Warning Signs of Nurse Burnout in Critical Care
By Jennifer Larson, contributor
Nursing is a very demanding job, both emotionally and physically. The physical toll may be more visible to the casual observer, but the emotional toll can be just as real. And if mounting emotional pressures are not addressed, there can be dire consequences.
Critical care nurses may be especially at risk for developing burnout and compassion fatigue, due to the intense nature of their work. Their jobs are very complex, their patients are critically ill or injured, and they may also be coping with other demands on their time and energy.
“All nurses are at risk for this because of what we do,” said Vicki Good, MSN, RN, system director for patient safety with CoxHealth and immediate past president of the American Association of Critical-Care Nurses (AACN). “But I think the critical care environment has been called the perfect storm for this.”
High patient acuity, high-stakes decision-making and minimal room for error all contribute to the problem, which is exacerbated by an ever-expanding workload.
“We are continually asking nurses to do more and more and more with the same resources or even less resources,” said Good, noting that many nurses cited this factor as problematic during a recent interactive session on burnout at the AACN’s National Teaching Institute and Critical Care Exposition.
Nurse burnout, compassion fatigue or both?
Nurse burnout and compassion fatigue aren’t the same, but they can and do often co-exist, causing a nurse to feel frustrated and even powerless.
Burnout develops out of dissatisfaction with the work environment--the scheduling, the staffing, the management, the unit design, etc. According to research on burnout syndrome, the symptoms tend to exist in one of these three areas: emotional exhaustion, cynicism toward work and/or reduced performance.
Meanwhile, compassion fatigue may show up as a reduced ability to feel empathy for patients, or callousness, which derives from constant exposure to patients in serious distress. It can also result in emotional symptoms like anger and resentment, irritability, anxiety, and even cause poor concentration or memory issues, according to “Compassion Fatigue: A Nurse’s Primer,” a 2011 article by Barbara Lombardo, MSN, RN, and Carol Eyre, MSN, RN, published in The Online Journal of Issues in Nursing.
A recent survey conducted by researchers from the University of Rochester Medical Center in New York examined the levels of nurse burnout, compassion satisfaction and secondary traumatic stress in 221 nurses from nine critical care units. Led by clinical nurse specialist Tara Sacco, MS, RN, CCRN, the authors noted that nurses reported that changes in management and unit redesign decreased a nurse’s compassion satisfaction, which can lead to compassion fatigue. The results were published in the August issue of Critical Care Nurse.
Although not all the symptoms overlap, some symptoms of burnout are very similar to the symptoms of depression. Burnout can increase a person’s risk of developing depression, too.
Some warning signs of nurse burnout
Burnout doesn’t look exactly the same in every nurse who experiences it, but the signs may include:
- Finding more reasons to call in sick to work, arrive late or leave early
- Profound negativity
- Overwhelming irritability
- “Checking out” or withdrawing, especially if the person was previously extroverted
- Extreme intolerance to change
What the individual nurse can do
Experts agree that leadership must recognize the potential costs of burnout and compassion fatigue among the nursing workforce and take steps to address them. They can champion interventions for nurses to help them develop resilience and perhaps even address some of the workplace factors that could be causing stress, including communication breakdowns.
But individual nurses can also make a difference. You can learn to recognize the symptoms that something is wrong--in your colleagues and in yourself.
“We need to know what our own signs are, the subtle signs of ‘I’m getting a little burned out,’ or ‘That last case really affected me,’ so we can stop it before it gets too bad,” said Sacco.
While travel nurses may have limited influence to advocate for changes in their assignment facility, they can embrace self-care strategies that help maintain a healthier attitude or work–life balance. That might include learning techniques for meditation or mindfulness, said Good, or it could be just doing the simple things like actually taking your lunch break, instead of skipping it.
Some nurses find that taking travel assignments is actually a great way to take a break from the pressures of staff nursing and find a fresh perspective on their careers while they explore new cities, visit family or find new ways to enjoy their time off.
“You’ve got to do some self-reflection and determine what is your path to resiliency,” Good said. “It’s going to look different for every one of us.”
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