Wednesday, April 10, 2013

Who are you callin' a Burnout?

We've all seen it. It starts in their eyes. They begin to have that "1,000 yard stare", then they begin to stare holes through their co-workers, maybe even their patients. Next they start to grumble under their breath, or start letting a few bad words slip at the Nurse's station. Then they start showing up to work late and their quality of work begins to degrade. Eventually they start calling in sick or in extreme cases they no-call no-show.  It's not long after this point that they call it quits. They will leave that job for another or some may leave the field of nursing forever.
You might say to yourself, "Burnouts are people who got in to this field for the wrong reasons, I won't burn out because this is my life's work, my calling." If you say or think this your are not only wrong you are at risk. "The individuals who are most vulnerable to occupational burnout are ones who are strongly motivated, dedicated, and involved in the work in which they partake." [1]  Add to that that we are in high risk career for occupational burnout and the odds are not in your favor. 

We call them "Burn outs" or say they have "Compassion Fatigue" and consider this the diagnosis. Well, I see it as the signs and symptoms of a bigger problem. A more systemic problem in nursing as well as many other health care professions. One reason is an epidemic of Nurse Managers, losing their identity as Nurses and focusing more on the management aspect. The only problem is that they are piss-poor managers and don't realize it. Case in point, my manager recently went back to school to get her Master's degree... In business administration!! I suppose she really needed that degree as it most likely helps her when she sits in her office and listens in on conference calls or attends meetings. In gaining this degree, however, she lost touch with her people, her brothers and sisters, her fellow Nurses. Now she can't see that all of the good Nurses that were the back bone of their respective units transfer out from under her grasp or leave the hospital completely. Leaving fewer and fewer of these, smart, experienced nurses trying to keep it all afloat. 

So, how do we prevent/treat "Burnout"? First you must perform a Root Cause Analysis to determine the cause of the Burnout. Some major causes of Burnout include: [2]

  • critical boss
  • perfectionism
  • lack of recognition
  • inadequate pay
  • under-employment
  • tasks with no end (This one ring any bells... or call lights?)
  • impossible tasks / nearly impossible problems for solving
  • difficult clients (Patients)
  • incompatible demands (many demands that may not be achieved together)
  • bureaucracy (This is a big one in hospitals)
  • conflicting roles (home, family)
  • value conflicts (personal / workplace values)
  • meaninglessness of achieved goals (the success type of burnout)
  • social and emotional skills deficit

Prevention is probably easier than treatment. You need to understand your limitations and set realistic goals. If you are a baby Nurse then you need to take baby steps. You will not be in charge of the unit/floor/hospital in your first year. At least you shouldn't be. So, set a goal you can achieve. Many hospitals track statistics such as bar code scanning compliance or pain reassessment times. These are great goals that have a quantifiable and measurable outcome. My favorite is total number of medications administered, I lead the entire hospital for three months in a row this winter in this category and maintained a 97-98% scanning compliance. That one felt good. Like I was getting recognition for always having the patients with the most medications.  Remember that you too need days off and that other people can work instead of you. When they call you in, you can say no. If it wasn't a choice they wouldn't ask the question. My hospital gives 3 weeks of paid vacation after a couple of years and no one uses them. Its like a damn contest to see who has more PTO. 
New Nurses, as you start in your new role/job as an RN at times you will feel like you are the fresh soldiers coming in to reinforce the shell shocked and war hardened troops on the front line.  A lot of times that is exactly what is happening, budget demands may have put a hiring freeze on certain units or the entire hospital for an amount of time and they had to fight with what they had. Some of them may look down on you because you weren't there when times were hard because they are looking for someone to blame. Some older Nurses have developed that "Eat their young" mentality and see you as a threat to them. You have to have the strength and the perseverance to withstand all of that and press on. 

No one started Nursing with years of experience under their belt.

Accept the fact that successful outcomes are not always achievable.

Repeat after me... This is NOT my emergency.

Find an escape or a hobby that is not Nursing related.

And practice saying NO to your boss.

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1van Dierendonck, D., Garssen, B., & Visser, A. (2005, February). Burnout Prevention Through Personal Growth. International Journal of Stress Management, 12(1), 62-77.
2. Beverly A. Potter, Overcoming Job Burnout: How to Renew Enthusiasm for Work, Ronin Publishing, 2005

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