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 the 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 an 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 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.
Specializes in LTC, CPR instructor, First aid instructor..
i have found that "burn out" is a term that is overused and misunderstood. i have spoken to many of my friends about the mental and physical "deficiencies" that i would experience, but they could only relate it to being tired and that an afternoon off would cure everything. i was grateful for their sakes that they didn't understand, but (not to be selfish) it didn't help me out. a previous writer stated that burn out is with you for life. i believe that to be true. like so many other diseases, it must be managed with lifestyle changes (easier said than done). i believe that two of the greatest risk factors for burn out are (1) caring more for others than for yourself, and (2) not being able to say "no!" we must remember that putting our own health first is not a selfish act. if we don't take care of ourselves, than what do we have left to give to those who are in need of our strength - a mind that doesn't function properly and a body that is worn down? i was so grateful to find this blog. i have met many "nurses" that are judgmental and couldn't care less of other people's needs. those of us who do must continue to encourage each other and to keep our health so that our patients may continue to have the caliber of advocates that they deserve.
kudos to you fellow coleague. you nailed it. the thing that bothers me most is when physicians take shortcuts and don't tell us about them. then we have to pick up the slack and fix the shortcuts if and when we find them. for instance, i was discharged from the hospital when i was so weak i was unable to walk. my physician even took me off my pain meds and ordered my oxygen to be discontinued because he relied on the machine instead of speaking to a real human being.
You summed it up great: Nursing is just hard work, physically and mentally. I think we all need to share that with as many people as we can, as often as we can. Unfortunately, this is a 24/7 profession b/c we do not stop nuturing/caring when we clock out... we nurse our families, our neighbors, strangers in need and we take on many "extra" responsibilities in our communities. We should pat ourselves on the back for our accomplishments and learn to say no.
Do a search on this site under the word burnout and you can read and make an informed decision based on serveral different perspectives w/in this given curse uhh, I mean profession called nursing. From my experience NO, hell no, it is in the end the bottom dollar every time, in every way, didnt used to be that way. So very sad, and frustrating
After 10 years in the ICU, I too experienced severe burnout. I had nightmares before going to work, gained a LOT of weight from "stress eating", and felt like everyone died - all the time.
I then took my years of ICU experience and did cardiac cath lab nursing. WHAT A BLESSING! You USE your hemodynamics, your ACLS, your compassion with a family who just lost a 45 year old to a massive AMI, your skills are rewarded by respect, and you work SIDE by SIDE with the doctors. You FIX coronary occlusions, and the patient goes HOME, BETTER!
I am now on a first name basis with cardiologists who ask for advice. There are other places to work. Education. Public health. School nursing.
Don't let burnout snuff out the flame. It is possible to be uplifted everday, you just have to find the niche. Good luck!:redbeathe
Scroopit-I think you are probably right. I did say I was burned out or close to it. I just know that I'm on overload most of the time. With all the changes they are making at my hospital and probably all over, it's getting even harder. Maybe it's my age. We get less nurses and less auxillary for the number of patients we have than we did a year ago. I don't want to give up nursing. I like what I do. The problem is no one listens as far as the administration. Our nurse manager listens, but she really has no more control than the rest of the nurses. I really have no one to talk to except fellow nurses who understand and I think that's why we complain about things to each other. I don't complain in front of patients. I go in the room with a smile on my face and tune out anything but that pt for the moment. The funny thing is some of my patients take care of me. At the end of the day one might say "you look so tired". I usually just smile and tell them I am, but my shift is almost over and a fresh nurse will be here soon. They usually smile or laugh. I'm just frustrated. I do the best I can with what I've got, but I could do so much better if we were well staffed.
Specializes in LTC, CPR instructor, First aid instructor..
Do a search on this site under the word burnout and you can read and make an informed decision based on serveral different perspectives w/in this given curse uhh, I mean profession called nursing. From my experience NO, hell no, it is in the end the bottom dollar every time, in every way, didnt used to be that way. So very sad, and frustrating
I completely agree. Nursing used to be an enjoyable profession. Now it's one where nurses are abusedin many ways. And that is sad.
Specializes in LTC, CPR instructor, First aid instructor..
After 10 years in the ICU, I too experienced severe burnout. I had nightmares before going to work, gained a LOT of weight from "stress eating", and felt like everyone died - all the time.
I then took my years of ICU experience and did cardiac cath lab nursing. WHAT A BLESSING! You USE your hemodynamics, your ACLS, your compassion with a family who just lost a 45 year old to a massive AMI, your skills are rewarded by respect, and you work SIDE by SIDE with the doctors. You FIX coronary occlusions, and the patient goes HOME, BETTER!
I am now on a first name basis with cardiologists who ask for advice. There are other places to work. Education. Public health. School nursing.
Don't let burnout snuff out the flame. It is possible to be uplifted everday, you just have to find the niche. Good luck!:redbeathe
It seems that so many unknowing people have made so many rules for me, that I can't even take care of my patients. I take care of my patients on the sneak. Sometimes you have to "Go forth and part the RED TAPE!"
Your question is answered by "YES" and with all our hearts, that is why we chose our profession. If we only took care of our patients, life would be bliss. Add greed and politics equals burnout with us questioning our abilities. God only gave us 2 hands and 2 feet. We know when we leave there will be someone to replace us, thus the cycle continues. After 36 years of experience, I have never seen it change, anywhere. I have " been there and done that!" and it is sooooooooooo sad that it only gets worse. I chose to believe being a nurse was my passion, only to discover that no one else really cared but other nurses and the patients. Now it is all about money.
You are eloquent and articulate. You should be exploring areas in journalism. My answer to burnout is to keep focused and prioritize.Try to overlook the inherent problems we all face and give the best care you can.Knowing you did your best is enough satisfaction.It is unfortunate that we care givers on the front line are treated as grunts.We are all highly intelligent,motivated and caring individuals, but the hospitals see us as easily replaceable because of the shear volume of nurses.Good luck and stay strong.
Specializes in PICU, NICU, SICU, CCU, ER, RN Paralegal.
I spent 30 plus years in hospital nursing. Whenever I felt the signs of burnout, I changed what I was doing. I took a year off to work Home Health, the back to the hospital. Then I would rotate to a new area every few years to keep things fresh and interesting. It's the only way I lasted so long.
FranEMTnurse, CNA, LPN, EMT-I
3,619 Posts