Nursing Burnout is Real and Dangerous
The current pandemic seems to have torn the band-aid off a problem in the healthcare system that has been festering under the surface for a couple of decades. Hospitals, and other healthcare agencies, do not want to pay nurses what they’re worth. Instead of following the free market principles through which they determine executive pay, they cry “nursing shortage,” leaving too few nurses with too many patients, trying to solve too many problems. This leaves nurses and their patients physically vulnerable- certainly emotionally vulnerable- and potentially unsafe.
As the husband of a registered nurse, and follower of healthcare news, every day I read or hear stories about nurses leaving the profession after experiencing trauma for which we barely have language to describe. “Burnout” and “caregiver fatigue” are probably desirable states compared to what is actually happening to nurses. “Trauma,” “secondary trauma,” “grief,” and “despair” seem to be more in the ballpark.
Nurses are often assaulted on the job, treated horribly from both sides by management and patients, and they are overworked. Their years of medical study and experience are often aggressively questioned by patients who’ve “done their own research” by reading posts from Russian bots on social media. Nurses are often the last people to hold the hands of patients who are dying.
Nursing education is based on the idea that there is some clear path to helping others through a combination of science and caring. The people who are attracted to nursing are some of the smartest and most caring among us. Nurse educators are not preparing nurses for the obstacles in this path. The concept of “get your own therapy” is not nearly as emphasized in nursing as it is in education for the behavioral health professions.
The result of all this is that nurses, when they’re suffering in ways they never anticipated, are essentially being asked to just “work more,” “help more.” Or they’re being given pizza by management and told that “Heroes Work Here.” Superficial office morale stuff is not going to solve this healthcare crisis. Also, nurses are not going to be able to nurse their way out of this quagmire by keeping their heads down and putting one foot in front of the other.
When helping professionals are troubled, exhausted, or traumatized, they can become depressed, anxious, irritable, emotionally numb. They can have less patience for their family, become less present for their families. Sometimes helping professionals contemplate suicide as a way out. To cope, helping professionals often turn to alcohol or drug abuse, or self-defeating eating patterns. They often become cynical and callous, unrecognizable to their younger selves when they first entered the profession.
What can we do when we find ourselves in this position? In healthcare, we are always trained to “rule out” root causes of problems. We tend to be a little less rigorous when ruling out our own demons. I always recommend that people take a personal lifestyle inventory before considering professional mental health help.
What is your exercise routine looking like? You don’t have to go to a gym to get some exercise. Are you walking? Working in the yard? Following a yoga video? People, like every other animal, were evolved to move around a lot.
What about substances? There are always memes on facebook about it being “wine o’clock somewhere.” It’s funny how social media picked up these conspiratorial rationalizations for getting drunk that existed way before the internet. In healthcare, professionals may have more access to prescription abuse. The internet has become a great source for all sorts of questionable drugs. Substance abuse is fun and soothing. However, whatever happiness you borrow from the serotonin bank, you’re going to have to pay back. The only variables are the interest rate and how long you have to pay it back. If you’re addicted, the serotonin bank is now a mobbed up loan shark that better get his money on the regular. If you find yourself unable to regulate your substance use, you could go through your off-site EAP without consequences (some people believe on-site EAP’s may be less confidential). You can get a substance abuse assessment and just hear the recommendations without having to take any action. There are 12 Step meetings in every neighborhood, some of which are specifically for healthcare professionals.
A big one for people who aren’t into substances is diet. Abusing food is like substance abuse without the moral baggage, but the cost to your physical and mental health could be equally high. Yes, nachos, soda, and ice cream are awesome. But being overweight, lacking energy, having health issues, not feeling good about our appearance are what happens in the big picture. There’s less of a formal infrastructure for food addiction help than substance addiction help [food seems like the all-American addiction?], but there is formal support available when we can’t regulate our eating on our own.
What about socialization? Family, friends, church, volunteering, groups who hike or run? When you’re exhausted from dealing with people, it seems exhausting and counterintuitive to reach out to deal with people. It’s different when they’re your people. Like exercise, it seems daunting, but you’re likely to get more energy back than you put out for a net gain of whatever you call that life force that we need to be strong and help others.
Hobbies? That thing that you like to do, or used to like to do, that has nothing to do with healthcare? Rule that out as a way to regain that life force. People like to make things, dance, be musical, learn stuff. It’s just in our dna. In a lot of video games, there’s a dynamic where you get shot by something, it drains your life force, and you have to go locate some health item to get your life force back up to snuff so that you can be ready to take out that final boss or whatever you’re up against in that game. Real life is the same, particularly in the helping professions. We get hit with real stuff that drains our life force and we have to look for that thing that recharges it.
If you can rule out all of the above and still feel like you’re bottom feeding in the pond of life, consider seeing a therapist. Sometimes when we see ourselves in a cage, someone other than ourselves might notice “Hey, that looks like a key” laying right there on the ground. Other people, who aren’t involved in our personal lives, can help us see things that we can’t because we’re too engaged in our own habits. Antidepressants may be helpful if therapy isn’t cutting it.
Nurses probably need strong unions and political lobbyists to push for real world solutions. They probably need to talk to each other and support each other more. In the absence of immediate external solutions, counseling may be a path to finding peace and meaning while surrounded by chaos.
r/nursing on reddit has some of the funniest, most insightful, most irreverent stuff about nursing. You will not feel alone.