Burnout: What Am I Missing?

[Katillac, RN]

I find it so interesting that in all of the materials on burnout and its cousin compassion fatigue, the emphasis is always on what the nurse should or could do about it. The articles talk about educating nurses to establish and maintain good professional boundaries, to take care of themselves, to achieve that work/life balance etc.

However, I never see mention of the role employers play in clinician stress and what employers are doing to prevent it. It's almost as if the clinicians are expected to take on all of the responsibility or even get blamed for acquiring a mental health condition that is at least partly caused by a culture that the organization directs.

In one article, the author writes in a scolding tone about nurses who burn out in his opinion because they refuse to leave the floor for breaks, thinking only they can properly care for their patients. Sorry, but I literally can't imagine this happening in any setting I've worked. The idea of my refusing to hand over the keys to anybody qualified and willing to take them would be laughable if it wasn't so presumptuous and insulting.

Another author literally wrote that if a nurse doesn't take a few minutes in a quiet spot” to process difficult situations, he or she is volunteering for compassion fatigue. If I took that few minutes to process every patient that went bad or friend throwing a tantrum or crying spouse I'd be in the clean utility room all day. I'm not being a martyr or trying to be a hero when I just suck it up and go on, I'm responding to a work load that makes it impossible for me to care for both my patients and myself, and my ethics tell me I have to pick them.

In any other situation where a number of employees of a facility came down with the same condition, attention would be focused on what in the organization caused or contributed to the malady. If several people go out on comp from lifting the same patient, the rule gets laid down that the patient is a Hoyer only. If multiple people slip and fall on a new kind of flooring that got put down, the suits from risk management show up and suddenly there are a bunch of caution signs followed by a new floor. But when turnover is sky high from burnout caused largely by the working conditions and management's refusal to address them, the silence from above is ominous.

Why are burnout and compassion fatigue not seen as an organizational problem? What am I missing?

[Ruby Vee, BSN]

I find it so interesting that in all of the materials on burnout and its cousin compassion fatigue, the emphasis is always on what the nurse should or could do about it. The articles talk about educating nurses to establish and maintain good professional boundaries, to take care of themselves, to achieve that work/life balance etc.

However, I never see mention of the role employers play in clinician stress and what employers are doing to prevent it. It's almost as if the clinicians are expected to take on all of the responsibility or even get blamed for acquiring a mental health condition that is at least partly caused by a culture that the organization directs.

In one article, the author writes in a scolding tone about nurses who burn out in his opinion because they refuse to leave the floor for breaks, thinking only they can properly care for their patients. Sorry, but I literally can't imagine this happening in any setting I've worked. The idea of my refusing to hand over the keys to anybody qualified and willing to take them would be laughable if it wasn't so presumptuous and insulting.

Another author literally wrote that if a nurse doesn't take a few minutes in a quiet spot” to process difficult situations, he or she is volunteering for compassion fatigue. If I took that few minutes to process every patient that went bad or friend throwing a tantrum or crying spouse I'd be in the clean utility room all day. I'm not being a martyr or trying to be a hero when I just suck it up and go on, I'm responding to a work load that makes it impossible for me to care for both my patients and myself, and my ethics tell me I have to pick them.

In any other situation where a number of employees of a facility came down with the same condition, attention would be focused on what in the organization caused or contributed to the malady. If several people go out on comp from lifting the same patient, the rule gets laid down that the patient is a Hoyer only. If multiple people slip and fall on a new kind of flooring that got put down, the suits from risk management show up and suddenly there are a bunch of caution signs followed by a new floor. But when turnover is sky high from burnout caused largely by the working conditions and management's refusal to address them, the silence from above is ominous.

Why are burnout and compassion fatigue not seen as an organizational problem? What am I missing?

New grads are notorious for not taking breaks. In some groups, it's almost a point of pride to push yourself more than anyone else so you can "humble brag" about how hard to work or how compassionate you are, always putting the patient's soda order before your own bladder. That's one of the things I try to stamp out in my own new orientees. Take care of yourself first. Some oven listen.

Taking care of yourself -- and it's corollary, taking care of yourself first -- is something that newer nurses seem to need to be told. Especially those with "the calling".

I don't think burnout can always be blamed on the nurse, but I'm not really sure it's always the institution's fault, either. Interesting post. I'll have to think about it for awhile.

[VivaLasViejas, ASN, RN]

Regrettably, nurses can't control what the organization does...only how we respond to it. The crazy staffing ratios and the offloading of other departments' work onto us are unfair and even dangerous, and that's not even considering what the patients need. The only thing to do, then, is to modify our response to the stress by taking care of ourselves first---meaning taking those breaks, going to the bathroom when we need to, staying hydrated. One cannot pour from an empty vessel.

We also have to learn how to leave work at work, and not allow it to interfere with our off hours and days. That's hard to do, and to be honest I never did figure out how to do it. Maybe it's because I was in management and had 24/7 responsibility for much of my career. But I do know it can be done, and each nurse has to find out for her/himself what works.

[Ruby Vee, BSN]

Regrettably, nurses can't control what the organization does...only how we respond to it. The crazy staffing ratios and the offloading of other departments' work onto us are unfair and even dangerous, and that's not even considering what the patients need. The only thing to do, then, is to modify our response to the stress by taking care of ourselves first---meaning taking those breaks, going to the bathroom when we need to, staying hydrated. One cannot pour from an empty vessel.

We also have to learn how to leave work at work, and not allow it to interfere with our off hours and days. That's hard to do, and to be honest I never did figure out how to do it. Maybe it's because I was in management and had 24/7 responsibility for much of my career. But I do know it can be done, and each nurse has to find out for her/himself what works.

This makes perfect sense.

[Katillac, RN]

Regrettably, nurses can't control what the organization does...only how we respond to it. The crazy staffing ratios and the offloading of other departments' work onto us are unfair and even dangerous, and that's not even considering what the patients need. The only thing to do, then, is to modify our response to the stress by taking care of ourselves first---meaning taking those breaks, going to the bathroom when we need to, staying hydrated. One cannot pour from an empty vessel.

We also have to learn how to leave work at work, and not allow it to interfere with our off hours and days. That's hard to do, and to be honest I never did figure out how to do it. Maybe it's because I was in management and had 24/7 responsibility for much of my career. But I do know it can be done, and each nurse has to find out for her/himself what works.

I understand that health care systems typically do nothing about burnout and agree it's dangerous. That's my point; other dangerous conditions get corrected if only because it costs the place money not to. Staff turnover is expensive, and every nurse an organization loses to burnout must be replaced at the org's expense. So why not save the nurses and the money? It doesn't make sense to me.