Beating the burden of burnout

It’s amazing to me that, not long after the start of a new academic year, many nursing faculty members are overwhelmed by stress with some nearing a state of burnout. During a lunch break at a recent nursing conference, I chatted with nurse educators from around the country. The conversation centered on their myriad work responsibilities and heightened levels of stress. Seated around the table, they described how each minute of every day seems to be filled with an endless list of family, life, and work responsibilities. They lamented the long work hours invested in preparing for classes, grading assignments and exams, meeting with students, engaging in committee work, working on scholarly activities, providing service, teaching—both classroom and clinical—and fulfilling a number of other responsibilities.

Manuel Faba Ortega

One professor commented: “It’s only the first month of classes, and I am completely exhausted. I’m teaching two 12-hour clinical days and an extra class as an overload assignment because we have unfilled faculty positions, and there is no one else to teach the class. I’m also enrolled in a DNP program, because our university requires all faculty members to obtain a doctoral degree. We have a new director, and she has asked me to take on some of the school’s administrative responsibilities, which I have agreed to do. On top of everything, our current cohort of students is more challenging than ever, and I am completely drained.”

Too busy for self-nurturing
Concerned for her, I asked: “What are you doing for yourself? How are you nurturing your body and spirit?” She looked at me with a perplexed expression and said, “To be perfectly honest, I am doing very little, if anything, to nurture myself. I’m just too busy.”

Unfortunately, this story is not uncommon. I often ask nurses, nurse faculty members, and nursing students the same question, “What are you doing to nurture yourself?” Sadly, the vast majority of respondents say they are working so hard and moving in so many directions that self care has taken a back seat to responsibilities that often overwhelm them.

This is deeply concerning, because lack of self care takes a significant toll on personal, physical, emotional, and spiritual well-being, and it can have a potentially negative impact on our ability to care for others, including patients. The pressure created by competing demands from family, work, and life responsibilities can cause stress and maybe even burnout.

Obviously, stress will always be a part of our lives, and mild stress levels can actually give us an edge and help us mobilize for action and achievement. However, too much stress, especially if prolonged and coupled with poor coping habits, can cause physical, emotional, and spiritual fatigue as well as ill health. Common signs and symptoms of stress overload include accumulation of belly fat, interrupted sleep, fatigue, irritability and anger, and lack of interest. Mental health problems, such as increased anxiety and depression, may result, and it’s not uncommon for stomachaches, headaches, intestinal problems, and cardiac changes to manifest when stress levels are heightened and prolonged.

A few questions to ask
For some, burnout may also occur. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. When we are burned out, we feel overwhelmed, depleted, unproductive, unhappy, unappreciated, and too tired to function. To determine if you might be experiencing burnout, ask yourself a few questions:

• Do you have difficulty getting out of bed and feeling excited about your day?
• Do you become irritable or impatient with students, coworkers, or patients?
• Do you lack energy and feel disillusioned about your work?
• Are you using unhealthy coping strategies, such as spending hours watching TV or browsing the Internet, or using drugs, food, or alcohol to feel better?

If so, you may be experiencing or approaching a state of burnout.

While eliminating stress is impossible, minimizing it and engaging in self-care techniques can be extremely helpful and ultimately important in achieving an overall state of wellness. So, take a minute to jot down your favorite stress busters and most effective stress-reducing techniques. Some of us benefit from physical exercise and activities, such as yoga, meditation, progressive relaxation, deep breathing, and enjoying music or the outdoors. Spending time with family, friends, and pets, eating nutritious foods, and getting enough rest also help reduce stress.

While these stress-management techniques can be helpful—and I certainly recommend them—real and lasting change comes from identifying the sources of our stress and creating an intentional plan to deal with them. It may be helpful to carry a small notebook or make a note using your smartphone to record events or situations that cause you stress. After a week or two, you will likely gain a clear picture of where your stress is coming from and how you might address it.

Putting yourself first essential
After reviewing your personal list of stressors, identify those that you can do something about and those that are out of your control. For example, you may be stressed by your work commute. Is there a way to change the method, timing, or route of your commute to reduce your stress? If so, this is something within your control. If you identify a stressor that you cannot effectively eliminate—caring for a child with a disability, for example—perhaps there are ways to reduce the stress involved. In the case of a child with a disability, are there other people or community resources available that can share your care responsibilities and thereby lessen your stress?

Regardless of the sources of your stress—whether you can change them or not change them—putting yourself first is essential. This is not a selfish endeavor. By taking care of yourself, you can better attend to the needs of others. Enter “me time” into your calendar and regard that time as important as any other work meeting or event. Resist the urge to cancel “me time,” because the healthiest way to cope with stress and burnout is to take excellent care of yourself.

Managing your time well and staying organized can also be stress-reducing. Start each day with a “to-do” list and arrange them by priority—from high to low. Consider dropping low priority tasks altogether by rescheduling them for completion sometime in the future, or better yet, when possible, delegate those tasks to someone else. Resist multitasking and the urge to immediately respond to every text or email message you receive. Prioritize the messages, and, if possible, save them to a folder to be addressed when you have more time.

“Unplug” from your phone, television, computer, and other distractions to enjoy a moment of peace and quiet. Take a deep breath, and clear your mind. When life is busy, we often get distracted and lose connection with those we care about most. Schedule a date night with your partner, enjoy lunch or a power walk with a friend, or spend time with your furry friends. Avoid negative people as much as possible, and surround yourself with those who bring fun and laughter into your life. Take time off, or schedule a mini-vacation. Whatever you decide to do to de-stress, remember, you deserve it!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not b posted.

Civility, an ethical imperative

Everyone should choose to practice civility. For nurses and the nursing profession, however, it is imperative, an ethical requirement. According to the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements (2015), all nurses regardless of setting or position have an ethical responsibility to create and sustain healthy work places and to foster an atmosphere of dignity and regard for all. The code is clear: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect. … Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors” (p. 4).

Moreover, Provision 7.2 of the code states: “Academic educators must also seek to ensure that all their graduates possess the knowledge, skills, and moral dispositions that are essential to nursing” (p. 28). Therefore, it is incumbent upon nurse educators in all levels of nursing programs to model ethical conduct, professionalism, inclusion, and civility. They must take the lead in preventing and addressing acts of incivility, set the tone by incorporating civility as a shared value within their programs, and prepare students to effectively address incivility and foster safe, healthy work environments. The stakes are high. Safe patient care hinges on our ability to self-reflect and accurately assess our own behaviors, effectively manage our emotions, and communicate respectfully.

mumininan/iStock

For several years, I have intentionally integrated professionalism and civility content into my courses. Students and faculty members must engage in deliberate conversation about these topics, identifying and practicing specific strategies to foster civility. One exercise I like to use is having students complete the Clark Workplace Civility Index. During this carefully arranged activity, each student assesses his or her own perceived level of civility as well as the perceived civility level of another student with whom he or she is familiar and has built an adequate level of trust. They then candidly—and privately—share their insights with one another.

The evidence-based, 20-item questionnaire is designed to assess civility, increase self-awareness, generate discussion, and identify ways to enhance individual and collective civility acumen. The index includes assessing behaviors such as treating others with respect, keeping confidences, avoiding gossip and spreading rumors, using respectful communication, taking personal responsibility, and being accountable for one’s actions.

In addition to completing the index and discussing the issues it raises, each individual makes a firm commitment—in writing—to behave in a civil, respectful, and ethical manner. After completing the index, I recently asked a group of approximately 100 nursing students the following question: “What specific individual action can you take to foster a civil, healthy work environment?” The responses were impressive and, in some cases, inspirational.

Here are the top 10 responses:

• Always focus on the patient; this will keep us centered and respectful.
• Listen well and welcome other points of view.
• Offer to help and be supportive of others.
• Assume good will and exercise patience.
• Model professionalism, kindness, and respect.
• Speak up, set the bar high, and be a crusader for civility.
• Strive to be the very best person possible.
• Value differences and avoid judgment.
• Take good care of myself, de-stress, and live well.
• Practice the Golden Rule; treat others the way we wish to be treated.

Engaging in reflective exercises and candid conversation about ways to foster civility are helpful strategies to prepare students—and others—to address incivility, establish and sustain healthy workplaces, foster positive interpersonal and intrapersonal relationships, and enhance ethical practices that contribute to the ongoing success of top-performing work teams and highly effective organizations. Addressing incivility can be challenging, but remaining silent not only impairs nurse performance, it ultimately jeopardizes patient care.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

It was the nurses!

Last month, I had the privilege and high honor of delivering the endnote address to hundreds of neonatal nurses who attended the 30th Annual Educational Conference of the National Association of Neonatal Nurses (NANN). Asked to speak on the topic of civility and healthy workplaces, my presentation was titled “Igniting the power and passion of civility in nursing: Creating healthy workplaces.”

My objectives were to emphasize the imperative of fostering civility in nursing and provide several evidence-based, ready-to-use strategies for creating and sustaining healthy workplaces. The organizers of the conference asked that I deliver a message of optimism and highlight positive aspects of transforming practice environments, a request that fit easily and comfortably with my views on the topic. Clearly, the dedicated, hardworking nurses in attendance wished to end the conference and return to their busy, high-stress working places refreshed and invigorated by a message of hope and inspiration. I was determined to do just that, because they deserved my best.

What the organizers didn’t know—and what I chose not to disclose until the day of the event—is that, just over 30 years ago, I was the mother of a high-risk infant, a baby who spent nearly two months in a neonatal intensive care unit. Conceived during a northern Illinois winter, known for its frigid, tundra-like conditions, my firstborn child was due to be delivered in early August, associated in our hemisphere with sunny summer days. Who knew, instead, he would enter the world in the spring, almost 10 weeks before his due date?

Eric’s story is one I had never shared outside our family and close circle of friends, and, as I prepared for the NANN conference, I wondered if the moment had finally arrived to share a small piece of Eric’s early beginnings. There would likely never be a more fitting audience than this group of exceptional neonatal nurses, so, with Eric’s permission, I closed my endnote address by sharing this story. After all, had it not been for the unwavering, exceptional care provided by the entire NICU team, especially the nurses, Eric might not be with us today. One of NANN’s core values is advocating for quality patient and family care. Eric's neonatal nursing team took this value very seriously and lived it—every minute of every day.

I was young and inexperienced. I read just about everything I could on the topic of pregnancy, and talked with my mother and grandmother frequently about my pregnancy and pending delivery. Like most young mothers, I was thrilled and a bit fearful—all at the same time. Most of my pregnancy progressed normally, but long before the due date, I began to feel sluggish and nauseated. I became quite edematous and easily fatigued. I kept thinking something was wrong, so I visited my physician, who assured me I was fine. Somehow, I knew that wasn’t true, but I forced my worries to the back of my mind and allowed myself to think only about delivering a healthy child. In my way of thinking, if I thought it, it would happen.

When it became evident Eric would be coming much too early, I was rushed—following a flurry of examinations and ER visits—to a nearby medical center that boasted an excellent neonatal intensive care center. I remember arriving terrified. Immediately, I was swarmed by members of the medical team, all of them trying to determine the best course of action. Tests were run, examinations completed, and consultations made, all in a hurried attempt to save Eric’s life. Specialists agreed that the only chance Eric had of surviving was to prepare me for vaginal delivery.

Tests had determined that Eric suffered from a rare condition that included an in utero bowel perforation, an enlarged liver, and gross abdominal ascites, so we knew going into the delivery room that the odds for his survival were poor. The delivery room was packed with nurses, physicians, medical students, respiratory therapists, and just about anyone else who might be needed to save our baby’s life. The delivery itself was excruciating, and the level of infection I incurred post-delivery kept me hospitalized for nearly two weeks. But the real story is about Eric. A tiny, vulnerable infant, his Apgar score was 1, but only because he had a weak and thready pulse.

Eric then—a tiny, vulnerable infant with a weak and thready pulse.

He was rushed to the OR, where surgeons fought to save his life, conducting a procedure so revolutionary it had only been performed twice before. Chances of Eric’s survival were grim, particularly when, six days later, his bowel reperforated in another area of the colon. Over the course of the next 10 weeks, I experienced a roller coaster of emotions—fear, hope, worry, and yes, a love so deep it is unexplainable—all juxtaposed, layer upon layer. Through it all, the nurses—yes, those glorious, wonderful, highly skilled nurses—took care of every one of us, not just Eric, while our devoted family and friends stood vigil, hoping and praying for Eric’s health and recovery.

It was the nurses who, day in and day out, held my hand, accepted my tears, and encouraged me to never give up hope. It was the nurses who loved my son nearly as much as I did and inspired me with stories of other babies who had graduated from the NICU and were living healthy lives. It was the nurses who gave me hope, who never grew tired of my need to talk, who found a way to help me through every second, minute, and hour of each challenging and exhausting day. And finally, it was the nurses who helped me prepare for that most glorious of days—taking our son home. I have never forgotten, nor will I ever forget, the kindness, caring, and dedication shown to our son, our entire family, and me. Because of the nurses, our son is alive today and leading an incredible life. Though he has some physical limitations and lasting deficits, none of them has affected Eric’s beautiful and brilliant mind. He has earned a master’s degree in civil engineering and works as a professional environmental engineer. He is funny, witty, highly intelligent, and an incredible role model, not only for his two younger sisters but for all who have the privilege of knowing him.

Eric today—an environmental engineer with a
master's degree in civil engineering.

I told this story to the audience of neonatal nurses at the NANN conference for the sole purpose of expressing my deepest gratitude for the tireless and important work they do every day. I shared the photos included in this blog to illustrate the incredible life that Eric now leads largely because of their efforts. I also shared with them a note, written in Eric’s voice, that we gave to his nurses the day we finally left the NICU. It’s funny, but I still have the original note. Why, you might ask. It's because Eric’s thoughtful, unselfish nurses made a copy of the note for their notebook and returned the original to me, knowing that someday we would probably wish to have it in its original form. They were right. The note has been tucked away in Eric’s baby book for more than 30 years. It reads:

My dearest friends,

Almost 10 weeks have passed since I entered the world. I leave you all today with great admiration and gratitude. In the first two months of my life, my parents and I have come to understand and realize the fragility and sacredness of life. From your hands and hearts came the loving and professional care which has enabled me to leave here with the potential for a very long and eventful life. The greatest gift we can ever give another is the gift of ourselves. You have given of yourselves over and over, and goodness knows, how much I have appreciated that most precious gift. Thank you so much for your knowledgeable assistance and prayers; and thank you for loving me as much as you have. Perhaps someday we'll meet again and I can do something wonderful for all of you. We will keep you posted on my progress, and I promise to stop by and visit whenever I am in town. May God bless you all, and may your remarkable work continue to benefit all of the little children who pass through this center. You are and always will be so dear and wonderful to me.

Thank you again,

Eric

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.