Recognizing and Avoiding Nurse Burnout

Mar 25, 2020
Erica Miller, RN

Burnout is something we hear so much about in the healthcare field--almost as if it’s an expectation that we will all get burnt out at some point in our careers. I’m tired of hearing “take better care of yourself” as the solution for burnout… seems a little too close to victim blaming if you ask me. 

I can get the best massage of my life, followed by an 18-hour nap in a dark, temperature-controlled cave, and it still won’t remedy the immense stress and other symptoms—such as depression—of burnout I experience. And this is only second to the toxic work environment I experience 36+ hours a week.

So, the revelation I made as a travel nurse on assignment after assignment? 

What Is the Real Cause of Nurse Burnout? 

The hospital. Facilities, themselves, may be the biggest contributor to my burnout.

I have the best job in the world as a labor and delivery nurse, but this doesn’t make me immune to burnout. Looking back at the five years worth of staff jobs and travel contracts I’ve worked, I can tell you exactly which hospitals caused burnout and which hospitals didn’t. 

For me—and likely most nurses—a huge cause of my burnout is consistently having unsafe assignments and not enough support on the unit. Staffing guidelines already exist to help hospitals know how to keep patients safe, but they are not typically thinking about it in terms of keeping their nurses safe from burnout. 

Hospital units that consistently assign borderline unsafe assignments every shift are burning down their nurses. As a labor and delivery nurse, for example, this could be always having two active labor patients both being augmented with Pitocin. I am happy to take a “heavy” assignment like this when it’s raining babies and there’s an acute need for my support, but this becomes a problem if it’s the normal or expected assignment on the unit. 

I’m not lazy or a poor time manager, the problem is that this type of assignment leaves me splitting my time between these two patients, who both deserve more of my time and attention, respectively. But, I’m only one person, and I cannot give it to them. I feel stressed and guilty about this, and it really weighs on me if I do this every shift for 13 weeks. Combine this with a negative unit culture and a whole unit full of exhausted staff, and it’s a perfect recipe for burnout.

To reiterate, I’m not talking about those crazy full-moon kind of days where heavier than usual assignments are inevitably necessary… that doesn’t cause burnout. It’s when those days feel like the norm that it will start to take the emotional and physical toll on nurses and contribute to the overall problem.

women looking through blinds depressed nurse burnout

How Can You Remedy These Challenges?

My thoughts on this have certainly changed over the years, following different experiences in different hospitals. As a new labor nurse in a very busy academic/teaching facility, I was eager to take on the hardest and busiest assignments, handle my own, and one day become one of those super nurses that does it all so effortlessly. 

I would take it as a compliment when regularly assigned two busy labor patients; I figured it was only a good sign if the charge nurse thought I could handle that! I could maintain this lifestyle, keep my patients safe, and do it with a smile… never mind that I was addicted to my “stress relief” essential oil and practically bathed in it. 

I was practicing self care like the good burnt-out nurse should! 

At this time, I would have never identified myself as being burnt out, this was simply the expected and stressful reality of nursing, and no one around me seemed worried about it. 

After two years of my staff job, I switched to travel nursing. One of my first contracts was at a wonderful hospital where the nurses would never dream of having a two patient labor assignment. After 13 weeks of this luxury, I realized I never dreaded going to work, was much more physically and emotionally present for my patients, felt very positive about work, and experienced an amazingly supportive unit culture. 

When nurses aren’t overburdened, they can help their coworkers more… shocking, I know! When hospitals prioritize budgeting for enough nurses on each unit to staff appropriately for both patient and nurse safety, nurses will feel less pressure and love their jobs even more, which I imagine can only lead to positive results in terms of patient care and outcomes. 

What I’ve Learned After Numerous Nursing Assignments

Fast forward a few years -- a few horrendous assignments mixed in with some great ones — and I’ve learned to ask more questions in the interview that can help me decide if it sounds like a supportive, safely staffed unit that isn’t going to rip me apart and take a huge emotional toll on my mental health.

Now, this approach doesn’t always work, and in those less than ideal assignments, I start the shift count-down earlier than usual. Managers are interviewing you because they want extra help on their unit. Will they disclose all the issues they’re having on the unit? Overwork, safety, toxic personalities? Of course not. You have to be crafty with your questions, expect some downplaying in their answers, and decide what your “deal breakers” are.

Everyone will have a different “wish list” for the hospital that best supports their emotional wellbeing; it’s more important that you have a list rather than what’s actually on it. Personally, I’ve learned I enjoy working at teaching hospitals that have a certain resource built into staffing, charge nurses without an assignment, allow you to self-schedule to some extent (completely self-scheduling can be hard to find as a traveler, but bonus points if the facility sounds flexible), and have both physicians and midwives attend deliveries. 

If the hospital meets all of these criteria, my experience has been that I have a lower chance of burning out there and a better chance of enjoying my time. I have passed up assignments in cities I was dying to go to because the interview revealed to me that I wouldn’t have the right conditions to satisfy my “wish list.” Frankly, a decision like this might be the best self care I can do for myself! 

So, just because you are a travel nurse doesn’t mean you must expect to work in the horrendously understaffed units and accept the worst, most draining assignments every single shift. 

Protect yourself, optimize your mental and overall health, be picky about your assignments, and you may have done all the self care you truly need to prevent nurse burnout.

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