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Topics About 'Burnout'.

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  1. I am ready to leave the nursing profession after 6 years. I have a bachelor's degree in biology and got my associate's in nursing. In high school, I decided that I wanted a career in nursing. By the time I entered college, I decided I wanted to become an OB/GYN. Halfway through college, I realized I didn't want to be a doctor. I wasn't sure what I wanted to do but I wasn't going to change my major and start over. Fast forward about 8 years, I considered nursing and applied to nursing school and here I am.....back at square one. I wish I had sacrificed and endured one or two more years of college by changing my major and pursued something else. I often-times cringe when I think of going to work. My attitude changes, my heart races, and anxiety sets in. My coworkers are nothing less than awesome. Most of my patients rock. Both have been unexpected blessings to me and I thank God for our paths crossing. But management, the physicians, and the facility at which I work have made nursing a profession that I wished I had not entered. I never have to wonder how devalued I am when I'm at work. Our voices are not heard, and as a matter of fact, our concerns are considered complaints. Not only am I a caregiver, but I am the business office, auditor, waitress, maid, logistics, IT, quality assurance, babysitter, personal assistant, and the list goes on. When doctors fall short, it is our job to clean the mess up.....and, no, I'm not speaking of mistakes that affect patient care. I speaking of simple documentation that they are supposed to take care of. I understand the importance of having all "I"s dotted and every "T" crossed, but when will the physicians be held accountable? I can't be chasing down physicians when they forget to check the correct box especially when it has little or nothing to do with a patient's outcome. That's not my job. We nurses are stressed, afraid, furious, and just plain depressed as a result of these added responsibilities. We already worry about our patients even after quitting time. After leaving work, many of us call back up to the floor or unit checking on our patients. We are genuinely concerned about them, but it is very obvious that management's agenda is not the patients. Whatever management's agenda is becoming our agenda, right? WRONG! I'm here to take care of patients, not physicians. There are so many nurses, YOUNG, fairly new nurses, that I know that started their nursing careers with a clean bill of health. They are now on antidepressants, benzos, blood pressure meds, and others due to the stress and unhappiness. Nursing has gotten away from patient care. It's about making money for the organization which is about making the physicians happy. If that means being stripped of our dignity, we are to do what it takes. I feel as though it is second nature to provide excellent care to our patients. WE have saved many lives anywhere from observing changes in our patients to discovering mistakes made by others (physicians) and correcting them or directing attention to the oversight. I wish they would let us do OUR jobs and provide care and management can run up behind THEIR "customers". If we can keep those two jobs separate, that would be great. We are a vital part in patient care, but yet, we are so underappreciated and taken for granted. We make a positive impact in many lives, but we are the first ones cursed out because someone is having a bad day. Not only are we unappreciated, but we are very disrespected, and in many occasions, we are unfairly belittled and we are just supposed to accept those words because "it's part of the job." I'm done accepting it. I'm reminded every day there are replacements waiting in line. I'm reminded that any fool can do my job. I don't want a pat on my back every time I do a great job, just acknowledge that I am a vital part of the team. I understand human resources has a stack of nursing applicants on their desks. I just don't have to be reminded of that everytime all my paperwork isn't on the chart (because I'm still working on it), or if I come back from lunch two minutes late. I am not cut out to take jabs and low-blows without throwing them back. I have so many responsibilities that I take on from the time I punch the clock to the time I punch out and I refuse to be disrespected by someone with a title because I happen to not move fast enough or I am having to clarify an unclear and, most of the time, an unfinished or incorrect order. I'm helping YOU out!! We genuinely worry and care about our patients that it often consumes us. When a patient codes or expires, we are crushed. I once had a patient who got stuck at least 15 times by various staff members, including physicians, to get IV access. The patient took those sticks like a champ, but I still went home and boo-hooed because I hated to see him go through that. We hurt when our patients hurt. On top of carrying out our responsibility as nurses, we are holding in so much emotion associated with our patients.....yet we get very little to no respect. Don't get me wrong, there are some physicians that I'm in contact with whom are polite and value my opinion and I do appreciate them. Of course, I'm not always right or may not make the most intelligent statements, but they acknowledged my voice. Again, I don't want a cookie. I just want to be acknowledged as a professional. I understand customer service includes dealing with angry, rude, and the dissatisfied. But when I have poured my heart, soul, and emotion into my job and my customers and I am still allowed to be mistreated and insulted, then that becomes a problem. I feel I have no rights as a nurse. Who is protecting me? Who is my voice? Who is standing in my defense? So at this point, it's time for me to bow out from the nursing profession gracefully and while in good standing with the organization, my family, and myself before I am forced out or OD on my meds(or somebody else's). My family, happiness, health, dignity, and peace of mind is worth leaving. They tell me Costco employees never leave. I'm-so-over-nursing-I-would-rather-work-at-costco.pdf
  2. Meetings A typical nursing faculty day starts an hour or more early to check emails and get organized for the first lecture or class. And bing! An email calendar reminder: a 30-minute countdown to the curriculum committee meeting. Frantic scrambling ensues – where are the previous meeting notes? A dreaded discovery – today’s report is a totally forgotten one. Off to the meeting with the embarrassment and self-torture brain tape running amuck. Not quite what the TV sitcom portrays. Teaching Two hours of teaching follows the meeting. A class break between class one and two brings student appointments. After class two is a quick lunch at the desk and phone calls. Student Appointments After lunch, three more student appointments, no break, term paper grading for the remainder of the afternoon. More Meetings Late in the day - bing! A phone alert reminder of a Nursing Department meeting and the research update presentation obligation as the (leadership requested) task force head. More frantic scrambling looking for the presentation that - sigh – was found. Following the task force meeting… oh no! today is the library trip – now closed, so much for working on the dissertation. Wearily locking the office door, juggling a tote bag full of nursing care plans to grade and leaving. Yet, until the care plans are graded for tomorrow’s 12-hour clinical day, the day is not done. There is More... A typical day? But wait there is more! In addition to teaching duties and responsibilities and serving on committees, there is completing license maintenance professional development hours. Advanced practice faculty have to complete extended hours of continuing education credits to keep working. As if that weren’t enough, common are requests for workshops or conference presentations, often outside of office hours. Peer mentoring can eat up precious time, as can additional classes due to faculty shortage. Active participation in research, self-credentialing, and community involvement are among the many other responsibilities. Northwestern University found that 60.9% of faculty at public universities and 56% at private ones find committee work stressful. Overlapping Roles Overlapping roles increases the demand for faculty time, which is already constrained with student needs and course requirements. Far from the capability of doing it all, and not being able to meet basic responsibilities causes stress. The inability to meet leadership expectations with committee or task force assignments that may impact one’s chances for promotion or tenure exponentially increases the stress. Northwestern University reported that three-quarters of their faculty suffered at least moderate to severe stress from multiple roles required for their position (Northwestern University, n.d.). So, What Can Be Done? Considerations for leadership when assigning additional roles to stressed faculty are the possible stress associated conditions: mental depression anxiety pessimism inability to concentrate Serious physiological ill that can occur: Alcohol abuse Substance abuse Chronic fatigue Sleep disorders Headache Muscle tension Gastrointestinal ailments (Better Health, 2012) Teachers who were surveyed listed several reasons for their job stress. Here are some common themes: Too little time Not being able to develop their class Not enough administrative support Changing responsibilities (Mulholland, R. et al, 2013) Consequences of nursing faculty stress on their performance include: Less efficiency Impaired student-faculty interaction Poor student outcomes Clinical errors especially medication errors Placing patients at risk due to poor supervision of clinical students Academic institutions should take advantage of opportunities to decrease the stress caused by overlapping responsibilities on nursing faculty: Provide mentoring for new faculty before assigning additional tasks Review whether current committees or task forces are necessary Offer paid time off for faculty pursuing advanced degrees Consider the course load of the instructor before recommending them to a committee Rotate responsibilities throughout the nursing faculty community Nursing Faculty can help themselves by: Speaking to the Dean or Department Head when the workload gets overwhelming Get help with prioritization and organization if necessary Reach out to a mentor or colleague for help Schedule some time for self to unwind and relax Don’t take unnecessary work home Take care of physical and mental health Consider whether the job is worth the stress Overlapping roles for the nursing faculty may never go away. It is possible, however, to prevent hating the job you used to love.
  3. I am a later in life RN (46 yo.) Nurse for 2 years. 1 yr hospice, 1 yr skilled/rehab unit in LTC. Hospice: too many HOURS so i switched to 3-12hrs on a rehab unit. I dont like what its doing to my PERSONALITY. Since its an ltc, a LOT of our pts are more "attention needy" than medically needy. Ex: call lights to "empty garbage" or "pick my lettuce off the floor" kinds of bs. Pts ringing like crazy for DUMB stuff or coming to nur station 30+ times a SHIFT. Not to mention the faaaamily members expecting 1 on 1 specialty treatment. Lots of pts are more hospice/LTC approp than "rehab"...Ive tried setting boundaries, pts acknowledge,apologize and then just REPEAT behaviors. Feel like im growing to HATE ppl and dont want to turn into that nasty burnt out nurse we all dread. Feel like Im dealing with a bunch of needy self absorbed, tantruming toddlers all screaming at the same time! Coworkers tell me "its just nursing, it does that to you". Thinking about switching to hospital setting but afraid of the unknown. Any advice?
  4. Dear Nurse Beth, I have been in Med/Surg for my entire nursing career, for the past five years. I recently sustained a lower back strain and have been on workman's comp. I am wrapping up my recovery. The thought of having to return to work with the neuro population of patients is overwhelming (physically and mentally very heavy, demanding work). I feel the need to find a job less physically demanding. I am considering working part time in my next role, I am so burnt out. I have become very jaded due to recent budget cuts, feel exhausted from the customer service aspect, and now, recognize this line of work has taken a huge toll on me emotionally and physically. I am an empath. (Just discovered this about a month ago, however). I have a creative, sensitive spirit. I love to write. As a nurse, I value being an educator. I want to feel like an expert in my field, and have a skill set I feel confident about. The hospital is so rushed. I realized as well, after working with medical patients, at the end of the day I enjoy helping make others happy not just healthy. This time on workman's comp has helped me recover; I am tired of having to sacrifice my needs for others. Do you have any recommendations for the next step in my career? My thoughts so far have been: injections/cosmetology would please my aesthetic/creative spirit; Dermatology to promote self care, prevention, education although working in a clinic isn't super appealing to me; or finding a job that includes writing - I was really good at working with NCLEX material? My neighbor had recommended working for insurance companies as well. Appreciate any inspiration, feeling frazzled and lost even after being a nurse for five years. Thank you! Dear Lost, Sometimes in life, you have to step back in order to gain some insight into your own needs. Like you have been forced to do with your injury. It's actually an exciting time for you because you are on the brink of moving on to something new, which will take care of your MedSurg-induced burnout. Working in cosmetics/plastics satisfies a lot of your requirements. It's less physical, and for the most part, you are making people happy. The pay will typically be less than acute care, at least to start with, but your salary will grow with your expertise. Training is on the job. Be sure and go with a reputable employer. Once you leave acute care, it is hard to get back in. Once 3-5 yrs have passed, you may need a refresher course to be competitive and there's still no guarantee. Be sure you are comfortable with leaving the hospital setting. Try a writing job part-time or on a freelance basis to develop your writing skills. You can search for "nurse writer jobs". HealthStream, GNOSIS, Prophecy, and many other companies use item writers to write test questions. Being an empath means you have a high degree of empathy and feel what others around you feel. You want to heal other's pain which makes you an excellent caregiver but can leave you exhausted. Your recovery time after these intense connections is key. Put out some feelers into the job market and see what the search brings you. Go on interviews and you will get a better idea of what appeals to you. Best wishes, Nurse Beth Author, Your-Last-Nursing-Class-how to land your first nursing job...and your next!
  5. First, the World Health Organization has declared that 2020 is the Year of the Nurse and Midwife. The theme for 2020, Nurses: A Voice to Lead - Nursing the World to Health, demonstrates how nurses are central to addressing a wide range of health challenges. It will encourage nurses and the public to celebrate, but also provide information and resources that will help to raise the profile of the profession throughout the year and attract a new generation into the nursing family. 2020 is also Florence Nightingale's Bicentennial – celebrating her 200th birthday on May 12. Having the Year of the Nurse and Midwife coincide with Florence Nightingale’s bicentennial raises the exciting prospect of nurses finally being recognized for all the good they do. And the Nursing Now Nightingale Challenge will produce a new cohort of young nurse leaders who will take the profession forward over the next decade. National Nurses Week is May 6-12, 2020. Supported by the American Nurses Association, National Nurses Week celebrates nurses and their role in society. The week also helps to raise awareness about nursing as a possible career choice and also to educate the public about the kind of work nurses are involved in. And, finally, coinciding with that week is: National Student Nurses Day May 8 National School Nurse Day May 8 International Nurses Day May 12 So there is a lot happening for you to get involved in. But we also need to be aware of and address some of the challenges that might be jeopardizing the forward progress of our profession. Challenge #1 There is a NURSING SHORTAGE on the horizon due to these factors: Aging Population As the population ages, the need for health services increases. Aging Work Force One-third of the workforce could be at retirement age in the next 10 to 15 years. Nursing faculty is also experiencing a shortage, and this leads to enrollment limitations, limiting the number of nurses that a nursing school can generate. Nurse Burnout Some nurses graduate and start working and then determine the profession is not what they thought it would be. Others may work a while and experience burnout and leave the profession. Career and Family Often during childbearing years, nurses will cut back or leave the profession altogether Regions Some areas of the country struggle to fulfill the basic needs of the local population as a whole. Growth A higher need is seen in areas that have high retirement populations. Violence in the Healthcare Setting The ever-present threat of emotional or physical abuse adds to an already stressful environment. Emergency department and psychiatric nurses at a higher risk due to their patient population. Challenge #2 Unhealthy Lifestyles There is an abundance of nurses with unhealthy lifestyles. We need to give attention to the personal health of our nurses. After all, if we don’t have healthy nurses, everything else we try to do to increase our nurse population will be of no avail. So let’s look at the state of our health. A study of 2,730 hospital nurses from the American Nurses Association (ANA) Health Risk Appraisal (HRA), surveyed from October 2013 to December 2015, found serious deficits in diet, sleep, and physical activity that may jeopardize nurses’ health and negatively impact the healing strength of the profession. (And from my vantage point as a Wellness Practitioner, this data probably holds and in fact may even be worse in 2020.) For nearly every indicator, the health of America's nurses is worse than that of the average American. Nurses are more likely to be overweight, have higher levels of stress and get less than the recommended hours of sleep. Here are some key findings: (Notice how many are within your control) Nurses are Exhausted 56-57% reported often coming in early and/or staying late and working through their breaks to accomplish their work 33% said they had often been assigned a higher workload than that with which they were comfortable 59% of respondents reported that they worked 10 hours or longer daily 47% slept fewer than 7 hours per day. Nurses are Overweight 56% were overweight/obese with a body mass index > 25 kg/m2. Only 14% of the nurses were eating at least five servings of fruits and vegetables per day (2.5 cups). Just 45% of the respondents were engaged in aerobic activity of at least moderate intensity for 2.5 or more hours per week, while 47% performed muscle-strengthening activities twice a week. Nurses Do Not Prioritize Their Health Over Others 68% put their patients’ health, safety, and wellness before their own. Nurses are Stressed and Burned Out From a study by the Cleveland Clinic of their nurses, 63% suffer from burnout. If it is not addressed nurses can become disengaged and eventually leave the profession. And, severe levels of stress are not only unhealthy but can negatively affect patient care. As you know, if nurses don’t adopt and maintain healthy lifestyle behaviors they are at risk for chronic diseases and early mortality. On the other hand, nurses who make healthy lifestyle choices have a spill-over effect and will be more apt to discuss and recommend preventive behaviors such as smoking cessation, more physical activity, and eating a healthier diet to the people under their care. With personal health on top of their mind, they may be better able to prevent workplace injury and avoid errors related to fatigue. So nurses who adopt healthy lifestyles may even provide better patient care. So What Does All This Mean For You? YOU can contribute by taking action on whatever you think would work for you. After all, you are the key to everything that will make The Year of the Nurse a truly important opportunity to showcase what we do and who we are. In my opinion, your best option that could be a win-win for both you and your profession is to take action on adopting a plan to get healthier. You are, after all, being watched by those around you as the expert on health, and if you embrace wellness as a lifestyle choice, you will make an impact on other’s behaviors as well. Don’t overlook the fact that you are a role model for not only your expertise but how well you model the health practices you teach to others to manage and prevent the chronic diseases they experience. And because this is the beginning of a NEW YEAR this is the perfect time to get started. What Are You Waiting For? Please share your lifestyle enhancement ideas to give other nurses ideas to draw from.
  6. Going to work should not be dreadful. However, for many nurses, the stress, burnout, and culture can sometimes make it downright painful to get dressed and head to work. After days, weeks, months, or even years of these types of feelings, you might lose the love you once felt for the profession. If you’re going through this, you must remember that you are not alone and that these feelings are normal. If they hang around for a few days or a month, it’s probably not too concerning. But, any longer than that and you may need to start looking at strategies to help you bounce back and reignite the passion you once felt for your career. Here are a few of my favorite things you can do to get back on track. Take Time Off Americans let 768 million vacation days go unused in 2018. This equals billions of dollars in lost benefits and often means that workers aren’t getting the rest, relaxation, and restoration they need. Unfortunately feeling like you’ve lost your passion for your work can sometimes be a double-edged sword. You feel burnout, so you keep working with the hopes of finding something that will reignite the passion you once felt. Unfortunately, it often makes the situation worse. If you’re feeling disconnected from work, talk to your manager or supervisor about scheduling in a few “mental health” days. Don’t plan any major events on these days, instead book time doing something you love. Or, you may want to make an appointment to get a massage, pedicure, or other restorative treatment. Treat Symptoms of Burnout Burnout is a challenging condition. If you start feeling like every day is a bad day or you’re exhausted all the time, you might be dealing with burnout. Other symptoms to watch for include: Feeling worthless or hopeless Feeling bored or overwhelmed Feeling under-appreciated Exhaustion Frequent illness Headaches or muscle pain Change in sleep patterns Change in appetite If you are experiencing any of these symptoms of burnout, you need to get the treatment you need. Talk to those around you about how you are feeling. If you have a workplace mentor or a boss you trust, start there. They may have noticed these changes, too and can offer invaluable feedback. You should also try to increase your connection with your coworkers, but avoid interactions with negative individuals. You might also need to look for activities outside of work that can increase your feelings of meaningfulness and purpose. Look for a New Specialty Sometimes feeling overwhelmed and unhappy can be a sign that it’s time for a change. If you work in a specialty like hospice, oncology, or other high-acuity areas, you may need to consider looking for a new area of nursing to try. Not only can a change decrease your level of stress, but it can also help you find your passion through learning about new areas you never thought about before. Work With a Coach or Mentor Reaching out to another nurse who has maybe experienced these same feelings can be helpful. If you have a mentor, start there. If not, it might be a good idea to hire a career coach who is also a nurse. You can discuss your feelings with them and also ask them for ideas of other areas of nursing that could be a good fit with your background. Take Care of Yourself It seems that self-care, getting plenty of rest, and eating a well-balanced diet is a good answer to just about any problems we have in life. And, feeling burnout and drained at work isn’t any different. Carve out time to get at least 30 minutes of moderate-level activity each day. Find a diet that is low in carbohydrates, junk food, and sugary foods. You might want to consider one that is plant-based or at least has high amounts of fruits and vegetables. Finally, make sure you are getting eight hours of sleep every night. Getting Back on Track Remembering your passion for nursing can be challenging when you are in the midst of burnout and other feelings of disconnection from your work. You can use these ideas, but there are also many other ways to reconnect with your passion for the art of nursing, it just takes a little work and time. Have you ever experienced burnout or “fell out of love” with nursing? What helped you get back on track? Share your ideas with us by posting in the comments below. We would love to hear them.
  7. You’ve probably felt the effects of workplace burnout at least once in your nursing career. As of this week, burnout has officially been recognized by the World Health Organization (WHO) as a formal occupational phenomenon. Clinicians of all types have been living with the effects of short staffing, stress, and other patient barriers that seem to zap their energy and ability to provide the best care. Burnout is now defined as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It’s characterized by reduced professional efficacy, feelings of exhaustion, and increased mental distance or negative feelings about your work environment. Nurses and Burnout The concept of burnout has been around since the 1970s when psychologist Herbert Freudenberger coined the term. When you’re under high levels of stress for an extended period, it’s common to start to feel tired and unhappy. However, the phenomenon doesn’t only make you want to sleep. It can create psychosomatic issues like anxiety, depression, and insomnia, too. Nurses in burns units, critical care, pediatrics, and emergency departments are at a greater risk of developing the condition. The high levels of care and increased uncertainty of outcomes in these areas can take their toll on the mental and physical faculties of any nurse. Other causes of burnout include inadequate staffing and caring for those who are nearing death or actively dying. You might also struggle with burnout if you’re a newer nurse or have continued conflicts at work that challenge your values. How Can You Prevent Burnout Many people think that burnout is driven by the way each nurse deals with stress. However, some experts believe that burnout is a consequence of administrative processes. This means that preventative measures must be initiated on a global level if you want to see changes in the level of burnout nurses experience. Here are a few ways administrators can help to minimize the number of nurses affected by burnout. Improving Communication Methods The concept of interoperability isn’t limited to the patient’s medical record. If you must access multiple platforms to gather information and then manually synthesize the data to make care decisions, this could be adding to your level of burnout. Another factor in communication involves having to search for policies and procedures, rather than having these types of resources in one central location. Think About Scheduling Whether you work 3-12 hour shifts or 5-8 hours shifts, nursing is challenging. Many nursing units have rigid scheduling policies that make it challenging to take a day off at the last minute for “mental health” needs or family events. You might also not get your schedule more than a week or so in advance, so scheduling life outside of work can be difficult. Facilities need to learn ways to adopt flexible scheduling policies so that nurses get the time off they need. This might mean hiring more staff, so that weekend rotations are decreased or using “prn” staff to fill in during times of high acuity. Some units use self-scheduling as a way to increase satisfaction with schedules Consider Nurse-to-Patient Ratios A 2018 study conducted at Marshall University concluded that nurse-to-patient ratios are directly related to nurse productivity and overall health, including mental, emotional, and psychological factors. Not only did the researchers find that the health of the nurse was in jeopardy during times of inadequate staffing, but they also suffered from job dissatisfaction. In California, nurse-to-patient ratios are mandated, but the rest of the country is left to the individual policies of healthcare facilities. More nurses are advocating for set staffing ratios and working with lawmakers to initiate legislation. However, this can take years for it to become the norm across the nation. Does the New Recognition from WHO Help? Do you feel that recognizing burnout out as a workplace phenomenon will help support issues such as staffing ratios, long hours, and job stress? Will employers finally look for new methods to fix the problems that plague nursing units? What do you think? Share your thoughts in the comments below.
  8. Have you ever seen a double-pan balance scale? It’s a scale that has two pans that are balanced against one another. As you put weights on one side, you must counter it with weight on the other to maintain balance. If you read about these scales, you will find that you must put weight on them in very small increments to maintain equilibrium. You must also take into account the weight of the container that you use to help balance the two sides. The idea of nurse work-life balance works the same. For everything you do at work, you need to offset it with something at home to keep balance. And if you take time for yourself at home, you would need to ramp up work to meet the weight of what you just did for yourself at home. This concept would keep work and home life equal in function, value, and amount. The more you think about this notion, the more you may consider that this is not a safe or healthy life for nurses. Maintaining a complete balance between work and home will likely lead to burnout, fatigue, and career unhappiness. Let’s take a look at the dangers of work-life balance in nursing. Work Doesn’t End When You Clock Out In today’s world of technological advancements, walking away from work is challenging. Even when you aren’t within the confines of the hospital or long-term care facility, you are probably connected. You may receive emails on your phone or text messages from coworkers letting you know that Mrs. Johnson took a turn for the worse. You might even carry a laptop home with you that seems to call your name each time you sit down to take some time for yourself. It’s easy to think, “I’ll just check on a few things. It will only take 10-15 minutes,” and before you know it, it’s been three hours and you are knee-deep in work that you shouldn’t be doing until tomorrow or the day after. This can further tip the scales of nurse work-life balance towards unbalance. Challenge of “Leaving Home at the Door” Have you ever had a supervisor tell you that you need to leave your home life and any problems at the door when you come to work? In theory, this is a good concept. However, it isn’t always practical. If you have an ill child, parent, partner, or another family member, you might have to answer questions or check in on them at work. And, sometimes life gets messy in ways that you just can’t “turn-off” because you are at work. Trying to block out home life when you’re working can tip the scales in a way that could lead to an unhealthy home life. Balance Can Be Dangerous Trying to keep balance in life could be dangerous. Think about it, your body is rarely in perfect balance. When you walk, you need a little imbalance to keep moving. When you are perfectly balanced, you are standing still, not moving forward or achieving any goals. The same could be true with the idea of work-life balance. If work and home are equal, you are likely not moving forward in either place. It’s important to allow the scale to shift from time to time. Maybe this month you are doing continuing education and a conference that requires work to be a little on the heavy side. But, next month you have plans to take a few days off and will be resting and having fun with friends and family. This is a healthy mix of imbalance that can help you move forward in both areas of your life. What Are a Few Strategies to Be a Healthy, Imbalanced Nurse? Call in When Needed Raise your hand if you’ve ever called in and felt extremely guilty about it. Okay, a sea of nurses' hands just went up! Nursing is a challenging career. If you or a loved one are sick, you may need to stay home. Heck, sometimes you just need to spend more time at home, even if no one is ill. You might need a “mental health” day or need to spend time with a child who is having a hard time at school. While it might feel that you are letting your coworkers down, it’s critical to remember that your sick days are “yours” and you get to use them as you see fit. Your employer provides these days to give you time to address family needs, so use them! Make Work Your Focus When you are at work, be present. We all need to check in on kids every now and then, but it’s essential to have a structure at home that can handle the nuances of life when you are at work. This means hiring a babysitter, putting a little more responsibility onto your partner on days you work or asking for help from family and friends. Plan Professional Development You became a nurse to help others. To do this, you have to invest in your continuous improvement and education. One of the best ways to do this is to join professional nursing organizations and get involved. Go to the annual conference and participate in education and self-improvement activities. Be sure to structure home life in a way that allows you to fully engage with your educational opportunities. Plan a Vacation Going on vacation might seem like a luxury that you can’t afford. However, it’s vitally important to give your family a good dose of imbalance at least once a year. Plan a trip or cruise and completely disconnect from work. Let coworkers know that you are off and need to not be contacted about work. This doesn’t mean your work-bestie can’t text you, it just means that they need to not tell you about the issues at work, but can check in to see how you and the family are doing. An imbalance is good. How do you keep a little imbalance in your life to stay healthy? Leave a comment below to get the conversation started.
  9. Destin293

    Burnout...what to do about it?

    Anyone here ever experience burnout? If so, what did you do about it? I have been a nurse for almost 5 years...which is really not long at all. But, I am heading closer and closer to burnout, if I’m not there already. I used to look forward to going to work...now I just get such a sick feeling in my stomach every time before I start my shift. I used to work med/surg before making the switch to ER. I just feel like new policies are constantly being passed which involve never ending “audits” of nurses. Everything we do from bedside report to blood administration is audited...it either involves someone physically standing there with a clipboard watching you do something and then checking off it you did it correct, or adding a bunch of different paperwork to fill out that gets placed in the managers mailbox for an additional audit. I would occasionally pick up on the floor and vitals now became a part of the RN’s responsibility, not the aides, because there was no help (VS are q4h). They started making nurses go to something called SNAP rounds which take 45 minutes...which comes after having to follow a huge checklist of (an audited!) bedside report that takes an hour. It’s also in the middle of med passes (that are at 8am, 10am, noon, 2pm, 4pm, 5pm, 6pm) that involve insulin...which, if it’s not given within 30 minutes, we’re audited and talked to! If we do blood administration and forget 1 VS (such as RR during 1 vital check, or are off on our time), we get audited and talked to. Add all this to patients becoming more demanding (and sicker!), census going higher, and wages staying lower, I just feel done...totally done. I have already cut back to 24 hours a week (my hospital started the Baylor program). I started counseling. I just don’t know what else to do...I feel like a giant bundle of nerves everyday, and I used to be so confident.
  10. Carol Ebert

    Is It Possible to Burnout in Retirement?

    And as I check in with others my age, I find several different paths that people take with their newly found free time. Take care of grandkids Travel Start hobbies Start a new business Go back to school for a new career Relax and hang out with friends Your path might be different because there really is not one path to take since the freedom you now have allows you to explore whatever you want. My path continues to be wellness because that is what I have always loved to do in my career and my passion has not stopped. What is different is that there is not a boss telling me what to do so I am free to do what I choose. And that is the reason I am writing about Burnout During Retirement. Can that be possible? I thought burnout was for those left behind who are over-worked, stressed-out, worn-down, exhausted and often depressed. As it turns out, when you aren’t answering to a schedule and the directives of an organization, you are still at risk for burnout. In my case, I blame it on my entrepreneurial nature which always directs me to seek more to explore, learn and do. And the result is that I find myself experiencing all the same symptoms of burnout that caused me to leave my last job in the first place. Here are some classic signs that employers report from their employees: Chronic physical and emotional exhaustion Sense of cynicism – everyone is bugging you, you don’t feel empathy for others Sense of ineffectiveness – you can’t see a path for yourself Lack of downtime – always “on” Lack of enthusiasm – can’t summon energy for what you used to be excited about Physical problems – headaches, stomach ache, bouts of cold and flu – especially if you don’t normally get sick Overreacting to requests I’m sure you are familiar with these or have even experienced some of these symptoms yourself. But if you are in your third act and happen to be an entrepreneur like me, you are still subject to this happening to you. I know that for a fact because I find myself overworking even more than I did as an employee because there is no schedule or corporate directive to tell me to stop and go home. I’m already home! So if you are entering the retirement zone, this is a cautionary tale – especially if you are an entrepreneur. But it is not hopeless. First step is to be aware that you might still burn yourself out if you have that busy nature as I do. So here are some excellent strategies to prevent this from happening. Tackle what frustrates you the most What stresses you out and leads to that headache? Pick it apart and see what you can change and what you can’t. Make the changes that you can and accept the changes you can’t. Surround yourself with inspiration Start and end your day with gratitude. Create a pleasant environment to work and play in. Listen, watch or participate in inspirational offerings Heed red flags Pay attention to the signs of burnout. Catch frustration early before your body starts to give you a symptom. (mine is a headache) Network with others your age who are entrepreneurs There is strength and support in numbers Find out what strategies they use to avoid burnout Do switch off Power down all your electronics before 8 pm to force downtime for yourself Create relaxing evenings before bed Get enough sleep We still need 7-8 hours/night Your body needs time to repair, restore, relax and during sleep is when that happens Talk things through Find someone you can talk to – friend, coach, therapist Find entrepreneur groups with your same interests who may be experiencing the same thing Take a break You may need to force this upon yourself because it is against our nature Keep a schedule and write it on your calendar Spend time with yourself Schedule time when you can purposefully do nothing Practice by working your way up from 5 minutes to finally about 30+ minutes. This inspired me. Hopefully, these strategies will be useful and provide you with a roadmap for creating a Third Act Retirement Plan that gives you the peace and wellness you desire while still honoring your busy nature. Your thoughts?
  11. Nurses have bad days just like everyone. 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. 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: 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!
  12. Nursing is an important and essential profession, and nurses serve as the backbone of the healthcare system. As such, various types of frequent large and complex demands are placed on this population on a continual basis. Challenges within the healthcare industry can create significant social (i.e., absence of fairness) and organizational (i.e., work overload) sources of chronic stress and burnout for the nurse. These sources have been found to be the largest contributors to nursing burnout. Sensory Processing Sensitivity Indeed, nursing is a stressful profession with high levels of burnout. Hence, researchers have been investigating other associations to stress and burnout as well. From an individual perspective, personality has also been found to play a partial role in the experience of stress and burnout. Dispositional variables such as the Five Factor Model (FFM; i.e., extraversion, openness, negative emotionality, etc.) personality types have been researched within the context of nursing to gain a deeper understanding of their impact on one’s chronic stress. The inclusion of those such as the FFM has helped this research along, but recent evidence suggests that the unique and innate personality trait of Sensory Processing Sensitivity (SPS) may also provide further insight into this issue. Having this trait increases one’s potential to be overwhelmed by certain aversive stimuli both internally and environmentally, thereby leading to emotional and behavioral difficulties. Examples of aversive stimuli might be negative social situations, rapidly changing or unpredictable environments, or certain or personally overwhelming noises, lights, smells, or odors. Thus, overwhelming or aversive stimulation can lead to increased stress, placing those with SPS at risk for occupational stress and burnout. This may be important to consider, given that it is estimated that approximately 20% of all people have the SPS trait. According to Gray, the three most common nursing stressors are workload, death and dying and inadequate preparation. Maslach’s three burnout dimensions are emotional exhaustion, depersonalization and personal accomplishment. SPS has yet to be expansively and exclusively studied within this particular context of nursing, or even nursing in general. The current research explored the most common nursing stressors as well as burnout levels in nurses that are considered highly sensitive by nature in comparison to their less sensitive peers. Distribution of Highly Sensitive People in Nursing: Stress Results 252 registered nurses and licensed practical and vocational nurses were recruited from Allnurses, Facebook, Reddit and a Southern Texas hospital. Results revealed that nurses with SPS were significantly more prone to stress and burnout after controlling for potential covariates and other significant personality factors. Upon hierarchical regression, after age, gender, years of nursing experience and the FFM types were controlled for, SPS was significant at p<.01 with 3.3% of the variance for overall nursing stress. Inadequate preparation (pertaining to the inability to deal effectively with patients and their families) was significantly predicted by SPS, with p<.01 with 5.8% accounting for the variance of nursing stress. Workload was also predicted by SPS, with p<.01 with 5.3% accounting for the variance in nursing stress. Negatively emotionality was the only FFM personality type that significantly predicted nursing stress, representing 5% of the variance at p<.01. Gender was a non-significant predictor for both stress and burnout. Negative emotionality was significant at p<.01 with 11% of the variance for stress. Burnout Results For burnout, SPS was significant at the p<.01 level with a variance of 9.2%. Emotional exhaustion was also significantly predicted by SPS, with p<.01 with 7.6% of the variance. The implications of these findings overall reveal that SPS is a unique construct which predicts stress and burnout separately and in addition to the commonly used FFM types. In general, this study shows that Highly Sensitive People (HSPs; those with the SPS trait) are more prone to increased stress and burnout as nurses, particularly emotional exhaustion. Due to this finding, people who happen to be highly sensitive in an already emotionally demanding profession such as nursing may also be able to better understand part of the reason for their current predicament with regards to chronic stress and burnout from emotional exhaustion. Knowing this should empower them to re-assess the level of stimulation that they can tolerate on a day-to-day as well as long-term basis. Implications In practical terms, this means that the HSP may have to figure out other ways to preserve their emotional energy during each shift, as most of it will be spent with people in general. For instance, the nurse may want to make an assessment of which people require the most expenditure of energy during interaction. The HSP could then better determine in a disciplined manner on appropriate time limits for spending with each person, including patients, and also how they choose to interact with those individuals or when they interact with them. In other terms of practicality, the HSP may also have to make an even more difficult decision on whether or not to stay in the current nursing setting or environment. HSPs take longer to recharge emotionally, and highly or chronically stressful work tends to bleed over into one’s personal life, affecting other areas of life not previously considered to be associated with a stressful work environment. Thus, for the HSP, it is highly important to be present in a work environment in which one does not feel constantly emotionally drained from. Lastly, the current study’s findings naturally implicate the organization. On this level, working to alleviate the most frequent and intense nursing stressors would be the most practical way to assist all nurses in addition to HSPs themselves. Conclusion In conclusion, a better understanding of the trait of SPS would most likely provide valuable contributions to many stressful and helping occupations. Since SPS exists in roughly 20% of the world’s population, the societal impact of this construct could be significant. Furthermore, the field of Psychology recognizes the importance of individual differences. As more of these differences are discovered, the increased complexity of the human condition will be more fully represented by studying traits such as SPS. To the Allnurses community: Thank you for all of your help with my thesis research. I sincerely could not have done it without you. I have as of recent successfully defended my thesis at the university I currently attend.
  13. Some background. I've been a Nurse for a little over a year. Work nights. Like many hospitals understaffed and overworked. 6:1 ratios with high acuity patients, sometimes no CNA's or CNA's have half of a high acuity floor, act like a step down ICU with some of the patients who are not appropriate for the floor, shorted in everything - the list goes on. You can push for resources as much as you want and get nothing. 10 nurses gone in about a 18 month period for the floor and counting. I'm sure many of you know how I feel. No matter how crazy the nights were I used to love my job. Used to. As I have grown in my practice and become more confident in speaking out my concerns for my patients, contacting and pushing educators and coordinators to voice my frustrations and try to spark a change - only to walk away feeling like a total fool. For a place that "promotes" and advocates for so many things, "promotes" highly encourage learning, "state" being open minded, "push" Nurses to make a difference and want changes to occur so that we all can advance and grow in an ever changing field - when the time comes to act, they refuse to live up to their mission and values and change. They have taken my questions and concerns with disdain. As a Nurse, every patient I deal with, is a human life in my hands. The patients I take care of each shift trust me to protect them, advocate for them, be knowledgeable about them, and over all value their individual lives regardless of how many patients or other people that need care are out there. I like being thorough. I believe I am doing a disservice to my patients if I do not get a whole picture from their chart (even if it is just very basic - it would be a dream to have enough time every day to delve into each patient) in order to serve them the best for that shift. I have begun raising concerns regarding my patient's safety being put at risk. Asking questions why things are done a certain way and trying to learn and also provide feedback as a floor Nurse. Those concerns are easily dismissed and in return we are docked on items that are solely intended to raise the hospital's status and finances. I get that is what hospitals have to do but if the employees can barely keep their heads above water - the patients are the ones who really suffer from hospital issues. All cares are affected. This hospital doesn't seem to understand that or care when concerns are brought up. Like many hospitals I am sure. It feels like they focus on the *** rather than what health care should really be about. I know this could open a whole can of worms and branch into other things but this whole post is really about one thing - Do I quit? I have had it. I feel cheated. Shorted. I have moral crises everyday. I fight with myself constantly after work when I go over how a shift went. The anxiety. The stress. The tears. Work thoughts always take over. No matter where I go, what I do - even my self care getaways. I am tired of being told that my passion for this job is a "new nurse (whatever they say)" and I am devastated. Today I felt that this place robbed me of my love for this job. Its weighing so heavily on me. I have never been at such a cross roads before. I sacrificed so much to become a Nurse but this place has me truly considering leaving the career completely and make me ask "what's the point". I could apply to another hospital but my work has made me feel there is no place in the health care world that isn't different than what things are like now. I am mentally exhausted. I can never refresh. Do I quit? Do I stay? If I stay, how do I survive? Would love to hear what people who have gone through this have felt, thought, and done.
  14. I'm an RN and am wondering if anyone would be willing to help me with my graduate thesis by taking my online survey. It is on stress and burnout in nursing, and I am researching some newer aspects of personality and cognition. I would really appreciate it! Everything will be kept anonymous and confidential. The survey takes about 15 minutes to complete, and you need to be a practicing RN, LVN or LPN within the U.S. The number of times allowed for survey participation is one. Thank you all for your help! I have included a more formal description of my study below, but if you would like to go ahead and take the survey, here is the link: https://angelo.az1.qualtrics.com/jfe/form/SV_3m9RwEJMiAcG5BX Highly Sensitive People To date, Highly Sensitive People (HSPs) have never been researched within the context of nursing stress and burnout, or even nursing in general. Although this is true, Sensory Processing Sensitivity (SPS), the temperamental trait that characterizes one as a Highly Sensitive Person, has only existed since 1997, and more widespread research on the construct did not begin until several years later. This refers to this particular construct, which is specifically defined within the literature. HSPs make up roughly 20% of any given population (Aron, 2012). This group can become more overwhelmed by internal and external stimuli, which stems from certain physiological processes within the brain. Examples of these stimuli are loud noises, too much social or emotional stimuli, or stimuli from the moods of others, strong smells, bright lights or new or changing situations (Aron & Aron, 1997; Acevedo et al., 2014). When overwhelmed, those with the trait of SPS can experience heightened levels of both stress and burnout at work. Stress in Nursing In addition, the nursing profession has been ranked by the US National Institute as one of the top 40 most stressful careers to have (Heim, 1991). Out of a study among physicians, pharmacists and nurses, Wolfgang (1988) found that nurses ranked the highest in stress levels by a significant degree. Also, research by the American Nurses Association (ANA) revealed that nurses ranked being overworked and the effects of stress as the most serious concerns in their profession, which has not changed in nearly a decade (Roberts & Grubb, 2013). Burnout in Nursing According to one study, burnout accounted for the largest explanation in mental health as well as physical health disparities of nurses (Maria, 2012). Cooper, Dewe & O'Driscoll (2001) describe burnout as the result of being exposed to stressful working circumstances for a protracted period of time, reflecting a state of both emotional and physical exhaustion. Burnout is divided into three dimensions: emotional exhaustion, depersonalization and low personal accomplishment (Renzi et al., 2012). Lastly, knowing that both HSPs and nurses are affected by stress and burnout, I believe this research is vital. Although different forms of sensitivity have been measured in the past in different ways, these previous tools did not measure what we know it today to represent, which includes a more defined set of criteria. We are still lacking insight into things that lead to stress and burnout (other than work-related causes) in some of our most vulnerable populations, such as nursing. Therefore, my goal with this research is to find more answers concerning the backbone of the healthcare industry: nurses! Thank you for reading! When my thesis has been completed, I will post the conclusions of the study for you all to see, most likely under the same title. If you are interested in my thesis research survey, here is the link again: http://angelo.az1.qualtrics.com/jfe/form/SV_3m9RwEJMiAcG5BX
  15. MistyDawnRN06

    Burnout

    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.
  16. bbear2102

    My Experience With Burnout

    For me it started four years ago. Like many nurses I was experiencing burn out. I had been a critical care nurse for six years in a large university medical center. In the beginning I started to feel a lot of anxiety when at work. I had the skill and the knowledge to do the job but over the years the emotional and physical stress had caught up to me. I preferred to work night shift and with that came the overwhelming responsibility of watching over the waves of new nurses that would all start on nights. There would be shifts when I would look around and realize that my options for resources that night were nurses with less than one year of experience. I would just hope that everything went smoothly. I started looking for jobs outside of the ICU environment. Every time I would think about leaving the job that I had loved for so long, I would think it's not time yet, I will know when I've had enough but not yet. So the emotional blows kept coming and I kept barely holding on because I knew that I was making a difference in the lives of my patients. To help with the burnout I started cross training in different areas. That helped for a little while as it changed things up for me. I would talk things over with my supervisor, who was also a great friend. She suggested going back to school. She knew that this was something that was always in the back of my mind and encouraged me to get started. Just as I was finishing up my school application the educator position for our ICU opened up. Instantly I knew I had to apply. I thought it was the perfect move for me. I thought for sure this would help me re-ignite my passion for critical care nursing. I got accepted into the Masters in Nursing Education program and got the educator position at the same time. I was so excited for both. School was a big adjustment and very stressful but I was really enjoying the new role as educator. I felt like I was making a difference again and impacting the new nurses as they went through their internships. This was merely just a band-aid for what was still looming below-burn out was still present, I was just distracted from it for a while. The demands of the job increased my fire and passion slowly decreased. I was working long hours and filling in on the unit when we were short. I felt like I was being pulled in a million directions. I wanted to make sure that the new nurses had the best chance for success, I wanted to give my patients the best care possible and I wanted my ICU to be the best in the hospital. Nurses on the unit were also showing signs of burnout and disengagement. Negativity was spreading like wildfire. It was really hard to keep trying to be positive when I was surrounded by negativity. Seasoned nurses were starting to leave, others were starting nurse practitioner programs, and some were transferring to different departments or hospitals to change their scenery. There were not many of us who thought we could sustain life as an ICU nurse for the rest of our careers. We found solace in talking to each other but that did not solve any of our problems, just let us know that we were not alone. The demands on the nurses were constantly growing yet the time to complete the growing amount of tasks was not. I would try to talk to family and they would try to help, but they just could not understand. They would try and remind me of the good that I was doing and the lives that I was positively affecting. My response would always be "but at what cost?" This job was killing me-emotionally, physically and spiritually. I now knew it was time to let go. At this point I had now been an ICU nurse for over 10 years. The thought of leaving the ICU broke my heart but I had to finally put myself first. I started looking for jobs but I really wasn't sure what I wanted to do. I was just about to finish my masters program so there were many options open to me. While I was searching for jobs and interviewing for various positions I attended the American Association of Critical Care Nurses National Teaching Institute. I went with a heavy heart knowing that I would not be an ICU nurse for much longer. I soaked in all the education that I could and enjoyed every moment. For the little time I had left I wanted to try and make a difference in my ICU. It took me a couple of months to find the right job but I did. I took a job as a nursing supervisor in an outpatient clinic. It was so hard to face the reality of leaving what was always my dream job but I knew I had to do it. I really enjoyed my new job. I started working out with a trainer, eating healthier, and since it was a Monday through Friday job I was finally on a normal sleep schedule. I still mourned the loss of my identity as an ICU nurse but it finally hit me that I did not miss the reality of what it is now to be an ICU nurse, but what it used to be. I could not ever get that back and that gave me comfort in my decision to leave. Looking towards the future I still have a passion for nursing and changing lives, I will just have to figure out a new way to do it. My dream to impact the nursing world is still very much with me. Jessica Strasen RN, BSN, MS
  17. I am a huge over-achiever and find this very difficult for me to let go of which leads to increased stress levels, no time for myself or family because I am constantly reading or researching nursing articles and doubting myself in my skills and competency. I know I am a good nurse but feel that I chose the wrong profession basically because of family pressure of the to good to be true stigma of nursing....I like home health, I mean it's OK at its best and less stressful than the hospital but definitely the pay sucks and gas at $4.00 a gallon with only .40$ per mileage! I was wondering if my nursing degree could actually be applied to something I may actually enjoy more..I originally wanted to be a social worker but changed degrees because my husband said that it was a dead end job and minimum wage at the best..which I came to find out was mostly true for our area. I feel at odds because I just want to make a decent living without having to deal with the Dr's crap like in a hospital setting. I am very smart but tend to be swayed by what other people want instead of what I want. BIG TIME PEOPLE PLEASER and equals more stress. I considered continuing my education in nursing to become a PA but the more I think about it I just don't think I want that kinda life either. I keep coming back to this same thing that pops in my head....a counselor/psychologist and yes I know they definitely don't make much money either but I think its a better fit possibly...any advice would be appreciated. Thanks!
  18. Bridgid Joseph

    Peer Support: How much do I really need it?

    Due to the burnout rates of our profession, and because administrators are starting to realize the impact of the everyday physical, emotional, and ethical issues that we deal with daily, some hospitals are trying different methods to support staff nurses' emotional health and well being. The good news is that the hard work that we do is noticed and being appreciated, and that administrators are trying to help and assist with some of the stress that we endure due to our jobs. I know that most people think, if we get more staff, that will decrease our stress, and maybe it would, but shy of reimbursement costs changing, and staffing ratios dramatically increasing, what are some things that your hospital can do to help support you? Some hospitals have created anonymous peer support systems, which staff have reported finding really helpful and decreasing stress. So how does it work? Staff that are looked at as leaders, professionals, and generally well-liked and considered approachable, are tapped by their managers, Clinical Nurse Specialists, etc. to be asked if they would like to volunteer as part of the Peer Support Network. If they agree to this position, they get training on how to support and speak with other staff that have been in stressful situations, similar to laymen who volunteer on various support hotlines who do not have psych backgrounds, however are trained to empathize with others and lend support, and offer outlets for frustrations within the hospital system, if needed. If the peers coming for support have bigger issues than the peer supporter feels that they can handle themselves, they can consult the Employee Assistance Program to allow for a fully trained MD/RN/Social Worker to offer more intensive anonymous support. The Peer Support Networks are created to support staff who have worked a really difficult shift and need to debrief/unload, but instead of speaking to a friend or family member who might not understand the intricacies of hospital life, speak to a colleague who can understand. Someone who understands losing a patient that you've been taking care of for the past few months, they were ready to go home, but coded instead. Someone who understands that you had a patient whose family could not have been more difficult to deal with due to disagreements about care and disrespect to the nursing staff. Someone who understands working with a staff of varying personalities, yet you all depend on each other to get through a shift, and it seems like family at times....and families can have some serious disagreements, especially in stressful situations. The Peer Supporters are staff that are willing to volunteer to speak with another staff member who needs to talk on a break, after a shift, or via email, and they know that the conversations will go no further (unless there are concerns about mental disease, plans to hurt self, others, etc.) but the guidelines of the program are outlined and reiterated when staff first contact a Peer Supporter. Essentially, it allows you a friend (an ally) that can be from any area of the hospital, not even your unit, that you can speak to, and who will offer advice if you want it, and just listen to you, if that is all you need. When I first heard of programs such as this, I thought it was a good idea, but wondered if many staff would utilize the program? Sure enough, the support is there and being used. Not only are the staff that go for support reporting an increase in job satisfaction because they feel more supported, but the Peer Supporters actually have reported feeling good about what they are doing for their peers. I also wasn't sure that a lot of staff would agree to becoming a Peer Supporter; I knew that some would, and obviously as nurses we are all healers, but we've been healing all shift and we all need a break right? But there seem to be many volunteers in these programs, with minimal drop-outs. It's actually a pretty simple premise, that is easily implemented and recreated, and despite some possible extra pay for Peer Supporters that may stay after a shift to converse with colleagues needing help, this program is pretty cost neutral for hospitals to run, and the staff that utilize the programs seem to feel that they are useful and help to decrease their stress. Would you utilize a Peer Support Network to help you deal with stressful situations at work? Do you think this would be a helpful program at your hospital? It's surprising how some simple ideas can help to decrease staff stress and improve morale in the workplace, and it's nice to see that some hospitals are truly trying to help their staff deal with everyday stressors.
  19. We all know nurses who exhibit signs of burnout. Everyone will have different reasons for their behaviour, and moral distress is often on the list. What does burnout look like? It has many faces, and no two individuals will have the same signs and symptoms. Often the most obvious is apathy, the loss of that attitude of caring about what goes on around them. They take shortcuts in providing care; they omit some of the basic nursing care activities we take for granted: mouth care, skin care, turns, dressing changes and the like. They ignore alarms at any other bedside and pretend to be busy when others around them could use a hand. They withdraw from the social activity on the unit, no longer chatting easily in the break room. They do their work and go home without interacting on any but the most superficial level with their peers. This withdrawal will eventually extend to their patients and if the underlying issues remain unresolved, to their families and friends as well. Apathy typically has its roots in frustration. When a nurse does the best s/he can to provide professional, competent, ethical care but finds those efforts continually unappreciated or thwarted by circumstances outside the nurse's control, there is a tendency toward irritation, dissatisfaction and unfulfillment. Repetitive feelings of having failed in some sense leads to attempts to change the environment, which if unsuccessful, adds frustration. Outward expressions of frustration may include short-temperedness, sarcasm, refusal to help others, refusal to engage in expected activities and insubordination. Another offspring of frustration is cynicism. Patterns of behaviour and predictable outcomes discerned on a unit create a sense of distrust and bitterness that evolves into pessimism. The expectation of failure in effecting the desired outcome may cause some people to simply go through the motions. It may not be spoken aloud but the nurse may be thinking, "Why are we doing this? It's not going to work and the kid is going to die anyway. When was the last time someone in this condition actually got better? What's the point?" This emotional disconnect cannot fail to affect care and the nurse's interaction with the patient, their family and coworkers. Couple this with an unsympathetic administration and the problem is magnified. Being told, "This is your job. This is what you signed up for. It's not your place to make decisions here, you're expected to carry out orders. Now get on with it," isn't helpful. (What does the nurse hear? "Suck it up, Buttercup!") It suggests that the individual is the only one on the unit with these feelings. Other frustration-related burnout behaviours may include control issues - inflexibility, rigid thinking, having to be "right" all the time... and bullying. Some facets of burnout that might not be recognised as such are depersonalisation and negative self-image. Depersonalisation has been described as feeling as though one is watching oneself from a distance, having no control over a situation. There are sensations of unreality, being in a dream state, divorced from one's emotions. Moral distress can lead to this state becoming a defense mechanism. Negative self-image may be an off-shoot of depersonalisation, when the individual is disturbed or disappointed by their own behaviour in situations they once felt in control of. Over time these emotional reactions may become self-perpetuating. A major component of burnout is compassion fatigue: a gradual emotional and physical exhaustion people in helping professions develop over time. It may be exacerbated by heavy work loads, absense of proper referral resources, witnessing pain and suffering in others daily without being able to help and other factors. It mimics depression, causing sufferers to feel hopeless, loss of experiencing pleasure in everyday life, stress, anxiety and negative attitude. Confusion, guilt, fear and grief are all associated emotions. Crying at inappropriate times can be most distressing to the individual, who may not even know why they're crying. At its worst, compassion fatigue can lead to abuse of the very people in need of help. This is obviously not where we expected to end up when we chose nursing as a career. Interestingly, critical care nurses are much more likely to have advanced directives in place than the average person. Participation in resuscitating people for prolonged periods with poor outcomes isn't exactly an attractive proposition when you're the one being resuscitated. They are also far LESS likely to be willing to donate blood or organs. The reason behind these statistics is that critical care nurses see what happens to these altruistic gifts.... blood banks being depleted for a trauma victim who never stood a chance of survival, organs being placed into patients whose comorbidities will result in failure of the transplant or failure of other organs with death ensuing in the short-to-intermediate term. Moral distress influences their thinking, their belief that their donation would ultimately be wasted. Sleep disorders are yet another side-effect of moral distress. They may walk hand-in-hand with depersonalisation; as the sufferer is lying in bed awaiting sleep, they relive their last shift at work and analyse their performance. They may obsess over some small detail or place inaccurate perceptions on interactions with others. They may fall asleep easily, only to awake several times and re-experience the filmstrip of their shift over and over, a sort of PICU Ground Hog Day. They may sleep for part of their time in bed but awaken much earlier than desired, worrying over what may happen during their impending shift. They may have dreams about work or nightmares about situations they've experienced at work. Alternatively, they may sleep excessively (although I don't know anyone with this complaint). Sleep deprivation only makes it all so much more difficult to manage. Physical effects may also manifest, although often not associated temporally with morally-distressing situations but cumulatively. Migraines, gastrointestinal disorders, weight gain or loss, musculoskeletal injuries, increased susceptibility to illness, memory loss and exhaustion are just a few symptoms. You might wonder how musculoskeletal injuries are associated with moral distress. When the combined effects of apathy, frustration, depersonalisation and cynicism collide with short-staffing, lack of equipment and other workplace circumstances, the sufferer will be less likely to be thinking about protecting their back and more likely to just want to get the job done. So lifts, turns, transfers and other physically taxing activities may be undertaken without due consideration for accessing adequate assistance and proper body mechanics. And so another layer is added to the burden experienced by the indvidual. Addictive behaviours may arise. Besides addictions to alcohol and mind-altering substances, food, sex, shopping, gambling or the Internet could become problematic. None is any less serious than the others; they all have the potential to damage a person's life and those of their loved ones. Interpersonal relationships are the usual casualties of addictions. Becoming further isolated from the "normal" world makes the sufferer of moral distress who follows this road even less likely to overcome it. The issue of boundary violations is typically downplayed in most cases. However, for nurses this represents a serious breach of their professional responsibilities. Nurses are expected to maintain a professional distance from their patients and patients' families. It is inappropriate to invite a patient's mother into one's home for a meal, to arrange for a spa day or to take a father to a baseball game. It's also not okay to buy birthday gifts for siblings, to buy toys or clothing for a patient or to lend them money. Professional compassion does not extend that far. Neither is it permissible for a nurse to accept personal gifts from families, borrow money, seek employment from or become romantically or physically involved with either patients or their family members. But when strong emotions are involved in combination with day-to-day proximity, it's not hard to lose sight of these boundaries. Yet another manifestation of moral distress is the crisis of faith. Most of us partake of some form of spiritual belief, whether formally or informally. No matter what we call our higher power - our God, none of us can conceive of a world where our God would allow suffering and loss of the magnitude we observe everyday. Our patients and their families pray for miracles that our experience tells us will be long in coming, if they come at all. Then we begin questioning our own faith... losing our religion. Once this stage is reached, bouncing back is more difficult than ever. All of these effects lead to one destination: moral residue. Even if a nurse is able to move from one distressing situation to the next seemingly unscathed, underneath the surface moral residue is growing. Webster and Baylis (2004) from the University of Victoria defined it thus: "that which we carry 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." Moral residue isn't an obvious, in-your-face thing; its' insidious creeping tendrils influence our behaviour and interactions often without us even realising it. It becomes a giant positive feedback loop. The more a person sublimates their distress, the more distress they will experience until eventually they implode under the weight of it. The effects of moral distress reach far beyond the individual. A 2007 study at the University of Pennsylvania revealed that 25% of nurses surveyed said that moral distress made them want to leave their jobs. These results were expanded upon by a study reported in the Journal of Advanced Nursing (2008) in which 15% of subjects HAD left their jobs as a result of moral distress. High turnover is very disruptive to quality care and the price goes far beyond the financial. Replacing an ICU nurse is reported to cost $145,000 in direct and indirect costs. Staff satisfaction and the impact on patient care are far harder to quantify. In 2006-7, Wendy Austin, RN, MScN, PhD from the Faculty of Nursing, University of Alberta collaborated with Franco Carnevale, RN, MScN, PhD Faculty of Nursing, McGill University, Arthur Frank, MA, PhD, Department of Sociology, University of Calgary and Daniel Garros, MD, FRCCP, PICU, Stollery Children's Hospital to study moral distress in pediatric intensive care. The study was a qualitative, narrative-based inquiry with participants from three teaching hospitals in two Canadian provinces, from which a number of themes were distilled. I'm unable to make the story one I can live with: "We did this to him." (RN) "I am uncomfortable with the idea of playing God." (Intensivist) This is a contest of plights: "The case was discussed in ethics rounds. I did attend but did not bring up the feeding issue because it seemed like a small issue compared to the kind of 'whether we should withdraw or not' issue. (Dietician) What do you mean, "STOP"??: "Faced with the question, "Could we stop it today?" their answer was "Not on my shift." (RN) We're not of one mind: "I don't mesh with the team usually on quality of life, or death, issues. It's discouraging to the point where sometimes I wonder if I can continue to work with a team that has such a disparate view."(Intensivist) PICU is a NO ANGER zone: "I don't get to express how I'm feeling as much as I would like. I save that for home, or when I'm with other social workers." (Social worker) The unrelenting pressures created by moral distress in this environment creates ripples that extend far beyond the PICU doors. How good are you at picking out those factors from a situation that may expose the PICU staff to moral distress? In Part III we'll find out.
  20. A few months ago, I wrote an article that basically expressed my shock at the first weeks on my first nursing job. (It's called "Raw: two months after graduation, one month after employment", if you are curious.) I wanted to share how life has been since then. I've been on the job for about 5 months now. My orientation ended about two months ago, and I'm honestly so glad for it. It's not that I don't feel like I have a lot to learn - definitely I have way more to gain before I feel confident. After having two back to back preceptors who were terrible leaders and teachers, it was a huge sigh of relief to be cut loose from them. I still struggle with the second one I had. She is terrible at communication, did her best to make me feel as small as possible, and regularly enjoyed the unit gossip and drama. She hovered. Not during patient care (at those times, she was usually unable to be found, and if I did find her, she would remind me that I need to learn how to do things by myself), but when I'd talk to other people. It didn't matter if it was patient care related or not. She literally forbade me from speaking to other people. It's was awkward at best, infuriating and distracting at worst. So if you ask me if felt I was ready to get off orientation when I did, yes, I was, but not for the reasons I should have been. So what's changed since then? Well, a lot, really, but not everything. I still feel the shock of the first year. You know - the one that probably led to this "First Year" forum being created in the first place. But I am better at what I do. I'm not quite as slow as molasses anymore. That's been a huge victory for me, actually. While I haven't been successful yet at real-time charting for assessments, I've been getting closer to it. Getting in assessments and notes before 2200 meds has been a massive win for Team Newbie Ixchel. I'll be honest - I won't get in my whole patient group, usually, but getting in most? Total victory. I can get through a shift. The whole thing. I'm not falling all over myself. And I've been reaching a point where I can often give report without reading like a zombie off my report sheet. The other day, I gave a bedside report with a complex patient and hovering Grandma in the room (no notes!), and I nailed every last bit of it. On top of that, I impressed Grandma because she knew I listened to her, and she demanded she get me back my next shift because she knew I paid attention to detail. Made me feel like a rock star! So what's still making me feel raw? A few things really. I'm still feeling the sting of the reality of nursing being harder than the expectation of nursing. I'm still pretty angry about that, actually, and the more time I have to think about it, the worse it gets. Four years of education almost scratched the surface. At first, I would think about this and say to myself, "it's not like nursing programs could really do anything any differently." Actually, yes they could. It is ridiculous to pretend clinicals actually give a student an impression of what nursing is. It is nuts to me that assigning massive volumes of studying and careplanning simultaneously is supposed to introduce us to time management skills necessary for success in real world nursing. How about instead of stressing students out by over extending them, give them time to focus on one type of thing at a time. I wish I had had the ability to focus on the theory content more without being distracted by careplanning. How about sticking theory up front, and clinicals in the end, so that we can actually build a more solid foundation? And stop pretending that nursing is filled with unicorns and glitter! Do you know how much I wish I could sit and hold the hand of every nervous patient and soothe their fears? I hate that I can't! Nursing school convinces us that that gets to be part of the job description regularly, for as much time as we want. So we are left feeling short when we find ourselves unable to do that. Clinicals are perhaps a good experience in making students less afraid of patients, and on rare occasion a new skill might be learned, but they generally set up the expectation that those days are actually what nursing is. Seriously, wouldn't it be fun to have one patient and just do total care for that one patient? OMG. lol Imagine it! Any student reading this, mark my words - you are being lied to in school, and you are being distracted in ways that are supposed to be teaching you time management, but the time management skills you are learning now have nothing to do with the time management skills you will need. Instead, they are distracting your attention away from the things you will later wish you did most, like read your textbooks. Man, I wish I read my textbooks. I still can, of course, but between kids and work, it hasn't been possible yet. Don't ditch your textbooks, friends. Maybe you'll find better time than I have. Another thing that has me raw is staffing. Okay, yes, you can google and find this crap anywhere, but lets face it - staffing is ridiculous. I was told my floor would be 4:1, and yet, I'd say half my shifts are 5:1, and charge nurses seem to have decided the time for gentle patient assignments for Newbie Ixchel is over. I get it - they need to be fair to the other nurses and not dump a harder load on them just to ease mine. But I'll honestly admit I've had a few shifts that have completely plowed me over with patient complexity. Only one of those has left me genuinely afraid that I couldn't handle the condition of a couple of my patients. But then I've had others where the night charge nurse recognized my group should be broken up because it was just too heavy, but then the day charge nurse would say, "Oh, hey, ixchel had those 4 or 5 last night, lets give them back to her even though she'll be in each room for so long there is no way she'll get a single thing done on time, let alone clock out within an hour of when her shift should end." (Okay, not literally, but good grief.) And on nights, we seem to be chronically under staffed. No one will take overtime to cover shortages. We've had giant staff changes, especially on my unit. The way they did the schedule had to change, but they realized that 6 weeks after it should have happened. So there are many shifts short by one nurse. Hence, the ongoing 5:1 issue that might end mid December. Might. So basically? I'm tired. Always tired. I'm disconnected from my kids and hubs because I am at work. Which, honestly, I signed up for this so I'll move past that. But it feels terrible because if I were happier leaving work, I wouldn't mind being so tired and rundown outside of work. Night shift suits me so very well. I do see my family more than I did on days. The easier shifts with higher pay can't be scoffed at either. I really thought I would hate nights. But, I don't. I just wish I were happier leaving them. It's not all bad, thankfully. I feel the most pride when I'm pushed the hardest and I succeed. I had one night in particular (the one I mentioned I was genuinely afraid during), where I totally nailed it. It was a night with two patients on their way to crashing, while I did all the normal routine with 3 other patients. And I got every last detail right. It was success. It was a win. Maybe a small victory, but mine. What I want is to not be new anymore. I want to get past this part. But I need this part to get past this part. So I'm pushing forward. It's demanding more of me, and as much as this makes me a masochist, I like that. Without that, I wouldn't feel satisfied. My favorite thing I've learned? Nurses are the hospital. Before I worked in one, I thought doctors were the hospital. Now, I know and it fills me with pride. The observation of the nurse as it is reported can be the difference between a good outcome and a bad one. A nurse trusting their instincts can be the difference between life and death. I had the most amazing opportunity to witness this in action. Our hospitalists aren't used to suddenly crashing patients. When a patient has a steady and predictable decline, they get shipped off to the ICU for the intensivist. But a suddenly crashing patient doesn't happen often away from the ED MD or ICU, so when there is a crash in the middle of the night, it can be scary. I watched a nurse take charge of a situation, snap a doctor into action mode (this poor MD was a deer in the headlights), and she stayed strong in her advocacy for the patient in the face of the RT and the ICU charge nurse trying to talk her down. It certainly didn't help the patient to have them arguing, of course, but she stood her ground and the patient didn't die that night because of it. If the nurse yielded to RT and didn't get the MD to act, that would have had a very different ending. Night shift is amazingly empowering because you see more directly the individual impact you have when the additional staffing isn't available and there is only one MD on. Our role is amazing. I haven't really said any single thing that hasn't been made the subject lines of so many threads in this place. I haven't said anything new. Goodness knows I've read all of this time and time again, but reading it certainly hasn't given the reality any amount of justice because I really felt like I was some kind of special snowflake. And eleventy dozen nursing students might stumble onto this post and say to themselves, "wow, nursing is my destiny and I'll never let it get me down!" The higher you think you are, my friends, the further you have to fall. Stay humble, and know that this is hard. I'm pretty sure it gets a lot better, but it's hard. So now I sit here and look at my calendar. I see this month I have very, very few days off due to staff meetings and education things. I'm so worn out. I'm tired, desperately. I'm frustrated that this isn't easier. (Yeah, I just admitted that.) I do still have days when I remember that retail management or bartending is still an option. I've never in my life worked so hard. But you know what? I'm sticking it out. And I'm going to be amazing.
  21. Overworked! Always overworked no matter where I have worked but sometimes I think we don't actually acknowledge or identify when we are not! I find that being bored is hard work too. LOL! Underpaid Well I don't really think I am underpaid but would never say no to a few dollars more. Exhausted Yes in 22 years I have often been tired in fact I think I am exhausted for half of those 22years. Bored Yep believe it or not even when busy busy busy I have been bored with the routine of some parts of nursing. Fed Up Yep get fed up with the lies. Disgusted Yep with peoples attitudes sometimes I think people forget that they actually have to work as a nurse and they don't do it for free. On the plus side I love my job and wouldn't consider doing anything else. I love the drama of it all. My co-workers have over the years had multiple personalities, moans and complaints but how we have laughed often and hard. How we have cried together and supported each other. Over the years I have considered myself to be blessed with the majority of my co-workers. Patients I have looked after every different kind of person, personality, race, religion, sexual orientation, color ever imaginable-I have learned about food from all over the world from the patients I have learnt about their culture, about how to handle delicate situations, extra marital affairs, I have learnt about discrimination positive and negative. I have learnt not to say sorry when I didn't finish a task, and that is one of the hardest things to not say in nursing. I have sat with dying pts and their relatives, I have laughed and cried with them. Brave patients who have taught me the meaning of life and how to respect it. When I am feeling depressed I can think of a 100 patients who would have loved the opportunity to reach my age and be alive. I have seen human beings suffer so much pain, discomfort and agonizing treatments that I vow to refuse them if it happens to me! I have learned the meaning of respect Respect for my fellow human being Respect for the bravery of others Respect of peoples privacy Respect for life Respect for nature Respect for freedom Respect for spiritual beliefs and the miracles I have often witnessed I honestly believe as a nursing community we have more to celebrate than bemoan. If you are "burnt" out I am sorry It must be horrible for you, years ago it was easy to switch from job to job if you didn't like the one you were in, nowadays there are so few jobs and so little movement once you have found a job, you have to stay put! Hopefully in the near future things will ease up again where you can try out a few different specialties until you find your 'niche'.
  22. ElizabethScala1

    5 Tips to Halt Nurse Burnout in Its Tracks

    As nurses, we know that nurse burnout pervades the profession. Insufficient staffing, long work hours, phone calls to come in to work on your days off, and a growing nursing shortage all contribute to nurse burnout. Sounds ominus, doesn't it? So given the cards that are stacked against nurses, is it inevitable for every nurse to suffer from nurse burnout in their career? Below are some tips and tricks to halt nurse burnout in its tracks before it gets a firm hold on you! Stop with the Brave Face and Admit There is Something Wrong When nurses are on the job, we put others' needs before our own; frequently not even stopping to go to the bathroom. But when we constantly push down our needs for a break or won't admit to ourselves (or others) that we're overworked and overstressed, we're setting ourselves up for failure. Nurses in direct patient care face tough jobs at the bedside. Stretched thin through insufficient staffing, nurse-to-patient ratios that are unsafe, patients with so many co-morbidities that it's impossible to address them all -- nurses' stress levels don't just put nurses' mental and physical health at risk, they also put the patient at risk. The most effective way to deal with burnout before it becomes a problem is to talk to someone. The department manager or nurse supervisor is the first stop. Yes, they have heard complaints about nurse staffing before, but management can't help a nurse suffering from burnout unless it's known to them. Every facility handles nurse burnout differently, and some, unfortunately still have no programs in place to help alleviate the burnout problem. The first step in addressing the problem, in any case, is to speak up. Second Line of Defense: Relationships with Coworkers In the event that a facility lacks a program, plan, or resources to alleviate nurse burnout, the relationships that nurses have with their co-workers can often relieve some of the more detrimental effects of nurse burnout. A nurse friend of mine never dreamed she'd ever been a person that fished (yes, I mean with a fishing pole and a tackle box), but after learning that so many of her coworkers got together on off days to go fishing and raved about how much of a stress reliever it was, she decided to give it a try. She said that dark cloud she felt constantly hanging over her head at work was suddenly not so dark after all. All the normal work stressors were still there, short staffing, sicker patients, but she didn't feel they weighed so heavily on her because she felt closer to her co-workers. She felt there were people who had her back. Engage in mindfulness and take a pause When work and life in general becomes too stressful and nurses know they are burned out, it is time to take a pause and look at the big picture. Quiet time -- when there is no "mind" noise from technology, family, patients, but just time to breathe in and out and be quiet -- creates a space to be able to see problems, possible solutions and even long-held desires for the nursing career you'd dreamed of having. It may take some practice to see what you wanted when you began your nursing career and what you need to do in order to get it back on track. Approach the situation looking for possibilities. The path to get to the goal(s) may be reveal itself in time, or you may know immediately the steps to take to get there. Let go of what no longer serves If you've been a night shift nurse your entire career and now you need to transfer to the day shift, ask to be switched. If you've had your fill of your nursing specialty and think a change may refresh you, check the job board at your facility. If your normal stress relieving activities are no longer working, try new tactics. Even simply taking up a new hobby or sport can refresh your mind and stop the overwhelm from overtaking you. In the same vein, if you haven't had made time to engage in your favorite hobbies or activities, schedule them on your calendar like an appointment. And then, keep the appointment. You'd do it if it were a doctor appointment or one with your child's school, right? Give appointments with yourself the same respect and reverence. Watch ants I don't mean that you have to literally watch ants, just observe nature. Whether it's watching ants build an anthill -- something you may have done as a child -- or a spider build a web, or simply noticing the different shapes clouds make. When you're observing this amazing planet, it's tough to think about all the stressors at work. Taking a few minutes or hours in nature helps us slow down the world a bit and take a look around. I'll bet there may be a few places that you used to go and enjoy spending time in that you haven't seen for a while. Could you schedule a date on your calendar to revisit one? Take a friend or loved one who has never been there and make a new memory. Sometimes in all the stress swirling around us, we forget to notice some things that have been missing for a while. Reconnecting with nature or a favorite place helps us fortify ourselves against burnout and as stated above, helps stop it in its tracks. OK, so what did we miss? If you were talking to a nurse who was looking for answers on how to deal with stress what would you tell them? What are some other ways to cope with and shift nurse burnout?
  23. VivaLasViejas

    Ten Ways To Know You're Burning Out

    Here's something a little different from the writer who usually brings you the funny top-10 lists. Recently, a good friend of mine I'll call "Viv"---an LPN who's worked at the same LTC for eight-and-a-half years---suddenly up and quit her job. Without notice. Just went to work one morning, told the DNS, "I'm done", handed in a hastily scribbled resignation letter, and shook the dust of the place from her feet. Not surprisingly, Viv is having trouble finding a new job, even though she's one of the best nurses I know and would hire in a New York minute if I had a position for an LPN. Quitting a nursing job without notice, especially in this economy, is a cardinal sin for which I fear she may pay a terrible price. Yet she is oddly calm about the entire episode, because, as she says, "there are worse things than being unemployed.....like going on the way I was." Now our group of friends are left to wonder what drove such a wonderful nurse to such a desperate act. Even Viv herself doesn't fully understand what happened; all she knows is that the stresses and strains incurred on the job quietly piled on top of each other for years, until critical mass was reached and she couldn't take it anymore. Now, she's just a statistic---another victim of nursing burnout. Most of us have been there. I know I have.......more than once. So how do nurses learn to recognize the signs that we're getting a little crispy around the edges and take measures to combat burnout, rather than wait until we're completely fried and then commit career hara-kiri? Here are a few clues I wish Viv had listened to before flaming out in such spectacular fashion: Ten Ways To Know You're Burning Out 1) Take inventory of the shifts you've worked over a period of at least 4 weeks. If the bad days outnumber the good ones, it may be time to look at changing positions. Life is too short for sucky jobs; to avoid burnout, you have to take action when the suckage overrides the benefits of staying put. 2) Do a gut-check. Are you mostly satisfied with what you do at work, or do you dread going in every day? Again, if you're having two or three bad shifts every week, you are probably not enjoying life even OUTSIDE of work and it's time to consider other options. 3) Ask your family and/or friends if you seem more on edge than usual. They're almost always the first to feel it when a nurse is in the early stages of burnout......oftentimes, before we're aware that we're getting frazzled. 4) Note your overall mood and energy levels. Sometimes, what we think of clinically as 'depression' strikes us when we're starting to brown around the edges: we start feeling anxious, sad or blue; we may sleep or eat excessively (or not sleep/eat enough), and so on. Other times, it may simply be a free-floating unease that we can't put a finger on.....we only sense that something isn't quite right. 5) If you spend a lot of your waking time daydreaming about winning the lottery or counting the years/days/minutes till retirement.....you may be approaching burnout. 6) If you constantly think about the job, talk about the job, have nightmares about the job......you're probably already there. 7) How's your overall health? Is your blood pressure creeping up? Have your diet and exercise habits changed? Are you still enjoying all of your normal off-duty activities, or do you find yourself saying "I'm too tired" and begging off whenever you're invited to go out with friends or family? When was the last time you read a good book........went to church........saw a movie........knitted a sweater........played a game with your kids? 9) If you have vacation time saved up (and what nurse with symptoms of burnout doesn't?), take a week or two and see how you feel after you've unwound for a few days. Imagine walking back in to your workplace; does the thought inspire a reaction like "Yes, I'll be ready to go back to work," or "OMG---if I never went back it'd still be a day too soon"? If it's the latter, you may want to consider using the last few days of your vacation to look for another job. 10) If, when you ask yourself whether you can imagine doing this for the rest of your life---or even for the next twelve months---and the answer is "Oh, HELL no".....you are burnt to a crisp and had better call for help before you get hosed. Believe me, if you're burned out, your supervisors have noticed it, and there are too many hungry new grads and older, experienced nurses out there who need work......so do whatever you have to in order to quell the flames and refresh yourself. Your career, your emotional well-being, and even your health may depend on it. Learn more about nursing burn out ten-ways-to-know-youre-burning-out.pdf
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