Q: WHO GETS BURNOUT?
A: First, let me clarify that nurses are not the only professionals who experience burnout. Every professional does. However, the term burnout has negative connotations — instead, I would like to suggest “work disengagement” or “emotional exhaustion” to describe the burnout we see today that causes nurses to quit their jobs or exhibit poor performance.
Q: WHAT ARE THE SYMPTOMS OF BURNOUT?
A: Symptoms may include high blood pressure, insomnia, depression or addiction. Oftentimes, people who are on the verge of burnout have difficulty focusing on key tasks and maintaining a positive attitude about their work.
Q: WHAT CAUSES NURSES TO LOSE THEIR ENERGY AND BECOME DISENGAGED FROM THEIR WORK?
A: People enter nursing for a variety of reasons. However, most enter this field because they like taking care of people, “want to make a difference” or have a passion for the science. This caregiving nature is at the root of who nurses are — they give of themselves physically, emotionally and spiritually all day long. After a while, they become drained of that positive energy the very reason they went into nursing in the first place.
Q: WHY DO SO MANY NURSES LEAVE THEIR JOBS?
A: VHA research has found that dysfunctional, unhealthy hospital cultures are one of the primary reasons nurses leave their jobs, not burnout. Lack of confidence and respect for hospital management, especially the front-line supervisor, is a key reason cited for leaving. If nursing is held in high esteem within an organization and nurses are rewarded, recognized and feel involved, they are more likely to stay and experience lower rates of burnout.
Q: WHAT ELSE AFFECTS A NURSE’S ENERGY?
A: Besides the heavy physical and psychological demands of nursing, many nurses work 12-hour shifts and have more schedules during which they work on their feet all day, lifting, rolling, and moving equipment and patients. In addition to becoming emotionally involved with their patients, nurses also have to be technically engaged throughout the day to ensure safe care. The technology used in a hospital today can be very overwhelming. Have you ever noticed all the noises you hear inside a hospital? Now, imagine constantly listening to all those noises and being responsible for monitoring all those machines. Technology adds safety, but it also adds stress. Many critical patients have at least five pieces of equipment attached to them, and this adds to the pace and frenzy nurses experience.
Q: HOW IS THE NURSING SHORTAGE AFFECTING THE WORK OF THE NURSE?
A: Fewer nurses means more work for all. Inadequate staffing results in a tailspin of events that is ultimately doomed to failure, resulting not only in loss of energy, burnout and disengagement, but also eventual loss of nurses. Many nurses feel overburdened by heavy patient loads and the increasing intensity of service that sicker patients require. They’ll work a double shift today when asked, but leave tomorrow.
Q: IS BEING OVERWORKED AND OVERTIRED A JOB EXPECTATION?
A: No! However, nurses are being asked to do more with less, which can cause them to feel continuously tired and overworked. For the most part, fatigue and alertness in healthcare is not as well understood as it is in the aviation industry. Pilots have work hour limits; why don’t nurses?
Q: WHAT ARE SOME STEPS HOSPITALS CAN TAKE TO PREVENT NURSING BURNOUT?
A: The term burnout suggests that there was once a flame, or passion, that has been extinguished. A nurse’s passion does not extinguish; it simply dims. It needs new fuel or life to be rekindled, which comes in the form of job role, time and support.
Hospitals need to ensure that nurses have jobs that are meaningful. The best places to work are Employers of Choice™, who retain the very best employees. Nurses need to be able to contribute their ideas, especially regarding clinical changes, and be rewarded and recognized for their efforts. Nurses need time to achieve balance in their lives, to walk away and to reenergize before coming back to work again. It’s called “life-work balance,” not “work-life balance”! Life comes first! Nurses also need support to leverage their talents and develop new skills. Many nurses leave their hospitals because they don’t have career advancement opportunities or continuing education funding.
Hospitals need to fully understand staff perceptions about the workplace and managers, listen to them and build healthy cultures, so staff never get “burned out” and want to leave.
Q: WHAT HELPS NURSES FIGHT BURNOUT?
A: One answer lies in understanding the very reason why nurses entered the profession — people. One of the core aspects of nursing practice is the relationship- building between patient and nurse. This is perhaps the single most important issue to nurses. Helping patients learn how to care for themselves, being able to take the time to answer questions and educate patients about their conditions, and helping patients get back on their feet, is critical to nurses. Fulfilling this patient need is what drives their dedication to this field. Today’s fast-paced patient care system that is filled with a great paperwork burden keeps nurses from doing what they love most — care.
Q: HOW CAN NURSES WHO FEEL BURNED OUT RE-ENERGIZE?
A: There are numerous support groups and workshops for nurses throughout the country. But first, hospital management has to understand this reality. In addition, nurses need to recognize and address their own needs as well. Nurses who constantly put their patients’ needs above their own will start to lose their energy, become dissatisfied and burned out. Self-care workshops, for instance, help nurses revitalize and strengthen their communication skills. Communication with family, friends, peers and leaders is critical. Talk with your colleagues and your manager, too!
Q: WHAT CAN NURSES DO TO RE-ENERGIZE THEIR WORK PLACE?
A: Strive to work in an environment that is less stressful and more productive. Nurses are very creative people and can often come up with ways to make their jobs easier. Volunteer for workforce committees, talk to colleagues about helping the hospital become recognized with quality designations such as “Magnet Recognition,” “Top 100 Best Places to Work” or “Employer of Choice”. Don’t resign yourself to the current situation. Keep your sense of humor; diminish your sense of worry and anxiety; learn to pace yourself; and stop denying that you feel pressure at work.
Q: ARE THERE ANY HOSPITALS THAT HAVE MODEL NURSING PROGRAMS IN PLACE?
A: Of course. Several VHA member healthcare organizations have outstanding programs to retain quality employees and focus on healthy cultures. Many have achieved Magnet Recognition status.
Baptist Healthcare Corp. of Pensacola, Fla., has become a leader in healthcare for its innovative employee satisfaction approach. They clearly understand the one-to-one connection between employee satisfaction and patient satisfaction. Their culture is characterized by:
- A “no secrets, open book” environment where staff members are “in the know” about customer and employee satisfaction and financial results through a number of information-sharing venues like employee forums and organizationwide report distribution.
- Reward and recognition programs to acknowledge and empower employees.
- Leadership teams accountable not only for their department’s financial results, but also for employee satisfaction rates.
For the past two years, Fortune magazine has named Baptist Healthcare as one of the “Top 100 Best Places to Work in America,” and the institution was one of the first hospitals to receive the “Employer of Choice” designation.
St. Bernard’s Medical Center of Jonesboro, Ark. recently received the prestigious “Employer of Choice” award as well. The hospital invests heavily in staff learning and development, has reduced turnover from 16 percent to 9 percent in only 18 months, and has an open culture in which nursing staff are invited to voice their opinions and do not fear retribution.
Q: WHAT OTHER PROGRAMS ARE IN PLACE TO HELP NURSES DEAL WITH BURNOUT?
A: VHA understands nursing is the largest healthcare profession, and nurses are the principal caregivers. Nursing time is also the single biggest operational expense in any healthcare delivery system. Consequently, nursing as an organized service and nurses as primary caregivers are critical to the success of any system. We work with our members to help them focus on nursing care, and offer a variety of services that are designed to increase staff satisfaction, improve operations and, ultimately, relieve burnout.
Clinical Knowledge Management, CKM, is an interactive, Web-based tool that allows members to exchange knowledge with other VHA members. This portal exposes members to fresh ideas, reduces research time, provides an opportunity to network with other organizations facing similar challenges and leverages existing materials and programs.
We have also developed a program to address the specific needs of patients in the intensive care unit. “Transformation of the Intensive Care Unit” provides a series of highly interactive meetings; conference calls and coaching aimed at helping organizations to streamline operations while meeting their clinical, operational and financial goals. One of the specific areas this program addresses is high ICU staff turnover due to stress or burnout. We have begun to understand the high-level changes that make a difference!
