NTI: Resiliency and Burnout

**allnurses**

Staff of allnurses recently attended the AACN National Teaching Institute (NTI) in Houston, Texas. One of the sessions was "Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments", presented by Vicki Good, DNP, RN, CENP, CPPS.

"I'm fried!" "I just can't do this anymore!" "I'm burnt out!"

How many times have we heard our colleagues or even ourselves say or think these thoughts? Nursing is a high-stress environment. Burnout is a state of stress that many high achievers experience. Some of the symptoms are:

physical and emotional exhaustion
cynicism and detachment
feelings of ineffectiveness and lack of accomplishment

Exhaustion is generalized fatigue that can be related to devoting excessive time and effort to a task or project that is not perceived to be beneficial. Depersonalization is a distant or indifferent attitude toward work. It manifests as negative, callous, and cynical behaviors or interaction with colleagues or patients in an impersonal manner. Reduced personal accomplishment is the tendency to negatively evaluate the worth of one's work, feeling insufficient regarding the ability to perform one's job, and a generalized poor professional self-esteem.

Experts estimate that one out of three critical care nurses is experiencing severe burnout syndrome, which is often referred to as a "silent epidemic" in healthcare. Organizational and individual factors lead to the presence of burnout syndrome and both must be addressed to prevent the negative consequences of the syndrome.

Critical care nurses are at high risk for burnout due to the complexity of care as well as the high mortality and morbidity of the patients they care for. Over the years, as patient acuity has increased, so has the immense responsibility of the critical care nurse. The ethical journey that we take also takes it toll. The question is no longer "what can be done?" but rather, "should we do it?" Should we continue full court press for all patients regardless of their quality of life? Should we offer all modalities and treatment options even knowing they come with a high potential for a limited quality of life? These questions and much more lead to stress which in turn leads to burnout.

We constantly care for others, yet sometimes we are not kind to ourselves. How many times have we put off going to lunch, break, bathroom because "our patient needs us?" How many times have we said "yes" to overtime that we didn't really want to do just so our co-workers wouldn't work short? Again, all circumstances that lead to added stress and burnout.

So...how do we combat burnout?

Based on a report from the American Association of Critical-Care Nurses, 6 standards are needed to establish and sustain a healthy work environment:

Skilled communication
True collaboration
Effective decision-making
Appropriate staffing
Meaningful recognition
Authentic leadership.

Additional commonly recognized tenets of a healthy ICU environment include "avoiding or managing conflicts" and "improving end-of-life care." Communication, collaboration, and effective decision-making during times when emotions are elevated are critical in engaging the team to decrease stress and BOS. A healthy work environment may be enhanced by utilizing team debriefings, structured communication, and collaborating with team members on critical decisions.

From Dr. Good's presentation, here are some environmental or organizational solutions:

Acknowledgment of stress and burnout
Established wellness program
Palliative care consultations
Active Ethics Committee

As individuals there are steps we can also take to reduce or relieve burnout:

Stress reduction training
Meditations
Work-life balance
Ensuring adequate rest, breaks, time with family and outside activities

We all realize that we work in a stressful environment. To continue to care for our patients and ourselves we need to recognize ways to minimize and cope with stress. It is important that both our organization and nurses work together to focus attention on this increasingly common issue and work jointly to combat it.

In the end, this will provide improved care for both patients and nurses.

References:

American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016.

Burnout Syndrome in Critical Care Healthcare Professionals

Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments

Tell-tale Symptoms of Burn-Out