Burnout

This past week was a rough one. We all have them from time to time. I can’t pinpoint exactly why, but driving back to work for four shifts over the weekend was difficult. The temptation to call out and avoid responsibilities was strong as ever, but so was the realization that doing so would only make me feel worse. It may have been partially because that work stretch fell on Halloween, a time I would much rather be at costume parties and watching spooky movies with wine/cider in hand… but instead I spent my halloweekend working and sleeping.

During my drive, I was trying to identify the cause(s) of my unhappiness. Was it job-related? Or everything else? I think it’s a little of everything but less so the work and more so everything else. Still, burnout could definitely be a part of it, and for many in the healthcare profession, it is a constant stressor. When my non-healthcare working friends ask me about my job and how it’s been during the pandemic, I struggle to fully articulate the experience. So many experiences and feelings, many of which those who haven’t been at the bedside may struggle to fully imagine. But one thing I can tell them, is that over the past year, there has been a noticeable change to the environment. At least for me it has been noticeable, when compared to how it was when I started (which was only 3 years ago!).

For a little perspective, here’s a little glimpse into work this week. A pretty typical work week, there have definitely been worse as well as better. Each of the four nights I spent on different units, with different types of patient assignments. The first (and oddly most chill night) was with 6 med-surg/tele patients (and no aide naturally). Common theme that night was pain meds and hygiene. Noteworthy patients that night included: a 32 year old with bilateral BKAs, a left arm amputation and now a NASTY right arm wound from IV drug use requiring amputation (which he was unfortunately refusing). I honestly felt bad so bad for him, and couldn’t imagine that pain. Nor the life that lead him there. Then there was the adorable 95 year old woman from home in for a fall (a classic). Next night was 5 patients including an admission, discharge and transfer in. Similar theme that night, pain control and hygiene. Third night, things began to get busier. 4 patients, including one trach’d, PEG’d, nonverbal, immobile, swollen, end-of-life/hospice (yet full code) patient, a fresh post-op ICD removal & external pacer placement patient, a frequent ringer in pain from new liver/kidney transplant, and a confused grandpa in for a fall (who I might add had a wicked right hook). Finishing strong for night 4/4: 4 neuro patients including 2 strokes (one occurring on shift), a pleasant 24-year old(but with sad story) with craniotomy and trach post gun shot wound to head, and a transfer from ICU with trach, nasogastric tube with feeding, peritoneal dialysis q4, fecal management system, and off/on seizures. Phew.

Kudos to the critical care & ED nurses out there who manage these patients - and BEFORE they are stable enough for transfer to the floors. Stable or not, those last two assignments especially made for busy nights, with nursing skills I do not frequently utilize. There were several moments I caught myself afraid I may not be able to provide adequate care to these patients. I don’t say this to complain, or say that the assignments are necessarily inappropriate. Yes, more staff and better ratios would DEFINITELY be beneficial, but all the patient’s were manageable (at least this week!). Just busy at times. And at the end of the week, I was pretty happy with the care I provided and knowing I was able to manage the assignments (I think) well.

I find myself often wondering if bedside nursing truly has changed as much as it seems, or if it’s all in our heads. A byproduct of a pandemic and constant media coverage. Maybe I’m just playing Devil’s advocate, as I said it definitely feels different to me, but why? And how long until it returns to normal, if it will at all? I know some places are REALLY hurting for bedside nurses, and many are being worn thin, especially in the covid units, and I myself am tired of the same old struggles. Poor staffing, poor resource availability, etc. All in all, making the profession I chose, one I am questioning more and more with each passing day. And it’s obvious I am not alone. Almost every nurse I have worked with has either considered, or is actively pursuing a career path that will take them away from their current bedside role. Some taking travel assignments to avoid feeling shackled to their place of work (and receive adequate compensation for their struggles). Some hope NP/CRNA will be better. Others opting for the educator route. Management. Sales. Outpatient. You name it. All proof of the unanimous truth - nurse’s are feeling burnt out and jaded.

And not just inpatient, bedside nurses. Also those in the outpatient settings. The nursing homes. Management. Sales. You get the picture. Lots of us are tired, and lots of us are stressed. Making career changes and switching from one role to another is just our way of pursuing a (hopefully) better future. True, some are in their niche and remain satisfied for the most part. But more and more of us are being faced with the bitter reality of job dissatisfaction. For those like me, who are unsure what direction to pursue, travel nursing offers an opportunity to at least earn better money while shaking things up enough to avoid experiencing burnout in the same places.

So. How do we combat burnout? And what does it mean for the industry as a whole? No really, answers would be appreciated (so feel free to comment below). I have a few ideas, and have read/listened to numerous perspectives on the topic, but remain unsure how to stave off burn out. So far, I’ve been taking it one day at a time, and often forcing myself/pretending to be happier at work than I maybe feel initially. The intention being, if I try hard enough to convince myself I am satisfied and enjoy my work, that will become my reality. I do believe our minds and thoughts can shape our realities, but simultaneously see how crazy it is to ignore the truth that is plain as the nose on our face. But “the patients have it much worse than the rest of us”. I remember being told just to think of that when feeling worn. Can’t deny the logic, and I do realize there are plenty of people out there who have it worse, but as an empathic individual, constantly caring for others above yourself can also be a cause of burn out. And if you’re anything like me - will result in a nurse just doing their job, possibly very well, but no longer genuinely caring.

I can’t say with confidence that I will remain at the bedside for 25+ years like some of those amazing senior nurses. Although our healthcare system could definitely use some improvements, I don’t even know where to REALISTICALLY begin. Initiatives to combat staffing shortages? Supply shortages? Or maybe community education/prevention strategies to encourage people taking ownership of their own health and avoid needing acute medical care in the first place? Whatever the next steps may be, for now it’s just one day, one shift, at a time.