Research Paper Needed for English Course

Prof. Lourdes Heuer

COMP 2000

Date

Nursing Burnout: What's to Blame?

When many people end up in the hospital, the first person they call out for is their nurse – not a doctor. Nurses have a hands-on relationship with their patients, doing everything from administering medicine to more personal clean ups and emotional care. They are usually the ones running from patient to patient trying to squeeze in as much care as possible in one shift. Consequentially, this often leads to an unfortunate burnout situation. Nursing burnout is known as the loss of motivation, compassion, and ability to deal with the stresses of work, though all nurses deal with it differently. But nurse burnout could be prevented if nursing programs amended their training, hospitals reconsidered staff operations, and nurses themselves made changes to their own personal life management. After all, without nurses who love their jobs, the hospital experience wouldn’t be the same.

Nurses need to be able to (almost) always put their patients first. That's what they've learned to do from the start of their education. But nurses often forget that there is a balance needed to maintain their own sanity and health, and nurses are people who must also remember to tend to their own mental and physical needs, too. Otherwise, there are mental and physical tolls that will plague nurses over time, even though they are often kept out of plain sight. Kelli Dunham, an RN since the age of 19, says in her book How to Survive and Maybe Even Love Your Life as a Nurse, that "with a constant sense of urgency that's in the hospital, many nurses don't stop to consider their needs, often skipping a sit-down lunch to tend to their patients.” Often, the pressures of having patients leave the hospital on their own two feet get nurses to trump their own care. Forgetting not to just eat lunches, but often also to take regular bathroom breaks, nurses may be forgetting that when they cut corners for themselves, the hospital is taking a toll not just on their patients, but on them, too.

There’s also the toll of patient trauma coming through the hospital doors. Many nurses leave with traumatic images in their heads from things they've had to deal with during their work day. Deaths and other things that can tug at the hearts of nurses often stay with them and can be severely damaging over time. According to Robert Wicks, psychologist and author of Overcoming Secondary Stress in Medical and Nursing Practice, "...as well as unrealistic expectations on the part of patients and health systems, the stakes are now so high for health care professionals that the potential for developing such psychological problems as emotional blunting on the one hand or extreme affectivity on the other is quite great." Often, coping mechanisms involve suppressing their emotions. Many people refer to this as "bottling," and when a bottle of soda is shaken enough, the top comes flying off and everything comes spilling out, creating a mess that is very difficult to clean up. Nurses are shaken so often that their tops come flying out when they enter burnout, and many of them can no longer be the same person they were before they experienced this burnout. Naturally, people like to feel like they have some sort of control over the situation that they're in. But in nursing, that control is often wavering, and many nurses beat themselves up long after the situation is over about things that they could have or should have done, when in reality, it was out of their control.

Families are another stressor that keep nurses strung high. With many patients, especially those with chronic and terminal illness, family emotions often run high. They take these emotions and frustrations out on nurses often because they are seen as the primary care providers that are working directly with their loved ones. When something goes awry that is out of the nurse's control, nurses are still often the ones to get the blame because they are the ones always around. According to Dunham, "Nursing school curriculum addresses relationships with patients, but most nurses we talked with said they got little instruction about dealing with families." With tension running high, fights are bound to break out. Many people are often worried about family members and are quick to attack at any sign of doubt. Dunham says, "We all have the same needs for respect and recognition of our humanity as do our patients and their families." Constant blame and emotionally charged atmospheres would have ill effect on any person regardless of profession. Nurses are often the first point of contact, but not the last – they don’t have to make themselves responsible for handling family complaints or for fixing family disputes. This is hard to remember in the heat of the moment – but it’s up to hospital administrators, particularly nursing at the management level, to step in and intervene for nurses caught in the crosshairs of family battles during sensitive times.

Problems are further compounded by nurses working off the clock. Whether it be a family member asking for help with athlete's foot or a friend asking for stitches to avoid hospital fees, there is always someone calling upon a nurse’s skills. In Dunham's book, boundaries are also mentioned. She stresses that, "...a very important boundary a nurse should maintain is the discipline of leaving work at work." In addition to patient and co-worker related boundaries, nurses must be taught to separate work and personal life. Otherwise, nurses’ personal lives can become work. The trauma and the physical issues may go home with them but should not be dwelled on. Nurses should have counseling available to them by their employers if needed or be taught early on in their training how develop a space of their own to decompress from the day's work.

Perhaps more seriously, when people hear the word nursing, they often bring up the nursing shortage. Many of today's nurses are older in age and like any profession, older workers intend to retire. With less and less nurses and hospitals also cutting corners, the ones that do have jobs face making up for the work not being done. In Dunham's How to Survive and Maybe Even Love Your Life as a Nurse, she says, "Studies have consistently shown that nurses leave nursing when they are forced to work mandatory overtimes, float to where they are not trained, and take care of a ‘nigh unto ridiculous’ number of patients." Overwork of nurses can cause stress on the nurse and degrade patient care quality. There is a difference between nurses doing their job and nurses treating patients. Nurses doing their job will push medicine and run to the next patient to make sure rounds are done in time. Nurses treating patient will stop to consider the patient's condition and assess pain levels and answer questions. Patients have the right to be treated properly and thoroughly, especially with the amount they are actually paying for their medical care. Allowing a nurse an acceptable amount of time to go through these routines without having them feel rushed is necessary for their best performance. When nurses don’t feel like they’re treating – when they feel that they are just doing, they’re bound to feel stress. This very stress is likely the cause of why nurses leave their jobs, if not the profession altogether, as studies seem to show. Only hospitals themselves can lead in this area. It’s up to them to simultaneously put patients and nurses first by hiring enough qualified caring nurses.

Finally, there seems to be a serious problem with feelings being acknowledged. When a life is lost while in a nurse's hands, the nurse often takes it to heart. But, with the previously mentioned fast pace of a hospital, time to come to terms with the fact that the loss of life was not a nurse’s fault or unavoidable just doesn’t seem to there. A nurse often has to get over it within seconds and move on to the next patient that is in need of care. According to Wicks, "We [healthcare professionals] learn that no matter how professionally prepared we are, we are not immune to the psychological and spiritual dangers that arise in living a full life of involvement with others." That has been my own experience working as a nurse myself. Even outside the hospital, stories of patient lives and losses are often shared with nurses. Death and sadness is regularly shared with nurses, usually not by choice. Nurses must be trained to be able to recognize the fact that it is okay to be upset over the loss of a patient, but it must not have a grip on their own lives and their capacity to perform. Unfortunately, these things are not regularly or thoughtfully taught in nursing school. Hospitals, short on staff, don’t provide their staff the appropriate time or space to grieve.

Nurses deal with a lot of things that most people couldn't dream of dealing with at their place of work. The life of a nurse does look stressful on the outside, and it is, in fact, as unimaginably difficult on the inside. Nursing students are not sufficiently taught how to deal with their personal feelings and the feelings of others beyond their own patients, but those two sources are the ones that can affect a nurse personally and performance-wise the most. Few people go to work expecting someone to die or walk in to work prepared to see blood on a regularly basis, but that is all a part of a nurse's life. This may be a career, but the people working are still humans, and many employers and employees themselves forget this. Physical issues can arise from the overwork and stress that a nurse goes through and can lead to long term illness or suffering. In order to deal with the burnout of nurses, the shortage should be stopped by advertising more aggressively about the importance of nurses and pushing it to be seen as a rewarding career, one that will pay accordingly. Burnout from a more personal standpoint can be avoided by a thoughtful modification of nursing curriculum. Nursing students should be taught that feelings are an inevitable part of the healthcare field. Although they not be allowed to rule performance, they should be acknowledged, and schools should spend more time throughout the curriculum preparing nurses for experiencing the grieving process from the viewpoint of a healthcare provider. Personal management is also important. Nurses should be taught that they must find the balance between taking care of themselves to avoid issues and taking care of patients effectively. Overseeing staff must ensure that nurses on shift take appropriate lunch and bathroom breaks, even if they themselves forget to, and work orientations should cover professional development subjects such as coping mechanisms for leaving work at work and setting professional/personal boundaries. Nurses are important, and they work extremely difficult and long shifts to provide the in-depth care that save the lives of many. They should be prepared for their careers and treated well for taking on such an important role in society.

Works Cited

Dunham, Kelli S., and Staci J. Smith. How to Survive and Maybe Even Love Your Life as a Nurse. Philadelphia, PA: F.A. Davis, 2005. Print.

Wicks, Robert J. Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional Resilience and Personal Well-Being. Oxford: Oxford UP, 2006. Print.