Adrienne has been a maternity nurse for seven years. She has recently also assumed some duties as a nurse researcher on her hospital’s program working with adolescent mothers. Midway into her 10-hour shift, she is trying to prep a woman for delivery, answer a blinking call button from a new mother who didn’t get her meal and show an expectant mother around the ward. On her to-do list are a dozen items, including finding a nursing student to help crunch data on young mothers and obesity. She is on her third cup of coffee and half her sandwich lies uneaten in the break room. And she can’t stop thinking about the preemie in the neonatal ward two days ago who didn’t make it.
On her way home from work, Adrienne rushes to the supermarket, spends 10 minutes with her daughter before it’s lights out and then argues with her husband about who’s turn it is to clean the bathrooms. She lies awake thinking about the things she didn’t get done and what awaits her tomorrow. She wonders how long she can keep up the pace and whether taking on additional duties is worth it, whether her plans to embark on an MBA are foolish and just whether she ought to tell off that stupid co-worker who almost put the wrong baby with the wrong mother to breast feed.
The nursing profession is very demanding and the challenges facing it – such as staff shortages, intergenerational conflict, healthcare reform – have magnified its complexity. So what Adrienne is experiencing is not uncommon. When nurses become cynical or critical, have to drag themselves to the job or feel disillusioned about their work they could be experiencing job burnout.
According to an article by Mayo Clinic staff, job burnout is a special kind of job stress – “a state of physical, emotional or mental exhaustion combined with doubts about competence and the value of your work.” The consequences of job burnout can affect both the nurse – health problems, lack of teamwork – and the employer – increased turnover and the possibility of compromised patient care.
The causes of job burnout can be:
• Lack of control. An inability to influence decisions that affect your job such as not having control over schedules, not having shared decision-making
• Unclear job expectations. Being unclear about the degree of authority you may have or what your supervisor expects from you.
• Dysfunctional workplace dynamics. Working with a bully or someone who constantly criticizes you.
• Poor job fit.
• Extremes of activity and constant interruptions.
• Compassion fatigue. Constantly being around people in pain or suffering.
Managing the stress
Experts say the first step to handling job burnout is to management the stressors that cause it. But some experts say there is a need for a more systematic approach and that managers should include stress-reduction education as a priority items. Here are some thoughts on what and what not to do:
Don’t push it under the rug.
“Really validating the notion for yourself that you are under stress helps manage stress,” says Jeffrey Schwartz, MD, co-author of the book, “You are Not Your Brain,” says denial makes things worse. “Literally saying to yourself that I acknowledge it helps manage it.” Contrary to old conventional wisdom, “sucking it up” or shrugging it off doesn’t help much, he says.
In his book Schwartz has exercises about “reframing” your mind – using your mindful awareness effectively to help manage stress and anxiety. It’s something you don’t do on the job and it may take some time to work. He also talks about “relabeling – observing you’re your inner responses with a clear mind to help you know what’s going on.”
Don’t try to eliminate it completely. One thing to keep in mind, Schwartz says, is that a certain amount of stress is always going to be present in the workplace. Sometimes stress can be good and lead to increased productivity – that’s why your supervisor imposes deadline. “A certain amount of stress will increase productivity if you have one deadline, but it starts to decrease productivity is you have too many deadlines at the same time.” Think about realistic ways to deal with deadlines, he says, or talk with your employer about how to do your job effectively within established limits.
Care for yourself.
“Nurses are notorious for not taking as good care of ourselves as we take care of people,” says Bethany Phoenix, RN, PhD, and University of California San Francisco School of Nursing health sciences clinical professor. She suggests several ways to do it:
Physical self care – eating regular meals, exercising, getting enough sleep.
Psychological self care – Self reflection, journaling, doing enjoyable activities, positive self talk
Emotional self care – Maintaining supportive relationships, affirmations, reading favorite books, doing comforting activities. Spiritual self care – Spending time with nature, listening to music, prayer, meditation.
Workplace or professional self care – Developing supportive relationships with colleagues, suggesting consultation, having a peer support group, arranging workspace so it’s more comfortable.
Support each other.
“Peer support is really important,” says Phoenix. “One of the consequences of a stressful environment is that often nurses are not very supportive of each other. You can always start by determining that you will be more supportive of them.”
Recognition.
One of the best and most effective stress management techniques is “simple, recognition, validation and visible committed efforts by the nurse executive,” says Paul T. Clements, PhD, APRN, BC, DF-IAFN, an associate clinical professor at the Drexel University Division of Graduate Nursing.
In his writings, Clements also suggests that nurse managers, “Recognize and acknowledge that stress being encountered by employees is real and of significant concern. Often, simple verbalizing the obvious provides a sense of support and validation, and subsequently, a foundation for proactive communication and suggestions for problem solving.”
About the Author
Joyce Routson is a journalist on the HEALTHeCAREERS' News Beat Team and who's written about healthcare, labor and recruiting for a number of publications including the Contra Costa Times, NurseWeek and Staffing Industry Report. A resident of the San Francisco Bay Area, she also works as an editor at Industry Intelligence Inc.
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