I know now how burnout occurs. It occurs with the death of nursing. It occurs when the compassion well has been overturned by those who insist on inflicting both nurses and patients to the moral depravity of never-ending torturous care.
Burnout starts with an oath, taken at the pinnacle of pride and passion when entering a new profession. Burnout starts with caring, which is a quality we hope all health-care workers possess. Burnout starts with hope; hoping that we can make a difference in our patient's lives.
I took an oath on the day of my pinning; my graduation from nursing school. It was the Nightingale Oath. Here is that oath:
“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.”
I have broken every aspect of that oath in my endeavor to care for my patients. My life is not pure. It is tainted with the misery of the broken that I care for. I don't practice faithfully. When my patient of six months is asking for death and an end to the monotonous routine of turns, dressing changes and mouth care, my faith fails me. I no longer have the faith that my patient will live a meaningful life.
I have not abstained from the deleterious and mischievous. Many of the therapies prescribed in the never ending ephemera of standing orders and the imperial standards of care, while trying to preserve the hospital's legal standing, bring harm to my patients. I position them in spine twisting angles which limit breathing and stiffen limbs placed on pillows to elevate bottoms and heels and hands. I have bloodied mouths with the routine mouthcare no matter how soft the sponges.
Every drug that I administer is harmful. I promote blood pressure at the cost of digits. I give life-saving antibiotics, yet I rob patients of their kidney function and hearing. Every drug has a cost. . . .
I attempt to maintain and even elevate the standard of my profession through my intelligence, my compassion, and eternal search for knowledge. I interweave therapies with the delicacy of a spider weaving a web. If one part fails, the web falls. I manipulate each organ system with a symphony of drugs in the attempt to create a harmonious whole. And when the physician calls me the mindless bedside attendant, or when the physician states that my tasks are so easy that a monkey could perform them, I smile with inner strength because I know that the physician does not even know how to work the pump to infuse the drug, and does not possess the skill to access a vein for their pharmacopeia's remedies.
I have broken confidence with families. I give reality. I give the grand picture. I comment on quality of life and last wishes. I talk of death with dignity. I broach those subjects which are so taboo to us. I give hope. I give reason. I give honesty. I give my heart and I have given my tears. I cannot uphold an image painted by a patient's service of hope and recovery when experience and statistics tell my heart the truth. I cannot support a physician that states a patient will walk out of my ICU when he is so weak that he cannot lift a finger, and can merely shake his head no to decline care. I can only do what my conscience and my heart guide me to do.
I have limited loyalty for physicians. I cannot bear dishonesty. The physician is no longer the captain of the ship steering the course to recovery. It is my job to question, to demand, and when called for, to take a stand between my physician and my patient when decisions are poorly made or when decisions are against my patient's wishes.
The one portion of my oath which I have steadfastly upheld to the best of my ability is that I have devoted myself to the welfare of those committed to my care. I have cared for my patient and my families more than I have cared for myself. I have become the object of ridicule on behalf of my patients. I have, despite great fear, risked myself professionally to uphold my patient's wishes by taking a stand on the patient's behalf.
And now, after having lost another fight on my patient's behalf, I feel like the nurse in me has died. The spark that lit my way to healing and the flame that guided my intentions has burned to ashes in the aftermath of flood reaped upon me. I am morally depraved and ethically sullied and I have become an empty shell.
I am no longer a nurse. I am a tender. I tend to the garden of patients with little mind for needs and a conscious drive of simply meeting obligations of care. This is burnout.
Is there a way to re-light the flame of nursing? I think it would take a new oath, one less pure, and one of less responsibility.
Jul 27, '09I feel for you and I far too much understand. I have only been a nurse for 3 years and am already so burntout that I dont know what to do with myself most days..... I love the patients, I love taking care of them, but.... policy and procedure get in the way... and on my floor, bathing is the MOST important item to do. It is nothing to have every person on the floor giving a bath to a patient and have the telemetry alarms blazing red with HR>140 in afib and O2 sats in the 60's because everyone is giving baths and noone is acting on these alarms.
I want to do more with my degree, I want to love what I do.... I, like you, dont know what to do to change this either.Jul 27, '09I also understand burnout. I am there. If I could just care for my patients the way I want to life would be good.
Our hospital has changed our grid twice now in 3 months. We get less staff and are asked to do more care and a better job.
It seems every few weeks another responsibility is put on our shoulders.
I went into nursing to care for people, not a corporation. Money is not the bottom line for me like it is them.
I have always done hospital nursing, but I'm looking for something else. I'm not sure what yet. I may not find it, but I have to work at least 10 more years. I know that I don't want to work 10 more years like I'm doing.
My 12 hr shifts turn into 14hrs easily.If the census is low they send someone home, but expect you to come in if needed.
My concern and obligation is to my patients. I am their advocate.
If I leave will I be abandoning those patients I could help or would someone else just do my job and it not make any difference. I'm just not sure anymoreJul 27, '09Thanks all!
I had a particularly bad week and writing is my outlet. Sometimes that writing needs an outlet other than my computer, so I offer it up to others. Writing helps me re-charge and let go and put things in perspective. Once I've let it go, I find the strength to do the internal re-phrase of the situation that I need.
I went through an emotional intelligence series at work and while it was helpful, it also brings up more of the work that I have to do internally to achieve longevity in this field.
Sometimes I catch a lot of flack when I try to fight the good fight at work. I'm still a relatively young nurse and am still learning my way through the bureaucratic and political mine fields that are hospitals. It's not always easy.
Anyway, thank you all for the kindness and the reassurances. If I was able to move some of you, I am grateful. Thank you for listening, and thank you for caring. We all need a boost at times . . .Jul 27, '09Burnout never goes away, after you take some time off, it is still there along now with the guilt you feel for being burned out. I have spent 28 years in the emergency room, burnout is the elephant in the room. I am trying to find "lighter" rn jobs, like giving flu shots and my goal is to make the guilt go away..........Jul 27, '09Someone told me that burnout occurs usually within about 5 years of becoming a nurse. That's not a very long lifespan . . .
My mom is a nurse of 30 years. She sent me this:
Nursing is occasionally comparable to the art of juggling piranhas while handcuffed, blindfolded, and riding a unicycle....on a high wire with no net. (author unknown)
That about sums it up!Jul 27, '09I would have to agree with your mom. The biggest problem though is a hospitial is run by people who never do hands on nursing or maybe never have. They might have a business degree.
Do they have more book smarts than I do? Perhaps. I only have an associate degree.
I just care about people and the care I give to them. If things keep changing I will no longer be able to give good care. This is really what is causing burnout for me. I've been a nurse for 23 years and I'm just starting to feel the burnout.
I work with an excellent group of nurses, but we are all on overload. We help each other when we can, but when you get several admissions at one time and have no unit secretary and no CNA you just can't help each other out.
I work on a pediatric uint that gets overflow. I might be taking care of anything from a r/o sepsis in an infant to a geriatric with altered mental status. It is just such a balancing act. If we do get a pediatric admission and have to start an IV sometimes it takes 3 nurses. That may be our whole staff. What happens to the rest of the patients?
Quality care is what I've always given and I want to continue to do so, but if they keep adding more work with less staff I don't see how that is possible.
Right now I just feel like I'm doing the best I can with what I've got. That's not a very good feeling.Jul 28, '09Thank you for putting into words so many of us are feeling these days. You try and you try and you just can't seem to get anywhere!
Thanks for letting me know I'm not alone.Jul 28, '09Great article and yep I'm burnt out and I didn't even last two years as an LPN. Haven't even worked one day as an RN and I'm not really looking forward to it. Right now becoming an RN is solely about a bigger paycheck and career advancement. It's the only way that I have even a chance to get out of bedside nursing and I knew after my first 30 days as an LPN that I couldn't stay one because the options are just too limited. I can't see myself working for the rest of my working life (30 more years?) as a bedside nurse. I feel guilty about it because I feel like I have an obligation to "serve" as a bedside nurse but at the same time it's killing my soul and changing me into someone I don't like. I give it 5 more years at the most and I'm done.Jul 28, '09This is all very disheartening. I am going to start nursing school in a month and I'm already pretty sure I don't want to spend my whole career working in a hospital setting. I can't stand money-hungry corporations. In my previous jobs I've seen greed. But to see it in an organization meant to care for people I would be very disgusted. Is this happening in all hospitals? Has anyone ever worked in a hospital that really does "care"? I need to know...Jul 29, '09I think alot is placed upon us and expected for us to deliver when there is no recipriciocity for us in that regard. No appreciation from upper management. Healthcare and Nursing is turning out to become a nightmare....at far too much of a cost---patient lives and the sanity of our fellow nurses.Jul 29, '09This is slightly off topic, but still adds to what you are writing about here. The physician can affect us in a serious way. He/she has our lives in their hands when they make decisions in our healthcare. I have become disillusioned mostly with certain ones. The ones who I call, "with big heads and tiny bodies." They are much too egotistical. I know, I had one for ten years, and then had a wakeup call after a serious decline in my health. Then I decided to get one who believed me and I am so much better now.Jul 29, '09Wow, what an eye full from all the responses to this posting. I'm an RN of 30yrs, and have been fighting burnout for most of them. I guess the only thing besides a paycheck that keeps me going in a relatively thankless profession, is the response I get from some patients. Amidst the bureaucratic and administrative jungle we all have to work in, the people that need us the most, give us the most. Job satisfaction comes in many forms. Smiles, verbal Thank Yous, a nod of the head, a handshake, a wink, etc. Policies, procedures, paperwork, and short staffing are all symptoms of the system, and not why we became nurses in the first place. No one ever said it was going to be easy! Unfortunately, a bad day at the office for us has much more impact than most people realize. It may not be a consolation to many nurses, but, believe me, many patients will remember you a long time after they've recovered from whatever led them to the hospital in the first place. We do make a difference! We are also all replaceable. So, do what you can to leave your mark. Learning how to make adjustments to what we have to deal with is the key. I don't have all the answers. Try to leave work at work, and remember that you're not all about what you do to earn a living. You're all, so much more! Good Luck to all on their journey.
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