Posts under ‘burnout’

Talking with an acquaintance at a cafe this evening, I mentioned that I’m on a leave of absence from work due to stress and overwork. Her response was, “Oh, so you’re detoxing from work?” I didn’t have to think about it for more than a moment before answering, “Absolutely. By the way, can I use that phrase?” She nodded approvingly.

Recently, an anonymous commenter on Digital Doorway responded to a post I wrote about nurses and stress. He or she wrote the following:

“One major reason why nurses are stressed is because hospitals are understaffed. Management has been able to get away with this understaffing because they don’t have to pay for workload-related chronic stress injuries.

“This is discrimination against psychologically injured workers who succumb to excessive WORKLOAD by getting depression or other chronic stress diseases.

“The hard-working employee who sustains a mental injury due to overwork is left without compensation which means they usually then go through a downward spiral of bankruptcy, loss of home, loss of pension and all the further stress that goes along with poverty.

“No wonder we have a health care worker crisis!“

The commenter makes some salient points. Taking my circumstance into consideration, seven years of working with trauma survivors and giving my all to the care of vulnerable individuals has led me to make a decision to take six weeks of unpaid leave in order to collect myself and heal. Why, within this society, are individuals serving the poor, ill and traumatized left to their own devices when it comes to recovering from providing such a public service? Why must burned out teachers and nurses take unpaid leave and use up their personal savings at a time when their service has exacted a psycho-emotional toll on their health?

Now, to draw an apt comparison, if a professional baseball player experienced undue stress and psychological trauma from the vigors of the season’s play, would he need to eschew his multi-million dollar salary in order to take a six-week leave to clear his head and regain balance? Would he be forced to use his savings to pay his bills and care for his family while he recuperates? Would some portion of his astronomical salary be withheld? That baseball player, handsomely compensated for his work (which, in my mind, bestows precious little benefit on humanity), will have little difficulty making ends meet while he rests and recuperates.

Furthermore, as an individual appreciated and respected far above the nurses, social workers, factory workers and teachers who are truly a part of the backbone of the society, the athlete in question will have no fear of income loss as a result of his temporary disability. In fact, a guest appearance on Oprah or a Newsweek expose on the psychological stresses of professional sports would most likely be in order. Our athlete suffers in ways which may actually enhance his career.

On the other hand, take a burned-out nurse like myself and consider my options. While I may have the Family Medical Leave Act to allow me up to 12 weeks unpaid time off, short-term disability insurance does not allow for disability for mental health or substance abuse. In fact, many long-term disability insurance policies also exclude a mental health benefit. Parity for those suffering from mental health-related injury are basically left out in the cold.

The conundrum is thus: if I injured my hand at work caring for a patient, workers’ compensation would be a no-brainer. But if I injure my soul at work? I’m on my own.

Thanks to a comment on yesterday’s post, I was recommended to read this article on stress and healthcare workers. Brief and to the point, the article elucidates that Canadian “nurses, doctors and lab technicians have the highest levels of stress related to their jobs” of all interviewees, with 45 percent reporting that there work was “quite” or “extremely” stressful.

The International Labor Organization has identified nursing as an industry with relatively high levels of stress and burnout. In identifying the sources of stress in nursing, they elucidate thus:

“The role of nursing is associated with multiple and conflicting demands imposed by nurse supervisors and managers, and by medical and administrative staff. Such a situation appears to lead to work overload and possibly to role conflict. One form of such conflict often mentioned in surveys of nurses relates to the conflict inherent in the instrumental and goal-oriented demands of “getting the patient better” and those related to providing emotional support and relieving patient stress. Role conflict of this kind may be most obvious when dealing with patients who are critically ill and dying. Indeed, one of the areas of nursing that has attracted particular attention has been critical or intensive care nursing. Health care is also a sector which suffers a high rate of violent behaviour (see our pages on violence at work).

“Many studies on stress in nursing have attempted to measure, or have speculated on, the effects of such stress on nurses’ health and well-being. There appears to be general agreement that the experience of work-related stress generally detracts from the quality of nurses’ working lives, increases minor psychiatric morbidity, and may contribute to some forms of physical illness, with particular reference to musculoskeletal problems, stress and depression.”

Hmmmm, says the nurse on medical leave of absence.

In South Africa, stress has been identified as the major cause of a nursing shortage in the setting of HIV/AIDS care. The BBC reported earlier this year that stress was harming nurses’ sex lives, causing nurses to smoke more, and that stress-related absences from work costs the British National Health Service more than 300 million pounds per year.

Many nurses complain about frozen wages, lack of clinical supervision, increasing nurse-patient ratios, and rapidly shrinking benefit packages. While loss of benefits and frozen wages are ubiquitous across the general workforce (unless you’re a CEO, member of Congress, movie star, or professional athlete, of course), nurses face other stressors which are singular to their profession. Workers in other professions also naturally face challenges typical to their careers and workplaces, and each of us can truly only speak from our own work experience.

We simply have to face the facts. Americans (and workers in other countries, as well) work too hard, earn too little, have paltry time for vacation and leisure, and are expected to marry their jobs to a degree never before expected in the history of labor. Unions have slowly been dismantled and vilified over the last century (especially here in the US), and healthcare benefits have crumbled, leaving many of us paying higher premiums and copayments for office visits, procedures, and medications. With housing costs and fuel costs through the roof, our paychecks have less buying power than they used to, and those of us in the middle class and working class are left to pick up the crumbs left behind by the 1 percent controlling the wealth.

Are nurses stressed? Of course we are. We earn moderate incomes within a high-stress industry where workloads have exponentially increased and benefits faltered. Retirement seems less than certain, the economy continues its volatile course, and the healthcare industry asks more and more of us without offering any further compensation. Still, I never regret my career choice, and have even encouraged others to walk this path. Nurses are always needed, work is generally easy to find, and when the economy hits bottom, we will still be irreplaceable, since illness never takes a holiday.

So, what’s an earnest nurse to do, you ask? Dedicated to my chosen career, I take a few weeks to reassess my options, care for my body and mind, soul and spirit, and plan to reenter the fray with—perhaps—a hopeful and newly-minted outlook and approach. I have been ravaged by the effects of stress and vicarious traumatization, and I now attempt to reconstitute myself during this brief hiatus. I consider myself both lucky and blessed, and pray for my nursing brethren who are unable to afford the luxury of such self-care. May we all be free from suffering.

After eleven years of providing direct nursing care—all in ambulatory settings, mind you—I wonder when it will be time to take a break and approach my work in the healthcare field from another vantage point. While I, like many nurses, thrive on the interpersonal relationships which nursing engenders, I also long for a rest from the emotional tugging which is part and parcel of my work.

But what is it about that “emotional tugging” that is so exhausting, you ask? The answer, to a large extent, is vicarious traumatization, wherein the act of bearing witness to the trauma of others can lead to internalization of trauma and psychic distress by the clinician. Several studies cited on the American Psychological Association website conclude that clinicians with their own personal trauma histories are more likely to experience deleterious effects when working closely with patients experiencing trauma.

Taking into consideration that the majority of my patients have suffered multiple traumas and live chaotic and difficult lives, I am consistently in a place of feeling unable to fully relieve the suffering of those around me. Confronted day after day by individuals whose suffering continues largely unabated, I surmise that my own level of suffering appears to have concurrently elevated, perhaps in response to those for whom my efforts seem to have little effect.

Many of my patients experience depression, anxiety, PTSD, and other forms of mental illness and psychic distress, not to mention chronic pain. Interestingly, my own depression, distress and physical pain symptoms have become significantly exacerbated in the last few years, leading me to more fully appreciate and understand my patients’ suffering based on my own experience. Having been diagnosed myself with PTSD six years ago following a friend’s murder, I appreciate the long-lasting effects of such experiences and the immeasurable difficulty of recovery.

The concept of vicarious traumatization is one which we all—clinicians and non-clinicians alike—might understand, but it is only now, as my own physical and psychic suffering has become augmented, that I more fully comprehend the insidiousness of its impact on the unwary clinician.

Luckily, this Thursday, I will attend a “Behavioral Health Grand Rounds” at a local hospital, where several experts on vicarious traumatization will present their research, their findings, and their recommendations to those of us interested to know more. As my leave of absence approaches at the end of this week, this particular presentation could not be more timely. I welcome this information, and also welcome the self-realization that it may engender.

Please feel free to surf over to Nurse Linkup to read my latest article published there, specifically about nurses and burnout.

These last few days have left me feeling pummeled, stretched to the limit, thoroughly beaten. The word “browbeaten” came to mind as I drove home, and the definition on dictionary.com seems fitting to my mood.

Browbeaten really means intimidated or bullied, and this does indeed coincide with my feelings today. This sensation does not arise from an individual—or even a particular institution, for that matter. I feel bullied and beaten about the ears by the “system” at large—that of healthcare, of politics, of economics, of that which creates, sustains and propagates poverty and its discontents.

There is no one in particular to blame, no single finger which I can point, other than to say that, on many days, I feel like I’m working against a tide which has no fixed point of reference, upon which few buoys float which offer respite from the constant treading of water. While I am not defeated, I’m certainly deflated, like someone let the air out of my tires and there’s no filling station for miles.

Taking the definition of browbeaten at face value, I feel intimidated by the seemingly endless struggle against entropy and helplessness that so many of my patients present at my doorstep. I see such pain in their pleading eyes which yearn for me to offer the magic bullet to separate them from their constant suffering. My inability to assuage their suffering—and their persistent requests for such magical powers on my part—often leaves them disappointed and me exhausted. Today is a day in the middle of the week when that exhaustion seems like it could preclude all further constructive action by me on their behalf.

But will it?

My answer, as always, is no, that I’ll get up tomorrow and try again. But this heaviness of heart and fatigue of the spirit sure do weigh one down.

As I write, my dog ambles over and forces her muzzle underneath my arm, using a jerking motion to detach my hand from the keyboard. She’s signalling me that it’s time to get out of my head and get down on the floor with her, returning to the present, the reality of having a body, and the comforting softness of a dog’s fur to stroke. I’ll cease and desist now from my rant of discontent, and hope that relief comes tomorrow in whatever form it desires.

Now, it’s the floor for me, and the comfort of canine company.

Those of us who work with people with HIV and other immune disorders understand the concept of “immune reconstitution”, when the patient’s treatment of the virus eventually begins to restore the immune system. There are positive and negative aspects of this process, but the overall returning of immune function is a good thing in the end.

Just as immune systems must reconstitute, so do nervous systems, especially the nervous systems of stressed nurses whose lives seem to have gotten the better of them. Sometimes Nervous System Reconstitution entails taking time off to relax, be at home, and practice good basic self-care. Sometimes it means increasing exercise, sweating out the toxins and stress, working tired muscles into shape. At other times, food and drink is the answer, vital elements from nature literally feeding the cells, nourishing the tissues. Drinking water is important for cleansing cortisol, a stress hormone, from the body, and exercise also helps in this regard.

The prudent nurse or healthcare professional will decide to do what it takes to nurture the nurturer, prevent stress-based illness, and bring balance to the mind, body and soul. Many other modalities of Nervous System Reconstitution are there for the taking: friendship; creative pursuits; enjoyment of the arts; sports; taking care of one’s responsibilities at home; pets; cleaning and organizing to decrease the stress of disorganization; time with children (or not!); meditation and other spiritual practices; yoga; massage; cooking; the pursuit of hobbies; gardening; the list is endless.

How can we as healthcare professionals, burnt out and crisp around the edges, hope to foster and encourage healthy living in our patients when we are walking on the edge of personal oblivion? How can we be so disingenuous as to expect our patients to follow our advice when our poor example is written in the lines of stress on our faces, in our hollow and fatigued eyes sunken with lost sleep and overwork, our short tempers, our obvious burn-out?

I have had a patient with a diagnosed thought disorder look at me and say, “You look really tired.” I’ve had other patients look concerned and ask, “Did you eat lunch today?” Whether the patient is mentally ill or physically ill, our stress is perceived, and although we think that the world at work will fall apart without us, we eventually learn that the clock at work travels from 9 to 5 (or 3 to 11, or 11 to 7) whether we’re there or not, and our well-meaning colleagues are entirely capable of covering for us when we’re gone. We can make ourselves indispensable in the big picture, but that little picture yearns for a time out, and if we don’t give it its due, it will come back to haunt us with a vengeance, bringing illness and unhappiness along for the ride.

Healthcare providers are notorious for being bad patients, often eschewing timely self-care because “there’s not enough time”. How many nurses are overdue for mammograms, dental cleanings, PAP smears, prostate exams? How many doctors ignore symptoms for which they would advise patients to seek attention? How often do we go to work sick, coughing on our patients because the office would never survive without us? When will we learn? When will we get it?

I’m guilty. I’m as bad as the rest. Luckily I have a spouse who can spot my stress in a heartbeat, who can see the signs, read the tea leaves, and threaten divorce if I don’t call in sick. She will cajole and coerce, determined to convince me that caring for myself is also an act of caring for others, allowing myself to reconstitute and return, refreshed and available to begin again, providing better quality care because I have cared for my own needs. How many colds has she helped me to avoid? How many moments of spiritual torture have I side-stepped by simply taking a few days to myself? To calculate the value of self-care would need a calculator not yet invented, with circuitry which recognizes inner peace, balance, and a body and mind at ease.

For now my inner calculator will need to suffice, that barometer in my mind which tells me when I am walking a fine line between health and illness. Keeping that barometer in check should be a prime focus, a measure of contentment and balance. If I lose sight of that marker, if I let myself go to that edge too often, the consequences are just not worth the paltry rewards. No one loves a martyr, and I’ll stake my future on the fact that my health will take me anywhere I want to go, but its demise will take me to only one place—an early grave—and I’m in no hurry to arrive at that final destination.

Here’s to health.