As nurses, we're the quintessential multitaskers of the healthcare field. We're highly skilled in managing competing demands within an increasingly complex, advanced technology healthcare environment that may be experiencing staff shortages. However, feeling overwhelmed isn't uncommon and can accumulate over time, escalating to the more serious condition of burnout. Defined as emotional exhaustion, burnout results in depersonalization and decreased personal work accomplishment.
In this article, we discuss the serious consequences of nursing burnout and compassion fatigue, along with mitigating strategies, such as cultivating joy at work and self-care activities.
Burnout and compassion fatigue
Nurses experiencing burnout may feel overwhelmed to the point of extreme fatigue, be unable to face the demands of the job, and have difficulty engaging effectively with others. Mistakes, resentment, and stress are likely to increase, whereas self-care and advancement opportunities are more likely to decrease. Multiple risk factors can contribute to burnout, such as time pressure, lack of control over work processes, role conflict, and poor relationships between groups and with leadership, as well as the emotional intensity of our clinical nursing work itself. Without purposeful intervention, burnout may result in loss of capacity for empathy, which is a core professional necessity of nursing.
More subtle than burnout, but no less innocuous, is the concept of compassion fatigue. Many stressors can place a nurse at risk for compassion fatigue, including the unpredictable course of a terminal illness, unexpected cardiac events, family disputes, repeated readmissions, and the need to support patients facing death without loved ones (as in the recent COVID-19 pandemic).
One study of compassion satisfaction, burnout, and secondary traumatic stress used an electronic health survey among healthcare workers (N = 764) at a southwest academic healthcare center, with nursing as the largest representative profession. The ED, ICU or critical care unit, and psychiatric department experienced higher levels of compassion fatigue, burnout, and secondary traumatic stress. Sleep quality and the experience of workplace violence were behavioral and work setting variables associated with decreased compassion satisfaction and increased burnout and secondary traumatic stress among healthcare workers. It's believed that sleep problems may not be just a symptom of anxiety, but a reason it may persist (see Sleep suggestions).
Joy at work
Not only is it important for nurses to avoid burnout and compassion fatigue, but we must also strive to achieve an actual feeling of joy at work. Yes, it's possible! This novel concept was first introduced in an Institute for Healthcare Improvement white paper in 2017. Like burnout, the absence of joy in work can ultimately result in lower levels of staff engagement, patient experience, and productivity and an increased risk of accidents. Each nurse needs to own his or her work satisfaction and chart a course for meaningful and enjoyable employment.
Environments that foster joy at work provide:
- physical and psychological safety
- meaning and purpose
- choice and autonomy
- recognition and rewards
- participative management
- quality improvement initiatives
- camaraderie and teamwork.
Although it may seem obvious to avoid physical threats, psychological safety can be more insidiously eroded. Small communication issues can escalate over time into large issues. Bullying and workplace hostility can intensify if unchecked. Open communication with coworkers and nurse managers is always important to mitigate threats to psychological safety. Choice and autonomy, as well as participative management, are fresh concepts inspired by many organizations with shared governance committees. Participation in quality improvement work drives not only improved patient outcomes, camaraderie, and teamwork, but also joy for those nurses contributing to improvement projects.
Healthcare environments are evolving to accommodate safe and meaningful work practices for nurses; however, it's up to us to continue to identify gaps, articulate concerns, and make meaningful changes for the nursing profession's future.
Developing a positive work-life balance is one way to ensure self-care while combating burnout and compassion fatigue. Positive work-life climate is associated with better teamwork and safety climates, as well as lower personal burnout. In one study, work-life balance was measured by responses to behaviors such as skipping a meal, eating a poorly balanced meal, working through a shift without any breaks, arriving home late from work, having difficulty sleeping (less than 5 hours), changing personal/family plans because of work, or feeling frustrated by technology in the past week. RNs were a large group within the analysis (N = 3,367) and scored about halfway between physician residents, who scored as having the worst work-life balance, and environmental service workers, who scored as having the best work-life balance.
One important activity that nurses can use to help overcome burnout and compassion fatigue is the practice of debriefing after stressful shifts or traumatic events. When a particularly difficult patient encounter or traumatic event occurs during a shift, it's important to take the time to process the event and discuss feelings with other caring professionals. Daily self-care health promoting activities, such as maintaining a healthy diet, sleep, and exercise, are also encouraged. Mindful meditation, guided imagery, journaling, aromatherapy, massage, and yoga are additional suggestions to manage stress. Implementing a routine that recharges your spirit daily will help provide personal insulation against the inevitable stress of caring for others.
The American Psychiatric Nurses Association (APNA) states that nurses can have reactions of anxiety, stress, or grief to the increased and persistent stressors and potential trauma they encounter. The APNA website (www.apna.org) has resources that are helpful in identifying the cognitive, emotional, behavioral, and physical symptoms of excessive stress. Practical tips are available for managing stress and accessing professional help when needed.
Resilience is a useful concept for nurses to understand to help buffer inevitable career disappointments. Resilience is the process of utilizing healthy proactive strategies to help recover from setbacks and mistakes while cultivating enduring joy and avoidance of burnout. Resilience helps us find meaning with lessons learned, even in experiences that feel like failures. Many healthcare institutions are embracing the high-reliability organization concept of just culture, which promotes learning from mistakes rather than punishing individuals who make mistakes. This concept promotes a culture of safety, as well as supporting the staff involved.
The Duke Center for Healthcare Safety and Quality provides evidence-based resilience tools to combat burnout and promote resilience and inner happiness (www.hsq.dukehealth.org/tools). These concrete tools are intended to promote cognitive restructuring of automatic negative thoughts, ultimately leading to more optimism. Some examples include writing a gratitude letter, cultivating awe, engaging in random acts of kindness, and practicing mindfulness. One simple tool is looking forward to an anticipated positive event, such as a vacation or holiday, to increase positive thoughts instead of dwelling on the negative or overwhelming events of today. Consider practicing gratitude daily by remembering three good things that happened throughout the day. You can do this within 2 hours of sleep to positively affect your subconscious sleep experience.
Chart your path
Burnout, compassion fatigue, and the lack of joy at work are associated with negative outcomes for nurses and patients, making these concepts necessary to examine. Today's nurses need to be agile multitaskers in fast-paced work environments. Now more than ever, we must strive for an equitable work-life balance and cultivate self-care practices that promote resilience to mitigate the potential for burnout and compassion fatigue.
As nurses, we need to be ever vigilant in nurturing our own spirit of well-being because our work is inherently stressful. If we wish to continue to help our patients, we must remember to help ourselves first. Prioritizing our optimal mental health through self-nurturing exercises assists in buffering everyday stress and promotes resilience. Ultimately, we control our own path to enhancing our professional satisfaction and joy of daily work as nurses.
- Keep the same sleep schedule
- Create a relaxing bedtime routine
- Maintain a cool bedroom
- Avoid screen time before bed
Agency for Healthcare Research and Quality. Burnout. https://psnet.ahrq.gov/primer/burnout
American Psychiatric Nurses Association. Managing stress and self-care during COVID-19: information for nurses. www.apna.org/i4a/pages/index.cfm?pageid=6685#Moral Distress
Duke Center for Healthcare Safety and Quality. Resilience tools. www.hsq.dukehealth.org/tools
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