The contributions of a nurse in today’s crisis – stricken society are countless, especially in the midst of this pandemic. For that reason, thorough explanation of the nurses’ role is imperative for greater appreciation. Nurses have well known responsibilities including but not limited to recording medical history, vital signs and symptoms, patient advocacy, monitoring patient health and administering medications and/or treatments. Nurses collaborate with members of the interdisciplinary team for better patient outcomes and educate patients and their families about the management of illnesses. In academic settings, we educate aspiring nurses and propel them to achieve their goals in the midst of challenging life circumstances. As they say, nurses wear many hats, and as a result, nurses are burning out.
A nurse must advocate for patients beyond the health care environment while utilizing a holistic care approach; a patient may be admitted to a hospital or other health care setting for a particular ailment. However, the nurse must question this patient’s ability to care for themselves on their own, and if incapable, ensure that adequate support is in place upon discharge. Nurses also care for patients’ families. Often times, difficult conversations must occur and nurses are challenged to interact with those on the receiving end. Nurses are usually the first to notice irregularities due to the first phase of the nursing process – assessment. Nurses are the punching bags for the frustration of others on a daily basis. While nurses ought to possess qualities of resiliency, they are also human, and if empathic in nature, easily carry the stress of others on their shoulders. Hence, while taking work load, work environment, and coping mechanisms into consideration, nurses are at increased risk for burnout.
Burnout is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. It has many physiological effects. In a recent study conducted by Salvagioni et al (2017), burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. Specific to nurses, in a 2019 study, 14.4% were found to be unengaged with their work, 41% of those respondents reporting feelings of burnout. Due to the physical and emotional demands of the job, nurses ought to be cognizant of the warning signs of burnout (anxiousness, chronic fatigue, insomnia, and frequent illness) because they are putting their health in jeopardy. Please take into account that these statistics are not reflective of the impact COVID-19 has had in the nursing industry. Therefore, in 2019 – 2020, these statistical figures are presumed to be more alarming.
In September 2018, I recall being transported by an ambulance from a clinical setting to the hospital. Runs of atrial fibrillation and ventricular tachycardia flooded the heart monitor as I struggled to maintain my strength, oxygenation and my life. “Look! You can show these rhythms to your students!” said the EMT as life threatening rhythms printed from the monitor. My usually jovial self immediately thought, “Did he really have to say that and could this get any worse?”
At the time, I was a nursing education supervisor for a technical school. The program grew exponentially and I was expected to supervise both day and evening programs. This not only meant overseeing and executing the curriculum’s development and application, but also subbing for instructors as necessary, which was quite often. I was a single mother in need of more support. My divorce was recently finalized. Ageism and racism were also my contenders in the work environment. I was challenged when giving direction to a group of women, my staff, who were older and looked different from me. I was expected to provide hope for my students who had lost hope in themselves due to extenuating life circumstances. Inadvertently, I experienced the warning signs of burnout such as anxiousness and chronic fatigue, but ignored them, leading to my experience in September 2018.
In the year of 2019, I went on a quest to find a work environment that was more holistic and welcoming. The familiar saying, “Nurses eat their young” resonated within me. My mental health suffered as I experienced feelings of being unappreciated and belittled. Nonetheless, in the midst of all of this rain, the sun did shine again. I decided to return to my home district as a school nurse, which gave me an opportunity to give back to my community and encouraged healing for my broken soul.
As a survivor of burnout and the consequences that came with it, I feel the need to bring awareness to the fact that nurses need to be nursed. So, who nurses the nurse? If possible, nurses must nurse themselves by doing the following:
Evaluate Your Own Personal Life.
Ask yourself, have I recently experienced life changing events and have I taken enough time to ride life’s emotional rollercoaster? Trying to balance work and these emotions can lead to a very bumpy ride (burnout). One may need to request time off from work or even take a leave of absence. Taking these actions does not mean that you are weak. It just means that you are taking a step closer to healing.
Identify Sources of Support.
As John Donne said, “No man is an island. No man stands alone.” It is impossible to navigate through these difficult times in solitude, so finding a trusted confidant is important. It may be a family member or a close friend. For some, it may involve getting help from a licensed therapist. Once having adequate support systems, you will come to the realization that you are not alone. This notion generates healing thoughts and behaviors.
Ask For Help.
Nurses have a tendency to practice autonomy and often forget about asking for help. We always give but do not want to receive.
Diet and Exercise.
You are what you eat, therefore in order to promote feelings of wellness, we need to eat foods and participate in activities that support wellness. Overall, one should base their diet on whole grains, increase fruit and vegetable consumption, and reduce fat, salt, and sugar intake. We should also aim for 30 minutes of moderate physical activity daily.
Watch Your Water Intake.
Men and women need approximately 3 liters of fluid daily, however water requirements vary depending on weight. As it pertains to burnout, water can help maximize physical performance. Water also significantly affects energy levels and brain function.
Make Time For Hobbies.
Do not forget about your interests. Make time for these activities. It could be as simple as listening to music or watching an interesting TV show. I’ve always loved dancing. Since my experience in 2018, I joined a ballroom dancing/social community.
Practice Mindfulness Meditation.
This is the practice of actually being present in the moment which in turn trains you to become more mindful throughout the day, particularly during stressful situations. There are an abundance of mindfulness meditation exercises that can be found on the internet. I do these exercises daily.
Get Enough Sleep.
We need at least seven to nine hours of sleep daily to function at our best. If you are having a hard time achieving this, talk to your doctor. You can consider non-pharmacological methods such as teas and lavender oils. According to the National Sleep Foundation, obtaining healthy sleep is important for both physical and mental health, improving productivity, and overall quality of life.
Watch Your Appearance.
If you think you look good, chances are you will feel good too. Participate in practices that enhance positive feelings about personal appearance. Do a facial. Get your eyebrows waxed and your hair done. Do you!
The above recommendations highlight the importance of self-care. I urge each and every nurse to take part in such practices before it is too late. The disease processes that result from lack of self-care are probable, but preventable. So before you become dependent on a caretaker due to illness, remain independent by being your own best nurse.
Special Thanks: Desmond & Lillieth Gayle; The Wong Family; Nayomi Walton, PhD, RN; Therelza Ellington, RN; Anisa Cole, LCSW; Bloomfield Public Schools
As the coronavirus pandemic reaches new heights across the country and hospitalizations rise, nurses are facing extreme and unprecedented demands. A recent study from the Journal of Occupational Health found that the coronavirus pandemic has significantly impacted the mental health of health care workers, especially frontline staff.
The heightened risk of exposure, coupled with inexperienced nurses providing care in fields where they have limited experience and veteran nurses feeling severe burnout, has caused many nurses to quit and move to outpatient clinics or home care.
As a result, hospital systems are turning to short-term travel nurses to fill the gaps in care as they continue to rely heavily on their nursing staff to manage the increase in hospitalizations due to COVID-19. These temporary nurses often struggle to feel connected to the resident nurses which can result in miscommunication and lapses in effective patient care.
These rapidly changing circumstances have put hospital systems in a tough place. Many are focusing all their energy on dealing with the crisis at hand, rather than addressing the deteriorating mental and emotional health of their nursing staff.
To protect one of their most valuable resources–their nursing staff–it’s crucial for hospital systems to think proactively about building resilience among their nursing teams and leaders. In my work with Innovative Connections, we we’ve been able to help nursing leaders at Baptist Health in Montgomery, Alabama, do just that.
In May 2020, it was clear to Gretchen Estill, MSN, RN, CNML, Chief Nursing Officer at Baptist Medical Center East (BMCE), that her nursing leadership team was emotionally exhausted from the nonstop care needed to handle COVID-19 hospitalizations.
“We had a multifaceted challenge,” Estill said. “This strong group of leaders were beginning to run on empty as we realized that this was not a transient pandemic. We are a very relational group, and we were missing the ability to get together in person and debrief.”
Meanwhile, at Prattville Baptist Hospital (PBH), chief nursing officer Meg Spires, RN, MSN, recognized a similar pattern of fatigue and frustration among her team of clinical leaders. Her close-knit leadership team still felt a strong commitment to their mission of putting patients first, providing passionate care, and pursuing perfection. However, the challenges from the pandemic made this mission seem impossible to carry out.
Although investing time in team development and resilience work during a pandemic may have seemed counterintuitive, these nursing executives at Baptist Health understood their teams needed emotional and psychological support to make it through the ongoing challenges of COVID-19.
Nursing teams participated in weekly team coaching sessions facilitated by Innovative Connections, a management firm in Fort Collins, Colorado, via videoconference. Nurses were able to discuss mindfulness, dealing with grief, changing their perspectives and building resiliency.
At the end of each training we give them a mindfulness practice to help ground them during their work. We had nurses dedicate the 20 seconds they wash their hands multiple times each day to practice mindfulness. Instead of adding one more thing to their non-stop schedules, we were able to incorporate this self-care practice into something they already have to do throughout the day.
“This resilience training is a necessary investment before and especially during a crisis,” Laurie Cure, CEO of Innovative Connections said. “If a team has been working to build trust, they are better positioned to show up and do their job when a crisis hits.”
Initial feedback found that the nursing team was grateful to have an opportunity to connect as a group in a designated place to debrief about how they were doing mentally and emotionally with their teammates. Many enjoyed the chance to unplug and understand how others on their team were coping to focus on their collective contributions and strengths during such a stressful time.
“I’ve heard repeatedly from my leaders that they’re extremely appreciative that we, as an organization, cared enough about them and their emotional health to invest in them,” Spires said.
Dedicating the time for resilience and team building during the demands of the COVID-19 pandemic may have seemed counterintuitive at first. However, the awareness that these key team members gained from having protected time to rejuvenate and support one another was invaluable. Pursuing this intervention has contributed to increased efficiency and connectivity for these nursing teams.
“The team had to acknowledge that we have to take care of ourselves before we can take care of others,” Spires said. “We focus on our physical health, but we don’t pay as much attention to our emotional or mental health. We can’t do justice to our patients or our team members if we’re not emotionally healthy.”
Nurses work as superheroes every day, and the high-performance demands of this profession can lead to side effects such as exhaustion, anxiety, and constant stress. However, as leaders in health care, nurses can choose the way they approach their roles and thrive.
Below are nine strategies that can help nurses manage stress and stay positive all year long.
1. Make Self-Care a Priority
Nurses are inclined to focus on the needs of others. However, the American Nurses Association explains, “Self-care is imperative to personal health and professional growth, serving as sustenance to continue to care for others.” Nurses should make a point to squeeze in at least one self-care activity that makes them happy every day, such as drinking a hot cup of tea or taking a bubble bath.
2. Spend Time With Positive People
When work life feels hopeless, nurses can benefit from reaching out to others to gain some positive energy. Increasing social contact and venting to a good listener are great ways to relieve stress and calm anxious nerves. Sharing work concerns, problems, or thoughts with loved ones can also help build trust and strengthen these relationships.
3. Set Aside Relaxation Time
Practicing daily relaxation techniques, such as prayer, meditation, yoga, or deep breathing, can help nurses achieve a state of restfulness. However, it takes daily practice to reap the full benefits. Getting into a habit of engaging in regular relaxation time can lead to improvements in overall health and happiness. These beginner-friendly guided meditations only take five minutes a day.
4. Begin the Day With Positive Self-Talk
Daily positive affirmations, also known as self-talk, can have a significant influence on how we react to our environment, jobs, and other people. Making a habit of this can help increase self-esteem and reduce feelings of anxiety and depression. For instance, write a positive affirmation and keep it handy at work to refer to when starting to feel overwhelmed.
5. Keep a Consistent Exercise Routine
Regular exercise is an excellent way to manage nursing stress and work burnout. As the Centers for Disease Control and Prevention points out, at least 30 minutes of daily physical activity helps to improve mental health, cognitive function, and quality of sleep, as well as decreases depression and the risk of many cardiac diseases.
6. Just Say No to Extra Shifts
Nurses are often eager to assist when someone asks for help. However, working longer hours and agreeing to take on more shifts than necessary can lead to burnout and even compromise patients’ safety. On the other hand, saying no to extra work means saying yes to more meaningful things in life. This could mean more quality time with family, outdoor nature hikes, or starting a new hobby. Plus, when we achieve a better work-life balance, we become more effective as nurses.
7. Take a Break from Social Media and News
When away from work, set a time each day to completely disconnect from social media, technical gadgets, and the news. Aim to also turn off cell phones, put away the laptop, and stop checking email. Instead, try spending some time outdoors, breathing in fresh air while doing something physically active and enjoyable.
8. Aim for 8 Hours of Sleep
Getting enough sleep every day is paramount—particularly for nurses. An article from health.gov discusses several benefits of sleep. This includes an elevated mood, reduced feelings of stress, improved cognitive function, and better maintenance of a healthy weight. Therefore, it’s important to make time for a few calming activities to help unwind after a stressful day.
9. Start a Gratitude Journal
Writing about what we’re thankful for can encourage feelings of optimism and boost overall well-being. Gratitude journaling works by adjusting our focus, and changing how we perceive situations over time. This type of writing allows us to see more of the world around us, deepening our appreciation for the things and experiences we have.
Conclusion
Stress and overwhelm are an inevitable part of every nurse’s life. However, developing healthy habits and coping strategies can help reduce feelings of burnout and boost resilience. Try to implement a few of these actionable steps every week to maintain a better work-life balance and improve overall health.
Nurses in the United States are facing unprecedented hardships that increase the risk that they will experience burnout. Health care workers, especially nurses, often experience high levels of stress due to the long hours they put in and the sheer number of patients that they interact with.
Avoiding burnout is necessary for a long career in nursing and it is important that nurses do their research when it comes to methods for preventing burnout. While there is a pharmaceutical answer in the use of antidepressants, this method merely treats the symptoms that can lead to burnout. For many nurses, the answer lies in a more natural path that will give them the tools they need to combat burnout holistically.
Building Resiliency
Health care workers have been shown to be particularly susceptible to experiencing burnout due to the fact that they are expected to perform patient care with consistent and constant empathy and patience. This can lead to emotional exhaustion which, coupled with the physical exhaustion that comes with working in the medical field, eventually morphs into what we know as burnout. Naturally, the stresses of this line of work can lead to fatigue that impacts motivation in the workplace and a misplaced sense of failure.
One of the best tools available to nurses in the fight against burnout is the development and strengthening of resiliency skills. When nurses possess a solid foundation of resiliency skills they are better equipped to bounce back from a particularly intense shift more easily and are able to maintain their ability to work effectively. Taking breaks during shifts, scheduling time to hang out with coworkers outside of work, and learning how to say no to taking extra shifts if they need breaks are all ways to increase resiliency.
The prevalence of burnout and resiliency’s effectiveness in combating it has led to the development of nurse resilience programs designed to arm nurses with the proper tools before they begin their careers. Through cognitive-behavioral training, stress inoculation therapy, and various other methods, nurse resilience programs are effective in preparing nurses for what lies ahead of them in their career and can be invaluable in the fight against burnout.
Taking Care of Mental Health
Another natural proven method for nurses avoiding burnout is simply taking care of their own mental health and well-being. While it might seem like obvious advice, for those working in high-stress environments like health care can find it far too easy to forget to take care of themselves. Self-care is vital for nurses who want to dodge burnout, and even something as simple as keeping a journal to acknowledge positive things that happen in life can be enough to stymie burnout.
Many nurses suffering from burnout experience feelings of inadequacy, low self-worth, and depression. It is important that nurses recognize that these feelings, while they can be intense, do not represent the reality of the situation and do not reflect their actual performance or capabilities either at work or life in general. Quieting that negative inner-voice is an effective way for nurses experiencing burnout to boost their self-esteem and sense of self-worth.
Learning how to practice mindfulness meditation is another excellent natural way to look after one’s own mental health in even the most stressful of situations. Mindfulness meditation has a whole host of benefits from helping to increase attention and concentration to improving practitioners’ heart rates and blood pressure, all of which can help to manage stress and fight off burnout. While there are plenty of books on the subject, there are also a multitude of free resources available online that are secular, simple, and can get a struggling nurse on the right track.
Looking Towards Nature
Should building resiliency skills and working on maintaining good mental health fail to do the trick, spending time in the great outdoors has also been proven to help prevent occupational burnout. Engaging in physical exercise outdoors helps to reduce fatigue and improve overall cognitive function and can result in a marked reduction in tension, depression, and anger. While nurses do indeed have wildly busy schedules, making an effort to set aside time for themselves in the outdoors can yield incredibly positive results for them.
If a nurse finds themselves unable to break away from the concrete jungle, there are still ways in which stress can be reduced naturally without going outside. Taking the time to unplug from technology frequently can reduce stress and allow for moments of silent self-reflection untainted by the constant and looming force of the internet and social media.
Finally, nurses that are looking for a way to combat burnout but are wary of getting a pharmaceutical prescription to manage its symptoms can always turn to mother nature. Cannabidiol, or CBD, is a compound found in cannabis that has no deleterious or psychoactive effects and is becoming a popular stress-reduction tool for many. While the science regarding CBD is still in its infancy, there is a huge amount of anecdotal evidence that points to the compound being an effective treatment for stress and a host of other symptoms and disorders.
At the end of the day, nurses and health care practitioners are some of the most important people in a functioning society. It is vital that they receive all possible help when fighting against burnout, whether that comes in the form of resilience training, mindfulness practices, or spending time with mother nature.
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.
