NurseWeek: Breaking point

Breaking point
Faced with burnout in the workplace, nurses take care of each other

By Melissa Gaskill
November 27, 2000
Photo: Photodisc

To avoid burnout, nurses advise colleagues who exhibit symptoms of stress to seek help. Employee assistance programs, which may include individual or family counseling, are good sources.


	You've read the article. Now tell us what you think. Related sites Sources of Nursing Stress Anti-stress prescription In a comprehensive study of stress on the pediatric nursing staff following the Baby K case, nurse practitioner Tammy Young and her colleagues identified measures that can reduce stress: Communication of morals and values in interdisciplinary case management At individual patient care conferences, discussion can bring in specialists in social work, psychology or pastoral care to help clarify issues. Patients, families, nurses, physicians and others involved in the care should take part in early and continuing dialogue. This increases a nurse’s role in decision making. Peer support Peers should listen to one another, provide guidance and support and remain sensitive to each other’s value systems. Grief support groups are important. Values education Certain personality traits may protect health care workers from undue stress. Health care workers need to be aware of their own emotional "baggage" and have appropriate coping mechanisms. Nursing ethics forums Such forums provide a place for nurses to discuss their ethical concerns and help them solve ethical dilemmas. Nurses need to be educated about ethics as well. ~ Melissa Gaskill

When Baby K was born with anencephaly – or only a rudimentary brain stem – standard treatment called for keeping her warm, offering fluids and waiting for the inevitable. Then her mother insisted on mechanical breathing support and the courts upheld her wishes.

Nurses were forced to provide care without their viewpoints being considered, said nurse practitioner Tammy Young, who studied the case’s effects on the staff. Providing care against their professional judgment, with no hope of the patient getting better and no response from the patient, proved hard on the staff.

Stress, of course, is part of nursing. But complicating factors leave today’s nurses more stressed than ever.

"People are sicker; they have multiple issues with the need for more intense services," said Elizabeth Moran Fitzgerald, Ed.D., ANP, a consultant to caregivers. "And you have less time and less support available to meet those needs. You don’t have decision-making power over variables that affect the patient’s care, and yet you are on the front lines."

Litany of symptoms
Because nurses may minimize their stress, according to Robert Scott, Ph.D., director of a stress management program for the Los Angeles City Fire Department, it can escalate to burnout.

Scott studied stress in his department and found three measures of burnout. "One is emotional exhaustion, where you just feel spent and empty inside," he said. "Another is depersonalization. You start to treat patients and other people in a callous or uncaring manner. A third is a low level of personal accomplishment, feeling that you don’t get anything from your work and don’t want to do it anymore."

Sometimes, family and friends are the first to notice symptoms of stress, Fitzgerald said, and nurses should listen if those people point out changes in behavior. There are many warning signs.

"You eat too much or not enough, sleep too much, or just lie there at night and can’t sleep," said Jodi Cotner, RN, trauma coordinator for Baylor University Medical Center at Dallas. "Your personal hygiene goes by the wayside. You start sabotaging your relationships. You cry a lot, or not at all. You’re sick a lot, calling in, missing shifts, not carrying your workload."

Some individuals become withdrawn or cynical. A nurse might shift to a position distanced from patient care or leave nursing altogether.

Those who see themselves in this litany of symptoms should seek help.

Tea for the Soul
UCLA Medical Center provides help in the form of a "crash" cart – equipped with cookies, herbal teas, soft music and pamphlets on grieving and stress. Chaplains accompany the cart, known as Tea for the Soul, so the staff has someone to talk to.

At Baylor, the trauma and chaplain departments run a Critical Incident Stress Management program. Trained staff members coordinate post-incident debriefings in which staffers talk about how it affected them.

"When you are involved in trauma day after day after day, it can get to you," Cotner said. "If you don’t find a way to let it go, you take it home and you get burned out and can’t do your job anymore."

Cotner experienced nightmares and bouts of physical sickness several years ago after treating a 5-year-old boy fatally stabbed by his mother. The woman was later convicted and received the death penalty. The boy’s 6-year-old brother also died.

"We’re so used to taking care of people, we don’t take care of ourselves," Cotner said. "We have to learn to do that or we can’t take care of anybody else. Everybody has those cases that really get to you. Get help immediately, if not sooner. Don’t think you’ll get over it in a few weeks."

Employee assistance programs such as Baylor’s, which includes individual or family counseling and chemical dependency counseling, are good sources.

Going to the source
Wanda Cheek, RN, now retired, remembers working in the ER when a young drowning victim was brought in. She doesn’t recall being offered any help to deal with the resulting stress. "It is incredibly wonderful to see that changing," she said. "I’m not sure there isn’t a time in everyone’s life when you could benefit from counseling."

Solutions such as debriefing and counseling are not as effective when the source of stress is a chronic problem such as overwork, Scott said. "Stress management can only go so far when the organizational stress isn’t changing. That is a harder, more complex problem that involves money and hiring practices."

Efforts to address this broader issue include collaboration between the Kentucky Nurses Association, the University of Louisville Hospital and School of Nursing, and England’s University of Leeds on a long-term recruitment and retention program. It seeks input from staff nurses about improving working conditions.

"If you give nurses an opportunity to control the environment, they will make the changes that need to be made. It sounds simple, but one of the first things we identified was that nurses want to be allowed to take a break," said Anne Powell, RN, executive director of the Kentucky Nurses Association.

Other measures proving effective are better communication between nursing and support staff, contracts outlining employee expectations and more flexible work schedules.

"We want to change the environment and reduce stress," Powell said, "instead of just saying here’s how we’ll help you with the stress."