Nursing Burnout, Moral Residue, and Resilience: An Interview with Anna Rodriguez

[traumaRUs, MSN, APRN]

Nurses have bad days just like everyone.  What's the difference between burnout and moral residue? This is an important issue for all nurses. 

Many people have thoughts about how to combat nursing burnout. There have been studies, conversations, symposiums. Speaking to someone who has experienced burnout helps to clarify the issue and a possible solution.

Interview with Anna Rodriguez, BSN, RN, PCCRN, CCRN

allnurses.com's Content and Community Director, Mary Watts, BSN, RN recently spoke with Anna Rodriguez, BSN, RN, PCCRN, CCRN at the AACN/NTI Conference about her journey through nursing burnout.

Anna explained that she went thru an experience approximately 3 to 4 years ago when she was in the right place at the right time and became a unit manager of a 10-bed CVICU. She held this position for two years and during these two years they had many changes including starting a new ECMO program, launched new and different technology and it just was a perfect storm. Anna got to the point where she went back to bedside via travel nursing. Currently, Anna is working in endoscopy. She had started a blog, The Burnout Book to collect her thoughts and to share with others as well as to bolster her spirits. This is based on the original burnout book that was a little journal she started writing during her second year of nursing school. She commented, "It's important to remember our "why" in nursing. It's the little things that matter. Now I'm a burnout survivor.”

Any human being will have bad days. As a nurse its important to develop a skill set to deal with bad days. However, when you have moral residue, it becomes harder to see that perhaps it's just a bad day versus actual burnout. From the ANA, moral distress is defined as:

Quote

"Moral residue is that which each of us carries with us from those times in our lives when in the face of moral distress we have seriously compromised ourselves or allowed ourselves to be compromised"

Understanding and Addressing Moral Distress - American Nurses Association

Signs and symptoms that can be indicative of moral residue include:

• Physically, and emotionally exhausted
• Dreading the job that you used to like
• Less connection with your job
• Chronic illness

All of this can lead to burnout. Early recognition is the key.

Possible solutions:

• Talk with someone, perhaps a trusted co-worker
• Acknowledge your feelings
• Employee assistance program
• Counseling if your mental health is endangered
• Changing jobs, shifts or specialties

Mary then asked if there are some personality traits that make a person either more prone to burnout or more resilient to this phenomena? Anna answered that in general people that are empathetic can have more issues with less resilience and this describes most nurses. As nurses, we have to find the balance between being compassionate and caring and separating ourselves from these feelings. They also discussed compassion fatigue which is when you take on the feelings of others to the detriment of yourself.

Anna's advice identifies that the goal is to be more resilient. When you feel a burnout moment, you need to get out of it. However, don't make huge lifestyle changes at the moment. You need to resolve the immediate stressor but once the stress lessens then you can rethink the situation and look at your life to see if you need to make big changes. All nurses experience this to some degree but its how you handle it.

Don't quit nursing, find your spark, there are a lot of different ways to be a nurse!

[Sarah Jividen, BSN, RN]

Great post! Burnout in nursing is real and you don't have to stay in the same specialty if you heart just isn't in it anymore. There are so many different ways to practice nursing.

[TitaniumPlates]

Question:

Why are you changing the verbiage from "Moral Injury" to the more sanitized and therefore less meaningful "moral residue"?

"residue" doesn't really even make sense in the context of what the definition you are using

13 hours ago, traumaRUs said:

• Physically, and emotionally exhausted
• Dreading the job that you used to like
• Less connection with your job
• Chronic illness 

This is the definition of injury.

Residue means:

noun: residue; plural noun: residues

a small amount of something that remains after the main part has gone or been taken or used.

Where does this verbiage sanitation come into being?

[traumaRUs, MSN, APRN]

9 hours ago, TitaniumPlates said:

Question:

Why are you changing the verbiage from "Moral Injury" to the more sanitized and therefore less meaningful "moral residue"?

"residue" doesn't really even make sense in the context of what the definition you are using

This is the definition of injury.

Residue means:

noun: residue; plural noun: residues

a small amount of something that remains after the main part has gone or been taken or used.

Where does this verbiage sanitation come into being?

This was from the speaker herself. She was speaking of the fall out or left over feelings or moral distress or moral injury. For instance (and this is my example); I care for chronically ill hemodialysis pts. I have several pts who beg the staff not to dialyze them, they don't want to do this anymore. Several have told me personally, "this just isn't even living anymore." However, at family meetings when end of life issues including the pts own wishes are brought up, the family almost bullies the elder to "stay the course," "you don't want to commit suicide", etc.. These are very trying meetings to orchestrate and yes, I go home and think about these situations a lot. That is the moral residue that I'm experiencing.

[tnbutterfly - Mary, BSN]

Moral residue is the scar that remains after the injury.

[TitaniumPlates]

6 hours ago, traumaRUs said:

This was from the speaker herself. She was speaking of the fall out or left over feelings or moral distress or moral injury. For instance (and this is my example); I care for chronically ill hemodialysis pts. I have several pts who beg the staff not to dialyze them, they don't want to do this anymore. Several have told me personally, "this just isn't even living anymore." However, at family meetings when end of life issues including the pts own wishes are brought up, the family almost bullies the elder to "stay the course," "you don't want to commit suicide", etc.. These are very trying meetings to orchestrate and yes, I go home and think about these situations a lot. That is the moral residue that I'm experiencing.

Thank you for the clarification. It hit home because I am leaving nursing because of moral injury---and it seemed almost like someone is minimizing this because it sounds like the profession is harming us---which it is.

It's not the patients, it's the profession. It's the requirements of corporate bean counters believing that this is a big chessboard or a robot factory--that no one has needs or feelings.

I see this a lot with my family of Veterans. I also worked at a VA. These men and women are treated as robots. Told what to do--"OWNED" by the US government. You can't even get a sunburn without fear of repercussions (that is considered damaging US Gov't property). These people are damaged beyond belief.

There is such a parallel between how soldiers are used and how Nurses and to a high degree---doctors, CNAs, technicians and other "front line" personnel are being used.

The results are the same. Inability to cope even with "lavender oil" sachets and "mindfulness training". Tell that to a soldier who watches children die whether it's by his own hand or someone else's. This is the same thing we go through as nurses every single day. Bad decisions made by rushed and overworked/overwhelmed physicians--poorly trained, some of them--horrible policies set in place by out of touch or inexperienced "upper management"--all for the same goal---

PROFIT.

Thank you for the clarification. This hits very very close to home for me and my family.

[Jasonsmb]

Heart, soul, and redemption: My journey to addiction -- and back

https://www.americannursetoday.com/blog/my-journey-to-addiction-and-back/

[Jesuah, RN]

It's not so simple to change specialties especially if one lives in a rural area with few facility options. I had been in one specialty for 28 years when I was belittled and constantly made to feel worthless and incompetent by one physician. Unfortunately, management took his side and I lost my job. I attempted to find employment in another area of nursing and was constantly turned away without explanation. After a brief time of employment in long term care, I started travel nursing in my original specialty. It was not something that I had ever really considered before because I am very much a "home body" and had built a house a year before I lost my job and really didn't want to move. I have been doing travel nursing for 7 years now and have found a way to make it work with my home life. I really do still LOVE what I do even though there are times that I don't LOVE the situation. AND....I am GOOD at what I do, but changing specialties is not always a viable option.

[Kooky Korky, BSN, RN]

On 6/15/2019 at 10:52 PM, Jasonsmb said:

Heart, soul, and redemption: My journey to addiction -- and back

https://www.americannursetoday.com/blog/my-journey-to-addiction-and-back/

It is wonderful that you were able to come back. I hope you continue to thrive and I ask God's continued blessings upon you and your loved ones and your patients.

What are you doing these days?

[Jasonsmb]

36 minutes ago, Kooky Korky said:

It is wonderful that you were able to come back. I hope you continue to thrive and I ask God's continued blessings upon you and your loved ones and your patients.

What are you doing these days?

Yes thank you! It was an absolutely horrific experience, but I’m way better off today for learning how to fight through the adversity. I am starting a job as a QA RN for a home health agency. Truly miraculous, I’m so thankful for a second chance. All of my convictions were expunged, and I have a new lease on life. Thanks for reading and please share with all the nurses and/or other health professionals you know. We really need to get the word out that these kinds of things happen to good people who get beat up by the profession. We all know it happens, we need to take care of each other.

[MelissaQLomas]

Hello, everyone - I'm new to this forum (my first post) and the topic of nurse burnout is something I'm currently researching. Though the literature and online postings encourage nurses to be proactive in seeking help, quality of life balance, and well-being for their burnout, I'm curious to know if anyone has experienced a tactical, clinically strategic solution within your unit or department to combat burnout? Something from within your institution that's not already covered by Employee Wellness or Employee Assistance Programs?

[TitaniumPlates]

Why are you researching this topic?  If you are a Nurse and you know anything about working as a Nurse, you already know why Nurses oftentimes do not seek help--hint: it has to do with their licensure and their employability.

"work life balance" is the term your looking for. If, again, you ever worked as a Nurse, you would know why that is a myth that the employers continue to push.

EAP programs.....um....you mean like....taking an exhausted, PTSD riddled soldier off the field for ONE HOUR a month to "talk to someone" so that......they can get sent back into the same crap that gave them the PTSD?  Riiiiiiiiiight.  How about CHANGE THE BATTLE. How about Nurse to Patient ratios that are decent and do-able (so that old "moral distress" thingie doesn't occur), how about pay that a single person as a Nurse can LIVE and actually pay for food?  How about decent staffing? 

EAP is also a whitewashing by facilities that "show they care". Wanna know how they can show they care and prevent burnout?  NURSE TO PATIENT RATIOS, FAIR PAY and FULL STAFFING.

If you're a NM or HR person who is looking for a strategy other than....oh....full staffing, fair pay, nurse to patient ratios?   Pizza parties STILL aren't the answer to burnout.