Stop Calling It Burnout

Daisy4RN · Mar 10, 2019

Thank you for posting this. The workload is fast becoming unsustainable and has only got worse in the last 20 yrs. And while i like the word change i honestly dont see it making a difference to management. Hopefully it might make it easier for an individual to cope knowing that the "burnout" was not necessarily an individual/personal issue but one of unrealistic demands of the corporate world of medicine.

Lemon Bars · Mar 13, 2019

This video is exactly right. Through unions, laws, or choice of workplace, we need to encourage a more reasonable working environment that features better staffing, resource/break nurses, more aides, etc. Squeezing of the employees seems to be happening more and more in many industries, but it's especially painful watching patients suffer because we don't have time to provide good care. Unfortunately, the aggressiveness and f-bombs on display in the video are a bit too colorful for my social media pages, so I won't be sharing the video. I suggest a new version of the video be made that shows passion and wisdom without dropping f-bombs, etc. Such a video might be shared with more people, or perhaps even be shown at a staff meeting or union meeting. But the message of the video is right on the money, for sure.

JKL33 · Mar 13, 2019

I called BS a long time ago on the idea that if someone (and then more and more and more "someones") struggled to accept and navigate the increasing divide between patient care ethics and the business of healthcare, there is something wrong with that person (and that person and that person and that person) or they are all individually weak in some way.

The business of healthcare doesn't only clash with nursing ethics, some of its own demands themselves are mutually exclusive.

I wouldn't put most of this in the same terms as ZD does (war, victim, etc.) and he also goes unnecessarily and inappropriately overboard in generalizing about the sacrificial virtues and altruism of healthcare workers. At the same time, it certainly doesn't take a rocket scientist to see how convenient it is to apply these words "burnout" or "burned out" to individual people who grow weary, fed up, troubled, stressed, conflicted, etc. in reaction to recent lunacy.

He sounds a little bit like he just learned about this "moral injury" thing - but that whole concept isn't completely new to nursing. We know about moral distress, ethical dilemmas, ethical conflicts and all the manifestations related to being conflicted when ethical principles clash or ethics and legal principles clash, or when we feel we are not able to do the job in the ways we are taught are right/correct/ethical. All of that is old news and we've all been taught to dutifully expect that internal conflict will arise at times. For the most part IMO we have been decent at navigating and processing basic (and sometimes complicated) nursing dilemmas that are not personal to us.

But the problem now isn't huge case-study-type ethical issues in medicine/nursing where, in worst cases an ethics committee will weigh in; instead the problem is constant demands that contradict each other in settings where success is already sabotaged by conflicting interests and failure can easily be ascribed at the individual level.

Old tools don't work for that. Time with loved ones or getting a massage or doing something fun or taking a vacation or finding a new job or using meditation don't empower people to learn how to more healthfully and vibrantly thrive at being treated like crap.

So I give him credit for publicly calling BS on "burnout" and on the idea that it is an individual's personal-fortitude problem.

MrNurse(x2), ADN · Mar 13, 2019

After three decades of bedside nursing, I can't wait to get out of inpatient nursing. ZDoggMD articulated my point succinctly.

Davey Do · Mar 13, 2019

I hesitate and look askance whenever I hear that there's a blanket label blame or solution to a situation, as in this case.

We have a tendency to label our maladies, such as it is with "moral injury", blame the establishment, saying that it's all their fault, wrap it all up in a neat package complete with a ribbon and a bow.

It's always easier to blame someone else for our lot in life. "If they would only do what's right, then I wouldn't be suffering from moral injury" or whatever else you want to call it.

Life is an algebraic equation containing whatever we do known as "X" with endless possibilities. Add anything to X and it changes. Being aware of variables added to X will somewhat prepare us for the product. And a lot of whiners and complainers never saw the variables coming.

"Well I thought if I became a nurse and wanted to help people I would be happy and fulfilled, but now I have to deal with all this stuff!"

Expectations. If they're not met, we're disappointed and cry "Foul!" when it is we who need to defecate or get off the pot.

I could go on and on but I don't like typing long posts any more that I do reading them.

Except, of course, some of JKL's.

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Katillac, RN · Mar 13, 2019

44 minutes ago, JKL33 said:
I called BS a long time ago on the idea that if someone (and then more and more and more "someones") struggled to accept and navigate the increasing divide between patient care ethics and the business of healthcare, there is something wrong with that person (and that person and that person and that person) or they are all individually weak in some way.
The business of healthcare doesn't only clash with nursing ethics, some of its own demands themselves are mutually exclusive.
I wouldn't put most of this in the same terms as ZD does (war, victim, etc.) and he also goes unnecessarily and inappropriately overboard in generalizing about the sacrificial virtues and altruism of healthcare workers. At the same time, it certainly doesn't take a rocket scientist to see how convenient it is to apply these words "burnout" or "burned out" to individual people who grow weary, fed up, troubled, stressed, conflicted, etc. in reaction to recent lunacy.
He sounds a little bit like he just learned about this "moral injury" thing - but that whole concept isn't completely new to nursing. We know about moral distress, ethical dilemmas, ethical conflicts and all the manifestations related to being conflicted when ethical principles clash or ethics and legal principles clash, or when we feel we are not able to do the job in the ways we are taught are right/correct/ethical. All of that is old news and we've all been taught to dutifully expect that internal conflict will arise at times. For the most part IMO we have been decent at navigating and processing basic (and sometimes complicated) nursing dilemmas that are not personal to us.
But the problem now isn't huge case-study-type ethical issues in medicine/nursing where, in worst cases an ethics committee will weigh in; instead the problem is constant demands that contradict each other in settings where success is already sabotaged by conflicting interests and failure can easily be ascribed at the individual level.
Old tools don't work for that. Time with loved ones or getting a massage or doing something fun or taking a vacation or finding a new job or using meditation don't empower people to learn how to more healthfully and vibrantly thrive at being treated like crap.
So I give him credit for publicly calling BS on "burnout" and on the idea that it is an individual's personal-fortitude problem.

I can't thank you enough for your response. You've brilliantly blown the muck off a piece of this that's been bothering me but I couldn't bring into focus. I never noticed before I've been lumping the intrinsic conflicts of the profession with the personal (although systemic) mistreatment and trying to use the same tools to deal with both.

But I do see the parallels between the experience of some in combat and some (most?) in health care professions. From having lived with two individuals with PTSD, one from Vietnam and one from being at Ground Zero on 9/11, I can say the fundamental schism with both them and me is the same. We all tried to do the impossible, having been intensely schooled and pressured to believe our efforts were our duty, and failing to successfully deliver was personal failure. The difference comes in that soldiers are taught it's their duty to sacrifice themselves if necessary, but health care workers are fed the denial that the tools to ensure their safety and well being are available to them. Further, the healthcare system itself denies complicity in the mistreatment, and deceptively markets its support of workers with the same glossy photos and lofty words it uses to market itself to consumers.

On a different note, I wonder what's going to happen as younger people enter the professions with what appears to me to be different expectations of and response to the demands of the workplace. Maybe it's just my limited view, but I see people with a cost/benefit outlook on their employment much more in line with the model I see employers using. I see a generation with lower expectations of decent treatment by and longevity with employers and more reliance on ongoing evaluation of the value of the specific workplace to them.

Anyhoo, I'm off to my own battles today, thanks again.

TriciaJ, RN · Mar 13, 2019

2 hours ago, JKL33 said:
Old tools don't work for that. Time with loved ones or getting a massage or doing something fun or taking a vacation or finding a new job or using meditation don't empower people to learn how to more healthfully and vibrantly thrive at being treated like crap.

That's why I've taken umbrage at the buzz phrase "work-life balance". It's the admonition du jour by managers, educators and the purveyors of nursing journal crap. When I was too exhausted to even change out of my scrubs for 2 hours after getting home, when my housework was piling up and I could do little more than stare into space on my days off, please don't chirpily suggest I find a hobby or get some "physical activity". A choice two-word retort always pops into my head.

Wittering on about work-life balance is the modern day version of "let 'em eat cake".

TriciaJ, RN · Mar 13, 2019

1 hour ago, Katillac said:
I can't thank you enough for your response. You've brilliantly blown the muck off a piece of this that's been bothering me but I couldn't bring into focus. I never noticed before I've been lumping the intrinsic conflicts of the profession with the personal (although systemic) mistreatment and trying to use the same tools to deal with both.
On a different note, I wonder what's going to happen as younger people enter the professions with what appears to me to be different expectations of and response to the demands of the workplace. Maybe it's just my limited view, but I see people with a cost/benefit outlook on their employment much more in line with the model I see employers using. I see a generation with lower expectations of decent treatment by and longevity with employers and more reliance on ongoing evaluation of the value of the specific workplace to them.

Exactly right to separate intrinsic conflicts from the systemic mistreatment. The intrinsic conflicts will always be an inherent part of nursing. But the sweatshop work conditions are a different matter.

About younger people - well, I'm actually encouraged. The same snowflake mentality that we like to poke fun at will quite possibly be nursing's salvation. The low BS tolerance, the increased willingness to be vocal and to vote with one's feet will probably be what turns things around, if anything does. The whole "suck it up and pay your dues" mentality is really a form of self-flagellation that the current generation doesn't feel a burning need to embrace. They might be onto something.

Katillac, RN · Mar 13, 2019

He offers some potential solutions in this Twitter thread.