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.
NursesGeneral NursingArticle
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.
