If you’ve ever felt completely worn out by your nursing job, you’re not alone. More than half of 2,000 nurses surveyed by the RCN said they had suffered from stress over the previous year – yet eight out of 10 went to work anyway. Aside from negatively impacting on patient care, “carrying on” when you are exhausted can do untold damage to your health and personal relationships.
Read on to discover what causes burnout, how to avoid it, and what to do if you’re at breaking point.
What exactly is burnout?
Exhausted, overwhelmed, self-doubting, frustrated, anxious, bitter, cynical – these are just some of the words Professor Christina Maslach uses to describe burnout.
A pioneer in the study of burnout, Maslach interviewed more than 10,000 people across a range of organisations and concluded that job-person mismatches fall into six categories: workload (too much work, not enough resources); control (micromanagement, lack of influence, accountability without power); reward (not enough pay, acknowledgment, or satisfaction); community (isolation, conflict, disrespect); fairness (discrimination, favoritism); and values (ethical conflicts, meaningless tasks).
The Maslach Burnout Inventory identifies three main areas where signs of burnout occur: 1) emotional exhaustion, 2) cynicism or de-personalisation, you’ve lost your idealism and are callous or detached in your response to others, 3) reduced personal efficacy, your competence and productivity is reduced.
While stress is characterised by over-engagement, burnout is characterised by dis-engagement: a loss of motivation, ideals and a sense of hopelessness and helplessness. Several studies have found a link between depression and burnout. One study (Bianchi, Schonfeld, and Laurent, 2014) found that 90% of burned-out workers meet diagnostic criteria for clinical depression.
Caring too much
Burnout tends to occur predominantly in the caring professions, where people get into patterns of over-giving (Snow and Willard 1989), while at the same time neglecting to care for themselves.
Nurses who are primarily motivated by a desire to help others are more likely to suffer burnout, according a researchers at the University of Akron, US. Janette Dill, Phd, explains: ‘Being motivated only by the desire to care comes at a cost – one that does not appear to affect those who are motivated by their intrinsic enjoyment of nursing tasks or the salary and benefits of the job.’
If you are on the road to burnout, taking action early can make all the difference. * List the situations that cause you to feel stressed, anxious, frustrated or helpless. Next to each, note down something you can do to improve the situation. Things won’t magically change overnight – but consistent implementation of positive changes into your routine is the best way to see improvement.
*Can’t fix the negatives? Build positives. ‘When burnout is counteracted with engagement, exhaustion is replaced with enthusiasm, bitterness with compassion, and anxiety with efficacy,’ says Maslach.
* Be brave and have that difficult conservation: with the bullying boss, the undermining co-worker, the inconsiderate partner. Think carefully about what you’re going to say and how to phrase it. Approach the person when you’re feeling calm – just don’t keep putting it off.
* Try mindfulness-based stress reduction by paying attention to your feelings and thoughts. Changing your negative thought processes in reaction to difficult situations can help prevent stress escalating.
* Take a course. Learning something new can help you reconnect with your passion and remember why you were drawn to nursing in the first place.
* Get a mentor. Having a motivated and passionate professional on your side can be hugely inspirational. Talk to someone who has gone through the same thing. What can you learn from them?
* Take your coffee breaks. A quick power walk and fresh air can do wonders.
* Have a holiday. Take the family away or arrange childcare and spend a few days alone, perhaps at a friend’s house or retreat.
* Practice yoga or tai chi for relaxation.
* Take seven slow, deep breaths before you open the door to a patient’s room.
* Take up an old hobby or try something new. When you’re fully immersed in something, you can’t worry at the same time.
* Delegate tasks to a competent person, even if they don’t do things exactly as you would.
* Distance yourself from “moaners” and socialise with non-colleagues. Reconnecting with old friends or making new ones can give you a fresh perspective.
* Avoid taking on new commitments or responsibilities. There will be some things you can’t get out of, but do your best to turn down work or social requests that tire you.
* Hate your job but still enjoy nursing? Consider finding new employment or switch to a different area, such as practice or community nursing.
If you’re on the verge of emotional or mental collapse, the first priority is to remove yourself from the situation, says Rev Prof Stephen G Wright FRCN MBE, author of Burnout: a spiritual crisis.
‘It might be necessary to take sick leave, or move to the home of a friend where you feel safe and taken care of or maybe seek out specialist retreat facilities.’
This is not a time for action or trying to make solutions happen as the effort needed can make the burnout worse, he warns. ‘This is a time to come to stillness, to wait and see, to get out of the situation and find the space to allow the solutions that are waiting within to emerge.’
See your GP and seek out counselling services. Time to rest, re-energise and recuperate – taking care of yourself by eating, exercising and sleeping well – is necessary before you can reflect and reconnect.
Part of the process of reflection may be realising that something fundamental has to change in your life.
As Rev Prof Wright explains: ‘As we burn out we tend to hang on to normality as best we can; one of the signs of a healthy recovery can be our willingness to let go of something – a relationship or a job, for example, that we have been working so hard to stay with.’
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