiting new nurses to take the place of those who have left the profession. Care begins with those in our family. In health care, the workforce is our extended family.
The vaccine is a game-changer for nurses. The more shots in arms, the lower the number of patients we will see fighting for their lives because of COVID-19. Let’s trust in the science and use the evidence to educate people about COVID-19 and how to prevent it.
And finally, nurses need to invest in their own well-being so they can invest in caring for others.
Oftentimes, nurses don’t take care of themselves like they should. While they focus on taking care of others, their self-care falls by the wayside. Especially during COVID-19 and the pandemic, they’ve put everyone else first.
Imani Wilform, MHC-LP, with Empower Your Mind Therapy, took time to answer our questions and give self-care tips on what nurses can do to make sure that they are making time for self-care. Our interview, which follows, has been edited for length and clarity.
Dealing with COVID-19 and the pandemic has been tough on everyone, but especially difficult on frontline workers such as nurses. Why should nurses be sure to practice self-care now?
As much as nurses care for everyone else, it’s crucial to pay attention to your own needs too. By its own true definition, self-care is about taking intentional care yourself: your mind, your body, your environment, and your spirit.
If we don’t practice self-care, we can become burned out, resentful, angry, and may even start feeling depressed. This also lowers your immune system and can make you feel tired and low. If you’re not feeling your best, how can you manage caring for others?
What are some things that nurses can do to be sure to remember self-care and to fit it into their busy days?
While the occasional self-indulgence like a spa day or getaway can be a great way to express some gratitude to yourself and all you accomplish, self-care is about more than an occasional treat. An intentionally cultivated daily self-care routine can make a huge difference in our lives and allow us to be balanced & more restored.
Today, ask yourself:
How do I typically take care of myself day to day?
Do I take time to regularly assess and address my needs?
How is that impacting both my mental and physical health?
I really want you to think about how (or if) you set aside time each day to take care of yourself. Do you have time to sit back and assess your needs? Do you listen to your body when it tells you that you need a break? When you’re mentally strained, do you have a routine that helps you rest and rejuvenate?
Is there anything they can do at work on a break or at home?
There are a lot of little things that are self-care, but aren’t exciting or Instagram-able. You can do these quickly:
Write down your to do list for the week to stop the constant nagging in your head.
Set a time to be done with screens before bed.
Make a meal plan that gets you excited to eat 3 meals a day.
Take a look at your calendar: are you overbooked, need a fun outing to look forward to, need to make a doctor’s appointment?
Call a friend to catch up.
Spend time outside.
What are absolute must-dos regarding self-care?
Assess your true needs: when we’re talking about daily self-care we’re talking mainly about wellness (mental & physical). For a week, keep a log of your physical and mental expressions of stress or strain. Are you tired? Do you have frequent headaches? Look at what comes up for you and come up with small, incremental steps to take action. Maybe you have constant headaches because you’re dehydrated. Start carrying a water bottle, set some reminders on your phone to actually drink from it.
Take a critical look at your routine: What is taking up your time on a daily basis? Often times we fall so behind on creating an actual daily routine that serves us that we end up playing perpetual catch up. Finding the right way to balance what you need day to day will help ease stress and keep you feeling more balanced and in control.
Prioritize rest: if you have to put it in your schedule or “to do” list to make sure you get time to rest and recharge then do it. Maybe it’s yoga, reading, taking a bath. Rest and rejuvenation should be a priority in your daily routine. Set aside small chunks of time each day where you stop the machine, ignore “productivity” and let yourself rest.
What would you say to a nurse who says s/he doesn’t have time for self-care because too much is going on?
Self-care can be something quick and small to help yourself with your own mental and physical well-being. As a nurse, it’s important to remember that you are just as important as your patients and family. Others rely on you, so rely on yourself too. Even if it’s a quick walk around the block during lunchtime or outsourcing personal to-dos to another family member—such as creating a shopping list or picking up a birthday gift for someone—try to take some time for yourself. Also remember that self-care shouldn’t create more pressure. If it’s too much to take time every day, start with setting aside some time once a month to check in with yourself.
As rates of COVID-19 infections continue to decrease and rates of vaccinations continue to increase, nurses will hopefully have a summer that gives them time to recharge and rest.
If you’re able to take some time to rest and recharge over the next couple of months, you’ll want to think of the best ways to take advantage of time that will help you. You’re likely still reeling from a year of work levels and stress that you probably hadn’t experienced before. Warmer weather and longer days lend themselves naturally to inviting less rushing, and more time to do what is good for you.
Here are a few ideas to get you thinking about how to feed your soul and start to recover from 2020.
Start with Gratitude
Today is Memorial Day and honoring those who have given their lives for our country inspires a deep well of gratitude. If you or a loved one has served the nation through military service, you deserve enormous thanks for all your sacrifice. And for anyone who has lost a loved one, the nation will never forget their bravery and dedication to defending the freedom we all enjoy.
Rest, Rest, Rest
Sleep is important for every part of your body, but when you’re under immense stress, it’s often hard to come by. If you have trouble sleeping, worrying about your sleep difficulties can make it worse. This summer, focus on getting rest. Read a book or listen to your backlog of podcasts in the park or in the cool air conditioning of a library. Binge watch Netflix, meditate, and don’t underestimate the power of a well-timed nap (just keep it short so it doesn’t interfere with your regular sleep).
Change Your Scenery
Several days each week, try to spend some time in nature for restorative mental-health benefits. Take a trip to the ocean or a lake, visit a nearby park or forest, or hike a mountain on a day off. A day trip is great, but even spending a 15-minute break outside can help. Or you can focus on your living space and give it a reboot. A coat of paint in a soothing color, pillows you can sink into, new plants or fresh flowers–all of these small changes can give you a lasting sense of renewal.
When your schedule is so busy that you can’t think straight, trying to plan for one more thing might seem counterintuitive. But making plans to do something you enjoy, like a vacation, a day trip, or a get together with family and friends can give you a real boost. And studies show that taking a vacation can make you a more resilient and better employee. Time to disengage and disconnect from the stresses of work is like pushing a reset button to recharge your energy.
As a nurse, you help other people all day long, but taking a different approach to service makes you feel more connected to your community. Offer help that isn’t related to healthcare–participate in a clean-up day in your neighborhood, plant flowers with a community group, help out in a shelter, cook food for a family in need, walk your neighbor’s dog after their surgery, offer to help distribute groceries at a food pantry, or commit a few hours to a cause you are passionate about. If you have family, get them involved.
The pandemic isn’t over and flare ups are likely to happen again. If you’re able to hit pause this summer, even for an afternoon, the benefits can help recharge your mental and physical health–and you’ll enjoy yourself in the process.
February celebrates heart health, but it’s not always easy to make all the best choices for your heart. Try any of these five heart health hacks to get started on a good path to better cardiac health.
1. Treat Yourself
Proper diet is essential to a heart-healthy lifestyle, but that doesn’t mean your food can’t feel decadent. Reducing fats, especially saturated and trans fats, is a given, but so is making sure you’re getting enough fiber, vitamins, and antioxidants. But a heart-healthy diet doesn’t have to be boring or bland. Experiment with spices and flavorings to add some variety. And while a banana split or a wedge of triple-chocolate cake isn’t going to do your heart any good, a few chocolate covered strawberries can satisfy your sweet tooth without overloading your heart.
2. Floss Your Teeth
Heart health depends on lots of protective behaviors, not just intense exercise. Daily flossing has long been known to be a protective action you can take to keep your mouth healthy, but does it also protect your heart? In general, periodontal disease may raise the risk of heart disease and may interfere with proper heart valve functions. Because gum disease can trigger inflammation, and inflammation is tied to heart disease, brushing and flossing every day can help you keep problems at bay and may give your heart extra protection. You get a lot of benefits from just a few minutes of effort.
3. Zone Out
Meditation is known to help bring down stress and reduce inflammation-triggering cortisol. But lots of people think of meditation as something that requires time they don’t have. What if you think of meditation as zoning out, but with a focused mental health purpose? When you walk, focus just on the feel of your feet hitting the ground. Listen closely to the noises outside or to the notes in a favorite piece of music. Watch a movie or read a book that engrosses you. Do something you so enjoy that time slips away. Getting into that kind of quiet state helps your heart reap some important benefits of restorative calm.
4. Stretch Your Legs
Something as easy as stretching, and stretching your legs in particular, can help with heart health. Some studies have shown that a regular, easy routine of stretching your legs can help keep arteries more flexible which improves blood flow. When the vascular system is in better shape, your cardiac health is going to benefit. Incorporate a routine of stretching your legs every day.
5. Laugh a Lot
From relieving your stress to increasing blood flow to upping your oxygen levels, laughing is serious business when it comes to your heart health. And while the weight of the pandemic might make laughing less easy to come by, it is worthwhile to seek it out. In this digital era, finding a funny video of silly animals or watching 10 minutes of a favorite comedian is easy enough. You can also check in with your funniest friend or even join a group that laughs on purpose—there are laughter clubs that do just that. Don’t wait for the laughter to just happen—make it happen for your heart health.
Long known as a month filled with valentines and heart-themed decorations, it’s no wonder that February was chosen as the month to highlight heart health.
The February 2021 celebration marks the 57th annual American Heart Month, and spotlights women’s heart health with a “Heart to Heart: Why Losing One Woman Is Too Many” campaign. In a time when one in three women are diagnosed with heart disease annually, this important month is a time when nurses can check their own heart health and strive to be a resource and help provide patients with accurate and timely information about heart disease.
As always, people can take lots of steps to keep their hearts healthy and can, in fact, prevent or mitigate a great number of serious heart disease cases. A healthy lifestyle can make a huge difference in heart health and even moderate steps can have significant impact. You don’t have to be a marathon runner to have a strong heart, and it’s important to talk about small lifestyle changes with patients so they feel like they can make a difference in their own health.
getting at least 150 minutes of moderate-intensity physical activity a week, and
getting regular checkups.
And other habits can be just as important for keeping your heart in top shape. Getting enough sleep, keeping socially active with friends and loved ones, and trying to reduce the impact of stress with stress reduction practices (whether that’s a hobby or talking to a professional), all play a part in keeping your heart strong. And everyone should know the symptoms of heart attack or stroke.
Beyond lifestyle changes, do some sleuthing and find out as much as you can about your family’s heart health history. As genetic components can predispose certain families to heart disease, knowing if anyone in your family has had or currently has high blood pressure, a history of heart attacks or strokes, heart valve problems, or heart failure, can help you determine if you’re at a higher risk. It’s especially important to know the ages of these diagnoses as a family history of early heart disease can help guide your own testing and monitoring decisions.
Cardiovascular nurses treat patients with heart disease and often act as a great resource for patients. As they walk patients through their diagnoses and treatment, they are also able to help connect patients and families with other resources including nutritionists, physical therapists, support groups, and other specialists.
Almost any nurse knows 2020 can’t be compared to any other point of time they have lived through. And 2021’s progress is in sight, but it’s slow going getting there. Vaccines are on the horizon and some nurses have even completed both doses, but hospitals are still seeing more patients than they can sometimes handle and the new strains of COVID-19 bring the threat additional surges. Nurses are seeking short bursts of stress relief to combat the burnout they are feeling.
The COVID-19 pandemic has left a path of devastation few are equipped to deal with physically, emotionally, or spiritually. As front-line workers, nurses bear the brunt of overwhelming stress, grief, and exhaustion. Stress relief is a priority, but hard to come by for most nurses.
Minority Nurse recently spoke with Crystal Miller RN, past president of the Infusion Nurses Society (INS) about the ways nurses are just trying to get through these times when days blur together and overtaxed is the normal state.
The emotional toll on nurses can’t be overlooked, she says. “Anyone in health care has been impacted,” says Miller. “Even if it’s not every shift, it has challenged us emotionally.” Nurses, who are problem solvers by nature, aren’t always able to find a solution, let alone the best solution, out of many choices. “The patients are so so ill and you can effect only so much change,” she notes.” And it’s not necessarily for a positive outcome.”
Maintaining a patient connection is now a hard-to-grasp process, but Miller says her team makes a significant impression in any way they can. “We’ve been put to the test in so many ways,” she says. “Making sure we have eye contact –that’s pretty much the most impactful contact we can have right now.”
What else helps? Miller offers a few suggestions based on her conversations with other nurses.
Talk to a Professional
“It’s about more than us and the care we provide and the equipment we use,” says Miller. “It’s about us being emotionally resilient and maintaining our mental health.” Miller, who has spoken or interviewed many nurses who are fighting back tears, says the hurt and the pain nurses are feeling is so dominant. With her own team, she tries to promote the use of employee assistance programs that offer counseling services and encourages that resource. “Sometimes it’s better to talk to someone who doesn’t work in health care and gives you a new perspective,” she says.
Find a Distraction
From watching quick and easy-to-digest TikTok videos to feeding the birds to deep breathing—finding something fast to calm you or make you laugh is valuable. And don’t worry how silly it might seem to others—you need relief and an immediate escape. If a few bursts of cat videos or watching reality TV or breaking out in song and dance help you, then just do it.
“I can’t stress journaling enough,” says Miller. Again, you’re not going for profound entries. You can write that today was a horrible day and just get that out. Or you can write that out of the horrible day your coffee was perfect and you’re grateful for that one thing.
Find Your Own Soothing Habit
“One person I know grounds herself before her next patient interaction,” says Miller. She touches the door or doorframe before entering the room as a way to say “I am going to see someone else now.” The purposeful action provides a divide between the experience she just had and the one she is beginning.
Acknowledge Your Limits
“Right now, most of us are of the mindset of work, go home, go to bed,” says Miller. “We are so tired.” Still, the grinding workload doesn’t mean nurses have lost their legendary spirit that keeps them going even when things are bleak. “At the end of the day, we just try to enjoy moments of levity when they present themselves and however they present themselves,” says Miller. “And chocolate goes a long way in my book.”