Nurses and burnout
What you can do to prevent it

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By Valerie J. Nelson

Do you remember why you became a nurse? If you think you’re too busy to slow down to contemplate an answer, that may be all the more reason to make the time. You could be a candidate for the nemesis of healthcare workers challenged by an ever-changing, stress-inducing landscape. It’s the big “B”—burnout.

The very word conjures up such negative images that a counselor at the University of Texas M.D. Anderson Cancer Center in Houston thinks it’s time to update the aging term, which was borrowed from the space industry. Instead of focusing on “avoiding burnout,” she prefers to think of it as “learning to stay well.”

“The imagery [of burnout] is negative to our cause,” says Mickey Bumbaugh, MEd, a senior counseling specialist at M.D. Anderson. She says the secret to having enough energy to keep giving compassionate care lies in creating a positive environment within yourself through meditation and positive thinking. You might think, “She doesn’t know the pressures I’m dealing with,” but Bumbaugh’s approach goes to the heart of the message from many counselors of healthcare professionals: Don’t forget to take care of yourself.

Kathy McGregor, RN, tries to get the same simple message across. Her company gives “burnout prevention” workshops for nurses, who are increasingly facing jobs laden with more responsibilities and less time to carry out their duties. “Remember to breathe,” she said. “Take care of yourself, and other natural boundaries occur.”

McGregor knows firsthand about the dangers of a high-stress job. She experienced such debilitating emotions that she woke up one day unable to return to her position as an AIDS hospice nurse at a hospital. “I kept telling my manager, ‘I am not OK,’ and crying all the time. They kept saying, ‘Hang in there. You are a great nurse.’ ” But such praise can actually contribute to burnout. “If someone says I’m doing great, I feel like I have to keep going,” McGregor said. “And the deal is, you don’t have to.”

As part of her own healing process, McGregor started Heal Thy Self Health Consultants two years ago with another nurse in Memphis, Tenn. “I want to teach other nurses not to let happen to them what happened to me. God called me to do hospice nursing, but right now I can’t do patient care,” said McGregor, who is suing her former employer for lost wages.

The first thing McGregor advises is to take care of yourself physically, emotionally, and spiritually. Bumbaugh also emphasizes taking care of your inner self. A handful of nurses she has counseled are reading one of a number of books about caring for the soul.

“If you are going to work anyplace where there is a high burnout rate—oncology, neonatal, ICUs, hospices—the manager needs to tattoo the number of the employee-assistance program on the nurse’s forehead,” McGregor said, only half-jokingly.

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Such counseling programs can help. But in the ongoing age of downsizing, they may be among the programs that are shuttled out the door. Because fewer healthcare settings have the staff for internal support, more people may be turning to outside sources for help. And that may give the appearance that burnout is occurring at a higher rate, according to Kate Muzzarelli, RN, a clinical practice specialist with the American Association of Critical-Care Nurses (AACN) in Aliso Viejo.

“Burnout has always been a problem to a certain extent. I’m not sure if we’re recognizing it more or if it exists more,” said Muzzarelli, who answers the AACN resource and information hot line. Of the 20 calls she fields a day, about half are related to stress. Those anxieties often stem from changes in staffing patterns and care delivery, such as the increased use of unlicensed assistive personnel.

“Sometimes, you are letting the person vent and working through the issue with them,” Muzzarelli said. “Lots of the time, I don’t say much other than confirming with them what is happening in health care. I let them know they are not the only one who is experiencing such changes.” Muzzarelli emphasizes that she doesn’t solve problems for callers, but tries to connect them with sources that can help.

“Recognizing burnout is getting halfway there,” she said. “If you have a supportive work environment, as far as your peers, find support in each other. Feel like it’s OK to ventilate. Recognize your feelings are normal.”

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The UCLA Medical Center has made venting a small, but important part of the job of many who work there. Nurses and other healthcare workers attend weekly or monthly “Teas for the Soul.” There is no agenda, just an hour set aside for a hospital unit to meet with a chaplain to discuss the stresses of the job. Soothing music is played, a nice tablecloth and flowers adorn the conference table. The aroma of herbal teas filters through the room; the most popular is one called “The Tension Tamer.”

The Rev. David Myler, director of pastoral care and supervisor of clinical pastoral education at the medical center, came up with the idea for the teas 2 1/2 years ago. His idea was a response to the tremendous stresses nurses faced as they coped with the changes brought about by managed care.

“We found that nurses were taking less care of themselves, not taking lunch breaks, not feeling comfortable sitting down and relaxing for a minute,” said Myler. His staff now stages teas for about 25 units at the medical center.

“It’s a way by which we can de-stress ourselves and talk about things that bother us, such as questions about justice and fairness that we can’t talk about in the presence of patients and families,” said Malou Blanco-Yarosh, MSN, RN, clinical nurse specialist and clinical manager in the UCLA Medical Center’s department of nursing and an assistant clinical professor at the UCLA School of Nursing.

When it recently looked like Blanco-Yarosh’s department tea was not going to be held, her staff demanded a substitute chaplain be sent so they could meet as usual. “To sit down and relax refreshes your soul,” she said.

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Programs such as UCLA’s certainly help healthcare workers realize the benefits of slowing down to take stock of their emotions. But Bumbaugh cautions that there is no quick fix to peeling away the layers of stress.

“Healing comes from our ideas and feelings about ourselves. There are a lot of how-to checklists, but they are kind of one-dimensional,” she said. “I’ve seen a thousand how-to lists. If you do all of these seven behaviors, you’ll be fine. There’s nothing wrong with those, but they aren’t very linear. They don’t reach the whole person.”

The days of management’s taking care of a nurse’s problems are gone, Bumbaugh said, which means nurses need to be aware of the stresses they are enduring. “A nurse should ask: Am I looking to management to fix all of my problems? To take care of me? If that’s the case, I am going to be frustrated. Nurses are expected now to practice more independently,” she said.

There is one question that nurses can ask themselves that quickly centers their thoughts, and the answer is always the same, Bumbaugh said. It’s always about “caring.” It’s just that nurses need to remember to care for themselves, too.

The question: Do you remember why you became a nurse?