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Think positively. Although Mazabob said she respects the difficulty of traumatic situations, she tries to remove the tension by telling stories about crazy things that have happened or reminding her co-workers how their circumstances could be worse.

Jane Manning, MSN, RN, nursing retention coordinator at The Methodist Hospital, which is part of Clarian Health Systems in Indianapolis, and Tawnee Parrish, RN, nurse retention coordinator for Clarian Surgical Services, try to help their nurse clients realize they can control their own destinies. Manning said she and Parrish try to instill a sense of accomplishment in nurses and help them see they're appreciated.

Nurses also should focus on the positive things they are able to do for patients, rather than what they aren't able to do, Manning said.

Make sure you work in the right environment. Burnout tends to be minimized in units where nurses experience a sense of teamwork, have supportive managers and open communication and don't blame each other, Manning said.

Monitor your stress; don't practice denial. Six years ago, San Jose (Calif.) Medical Center intensive care unit nurse Denise Paulo-Colaci, RN, said she didn't know how to gauge her stress and would medicate herself with alcohol. She became careless and stopped covering her tracks, and she was brought in to her supervisor for missing work.

Paulo-Colaci attended an outpatient day program, where the facilitators stressed that she find a sponsor and support group. After taking time off and following the advice, she returned to working in the intensive care unit, where she has worked for 14 years, and has remained sober ever since.

Develop strong support systems. Paulo-Colaci has developed healthy coping skills to deal with her stress, partly because of a support group she belongs to, We Care, which Lutman facilitates. We Care is for health professionals who are attempting to recover from chemical dependency. The group educates participants about their disease and offers medical and psychological referrals.

Nurses participate in We Care if they are on probation with the California Board of Registered Nurses or through the California Nurse Diversion Program.

Also, Lutman said, "It's really helpful for [nurses] to sit in a room with other nurses [who] say, 'I did that, too, and I got into recovery. I'm healthy now,' just to give them hope that they can recover and return to their nursing practice."

At least 37 states offer diversion programs. Paulo-Colaci believes hospitals could alleviate nurse burnout by running support groups for their nurses, regardless of whether they have chemical dependency issues. She said nurses would benefit from receiving support from their co-workers, who are like a second family.

"Nurses deal with tragedy every day and don't get support for it," she said.

At hospitals without nurse support groups, nurses can help each other by supporting each other during tragedies: If a patient on the unit dies, acknowledge it, Lutman said.

Mazabob also recommends finding mentors or nurses who seem to have it together.

Find ways to decompress. After work, Mazabob works in security at Cynthia Woods Mitchell Pavilion in Houston, where she enjoys listening to concerts. She also does "mindless" activities like walking her dog.

Other nurses have spiritual rituals. Paulo-Colaci meditates, while Lutman begins each day in the chapel.

Pace yourself for the long run. Don't throw yourself 120 percent into your job. Instead, if possible:

• Take periodic breaks and spread your breaks throughout the day.
• Get off the unit during break.
• If you can't get off the unit during break, at least take a mental break. Don't talk about work on break, and don't just sit and eat while you chart.

Maintain a healthy work/life balance. Some nurses mistakenly base their self-worth on their job performance. In We Care, participants focus on ways they can feel good about themselves that aren't nursing-related, such as through hobbies and relationships.

We Care wants nurses to feel they want lives to add work to, not work to add life to, Lutman said.

Paulo-Colaci doesn't work overtime unless she has a special expense. Although the demands of hospital staffing sometimes make her feel guilty, "It's OK to say no," she said, adding that someone else can always do the work.

Nurses should "schedule enough time for play," Paulo-Colaci said, and realize their jobs are "a way to pay bills, not everything in life."

"You've got to have balance," she said.

Contact Rebecca Ray at rebeccar@nurseweek.com