By Laura Webb, BSN-RN, MRP
How many times have you had one of those exhausting shifts, or a series of exhausting shifts, when you were too tired to even find the words to describe your fatigue? Clichés like “bone tired” and “totally wiped out” can’t quite describe the depth of a nurse’s exhaustion after 12 hours of running and lifting, communicating and documenting--all while caring for a heavy load of patients whose lives may be literally in your hands.
It may seem insensitive to think of ourselves as “dead on our feet” when caring for patients who may be facing life-and-death struggles, yet there are times when that is exactly how it feels!
What is burnout?
We sometimes use the term “burned out” to describe nurses who seem especially dragged down, physically and/or emotionally, from the constant stress and chronic fatigue of our profession. Numerous researchers have studied burnout among nurses, especially in hospital environments. Perhaps burnout is best described as a kind of unresolved stress that accumulates over time until it becomes unmanageable.
I would venture to guess that most experienced nurses feel like they have a lot of expertise with burnout, as well--either from personal experience or from observing it among colleagues.
Burnout is often used to describe a combination of symptoms and behaviors that may include irritability, extreme fatigue, bullying, inappropriate humor or chronic call outs. However, some of these behaviors may be temporary, or simply due to short-term stressors in our lives.
So what is real burnout, and what can we do about it?
In 1981, UC Berkeley Professor Christina Maslach and colleagues published the Maslach Burnout Inventory (MBI). This 22-item questionnaire is a popular measurement tool that is still in use today.
Maslach’s model describes burnout as a syndrome consisting of three primary dimensions or subscales:
1. Emotional exhaustion - a sense that we are overextended and exhausted from our jobs;
2. Depersonalization - a callous, unfeeling response toward clients; and
3. Reduced personal accomplishment - a sense of incompetence or lack of success in our work.
What causes burnout?
While every professional faces certain stressors, most of us employ coping mechanisms to manage that stress. Burnout occurs when stress becomes too much for a nurse’s usual coping skills.
Nurses are often on the frontlines of healthcare, working long hours directly with patients who are often in physical or emotional distress. Our jobs can be physically and emotionally exhausting. We work in close quarters and unpredictable environments with other nurses, and our shared stress can lead to even greater pressure that affects everyone around us.
Certain workplace settings may be more prone to causing burnout than others. Short-staffed, high-acuity and dangerous environments can seem like pressure cookers. Meanwhile, there is no room for error; we are talking about human lives, after all! And so the pressure builds. Or if nurses feel that they lack time or energy for optimal performance, or feel a lack of respect or appreciation from peers or patients, these feelings can lead to frustrations and burnout.
What does it look like?
Physical signs of burnout include exhaustion, insomnia and various aches and pains. Some nurses develop high blood pressure, changes in appetite or a tendency toward accidental injury.
Psychological signs include irritability and depression, anxiety and withdrawal, guilt and cynicism, and a lack of enthusiasm. Nurses may have trouble concentrating or even develop addictive behavior.
Burned out nurses can become socially strained. Communication may suffer. These nurses may act hostile or overly critical of colleagues or friends. They may neglect their families or social obligations, or experience marital problems.
The cost of burnout is often high, and it tends to have a ripple effect. It can lead to unhappy or unsafe patients, high rates of nurse turnover, and personal distress among staff.
What can nurses do?
In order to prevent burnout, it is important that nurses and administrators are able to talk about the issue. We need to be aware of its dangers and have enough self-awareness to notice the signs in ourselves, and our colleagues. And then we need to speak up and address it.
It is also important for nurses to maintain a healthy perspective by pursuing interests outside of work. We also need to take care of our own needs and manage our stress in positive ways; at a minimum, we should be eating healthy diets and getting enough exercise and rest.
Finally, we need to be honest with ourselves. If we find that our current job situation is causing too much stress, we may need to pursue other positions in order to avoid personal burnout.
Tuesday, August 13, 2013
By Laura Webb, BSN-RN, MRP