One Reason For Nursing Burnout

As nurses we walk a fine line between professionalism, providing excellent patient and family care, and our ever-present imperative to maintain "customer satisfaction". While our patients are always our primary priority, we now find ourselves in a culture where the whims of the family are deemed more important by our superiors than the outcomes of our "clients". This dynamic causes a great deal of stress on the nurse's self esteem, and damage to our professional satisfaction. It is part of the reason for the ever-present march of nurses away from the bedside and toward less patient-contact positions. Nurses Announcements Archive Article

One Reason For Nursing Burnout

First let me say that the events in this story are true; however, the particulars have been changed so as to disguise the event and to eliminate any HIPPA violations. As of 3 PM today I am on vacation. I'm trying to concentrate on all things that are non-work related, but my head is still in the ICU. I spent the last four 12 hour shifts working with an elderly lady who is very ill. All three of her daughters are nurses at other facilities, and they all stayed attentively at her bedside. The first day they handed me a list of things they "didn't want me to forget to do for Mom." These included repositioning, incentive spirometry, feeding her meals, and the like. Well, I've been a nurse for a long time now, but I thought, okay, they are stressed. It's alright. They need to maintain some control in a situation that they have no control.

I made a point to pull up Mom's lab results and scan reports for them to read so they would feel well-informed and able to participate in her care. At the end of the first day, Mom coded. By the time they returned to her room, she had recovered enough to be awake and talking with us. I thought to myself how glad I was this family still had their beloved matriarch. Mom slept poorly that night and was quite lethargic the next day; however, she was appropriate when awake. By 6 PM the ladies had worked themselves into a state of near-hysteria because Mom was "not herself", and had not been strong enough to get up and walk. It had been less than 24 hours since she nearly died, and less than 24 hours since she had major orthopedic surgery. In the midst of their melt-down, they stated we (that would be me) were withholding information about Mom's condition and "not taking them seriously enough".

Okay, it was 6 PM, but I called the surgeon at home and got him to talk with them on the phone to answer their questions. I reminded them they had access (with Mom's approval, of course) to all lab results and scan reports. Their anger only escalated. The next day, part way through the shift I was told the new medication Mom had been given should not have been given without their express approval. Now Mom is alert and oriented and able to make her own decisions. As a matter of fact, Mom is a retired nurse herself. It never occurred to me to call the kids for permission to give her medication. They took this complaint to my manager. Now, I had spent four 12 hour days caring for this precious lady, washing her, feeding her, changing her dressings, and, yes, doing CPR on her. Successfully. I had worked hard...really hard...to care for this patient. Most days I didn't take lunch. I don't regret it for a second, and I certainly don't expect gratitude, but I didn't expect to be kicked in the gut either.

No, I don't do this job for money or for anyone's approval. I am so glad this sweet woman is going to live to go home and resume her gardening and canning and care for her cats. But I am also crushed. I am so frustrated, so depressed, so hurt. I feel hopeless, and just now I don't feel like going back to work at all. Ever. I'm sure I will eventually convince myself to carry on, but this has taken a toll on my spirit. Thank you for letting me vent. No one actually understands what we do but other nurses.

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dec2007

About dec2007

I'm a bedside RN from South Dakota.

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Burnout has a lot of causes but it usually has to do with a certain amount of emotional "over-involvement" meaning that you have been emotionally very invested and the family cannot cope - so putting another stress on top with their requests and such.

What sometimes helps with those families to have a family meeting in the room with the patient and those family members so they can all hear the same information. The MD explains the medical situation and what is going on - so they can ask their questions right then. The nurse can explain what their are doing in terms of care plan (if applicable). I set up family meetings as part of my job and usually also invite the social worker and the chaplain plus case manager to attend. MDs are often very open to it as long as they do not have to organize it and the time works.

It can be a 30 minute thing - the main point is to ensure they all hear the same thing and can ask questions and you have a team to provide support.

The other thing is that sometimes it is good to distance yourself emotionally somewhat. It is naturally that we want to "make things better" but there is no guarantee that the other person will even recognize your efforts or appreciate them. So if you are so emotionally invested that it burns you out you probably should take some steps in reflecting on that as well. I work in emotionally charged situations every day and would get burned out without reflection on my own need "to fix things" or the urge to "make it better". We need to be caring but it is easy to burn out especially when you have family situations that suck life out of you.

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You are a badass who put a gracious old nurse back in her garden. That is what you need to take on your well deserved vacation.

The daughters have their own junk for whatever reason, just like anyone else who copes poorly under the pressures of fear and guilt and finds a scapegoat.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Unfortunately, ingratitude often comes with the territory. You helped save their mother's life, yet they still nitpick over certain issues and displace their anger upon you when it really is not about you. You are simply a safe target upon which they feel they can displace their wrath.

You did a wonderful job. Here's a hug. (((((hugs)))))

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Just now figuring out patients and families can be total jerks? You let the daughters walk all over you. I would have turfed all of their questions to the resident.. because the harder you tried to appease them, the less they respected you.

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Specializes in SICU, trauma, neuro.

(((Hugs))) Don't give them any more head space. It sounds like this is their issue -- some people are always controlling. You did fine.

For what it's worth, I never ask family's permission when implementing a new order, and certainly not with an a&o patient. (I do ask the a&o patient.) If they have concerns I'll get the provider to address them -- as an RN I have enough to do without being the middle-woman without prescriptive authority. I don't have people's conversations for them. I will *help* have conversations if I am needed, but don't *have* them.

Had it not been you caring for Mom, they'd be mad at the next RN. Because it's not about you, your knowledge, or your nursing care.

Now enjoy your vacation! You've earned it!

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Here's another hug (((billswife)))

I hope this particular family's behavior just turns to a wisp during your vacation. I am of the belief unexpected moments where someone will make a heartfelt comment or a thank you help to deal with the inevitable difficult types. I don't expect to be appreciated by any individual patient or family.

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Specializes in Tele, Interventional Pain Management, OR.
(((Hugs))) Don't give them any more head space. It sounds like this is their issue -- some people are always controlling. You did fine.

For what it's worth, I never ask family's permission when implementing a new order, and certainly not with an a&o patient. (I do ask the a&o patient.) If they have concerns I'll get the provider to address them -- as an RN I have enough to do without being the middle-woman without prescriptive authority. I don't have people's conversations for them. I will *help* have conversations if I am needed, but don't *have* them.

Had it not been you caring for Mom, they'd be mad at the next RN. Because it's not about you, your knowledge, or your nursing care.

Now enjoy your vacation! You've earned it!

I'm just a lowly eight-months-in acute care RN, so not the most seasoned opinion on the block. But I agree with the above.

I NEVER, regardless of involvement/over-involvement/craziness of family members, make decisions about med admin or anything else without consent from an AOX4 patient. If the patient knows who/what/when/how they are, THEY are who I address questions to, make eye contact with, assess, decide pain plan with, etc. NOT the family, pushy and over-involved ("Mom, you're having a bowel movement, right? And I can tell YOU'RE IN PAIN with that bowel movement, right?" with AOx4 mom denying pain and "Oh, we {family members} all need ice and warm blankets and turkey sandwiches") as some may be.

I have zero qualms about clearing a passel of family out of the room for my nursing assessment. It's not their automatic right to be present while I assess and question the alert and oriented patient.

No, I'm not in ICU but I understand how certain patients/situations stick in your brain well after the fact. I'm also on vacation--one week for the first time in years, counting my non-/pre-nursing job--and I find myself reflecting on what might have been in some circumstances. All we can do is know we've done the best for our patients.

Reading your post, I have no doubt you provided the best patient care possible. Please enjoy your vacation. You've more than earned it.

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Specializes in Med/Surg, Tele, Dialysis, Hospice.
Just now figuring out patients and families can be total jerks? You let the daughters walk all over you. I would have turfed all of their questions to the resident.. because the harder you tried to appease them, the less they respected you.

I haven't worked acute inpatient for a few years, and I have never worked ICU, but I don't think it's quite this simple in that setting. Since she maybe only had 1-2 patients, she was forced to constantly be in the cross hairs of these bossy and all knowing daughters, and to constantly answer their questions with, "Let me get the doctor to discuss that with you" would have made her appear either incompetent, disinterested, or both, and then she would have had the management up in her grill anyway.

We all know that patient and family satisfaction is the sacred cow of today's inpatient world, regardless of whether they are right or wrong, and these daughters were out for blood the minute Mom entered the unit. They knew, being nurses themselves, about the financially driven "the customer's always right and might take their money elsewhere so kiss their you-know-whats if you know what's good for you" atmosphere in today's inpatient setting and took advantage of it. One of the many reasons why this old nurse is DONE with acute inpatient care forever.

OP, you saved this lady's life. You warded off not one, but THREE, bossy adult kids who took full advantage of being the customer who is "always right" and who can complain about anything and everything and throw a nurse under the bus just because they can, even after she saved their mother's life. Enjoy your much deserved vacation and bravo for doing such a great job in such a thankless situation.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Are these daughters really all nurses? And not one of them could be the voice of reason? They all sound like whack-jobs.

It might be that they have a long history competing with one another. So they were trying to "out-nurse" each other by nit-picking you. It also could be what I call "guilty family syndrome". This is where no one bothers about mom for months on end till she ends up in hospital. Then they prove what loving and attentive children they are by finding fault with everything you do.

At the very least, they are a bunch of ingrates, who because of you, still have their mom. (Maybe they were already spending their inheritance.) In your head, you can sarcastically tell them "You're welcome!" Then don't give them another thought. They're the poor hags who still have to live with themselves and each other. You, on the other hand, are a conscientious nurse who will enjoy a well-earned vacation. Ahh!

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Specializes in Med/Surg, Tele, Dialysis, Hospice.
It also could be what I call "guilty family syndrome". This is where no one bothers about mom for months on end till she ends up in hospital. Then they prove what loving and attentive children they are by finding fault with everything you do.

I thought of this too. How many times over the years, between inpatient and especially hospice, have I seen adult kids, many of whom had just flown in from a distant state and had not seen Mom or Dad for years in some instances, throw their weight around and act like they are their parent's number one advocate and caregiver and are soooo concerned with the care or whatever that Mom is getting, often to the point of getting nasty with the staff (not just me). When I see this, it is usually either that a.) they feel a tremendous load of guilt and are trying to dump it on someone else, or b.) there is money involved and they sense the arrival of the undertaker and need to quickly kiss up to the soon to be deceased, just in case.

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Those daughters saw the awesome, amazing, one of a kind care only you can provide and they were so green with envy they felt the need to throw themselves around to feel better about themselves as nurses. ;)

My mom is my best friend and you can take care of her any day.

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