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Why Nursing Burnout is a Taboo Subject

TThis months blog post considers why Nursing Burnout is a taboo subject and why nurses struggle feeling guilty about putting their self-care needs first and how this can lead to burnout.

One of the most common problems that I hear from nurses that I coach is that they feel often guilty about taking time for themselves. Work takes priority, and the paradox is that as a caring profession when it comes to nurses and their self-care, it often comes way down the list. If left unchecked a lack of taking some time for self-care can lead to burnout. 

Understanding burnout

Burnout is not a symptom of work stress; it is the result of unmanaged work stress (Altun 2002). A National Survey of Australian nurses in 2013 found evidence of increasing work demands, nurses considering leaving the profession and unmanageable workloads. Undertake a quick literature search, and you will find a plethora of articles about nurses and workload related stress. It is a similar picture in the US and UK. We cannot afford to lose nurses from the profession at a time when a predicted shortfall of nurses in 2030 in Australia is 123,000. That’s a lot of nurses to lose.

Shame and Vulnerability

Burnout is a taboo subject in nursing that is tangled up with shame and vulnerability. Shame about what people might think about you if as a nurse, you admit that you are feeling overwhelmed and not coping at work.  The shame associated with burnout is a topic that often comes up in the interviews with the nurses on my Podcast. Vulnerability is also expressed in having this conversation with their manager. The more senior a nurse is the greater the shame and vulnerability in admitting that you are not coping at work.

The reality is that many nurses continue to feel overwhelmed until it starts to take a toll on their physical health and wellbeing. It is at this point that someone else usually recognises the symptoms as burnout. Once a nurse reaches this point, they can be off work for a considerable period of time and, some may never return to the job that they had. The reality is that part the problem that caused burnout in the first instance remains in the workplace and so the cycle begins all over again. The remaining part is learning how to prioritise yourself and not feel guilty about this.

Recognising the burnout Red flags

Burnout can present itself in many different ways for example; Irritability, exhaustion, not sleeping, unable to switch off from work, emotional deregulation and a complete feeling of overwhelm, reduced performance and productivity, anxiety, detachment, low mood, lack of creativity, listless, difficulty concentrating. Some people fall into a wallowing hole where everything seems hopeless and negative and, no matter how hard you try you can’t seem to pull yourself out of the wallowing holland view things in a positive way.

The complexity of burnout

There is a lot written about burnout and nursing but, like resilience, it is a complex subject and, there is no one simple solution. Nurses can’t suddenly start to put their own needs first, old habits die hard and new habits need to be relearnt. It is also difficult for nurses to put their self-care first if their leader doesn’t model this behaviour. 

It is a bit like a recipe for baking a cake; all the right ingredients have to be carefully mixed to create the right environment for the cake to rise. If the leader sends emails outside normal working hours for example then the team sense the expectation that they are to respond to emails once they have physically left work. If the culture is one of head down bum up and get on with it and an acceptance of that is just the way it is and no opportunity to question or offer different solutions then you will inevitably have high staff absence rates and burnout in your nursing workforce.

For staff to be able to raise concerns they need to feel safe to do so and the leader is responsible for creating a psychologically safe environment to actively seek feedback and listen and be open to suggestions and making improvements to foster a positive work-life balance.

Resilience bank

That said there are small changes that you can make on an individual level that can help you to buy back time for you. Time is always in our control we just have to change the lens in which we view taking time for ourselves. The aim is to give the best of you not the least of you when caring for your patients. If you think of it literally as a bank where you are depositing self-care credits to protect you during those times where there is high stress at work. Each time you take time for you, you are adding to your resilience account. The more credits you have the more healthy your resilience becomes.

Steven Covey Time management Model

This is a useful tool in beginning to identify where your time is spent in a typical workday and understanding how you spend your time that might be depleting your resilience and contributing ultimately to burn out. It helps to identify where you can create more time to spend on activities that help to keep you resilient and lessen the ones that deplete your resilience.

Covey identified that we almost always spend time in Quadrant I, activities that are important and urgent and that we also spend too much time in quadrant III, urgent but not important things. Covey suggests that we need to spend more time in quadrant II and activities in this quadrant that are at an individual, team and organisational level and help to drive innovation and boost resilience.

Working in health care, there will always be a reactive and fire fighting component to the work and this causes a certain amount of stress. The antidote to this is to be found in quadrant II

Making Time

Sometimes we are our own worst enemy when it comes to making time for ourselves as nurses. It does take some planning and conscious thought to be able to fit in those activities that help us to stay refreshed and ready to face the challenges of the next shift. One of the things that get in the way is trying to fix everything, especially if you are in a senior role

Being a fixer in the context of the nursing profession is about feeling responsible for everything and everyone else on your team. It is a common pattern in nursing particularly as nursing has a long history of problem-solving and fixing things.

What drives the fixing pattern of behaviour within us? To understand this question, it helps to understand what attracts us to certain professions and not others. For example, nurses tend to go into nursing want to help others. This desire to help or fix problems for others is not always a helpful trait to have on a personal level. Being a fixer helps someone to feel that they are valued by the very fact that they are helping to fix things for others. 

Often as nurses, we are so busy being the fixer of external issues in the workplace and within the team that we don’t then have the time or energy to fix ourselves. 

A fixer can seek validation from team members and colleagues that they are doing a great job by problem-solving and fixing things for other people. 

This acts as a distraction from looking at ourselves to focus on being the best that we can be and importantly understanding what our own self-care needs are to allow us to be the best that we can be.

Letting go of the need to be a fixer can provide a huge sense of relief by letting our team members choose and take responsibility for themselves and allow each of us to be the best that we can be. It frees up your time as a manager and leader and most importantly it allows your team members to develop.

Small positive steps

It is never too late to start to make small changes in your day to build in small amounts of time for you and gradually increase the amount of time as you start to feel the positive benefits. If you think about caring for yourself is akin to how you care for others as a nurse; you have to put your oxygen mask on before you can help someone else!

The key is to make these small changes a regular part of your life and once these are established try to add in some more opportunities. I love the saying “you can’t eat an elephant whole, only in bite-sized chunks” the same is true for our own self-care. Small steps in the putting yourself first can lead to much bigger positive changes in our resilience which ultimately helps to credit our resilience account and protect us from burn-out.

If you would like some help with prioritising your self-care contact me here to learn how coaching can help you.

Useful Resources

The Resilience Project