Nurse Burnout: What is it and what can be done about it?

Nurse Burnout: What is it and what can be done about it?

Nursing burnout is described as disengagement. It differs from experiential stress in nursing as burnout usually implies disengagement from caring, and nursing stress usually results from caring too much.

It is important to define these as they are inexplicably intertwined, with nursing stress being one of the causes of nursing burnout but they are not one and the same.

What is nursing burnout?

Nursing burnout has been described as frustration, disengagement, loss of interest, and general unhappiness with the job.

It is important because not only does it affect the nurse, but it affects the quality of patient care.  It impairs comradery among the nurses on the unit and creates an unhealthy working environment.

Disengaged, disinterested and burned out nurses are more likely to make medication errors, call off shifts, and add additional stress to the working environment. It factors significantly in decreased patient satisfaction and results in subpar patient surveys.

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What are the causes of nursing burnout?

Burnout in nursing is prevalent and widespread, and there are typical and predictable contributing causes and variables which factor into increased burnout. There are certain types of nursing, and there are certain conditions of nursing that can align and increase burnout.

Nursing is not an easy profession. It is challenging on even the best days. Layering on top of an already stressful and challenging job description is the ever changing environment with different patients, doctors, new medications, expanding knowledge , changing healthcare regulations. It is a volatile cocktail of potential dissatisfaction and burnout.

While some of these are not unique to the nursing profession, all of them are important.

Shift work is a particularly significant one. Rotating shifts, often in the same week, can disrupt a person’s life and sleep schedules and are difficult to manage for some.

Shift work also leaves the nurse vulnerable to call offs on the following shift, and possibly being mandated to stay overtime.  Rotating shifts are particularly stressful.

Another stressor that is not unique to nursing is workload. Our current economic client creates stress by employers attempting to be more efficient by asking more of their current workforce.

In nursing, this is particularly stressful as patient acuity keeps rising with sicker patients staying with shorter hospital stays.

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The pace and acuity leave little wiggle room for the nurse and the patient to build rapport and develop the therapeutic relationship which is the essence of nursing.

A nurse must be productive and efficient without compromising patient care, and he or she is expected to be knowledgeable about what they are doing.

Education is continuing and continuous, a nurse cannot and should not pass a medication without knowing what it is.

Nursing is not an assembly line. For example, each CHF patient is unique. While there are similarities in diagnosis, the nurse must understand that each patient is uniquely complicated with different needs, reactions, medications, prognosis, and eventual outcomes.

Not all days are good, but a good number of nursing days should be fulfilling and worthwhile even with patient death.

In the hospital setting, there are patient deaths, hospital inspections, medication errors, patient falls, call-offs, difficult patients, difficult families, missed breaks, stretched bladders and many others things that can make a good day turn into a bad day.

Being that patients are sicker and more acute, care becomes more complicated.  Your co-workers may be experiencing increased stress, and therefore work relations can be stressed and not supportive.

Signs of Nursing Burnout

A nurse may be experiencing burnout if she is experiencing frequent somatic complaints such as a headache or upset stomach, or is prone to illness. Emotionally, he or she may be feeling undervalued or underappreciated by patients, families, co-workers, and management.

A nurse will burnout may dread going to work, become apathetic and disinterested, and disengage from her patients. Burnout is sometimes referred to as compassion fatigue.

How to stop new nursing burnout?

First, it is not always possible. But there are things a new nurse can do to minimize nursing burnout. Knowledge is power and organization is a key to effectively curtailing burnout.

The first thing to for a new nurse to understand is that they will not have the skillset necessary fresh out of school to be a competent nurse.

If possible, a graduate nurse should find employ in a magnet hospital, or one with superb training and teaching opportunities and with a solid mentorship program.

This minimizes the “sink or swim” experiences of some first type hires. Hopefully, the graduate nurse entered this profession with the goal of being exemplary, so the graduate nurse should do herself and her patients the favor of getting the best graduate nursing supervision possible. 

Most graduate nurses have a vision of some exciting “flight nurse or trauma nursing” position, and while excellent nurses are needed in these areas, the graduate nurse’s goal should be to receive a solid core base of nursing experiences. Solid core knowledge and nursing skills minimize the chaos and stress of nursing.

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Take time to learn new skills and be confident in them. Allow yourself to be a novice and ask for supervision. When you interview for a position, remember you are interviewing THEM as much as they are interviewing you!

A new nurse can get a sense of the hospital environment just by paying attention and doing her research before the interview.

Again, working for a magnet hospital has many advantages.  If you don’t know what one is, take the time to research it and learn about them.

Find out if your potential place of employment has strong nursing advocacy.

Know yourself and your limitations. If you are the mother or parent of triplets in diapers and a tween with an attitude, this might not be the time to realize your dream of working in a fast paced ER with long hours and an even longer debriefing time.

Put your ego aside. Every patient in front of any nurse is a worthy one.  A nurse can give exemplary care to a dementia resident as well as a Level I trauma patient. One may make the adrenaline pump faster, but the other patient might need your caring expertise even more.

Learn to say no, and have boundaries. No one is really good at multi-tasking and that instead of doing two jobs well the person ends up doing two jobs poorly.

As much as nursing is an avocation and done with love, it is also a job.  A job pays your bills, puts food on the table, and hopefully gives you enough time and money to spend time with your family and maybe take them to Disney World.

If someone asked you to do something and it is something that you have the power to say no to, the first thing to ask is if that person needs an answer immediately.

If they do, then say no if that is an option. Tell them if they don’t need an answer immediately, you will get back with them in a day or two with an answer. That answer might still be no, but it’s a definite no if they need an answer immediately.

This gives a person wiggle room, or the reserve, to make the best decision for themselves and their families. Learn to say no to picking up extra shifts, baking cookies for the bake sale at school, helping your cousin Benny move on your day off, and just about anything that you have the option to say decline. Learn to ask for help if you need to, and offer help if someone needs you to on the nursing unit.

A new nurse should take every opportunity to learn because knowledge is power. Think about a time when you didn’t know how to do something and how stressful it was.

Any parent who waited until the kids went to bed on Christmas Eve to assemble a toy with too many pieces knows this too well. Learn the basic skills that you need to learn.

Don’t wait until you need to use them fast, and don’t try to learn them while you’re already stressed and missing a break.

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Build reserve or wiggle room into your day. Take the time to organize your day. Arrive at work at least 10 minutes early. The previous shift  will be grateful, and that is a great way to start your day.

Don’t be a hero. Take bathroom breaks.  Do not miss a break unless absolutely critical.

Learn to be your best advocate and then advocate for yourself. Know your value and provide value to your patients and your employer.  It feels good.

Be pleasant and direct. Ask for clarification if needed.  Do not assume what others think.  Simply learn to ask for clarification.  Having clarity of thought, purpose and action will save you much time and trouble.

Learn to take care of yourself! You are and always will be your most important patient!

Conclusion

Nursing burnout is common in nursing and causes both nurse and patient dissatisfaction.  Many times it cannot be prevented altogether because healthcare if becoming more complicated.

The patients that we see are sicker and we discharge more quickly, which leaves little wiggle room for exemplary care.

However, there are steps that a new nurse can take which involve advocacy for both self and patient and excellent self-care.

A new nurse needs to heed the words of every flight attendant who tells us patiently again and again.

“Put the oxygen mask on yourself first!  If you cannot breathe, you cannot help anyone else!”

Nightingale Knows