Even Keel
By cooling off from personal and professional stress, RNs can avoid job burnout—and rekindle their passion for nursing

By Rebecca Ray
September 17, 2003


About 10 years ago, Janine Mazabob, RN, director of neuroscience services at Memorial Hermann Hospital in Houston, said she felt "totally exhausted." Working full time under high-stress, high-trauma conditions and then having to meet certain demands at home had left her feeling burned out-and wondering if she should change her career.

"You don't have that same spark that you used to have," Mazabob said. "You feel overwhelmed. I knew I had to do things for myself to continue to stay in nursing."

She took a year and a half off, and discovered that what initially drew her to nursing was still there: She liked being able to connect with patients during both the happiest and most devastating times of their lives.

Mazabob realized she could recapture her initial spark if she eliminated other stressors. So she did, and returned to critical care, where she had worked since 1974. She hasn't experienced burnout since.

Mazabob's experience isn't unique. Although the 2002 NURSEWEEK/American Organization of Nurse Executives National Survey of Registered Nurses showed 77 percent of respondents as being satisfied with being nurses, 42 percent said they planned to leave their nursing positions within the next three years. Of that 42 percent, 71 percent said they would stay within nursing, pursuing career opportunities or education; 21 percent said they planned to leave nursing for another career; and 14 percent said they planned to retire.

Of those respondents who were not working as paid nurses, 6 percent listed their main reason for not working as being burned out.

Kenny De Meirleir, MD, Ph.D., human physiology professor at Free University of Brussels, found that career-related depression exists primarily in "people-helping" professions such as nursing. "The main cause of burnout was a 'too-heavy workload,' especially due to a shortage of personnel," De Meirleir concluded in his study.

Linda Aiken, Ph.D., RN, professor at the University of Pennsylvania School of Nursing and director of the Center for Health Outcomes and Policy Research, and her research team, whose study appears in the October 23-30, 2002 issue of the Journal of the American Medical Association, found that one additional patient per nurse increased burnout by 23 percent.

However, as Mazabob's story shows, experiencing burnout doesn't necessarily mean it's time for a career change. Sharon Lutman, RN, a licensed marriage and family therapist in the San Jose, Calif., area, said that burnout usually is not about the nursing job itself, but about nurses not knowing how to take care of themselves.

By learning how to reduce their number of stressors, nurses can minimize burnout and rediscover their passion for nursing:

Figure out what's causing your burnout. If it really is your career, then you may want to consider a change. However, if it's other parts of your life, then you should eliminate those stressors instead.

Look at what's negotiable. Mazabob cut down on watching television and devoted more time to doing things that were more important to her, such as spending time with her sons. She also buys more prepared foods, so that she doesn't have to spend as much time cooking, and leaves the chores to a housekeeper.

Mazabob also realized that she wasted 10 hours each week commuting. So she began taking the bus, where she uses her laptop and finishes paperwork.

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