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Who You’ll Hear
Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.
Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center
Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.
What You’ll Learn
- Appropriate Boundaries
- Staffing
- Self Compassion
- Burnout
Appropriate boundaries between home and work
- It’s very easy for our identity wrapped up in our profession.
- Especially in nursing we have a tendency to over-extend ourselves because we feel we are doing it for our patients.
- A harsh truth to understand: our employers are replaceable to us, and we are replaceable to our employers.
- Your employer is a business and they will take from you as much as you are willing to give.
It is the hospital’s job to staff the unit.
- It feels great to come in and be that extra nurse that picked-up. Your coworkers are incredibly grateful and it feels good.
- But! It’s not your responsibility to take care of your coworkers. It is your responsibility to take care of yourself.
- You need time away from work to rest and reset– it will ensure you have the focus and attention to detail that is needed when caring for the lives of your patients.
- Don’t set yourself on fire to keep others warm.
- This means becoming comfortable saying “no thanks,” and not feeling obligated to provide a reason why.
Self-compassion
- Regulating your emotional response by recognizing an emotional stimulus, choosing to acknowledge it, and leaning into it with a balanced awareness.
- It helps you to avoid falling into the pain your patients are enduring or over-identifying with a mistake or failure.
- It’s something you must do in the moment, as you are experiencing a tough situation.
- Three components of self-compassion
- Mindfulness
- Acknowledging the difficulty of the moment and putting a name to the emotion you are feeling
- Allowing the emotion to visit you, but not hijack you
- Common-humanity
- We are all fallible humans that have imperfect life journeys.
- We tend to get lost in the negative emotion associated with a mistake or failure, and then isolate ourselves in that.
- Must conscientiously remind ourselves that everybody makes mistakes, everybody struggles.
- Self-kindness
- Warmth and gentleness towards yourself
- Saying to yourself the things you very naturally say to others when offering comfort and support
- “It’s OK, I’m gonna get through this.”
- Mindfulness
- Think of it like exercise for your brain. The more you practice it, the better you get at it and more natural it becomes.
- Nurses who frequently practice self-compassion have lower rates of burnout.
What nurse burnout looks like
- Have you become cynical or critical at work?
- Do you drag yourself to work or have trouble getting started?
- Have you become irritable or impatient with coworkers or patients?
- Do you lack the energy to be consistently productive?
- Do you find it hard to concentrate?
- Do you lack satisfaction from your achievements?
- Do you feel disillusioned about your job?
- Do you use food, drugs, alcohol, etc. to feel better or simply not feel?
- Have your sleep habits changed?
- Are you troubled by unexplained headaches, bowel problems, or other physical complaints?
How to deal with nurse burnout?
- Prevention is key!
- Start addressing the situation before you are answering yes to many/most/all of the questions above.
- Exhaustion is not the requirement for rest. It’s a sign that you’ve waited too long.
- Self-care
- Should not just be distractions (social media, shopping, over-indulgence) or escapes from normal life (partying, vacations).
- Genuine self-care is a lot more about rest, routine, boundaries, gratitude.
- Many of us at the bedside are experiencing secondary trauma which may be driving the burnout.
- Out of self-preservation, we cut ourselves off, which then prevents us from connecting with anything at all.
- Find out if your institution has an Employee Assistance Program (EAP). These counselors are trained to work with healthcare providers.
- Setting appropriate boundaries
- Requires developing assertiveness, to speak with respect for the other person and for yourself.
- This applies to interactions with patients, providers, and coworkers.
- If someone reaches your boundary it is up to you to inform them of that.
- “I am your nurse and I’m here to take care of you. I will treat you with respect, I ask the same in return”
- “Excuse me, the way you’re speaking to me is disrespectful and there is no need for that.”
- Don’t say “I’m sorry.” It’s tough, but you do not need to apologize to someone when they are being disrespectful to you.
- Always remain professional (do not hold a grudge or shun the person for the rest of the shift).
- Even if the interactions/requests are kind-hearted (ex: patient wanting to be friends on social media) or accepted as part of the culture of your unit (ex: coworkers talking about their sex lives) you need to find your own boundaries of what you are comfortable with and stick to them.
Final thoughts
- Our emotions are something we feel, but they are not who we are.
- Self-compassion is being mindful, having a sense of common humanity, and practicing self-kindness.
- Set appropriate boundaries, and respect others when they do the same.
- Practicing self-compassion and setting boundaries can make this stressful and exhausting job doable.
YouTube Video of Episode
More Resources
- Work/Life Balance Fresh RN Blog
- Whole Life Nurse on Instagram: instagram.com/wholelifenurse or @wholelifenurse
- Breakthrough ICU: A Crash course for New ICU Nurses discusses self-compassion and assertiveness
- Job Burnout: How to spot it and take action – Mayo Clinic
- Self-Compassion resources directly from Dr. Kristen Neff
- Buczynski, R., et. al, (2019). Clinical applications of compassion: How compassion-oriented therapies work and what makes them so effective. [Video lecture]. Retrieved from nicbam.com.
- Buczynski, R., et. al, (2019). Clinical applications of compassion: The neurobiology of compassion. [Video lecture]. Retrieved from nicbam.com.
- Decety J, Yang CY, Cheng Y. (2010). Physicians down-regulate their pain empathy response: an event-related brain potential study. Neuroimage. 2010; 50(4):1676–82. doi: 10.1016/j.neuroimage.2010.01.025
- Duarte J, Pinto-Gouveia J, Cruz B. (2016). Relationships between nurses’ empathy, self-compassion and dimensions of professional quality of life: a cross-sectional study. Int j Nurs Stud. 2016; 60:1-11. doi: 10.1016/j.ijnurstu.2016.02.015.
- Gracia-Gracia, P., & Oliv ́an-Bl azquez, B. (2017). Burnout and mindfulness self-compassion in nurses of intensive care units. Holistic Nursing Practice, 31(4), 225-233. doi:10.1097/HNP.0000000000000215
Hello, my name is Katrina. I am a registered nurse in Dutchess County, NY, U.S. I am also a student at SUNY Plattsburgh completing an RN to BSN program. Thank you for your efforts to draw attention to nurse burnout.
I myself am currently advocating for NYS assembly passing bill A01532, the Safe Staffing Quality Care Act. The correlation between adequately staffed nursing departments and positive patient outcomes has been substantially documented within scholarly nursing literature. What studies have found is that for each understaffed shift that occurs it increases a patient’s risk of death by 2% (Helfrich et al., 2017). It also increases risk for falls, pressure ulcers, medication errors, and missed tasks by nurses (Needleman et al., 2011; He et al., 2016). All of this then results in patient perceived lower quality of care (Qureshi et al., 2019). A direct correlation between inadequate staffing and nurse burnout has also been extensively documented.
In the US through the offices of Medicaid and Medicare reimbursement has been modified based off of lower quality care, lower patient satisfaction, and readmission rates (Mason et al., 2016).
According to Mason et al. (2016), nursing accounts for approximately half of labor budgets in most hospitals, making nursing labor an enticing area to reduce cost. However, quality of care, patient satisfaction, and readmission rates all directly tie into nursing care.
California currently has state mandated nurse to patient ratios (NPRs). Due to mandated NPRs, nurses in California have reported an increase in completion of nursing tasks with improvement of quality patient care (Aiken et al., 2010). Additionally, with mandated NPRs, California has been able to actually increase hospital revenue as a result of decreasing costly complications, and complete documentation (Aiken et al., 2010).
It is clear that safe staffing not only promotes patient care but the work environment as well. I am hoping adding to your blog will assist in educating and advocating for safe staffing, not just in New York State, but across the US. Thank you for the ability to share on your blog!
References
Aiken, L., Sloane, D., Cimiotti, J., Clarke, S., Flynn, L., Seago, J., Spetz, J., & Smith, H. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904–921. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-6773.2010.01114.x
He, J., Staggs, V., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BioMed Central Nursing, 15(60), 1–10. https://bmcnurs.biomedcentral.com/track/pdf/10.1186/s12912-016-0181-3
Helfrich, C., Simonetti, J., Clinton, W., Wood, G., Taylor, L., Schectman, G., . . . Nelson, K. (2017). The association of team-specific workload and staffing with odds of burnout among VA primary care team members. Journal of General International Medicine, 32(7), 760–766. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481228/pdf/11606_2017_Article_4011.pdf.
Mason, D. J., Gardner, D., Outlaw, F., O’Grady, E. (Eds.). (2016). Policy and politics in nursing and health care. 7th ed. St. Louis, MO: Saunders.
Needleman, J, Buerhaus, P., Pankratz, S., Leibson, C., Stevens, S., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037–1045. https://www.nejm.org/doi/pdf/10.1056/NEJMsa1001025?articleTools=true
Qureshi, S., Purdy, N., Mohani, A., & Neumann, P. (2019). Predicting the effect of nurse–patient ratio on nurse workload and care quality using discrete event simulation. Journal of Nursing Management, 27(5), 971– 980. https://www.researchgate.net/profile/Sadeem_Qureshi/publication/330995414_Predicting_the_effect_of_Nurse-Patient_ratio_on_Nurse_Workload_and_Care_Quality_using_Discrete_Event_Simulation/links/5e69ba79458515c5de628534/Predicting-the-effect-of-Nurse-Patient-ratio-on-Nurse-Workload-and-Care-Quality-using-Discrete-Event-Simulation.pdf