Today I synthesized some emails sent to me by other members of the cohort into a formal "discussion response" to the last of four questions posed to us by our faculty. The question was "As you consider employment over the next year what are potential strategies in preventing burnout?".
Unlike a true "discussion", however, the discussion forum they've set up is merely a repository for our formal responses, followed by paragraphs of "great job! I agree with you! This reminds me of something very similar to what you said!", without any true discussion taking place. This irritates me.
Anyway, here's what I wrote:
Who Guards the guards?
Who Polices the police?
The long garden-party of Student Nursing is about to come to a close, and soon we will become responsible for the health, safety, and general well-being of our communities. This responsibility is handed down to us through Law, through our personal and professional codes of Ethics, and our own biosurvival needs for gainful and fulfilling employment.
The World Health Organization has called job stress a "World Wide Epidemic", costing American industry in general 200-300 billion dollars annually. The US Bureau of Labor Statistics ranked "neurotic reaction to stress" as the fourth most prevalent disabling workplace injury (Medi-Smart, 2004).
Few would argue that Nursing is a profession typified by lower-than-average levels of stress. TRCC Clinical group Five supported this nicely by citing studies that reveal some worrisome figures about Nursing in particular in relation to Job Stress and burnout, particularly the fact that the rate at which new RNs leave their first position is higher than the turnover rate for RNs in general, for reasons directly related to Job Stress at that particular facility (Dufour, 2008).
The human physiologic stress response is a beneficial and necessary feature of our neuroendocrine system that allows domesticated primates such as ourselves to adjust our senses and our metabolism to meet (sometimes rapidly) changing demands (Medi-Smart, 2004).
Our own reaction to the experience of stress is the key factor in determining if the stress response is adaptive or maladaptive. When stress is allowed to persist and become chronic, numerous symptoms often develop, such as irritability, weight changes, frequent headaches, gastrointestinal disturbances, chronic fatigue, insomnia, depression, feelings of hopelessness, negativity and angry outbursts (Zerwekh, 2006).
Now imagine that person with a stethoscope around their neck. Would you want to be that person's patient? Would you want this person to be your teacher, your employee or your coworker? How about yourself? Obviously, no one -wants- to suffer from chronic stress, and yet it is a problem of pandemic proportions (Medi-Smart, 2004).
To answer the riddles/koans posed above, consider that Guards and Police, by virtue of their specialized nature and responsibilities, are charged with the burden of guarding themselves, policing themselves.
So, who cares for the caregiver? Can you guess the answer?
The Nursing Process itself offers the solution. Assess, diagnose, plan, implement, evaluate. Recognition of the symptoms of Job Stress and Burnout are vital in any practitioner's self-care strategy (Timmerman, 1999). Once symptoms have been detected through routine self-assessment, an analysis can take place to identify deficits in self-care, which may then be ameliorated by changing diet and exercise routines, workload, or even one's outlook (Zerwekh, 2006).
The ability to self-assess is not an easy one to develop, and so establishing a network of peer-support is of vital importance. In working together towards a common goal, one person's breakdown can soon effect everyone, so it's necessary to not only care for and support your peers, but to ACCEPT that support from -them- at the same time by resisting defensiveness and egotism.
Treatment of Burnout after the symptoms are evident, of course, would not qualify as "Primary Prevention", which is commonly understood to be the most efficient, effective, and elegant mode of treatment. We most effectively treat pressure ulcers by not allowing them to happen in the first place, for example. It's far easier to prevent a nosocomial infection than it is to treat it once it's taken hold.
Graduate Nurses can save themselves a lot of anguish and frustration by doing a little research on the facility where they plan to enter into practice. What do you think of your future employers? Your future co-workers? What are the patient-to-nurse ratios like? Did you get to meet any of the preceptors? Talk to the staff (staff YOU select to speak to). Do they feel like they can speak their minds and raise concerns freely? You can maximize your control over this by asking and answering these questions early, so you can apply to the facility that is truly your choice and not just the facility that has openings left. Other GNs are doing their homework, too, and the facility with openings "left over" is likely to be the one where no one wanted to work (Formanek, 2008).
Don't be afraid to speak your mind, and don't settle for a Bad Situation just because you don't want to look for another job. There are plenty of opportunities in the Nursing field, and you have to put your own life and happiness above that of your employer and even your patients. The alternative can be ruinous to yourself and your family, who may depend on you for support as much as you depend on them. Equally ruinous is the effect on your patients if their caregiver feels trapped and miserable (Formanek, 2008).
Whether you live to work or work to live, having a life that is separate from work (even if it's shared with coworkers) may be a crucial strategy to avoid burnout. One major impediment to this is taking a lot of overtime shifts. We all need more money than we have, and those shift-differentials sure are tempting, but self-care has to come first if we are to preserve our licenses, patients and sanity.
So, my friends and future colleagues, take care of yourselves, take care of each other, and together we'll take care of everyone.
Claborn, J., & Zerwekh, J. (2006). Nursing Today: transition and trends (5th ed.). St. Louis: Missouri Saunders.
Dufor, M. (2008, April 25) Final Posting [Msg 1]. Posted to http://vista.ctdlc.org/webct, archived at http://vista.ctdlc.org/webct
Formanek, F. (2008, April 21) RE: discusion topic [Msg 2]. Message posted to http://vista.ctdlc.org/webct, archived at http://vista.ctdlc.org/webct
Medi-Smart (2004). Facts about workplace stress. Retrieved April 17, 2008, from http://www.medi-smart.com/stress1.htm
Timmerman, G. M. , (1999). Using self care strategies to make lifestyle changes. Journal of Holistic Nursing, 17. Retrieved April 17, 2008 from http://jhn.sagepub.com/cgi/content/abstract/17/2/169.