Burnout can steal the enthusiasm, satisfaction, and joy that prompted you to become an NP. It can rob you of the joy of caring and potentially deprive your patients of the care they need.
As a nation, the U.S. can ill afford to have NPs burn out. A national survey of U.S. adults conducted by the American Association of Nurse Practitioners (AANP) in April 2023 found that more than 40% of respondents have experienced a “longer than reasonable” wait for healthcare. In a press release, 26% of those surveyed reported waiting more than two months to gain access to a healthcare provider. NPs, notes the AANP, can help fill that void.
At the same time, NPs deliver more of the care patients receive in the U.S., according to a study published in September in The BMJ. From 2013 to 2019, the researchers found the proportion of all traditional healthcare visits delivered by NPs and physician assistants (PAs) increased from 14.0% to 25.6%.
We’ll look at some factors that cause burnout and ways to prevent it from diminishing your enthusiasm or leaving practice entirely.
First, let’s take a brief look at the signs of burnout.
Signs of Strain
Burnout is characterized by emotional, physical, and mental exhaustion, notes April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the AANP. A practitioner can feel less valued and lose interest in their work.
You may have trouble sleeping, experience tension and stress, and potentially have prolonged feelings of depression, according to Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor, pediatric nurse practitioner, M. Louise Fitzpatrick College of Nursing, Villanova University.
COVID Makes it Worse
While blaming the pandemic for NP burnout would be easy, burnout was a phenomenon before COVID. “What happened during the pandemic is the phenomenon of burnout, which has been consistently well documented in the healthcare literature for decades before COVID. Those events were exacerbated by the pandemic,” according to Hallowell. “It was already there. It just got so much worse.”
One data point of burnout before the pandemic comes from a study conducted in early 2018, which examined advanced practice registered nurses, including NPs and PAs. It found that 59% of respondents experienced or formerly experienced burnout. The pandemic “really blew everything up,” says Kapu, the study’s lead author, published in the Journal of the American Association of Nurse Practitioners.
Forces of Stress
Besides the pandemic, unhealthy work environments can lead to burnout. In those environments, notes Kapu, staff shortages continue to take a toll, overtime may be needed, and there needs to be more opportunity for professional growth, development, or change.
Furthermore, the back-and-forth involving full practice authority for NPs may also cause stress. During the pandemic, various states provided temporary waivers allowing full practice authority for NPs. Since then, some states have reverted to reduced or restricted practice laws. This sends a “mixed message,” notes Hallowell, breeding mistrust, uncertainty, and confusion.
“In states that have moved to full practice authority, we’ve seen an increase in the workforce; NPs enjoy working there,” says Kapu. “We’ve seen those states move up in terms of overall healthcare outcomes. The top five states in the U.S. in terms of healthcare outcomes are all states where nurse practitioners can practice to what they’ve been educated and trained to do.”
NPs might also suffer from stress in dealing with inexperienced healthcare colleagues. “The distribution of healthcare delivery has shifted in such a way that we have a lot of inexperienced folks at the frontline now,” Hallowell notes.
“We need to create a structure to onboard and train and bring these new workers into the work environment, help them develop confidence in their skills, make sure that they’re competent in what they’re doing,” notes Kapu .” We’ve done this as nurse practitioners for years. We have onboarding, orientation, and training programs, and we support them through that so that they feel competent and integrated into the team. They have a supportive environment where they can reach out and ask questions as needed.”
Self-care is Key
When it comes to preventing burnout, tactics involve self-care, notes Hallowell. They include:
Rest.
Asking for help. Hopefully, you can call on experienced colleagues who can provide emotional support to offset the stress, demands, and mental load of patient care.
Requesting training. If you are doing something unfamiliar, ask for education.
Exercise.
Good nutrition.
Having interests outside the profession.
Socializing with friends and family
Mindfulness.
“We need to make sure that we recognize the signs and symptoms and then determine what will be our change,” says Kapu. “Do we need to work in a better environment? Can we help contribute to making our work environment better? What are we doing in terms of self-care?”
Addressing the exhaustion that can lead to burnout is similar to exercising a muscle, notes Kapu. “You work a muscle to a critical mass and then recover. That’s how it gets stronger. It’s the same thing with stress,” she notes, where some stress is good, but it may get to a point where you have to take time away.
“We have to give ourselves time to recover, to refuel, to constantly check in and say, Am I taking care of myself so I can bring my very best self to my patients?”
There has been a greater focus on creating healthy work environments in recent years, and nurses deserve kindness, too. Regardless of your nursing position, remember that kindness is still in style.
If you are a nursing student, new graduate nurse, educator, or chief nursing officer, remember that the foundation of nursing is rooted in caring. I don’t know what has happened to nursing over time, but we must return to caring basics as a nursing profession. Emotional intelligence and empathy can go a long way in nursing.
Research shows that kindness and helping others can decrease stress and benefit our mental health. Demonstrating kindness has been shown to reduce cortisol levels, increase self-esteem, compassion, and empathy and improve your mood.
Being kind to ourselves and caring for ourselves as nurses should be a priority.
Here are some self-care activities you can implement to be kind to yourself and others.
Sleep
Sleep is truly underrated. It is crucial to get your rest and relaxation.
Healthy Eating
It’s not easy sometimes, but try to look for healthy eating options as much as possible. I know nurses love all things caffeine. However, reducing caffeine can be helpful.
Massage
Massage can be highly relaxing and stress-reducing. Some nursing positions can be physically demanding, so try a nice massage. Some insurance will cover this as well.
Exercise
Even if you are not a big workout type, you can at least go for regular walks. Walking outside and being in nature is also relaxing.
Music
Research shows that listening to 30 minutes of music a week can reduce stress and have physiological benefits such as reduced blood pressure.
Aromatherapy
Aromatherapy has also been proven to reduce stress. Even having different lotions, such as lavender, can instantly reduce stress.
Deep Breathing/Stretching
These are easy to do and can only take a few minutes but have powerful positive effects.
Healthcare providers must prioritize putting their health first. Remember to take time off regularly. No job is worth your mental or physical health. It is time we start normalizing taking time off regularly in the healthcare industry. If you are in leadership, please encourage the staff to take time off. When the team feels happy and relaxed, they can be more productive.
Be kind to yourself so that you can have more kindness for others.
Nursing for me is about making a difference — and every day I’m making a difference in the lives of the people I care for. Take a Monday earlier this month. A patient of mine living with cerebral palsy was struggling to complete her therapeutic exercises. Her mother, clearly frustrated, feared her daughter wasn’t making sufficient progress. Dedicated and caring, the mother also worried that she wasn’t doing enough to help her daughter improve and succeed.
But this young woman was improving — slowly, surely, in ways imperceptible to the untrained eye. “Your daughter can now open both of her hands; all of our hard work is clearly paying off,” I explained, as the mother’s face transformed from hopeless to full of hope. “Your daughter just wants to be independent,” I continued, “and she obviously gets this spirit from you.”
Independence – as much as making a difference – is becoming a bigger focus for me in my career. The freedom to control my schedule. The freedom to control my income. The freedom to care for my three children. The freedom to care for me.
Until recently, I didn’t really have that choice.
For too long nurses have been treated like afterthoughts. We’re burned out and stressed out – from Covid, from our home lives, from feeling like our needs are always considered last. And this not only impacts our ability to perform, it threatens the effectiveness of the entire healthcare systems we’re so passionately committed to supporting. Yet, the working conditions and rigid schedules have not changed with the world around us.
Over my six-year career in nursing, I’ve witnessed both the indifference and abuse that has become too common in our industry. As a result, our community is suffering. Less than half of the 12,000 nurses recently polled by the American Nurses Association (ANA), for instance, believe that their employers care about them – a mere 19 percent for nurses 35 and under. More than 50 percent of all nurses are also thinking about leaving nursing; a figure that rises to 63 percent for nurses under 35. The latter numbers particularly worry me; with so many of my younger brothers and sisters ready to give up on nursing – and a national nursing shortage only expected to get worse – the future of the profession I love has never felt grimmer.
I know what it’s like to be undervalued in the workplace. I’ve been told by nursing agencies to wait in the cold if my patients are running late. Then when they finally do arrive, I’ve been expected to wash their clothes – even though I’m a nurse, not a housekeeper. I’ve been berated by patients for “moving too slowly” and battled with administrators for adequate PPE safety gear during the height of the pandemic. I’ve been made to feel like a number – a body – by nursing agencies just focused on profits and disrespected by patients and family members aggressively insistent I could just “do more.”
But more must be done to consider our needs, too – both by the nursing industry and the community of nurses to whom we all belong. What we seek is to be seen, valued, and supported in ways that matter. To be listened to if we are struggling during a hard shift. To hear “thank you” instead of being ignored. To give us tools and resources to take care of our mental health because after the past two years, we need it.
I experienced this kind of support unexpectedly when I found connectRN, a new platform that matches nurses with health care facilities that need our services. The ability to work when I want, where I want has given me the independence I was seeking, and an opportunity to step away if I need to recharge. As a mother, this flexibility is more important than ever. I can take on shifts that work with my child-care needs, eliminating the stress that usually occurs when making money and being a Mom collide. This should become an industry standard, rather than a perk from a digital start-up.
One of the things I value most about connectRN is that they are nurse-first and care as much about our community as the shifts they post. When I joined the platform, I was given access to The Beat, a private community of nurses who also work with connectRN. It is a safe space to chat with your peers about the things only nurses can truly understand – without the fear of reprisal or retribution. We share stories about hard shifts, give each other support to keep going, and often find “work buddies” in the places we work often. As debates rage around the role of nursing unions, hospitals and agencies must understand that a united nursing community is a better nursing community – better equipped, better prepared, and far better focused on the needs of our patients. With my life far more than just nursing – kids (both teens and a toddler), my extended family, a bit of me time – I feel lucky to be part of this community
For me, personally, The Beat proved particularly helpful when dealing with mental health concerns. At the height of Covid, the community offered telehealth therapy sessions through a partnership to use at our discretion. To be honest, I never considered I might need this kind of help — no one had ever asked me. But the death of a colleague — a young mother who passed away shortly after giving birth — hit me harder than I’d initially expected. I needed help to process how I was feeling and I took advantage of the offer. To have that support – for free – made me feel worthy and valued.
Over the past two years, I’ve been struck by a newfound respect for nurses as the Covid crisis continues unabated. Patients and families recognize our role at the frontlines of the pandemic and understand the risks taken daily to help their loved ones survive. What’s needed now is a parallel boost in understanding and appreciation from the hospitals and nursing agencies that power our profession. Because fairer pay, added flexibility, stress reduction, and self-care won’t just improve the lives of nurses, they’ll help ensure the positive patient outcomes we all desire. As nurses, we intuitively understand the necessity of these demands; it’s time for staffing agencies and health facilities to embrace this mindset with equally open hearts and minds.
All my life I have rarely been sick, in fact there have only been two times that I can recall. So, about three months ago when I started feeling bad, it was out of the ordinary. I did not have any obvious symptoms, such as nausea, vomiting, headache, runny nose etc. I just had a lack of energy and no appetite. During this time it made me realize that “I would rather have great health, more than any material thing”; not that I do not like nice things or places. As children, many of us dreamed of growing up and having lots of money, big houses, cars and anything else that money could buy. We were only focused on the “material” things. There were never any thoughts about our physical or mental health.
I would rather have excellent health, than all of the money in the world. If you are sick and cannot get around, what good is having money and things, if you cannot enjoy it? Some people may say that they would use their money to hire the best doctors, but that is no guarantee that you will have good health. I often think of our patients that we are taking care of in the hospitals and clinics, they are relying on us to give them the best possible care to make them feel better. During this time, they become dependent on the healthcare staff and this may be hard for many that are used to having control of their own lives. Before you make an assumption that the patient is “difficult” or “hostile”, remember that these are people that were working, taking care of themselves and families and making their own decisions. We need to include them in all aspects of their care, instead of dictating what will be done. Although we may have our daily assignment planned, discuss with the patient the Plan of Care and let them have some input on the order of some things, to give them that feeling of control. We still have to stay on task, but we need to make them feel like adults and not like children being told what to do. Some people may think that this will interrupt your normal day, but imagine if it were you laying in that bed, how would you want to feel?
I have decided that I am going to enjoy life, spend more time taking care of myself and creating experiences with my daughter. I have been privileged to accomplish a lot of things in my life: writing my first children’s book, starting a home-based travel business, building my photography portfolio, traveling domestically and internationally; all while being a mom and nurse. We spend a lot of time taking care of others; but we must start taking care of ourselves; otherwise we will not be here for others.
So, the fatigue and loss of appetite that I was having was due to my Vitamin D level being critically low. I am currently working remotely, so eight hours of my day is spent inside on the computer. When I get off work, I wait until the sun goes down to go on my evening walk; therefore I was getting minimal to no sun. I am happy that this is a condition that can be easily corrected by diet, taking nutritional supplements and spending a few minutes sunbathing (in moderation). The benefits of sunlight is that Vitamin D is produced when your skin is exposed to the sun and it is one of the many vitamins our bodies need to stay healthy, relieve stress and increase energy.
I realized that work will be there; so I have made it a point to sit outside on my breaks and lunch. I am glad to say that I am feeling a lot better now. Never take your health for granted. You only have one life and you need to make sure to maintain your health. Take care of yourself, mind, body and spirit. The six best doctors in the world: sunlight, exercise, rest, diet, self-confidence and friends. Maintain them in all stages of life and enjoy a healthy life. Remember Health is Wealth!!
If you’re a nursing student, this time of year generally brings a schedule full of midterm exams and projects. Many students say this time of year is the toughest for studying. The weather is still chilly, and everyone’s ready for something, anything, than what they have to get done.
Being a nursing student is stressful and pretty busy in general. You’ve got a lot of work to do, a limited amount of time, and haven’t shaken off the winter hibernation mode yet. If that sounds familiar, here are a few ideas to help you power through this tough time.
Block It Out
The news is full of upsetting events. Coronavirus. Politics. Climate change. Influenza. If you have a fear or an anxiety, there’s probably something about it in the news. You’ve got work to do and world events are overly distracting—but you also can’t just pretend it’s not happening. Set aside specific times to check in with daily events. Don’t scroll through on your phone every hour. Resist the urge to check the news on TV when you’re making dinner or eating with friends. Being in control over the way you consume the information will make it less distracting and leave you time to focus.
Find Your Study Sweet Spot
You might find studying in the library is not the best location for you. Maybe you prefer studying in the gym with the rest of your gym buddies or your team. Maybe a coffee shop is for you or a lounge in your school’s campus center. Or maybe your best study spot is a comfy corner in an academic building. Wherever you can focus on your work and get the most done is the place for you to go during midterms. Find that place and set yourself up with snacks, a water bottle or some coffee, and get your work cranked out.
Time to Relax Isn’t Wasted Time
Endless studying is actually going to work against you. Your brain needs to take breaks to help it process what you are learning and what you are trying to get done. The key is to plan it into your day. A couple of hours of cramming deserve to be followed by a short walk with a friend or some time listening to your favorite podcast or watching funny cat videos. Plan a dinner in which your only company isn’t just a textbook. Connect with your family, friends, or pets. Take time to eat. Watch a movie. You’ll actually give your brain a much needed rest so it, and you, can perform best.
Pay Attention to Self-Care
You probably are going to skimp on sleep during midterms. There’s a lot to get done and only so many hours in the day. But try to keep as much to a schedule as you can. Fit in short naps during the day if you’re really dragging—they will refresh you. In this time of flu and colds, be sure to wash your hands frequently with soap and water—even when you feel like you’re washing your hands all the time. Stay hydrated with lots of liquids (water is always best) or even fruits and veggies like watermelon and cucumbers. Get outside when you can because sunshine and fresh air are refreshing to tired bodies.
Get Help
If you feel overwhelmed by the academics or the life overload, get help. Tutors, student success centers, study groups, or even reliable online help can give you a better understanding of work that you’re having difficulty with. Many schools offer counseling centers where trained therapists can help you manage the stress and anxiety many nursing students feel during midterms (or at any other time as well). The help is out there and taking advantage of it can help you through this tough spot.
Remember, midterms will be over soon enough and you’ll be on to the next great challenge that nursing school brings. This is part of the road to a career that will be rewarding to you and will make a huge impact on humanity. Good luck—you’ve got this!
Dr. Tammy Sinkfield-Morey, DNP, MAN, RN, PHN, CCRN, is a Nursing Supervisor at Gillette Children’s Specialty Healthcare in St. Paul, MN. In 2018 the March of Dimes named Dr. Sinkfield-Morey “Distinguished Nurse of The Year,” and the Minnesota Hospital Association appointed her as 2019 “Caregiver of the Year” for her work in Storying, Diversity and Inclusion. With her background, she was naturally inspired by the concept of the nurse’s salon, and started one in the Twin Cities dedicated to the needs of nurses of color [NOC]. In the latest issue of Creative Nursing, Dr. Sinkfield-Morey discusses the NOC salon and its history.
Nursing salons are a thing of beauty and dynamism! They provide opportunity for collegiality, comfort, collaboration, connectivity, and conversations about what’s on the hearts and minds of the participants.
I first experienced Marie Manthey’s Nursing Salon in 2013. In 2016, I revisited her gatherings and attended seven salons that year, when to my wonder, I realized that the issues on my mind as an African American nurse were quite often not the same as those on the minds of the White nurses present. During that same reflection, I was moved by the fact that during each of the salons, I was the only nurse of brown hue. Marie had reassured me that other nurses of color (NOC) attend the nursing salons; however, it is common for them to also be “the only” when at any one of the gatherings.
The experience of being “the only” was nothing new to me. I had spent most of my life as the only person of color in the spaces I inhabited. That was the case at the Catholic school I attend during my preschool, elementary, and middle school years, and I was, for the first 7 years of my professional career, the only nurse of color where I worked. It is not uncommon for a person of color to be “the only,” but it is almost never entirely comfortable.
Ta-Nehisi Coates beautifully articulates the sentiment of the feeling I had as a lone Black professional among my colleagues at one of the salons. He said,
“I knew that my portion of the American galaxy, where bodies were enslaved by a tenacious gravity, was Black and that the other, liberated portion was not. I knew that some inscrutable energy preserved the breach. I felt, but did not yet understand, the relationship between the other world and me. And I felt in this cosmic injustice, a profound cruelty, which infused an abiding, irrepressible desire to unshackle my body and achieve the velocity of escape.”
–Ta Nehisi Coates, Between the world and me
There it was.
I became consumed by the distance I perceived between the world of the other nurses and my own. I also recognized the healing moments and revelations that the nursing salons rather serendipitously rendered for their participants. I knew that these forums of uninhibited sharing and purposeful dialogue about all of our experiences as nurses could also be a sacred space for authentic discussions about race, racism, and the foundational contexts of discrimination and White supremacy in health care that people of color, as consumers and providers, have all experienced.
I pondered for weeks the possibilities for change. I wondered what could be accomplished by a collective of Black and Brown women and men in health care, gathering in conversation about what’s on their mind regarding the social construct we call race and the undermining behaviors and divisiveness that accompany it. What effect could it have on, for example, the experience of professional validation and emergence, and yes, even on the institution of racism?
Marie Manthey says, “Salons are lively gatherings where people engage in big talk—talk that amuses, challenges, amazes and is sometimes passionately acted upon. Most importantly, salons are gatherings where each participant forms and informs the conversation. Unlike formal meetings, they are opportunities where people can casually connect and share their experiences.” In addition to Marie’s view, I envisioned that a “NOC” salon would provide a shelter under which the burdens and pain of discrimination, racism, bigotry, bias, and White supremacy, that some of our professionals in health care experience when caring for others, could be spoken aloud, unharnessed, finally heard.
I knew in that instant that I needed to help create a space for nurses and other health-care workers of color to escape from the confines of prejudice and any other judgment they face in their practice; and I knew that a nursing salon for NOC, modeled after the salons that Marie had designed, would be the propitious space for the rich conversation that would emancipate our voices. In a loving moment of mutuality and grace, on June 19, 2018—Juneteenth (an African American holiday commemorating the date in 1865 when many slaves in Texas learned they had been freed by the Emancipation Proclamation of June 1, 1863)—we experienced our first NOC Nursing Salon in Marie Manthey’s home, a moment created as a catalyst for ongoing conversations.
At our first NOC salon we defined our purpose as having conversations about our lived professional (and personal) experiences with racism, difference, and the pursuit of inclusion and equality, on a continuum to learn from each other. Our intention was to convene as NOC, in dialogue about our individual and shared journeys and about our encounters with others who place less value on the beautiful essence of who we are. As we all consciously contributed, genuinely from our hearts, about the ways we deal with racism, we were empowered through learning each other’s stories. Through dialogue, we discovered hope that we could create opportunities to make our practices more inclusive, and reduce the biases and microaggressions that we experience. We established a safe and caring environment, centered around listening to each other.
Our subsequent NOC salon was filled with heartwarming, inspiring, meaningful, and interconnected dialogue. Prominent Black Nurse leaders and people of color in nursing joined in rich conversation and acknowledgment of our impact in nursing historically, and in nursing practice in general. We ended the salon feeling heard and acknowledged, having had the opportunity to share our personal experiences, both good and bad, that occur in our healing environments. We all participated in conversation about our positive and negative experiences of equity adversity and racial inequality in our practices.
True to the nature of the salon, these beautiful NOC and their hosts created a lively gathering in which we all engaged in big talk; talk about challenges we face as NOC, discussions about racism past and present, renewal of the spirits within us, and our endless passion for what and who we are as nurses. I have so much gratitude for the beautiful people who attended our salons and created an exquisite tapestry of thoughts, experiences, and new memories through which we can all grow, expand our practices, and share our voices. I look forward to more conversations at our NOC Salons on institutionalized supremacy and its corrosive effects on all of our bodies, Black and White. I am energized to create space through the power of the salon for the pursuit of knowing, and the right to declare our own curiosities as we “evolve towards some truth that is ultimately outside of the boundaries” (Coates, 2015) of our lives and bodies and our nursing practice.
To attend the NOC Salons in the Twin Cities, or to learn more about how to create a NOC Salon in your area, please visit our Facebook page: https://www.facebook.com/nursesofcolorsalon/
