treading water: burnout and compassion fatigue

Ruby Vee, BSN · Mar 23, 2014

I think a lot of your story is in the last paragraph. Your husband got hit by a car, and he's not in the work force right now. You've had the weight of being the sole breadwinner on your shoulders PLUS picking up the slack at home doing jobs your husband would ordinarily do. AND you've had to take care of him as well. That is all an incredible burden, and it's small wonder you're burning out and experiencing symptoms of depression.

Ordinarily I would advise you to seek counseling, but since you already have and it doesn't seem to be helping, I'm at a loss. Have you discussed the depth of your depression with your counselor, or are you trying to keep a pretty face on it? (I ask because I've always been one who strives to keep a pretty face on it, even when I'm drowning. I realize that counseling can't help unless you share the nitty gritty, but somehow, that never comes out until I've seen the counselor several times.)

Pure burnout is easier to treat. Sometimes all you need to do is switch shifts for awhile. Or, if you're rotating, pick one. Even if it's the night shift. Change shifts, change jobs, change specialties, change hospitals . . . any one of those will cure burnout. My last case of burnout was cured by a 3000 mile move, but you don't have to go that far.

Self care is good advice, too. Even if you don't WANT to go to the gym, go anyway. If you don't WANT to see friends, see them anyway. Going through the motions does help. And please take some time for yourself away from your husband so you can vent to friends about the strain it's been having him off work and needy while you're trying to cope with everything. It helps.

Big hugs! I hope it all gets better!

vintagemother, BSN, CNA, LVN, RN · Mar 23, 2014

I agree with what RubyVee said about your carrying a lot of stressors. Between your husband being ill and your concern for him, your being a sole bread winner and the demands of a high stress job, it is reasonable that you now feel constant anxiety and / or depression.

I responded to your post because I've been in a similar situation. I worked in a job where I took care of others and as time went by, I truly felt the "system" and the responsible parties for my clients were showing such disregard for my clients well-being that my efforts were futile. So I worked harder and got better at providing for the needs of my clients. I became burned out VERY badly. My health was affected. I quit, with the same righteous indignation you spoke of, that I promised is quit before I became apathetic toward those I'm supposed to care for.

I'm wondering what age bracket your in....I'm an "old soul" so I'm in my mid thirties having lived what I feel are the life experiences of a person a decade or more older. Aging has shown me I'm not superwoman and even I have a breaking point. I am learning to listen to put my needs first and *it is so hard!!!!* Putting my needs before my jobs demands or kids demands makes me feel so guilty but I became so crippled with anxiety and depression that I now literally know I can not be all things to all people and you know what else? I don't want to!!

I think you should see a better/ different counselor. They are not all effective. I had many over the years from age 18-29 who said I was basically fine. At 32 my symptoms worsened due to work/money/divorce stress and I was diagnosed with a disorder they should have recognized when I was much younger. A good counselor (LMFT or Psychiatrist) will help you develop an action plan on how to fix your issues as well as give you pharmacologic therapy as needed.

I'm most concerned with the fact that you said you went from having anxiety to feeling numb. This is not good. It's a coping mechanism but one that's not good for you! (((Hugs)))

sadiemae1123 · Mar 23, 2014

If your therapist hasn't recommended medication or if you are on medication and still having such severe symptoms then you should definitely make that the focus of your next session - which should happen ASAP. Making an action plan of how to deal with your symptoms on a daily basis should also be a high priority in the session.

I know you said you've used all your sick time but if you still have FMLA available then you should use that. It doesn't have to be taken out in one big chunk of time. You could use it for 1 day a week as long as the paperwork is in order.

You should also look into jobs that don't involve direct patient care such as QI or working in a skills lab at a nursing school. This could help relieve some of the stress until you get back on your feet.

Bets of luck to you and keep us updated please. Many hugs.

tokmom, BSN, RN · Mar 23, 2014

(((hugs))). Yep, been there and have come full circle back into the profession after taking a 5 year hiatus from the profession, I didn't think I could ever hate. I only went back into nursing because my husband became ill and I had no choice. I had a home and kids to support and I could make enough money to keep our same standard of living. When I found out I had to go back, I cried every single day while looking for jobs and didn't want to crawl out bed in the morning, but I had no choice, and I sure in the hell didn't want to turn into that co-worker that everyone hates. We know who they are. The frequent absent one, who is snarky and cynical when they do come to work.

Anyway, I found another hospital with values I could relate too and I chose to change the way I practiced. I no longer sit back and let the facility own 'me'. I put myself on committee work, changing policies and I'm very pro-active. It helps me give back and help protect both nurse and patient, just in a different way. I'm working on year 5 and have to say I love nursing again and I'm very, very passionate about nursing burnout and compassion fatigue and want to be proactive on the state level. When I have a bad week, I make sure to do something that 'fills my glass' such as swimming, taking walks or gardening. Next I want to try my hand at photography. Another peaceful and insightful hobby. :) I find that if I continue taking care of me, I'm a bit more impervious to the chaotic world of healthcare.

It sounds like you suffer from both and I understand that you cannot quit for financial reasons. In the meantime, do what others are saying. Take that time for yourself. You need to fill your own glass and let go of those that try to drain it. If working bedside isn't the answer, then get away for awhile. Change departments, floors or specialties. Take that passion that you have and redirect it into another area of nursing.

Please keep us posted and again big hugs to you.

toomuchbaloney · Mar 23, 2014

You need some intensive self care.

A number of us have been there done that and are here to reassure you that this is survivable.

You can rock this, you CAN!

trishmsn · Mar 24, 2014

If your therapist hasn't recommended medication or if you are on medication and still having such severe symptoms then you should definitely make that the focus of your next session - which should happen ASAP. .

PLEASE get into see a medical doctor, in addition to your therapist.....you are not "burned out" on nursing, but I really feel that you are suffering from a major depression. I have felt the way you feel now, and only my faith kept me from leaving this world at my own hand. You have a ton and a half on your shoulders, and you need help---from other people, from professions, from medication (probably) and some relief and peace.

Be gentle on yourself, and remember that suicide is a permanent answer to temporary problems.....it does not seem that way, but please believe that life WILL get better. You cannot see that, I know, but trust that it is true from someone who has been there. There are so, SO many who have been in this dark place.....you have to trust that this, too, shall pass, and the light WILL return.

iluvgusgus · Mar 24, 2014

I just transferred to the ICU, so I sympathize with you. On the Med/surg floor I was on we had cases of pt's with TBI who were just bounced around from unit to unit for months and months....and I've had pts with locked-in syndrome, in their 80's whose family were just keeping them alive. I became very angry at families who would just not agree to a DNR for these people because these people are obviously suffering. However, on my last shift I worked, I had yet another pt who should be a DNR. Intubated, not really following commands, increased ICPs. He would squeeze my hand and hold onto it and not let it go unless I pried it from his hand with my other hand. I felt that he was still in there, yes he's suffering, he may even know this is the end and that is so sad to me I am tearful thinking about it. So by empathizing with him in that aspect, I have completely changed my attitude towards pts and their families in these situations. I think it is important to remember their suffering and we are there to ease the pt's suffering as long as it is prolonged by the denial of their loved ones. They may not want what is happening to them to happen, they may want to die, but they are not in control. We are obviously the only ones in these situations who truly empathize with the dying pt and they need that and they need us.

tokmom, BSN, RN · Mar 24, 2014

I just transferred to the ICU, so I sympathize with you. On the Med/surg floor I was on we had cases of pt's with TBI who were just bounced around from unit to unit for months and months....and I've had pts with locked-in syndrome, in their 80's whose family were just keeping them alive. I became very angry at families who would just not agree to a DNR for these people because these people are obviously suffering. However, on my last shift I worked, I had yet another pt who should be a DNR. Intubated, not really following commands, increased ICPs. He would squeeze my hand and hold onto it and not let it go unless I pried it from his hand with my other hand. I felt that he was still in there, yes he's suffering, he may even know this is the end and that is so sad to me I am tearful thinking about it. So by empathizing with him in that aspect, I have completely changed my attitude towards pts and their families in these situations. I think it is important to remember their suffering and we are there to ease the pt's suffering as long as it is prolonged by the denial of their loved ones. They may not want what is happening to them to happen, they may want to die, but they are not in control. We are obviously the only ones in these situations who truly empathize with the dying pt and they need that and they need us.

Very true. Another part of our job is getting the family to the point they can let go. I understand why it is with them. Past guilt and longing to make things right, and a jillion other emotional ties that only the family understands.

Illusionist · Mar 30, 2014

I understand your stress. I, myself, struggles about the ethics of what I am doing. Like you, I think sometimes my hands are just being used as an instrument of harm. I see all these medications that is being passed which are a bit questionable, and sometimes I feel like doctors only care about sedating their patients.

It is such a shock as a new graduate, and I hope I find myself along the way. I don't want to end up soulless like other nurses who has been there for a very long time.

tokmom, BSN, RN · Mar 30, 2014

I understand your stress. I, myself, struggles about the ethics of what I am doing. Like you, I think sometimes my hands are just being used as an instrument of harm. I see all these medications that is being passed which are a bit questionable, and sometimes I feel like doctors only care about sedating their patients.
It is such a shock as a new graduate, and I hope I find myself along the way. I don't want to end up soulless like other nurses who has been there for a very long time.

That is so sad you feel that way about your hands. There are times I disagree with the docs, but I try to make sense of the why. When we do something to a patient that seems to be harmful and against patient wishes, I focus on the family and educating them as to why we need to stop treatment or how this procedure may feel to the patient. I make it 'real' for them. Do I still drop that dobhoff that the pt probably never wanted anyway? Yes, I do, because I'm told to. However, as I said before, I then start working on the family, and doc if needed until there is a resolution to the problem. Sometimes it works and sometimes it does not. However, I can only advocate so far and when I'm at the end of the road, I have to let it go and know I did my best. It doesn't mean I stop, it means I keep advocating until there is no reason to do so.

However, there is far more good my hands have done than what I consider harmful. They have passed meds that have helped cure a pt, wiped a perspiring forehead of a dying patient and brushed back hair in a loving way, when there was no family there to do so, and held their hands as they passed on.

My hands give pats on the back to co-workers, perform CPR, and even have been used to thumb my nose and wiggle my fingers (while sticking out tongue) to another co-worker in a whacky moment to make others laugh. My hands are not pretty and soft like my non-nursing friends. I think they look older from all the hand washing over the years, but it's a worthwhile reason.

As for becoming soulless. I don't think you have to. However, you need to be realistic of what you can and cannot do as a nurse. You aren't going to save the world nor make in imprint on everyone you touch. You will do more good than you realize even if pts and family never tell you.

Be aware of your glass. When it's half full and when it needs to be replenished. Keep journals, meditate and try to find the good in what you do. Be proud of what you do and who you are. I really think one needs awareness of their emotions BEFORE burn out to help prevent it. Burn out takes years to take hold. It's not an overnight thing. If you start identifying what makes your glass empty, you can keep ahead by keeping it filled with what works best for you. ((hug))

Oh, read my siggy below. It's my nursing mantra

coderunnerRN · Mar 30, 2014

Thank you to everyone who responded to my post. There is a lot of wisdom here.