When it became clear that COVID-19 was a pandemic in early 2020, many in the healthcare profession began referring to doctors and nurses as “like soldiers going to war.” But the truth is that managing mental health issues among healthcare professionals in the United States has always been an ever-present and tricky situation. The arrival of COVID-19 further highlighted many major issues that have always been there.
Registered nurses and other healthcare professionals willingly put the needs of others before their own under very stressful circumstances, many of which involve severe illness and loss of life. Moral injury is now a common term that more accurately describes how moral consciousness and values become injured for healthcare workers in the aftermath of horrific work events. These distressing events often produce extreme guilt and shame – and lead to mental illnesses such as depression, anxiety, and in extreme cases, even suicide.
Over the course of my nursing career, I have seen this many times. I have often tried to explain to friends and family (who don’t work in direct patient care) about the physical and moral demands that are placed on nurses. But unfortunately, I have found that if you aren’t there to witness it directly, then you don’t have the experience to really understand it. As a result, many healthcare professionals are gaslighted and think the problem is them, and not the healthcare system they are a part of.
It helps to look at the big picture and know that you are not alone in your struggle. Take a look at the below infographic to see how mental illness is affecting healthcare workers since the pandemic started and what you can do to help yourself.
Effective Strategies To Combat Nurse Burnout and Moral Injury
Have you ever experienced an overwhelming amount of stress or exhaustion from work? You wouldn’t be the only one. These extreme feelings are often referred to as burnout, which is categorized by a decrease in emotional, physical, and psychological energy resulting from work-related stress. This is a problem employees face in all industries but is particularly trying for those in demanding professions such as healthcare.
How can you tell if an employee is suffering from burnout or moral injury instead of just normal levels of work-related stress? Researchers have indicated that there are three primary aspects of burnout in employees.
#1. Emotional Exhaustion
Emotional exhaustion results from the feelings of immense stress and pressure on employees that leave them feeling emotionally and physically spent by the time they’ve finished their shift.
#2. Depersonalization
Emotional exhaustion goes hand in hand with another aspect of burnout, depersonalization. This type of detachment reduces the amount of empathy an employee is able to expend toward the people they work with and for. In the healthcare industry, this can raise questions regarding the quality of care that nurses are able to provide when they’re experiencing burnout.
#3. Feelings Of Low Accomplishment
The final aspect of burnout is described as a feeling of low accomplishment. Employees may feel worthless despite their established skills and contribute less toward the responsibilities of their position. This can have some serious implications in the case of nurses and other healthcare professionals.
For as common as burnout and moral injury is in the healthcare industry, not many organizations feel they have a good grasp on programs to address these issues. Below are a few strategies that would serve as effective tools for combating nurse burnout.
Creation and Implementation of Wellness Programs: programs designed to educate nurses on stress reduction and wellness strategies are a great start. These programs would provide methods that can be incorporated in their days to maintain stress levels.
Healthy Work Environments: providing nurses with an environment where they’re respected and able to communicate about their issues openly has a positive effect on their performance and stress levels.
Incorporation of Scheduling Software: integrated scheduling tools that provide clear information for nurses allows for a higher quality of care for patients.
Establishing Healthy Habits: though it may seem cliché, the basics are often the most important. A nutritious diet, a full night’s sleep, and exercise go a long way in terms of positive mental health.
Management Involvement: for the management staff, allowing nurses to bring attention to workplace issues with confidence and establishing an open dialogue will allow for a greater understanding of the employees and how they respond to stress.
For more information on how burnout affects the healthcare industry and nurses, as well as strategies to combat this burnout, be sure to review the accompanying infographic courtesy of ScheduleAnywhere.
Nurses are a critical part of the healthcare system during public health emergencies. They are highly trusted, compassionate, and willing to go to great lengths to protect their patients. However, with no clear endpoint, COVID-19 is not a typical public health crisis and has created a range of mental health challenges for nurses.
Today’s nurses are working under a cloud of fear and stress, which can lead to physical and psychological symptoms. However, there are steps that nurses can take to minimize the effects of high-stress levels and keep themselves and their families balanced.
A Two-Pronged Approach to Managing Stress
Stress levels cannot be managed through mental health strategies alone. Making healthy lifestyle choices can directly affect an individual’s outlook on life, energy levels, and mood. These five tactics can create a positive impact on mental health:
Eat regular meals – focus on whole foods that decrease inflammation and build immunity
Stay hydrated – choose water instead of caffeinated beverages, which can cause headaches and mood swings
Exercise regularly – a simple walk with the dog can keep anxiety and depression symptoms at bay
Limit alcohol consumption and refrain from smoking
Make sleep a priority and practice good sleep hygiene
When it comes to managing stress levels, a nurse’s mental health is just as important as their physical health. Incorporating these self-love strategies into your daily routine can help:
Take mini-breaks throughout the workday to practice deep breathing
Keep in touch with friends and family
Limit exposure to media coverage of the pandemic
Lower expectations of yourself and others, reminding yourself that “done” is better than “perfect”
Practice positive self-talk, such as “nurses have a purpose and make a difference”
Talk it out with colleagues or a supervisor, because nurses don’t have to walk this road alone
Accept help when offered, and ask for support when needed
Help Children Manage Stress
Nurses with children at home have a responsibility to help them understand and respond to our changing world. Children may pick up on the stress that a parent is feeling and struggle to understand what is wrong. Children need to receive reassurance and guidance that’s centered around safety, consistency, and love.
Here are some tips to help children manage stress:
Maintain a consistent family routine – establish set bedtimes and meal times
Include children in conversations about the pandemic, but keep their age in mind and help them navigate their feelings
Set family rules for proper hygiene
Make routines fun for kids – consider singing during handwashing or developing games for wearing masks
Remind children that the situation is temporary
Allow children to help out around the house to give them a way to contribute – young children can carry dishes to the sink and help tidy up, while older children can take on bigger chores such as cleaning and yard work
Reassure children that the parent is safe in their job
Nurses should self-monitor their mental health status on a regular basis and take action when necessary. Symptoms of depression can include:
Sleep difficulties
Persistent crying or sadness
Feelings of hopelessness
Nurses who are forced to make clinical decisions that conflict with their ethical training may experience signs of moral distress, such as feeling guilty or ashamed. Other symptoms to watch for include:
Difficulty with decision-making or memory
Emotional outbursts
Risky behaviors
Withdrawal from social interactions
Unexplained physical symptoms such as headaches, palpitations, and gastrointestinal issues
Nurses experiencing moral distress or consistent symptoms of depression should talk to their supervisor and seek professional help. Early intervention can be critical to working through moral dilemmas and extreme stress. Nurses seeking to connect with a mental health professional can contact their insurance provider for options in their area.
Mental Health Resources
Anyone experiencing suicidal or homicidal thoughts should call 911.
Nurses who have decided to step away from bedside nursing amid the pandemic should keep in mind that they are not alone. Taking a break and hitting the reset button can be the difference between a nurse developing serious mental health problems and a nurse maintaining their sanity. Some nurses may use this time to further their education from the comfort of their home by enrolling in an online nursing program. An online program can keep the nurse’s knowledge current while potentially offering a pathway to a better position and higher future earnings.
Self-care is vital to a nurse’s health and well-being, especially in the face of a pandemic. Nurses can fill their mental health “bucket” throughout the day using tools of the trade, and perform regular mental health gut checks to ensure that they get the help they need when they need it.
Cindy Blye, RN
Cindy Blye is a nurse-turned-writer with experience in Newborn Intensive Care, Pediatrics, and Case Management. Her works include pediatric nurse certification review materials, policies and procedures, training materials, nursing blog articles, health and wellness articles, and local business reviews. Cindy has three grown children and lives with her husband in North Carolina where she enjoys spending time with her family, gardening, and cooking.
During the COVID-19 shut down in California, I found myself looking for more creative outlets at home. I’m not sure if it was the fact that I suddenly had to home school my two and 4-year old children, or I had been suppressing the urge to start coloring, but I found myself doodling in my daughter’s anatomy coloring books almost as frequently as she was.
I first discovered anatomy coloring books as a nursing student many years ago. At the time, I was overwhelmed with the sheer amount of information I was expected to memorize. I wasn’t sure why, but putting markers on paper helped me remember the anatomy and physiology better than anything else could.
I later learned that coloring the body and its systems is the most effective way to study the structure and functions of human anatomy according to research.
Here I am now, in the middle of a global pandemic, and I’m coloring again. My point is that coloring isn’t just for kids. I think coloring with a crayon or marker should be considered a relaxation or stress-relieving technique. I am surprised that I am just figuring that out now.
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A great anatomy coloring book has every body system
• The Integumentary System
• The Skeletal System
• The Muscular System
• The Nervous System
• The Endocrine System
• The Circulatory System
• The Lymphatic System
• The Digestive System
• The Respiratory System
• The Urinary System
• The Reproductive System
By coloring each of the body systems, you can learn how the systems affect and work with one another.
Benefits of coloring
Reduces stress and anxiety – coloring helps to relax the brain, in a similar way that meditation can. In fact, coloring can be a type of meditation in itself. When you color, it forces you to be still and quiet, which can help generate mindfulness – especially after a stressful day of work, school, or parenting.
Improve focus – Coloring requires attention and allows you to live in the moment.
Improve sleep – Coloring is always better than looking at blue-light electronics like cell-phones; it also much better than browsing through social media, which can cause more stress and keep you awake at night.
Coloring a kidney will help you understand its anatomy and function.
This fun mix of coloring book and instructional guide demystifies anatomy for the yoga enthusiast! This book is great for yoga teachers learning anatomy used in all different yoga poses.
The creator of The Yoga Anatomy Coloring Book is a yoga instructor, licensed massage therapist, and anatomy teacher Kelly. The workbook provides an entertaining and informative journey through the human body, focusing on the bones, joints, and muscles used in yoga.
After an overview of helpful terms, Kelly covers the skeletal system, joints, and connective tissue, followed by the muscular system. Each anatomical feature is illustrated with a beautiful black-and-white drawing of a yoga posture, or asana, to color.
Coloring the bones and muscles, and their names, will help you to remember their location and function, and 32 perforated flashcards enable readers to quiz themselves and study yoga anatomy on the go.
This anatomy coloring book features detailed illustrations of the body’s anatomical systems. Plus, Color Guides on every 2-page spread offer instructions for best coloring results so you can study effectively. The Amazon description states this coloring book has:
More than 450 detailed, realistic medical illustrations, including microscopic views of cells and tissues
Exclusive perforated, flashcard-format illustrations of 96 muscle structures to color and study on-the-go
Clear, descriptive overview on the page opposite each picture, with key learning terms in boldface
Self-quizzing for each illustration, with convenient same-page answer keys
Full coverage of the major body systems, plus physiological information on cells, tissues, muscles, and development
The Human Body Coloring Book takes an interactive approach to human anatomy that will help users learn, understand, and revisit the subject with ease.
Drawing on an unparalleled library of state-of-the-art specialist anatomical illustrations, The Human Body Coloring Book is structured system by system for ease of use, with comprehensive coverage of the human body from cell to system.
The Human Body Coloring Book is a unique study aid that provides students with an innovative approach to learning. At the same time, the opportunity to self-test maximizes the ability to recall knowledge.
Another great book that helps with a concise understanding of anatomy.
The Anatomy Coloring Workbook includes:
• 126 coloring plates with precise, easy-to-follow renderings of anatomical structures
• Comprehensive explanations of the pictured structures and anatomical concepts
• An introductory section on terminology to get you started and coloring suggestions to assist you
• A glossary of standard anatomical terms
• New injury & ailment appendices, with additional memorization techniques
This Student’s Self-Test Coloring Book includes hundreds of anatomically accurate line illustrations to help you learn the human body.
Coloring the anatomy systems helps you learn the shape and location of each body part, making it easier to visualize, retain the information. In addition to clear explanations and instructive content, it features
New to this edition: Clinical points text boxes to illustrate the medical significance of the structure
144 two-color pages that lie flat for easy coloring.
16 new pages of text
Extra-heavy paper that minimizes show-through
Includes every body system and part
All parts labeled with correct anatomical names
Conclusion
Any of the anatomy coloring books on this list are very detailed and helpful for learning. Or, if you just need a coloring outlet to relieve stress that also allows you to learn something new, any of these works perfectly.
*This post about compassion fatigue in nursing may contain affiliate links. You can find our disclosure page here.
I first realized that I was experiencing compassion fatigue as a nurse after only two years in the profession.
That’s correct. After only TWO YEARS, I was already feeling overstressed, exhausted, and cynical about my career.
When my mind finally wrapped itself around this understanding, I thought I’ve barely graduated with my BSN, and I’m ALREADY burned out? How am I going to continue in the nursing profession for an entire career?
I was frustrated, confused, and, to be honest, a little heartbroken. I was passionate about helping others, and I did enjoy the mental stimulation that I got as a nurse. But I couldn’t figure out how there were nurses on our unit who had been doing the same thing for the last 5, 10 or even 20 years. Didn’t they feel the same way?
Lately, I have spoken with a lot of nurses about their experiences with compassion fatigue. The truth of the matter is that most, if not all, nurses feel spent and exhausted at some point throughout their careers.
What is compassion fatigue in nursing?
Simply put, compassion fatigue is the gradual lessening of compassion over time due to extreme caregiver stress and overwork. Compassion fatigue in nursing is also almost always tied to the chronic stress that comes with working 12-hour shifts, which can be very physically, mentally, and emotionally challenging, even on a good day.
Unfortunately, compassion fatigue is prevalent in the nursing profession. But with awareness and the willingness to make a change, it is possible to overcome this chronic, stressful state and learn to thrive within your nursing career again.
Here are seven tips to help deal with compassion fatigue in nursing:
1. Find a better work-life balance
Are you rotating days and nights? Constantly working overtime? Or maybe just working too many hours per week?
That may work for a while, but it is not a very good long term plan. Everyone needs a break, especially nurses.
Consider taking a vacation (or stay-cation) and plan a few solid days of “me” time. A little TLC can go a long way. You simply can’t continue to take good care of others before taking care of yourself first.
One of the best things a nurse can do to help prevent nurse burnout is to take good care of themselves. Often this notion is counter-intuitive to nurses because the nature of their job is to put others’ needs in front of their own continually. Ask yourself, what do I need to be healthy? Here are a few suggestions:
Make sure you plan for your 12-hour shifts, so you have healthy snacks while you are at work.
Get at least 7-8 hours of uninterrupted sleep before a shift.
Try meditation or just sit alone with your eyes closed for 10 minutes during your lunch break.
Create a calming environment (at work or home) with a stress-relieving essential oil such as Lavender.
3. Find the “why” in your compassion fatigue
What is it that is causing you to feel compassion fatigue? Try writing your thoughts down at the end of a few shifts to help figure out what is overwhelming you.
Is there a pattern? Perhaps you need to plan your shifts differently. Are there a few personalities in your workplace that you are not jiving with?
Or, maybe you just are not inspired by your chosen specialty. Permit yourself to be brutally honest. If a change is what you need, then make a change.
Compassion fatigue and nurse burnout are so common among nurses. Left unchecked, they can lead to mistakes, unhappiness, or even depression.
Share your nursing compassion fatigue struggles with a close comrade from work who can empathize with your effort. If that doesn’t help, consider talking to a trusted mentor, a therapist, or find a career coach that can help you work your way out of nurse burnout.
Nurses are self-giving creatures by nature, but we must give to our own needs as well. Crawl out of your shell and start talking it out.
6. Find an outlet
What do you do on your days off that may you happy? If you don’t have a stress-relieving outlet, then its time to find one.
Is your inner artist craving a creative outlet, such as painting, designing, or even scrapbooking? Does a day on the golf course or an afternoon on the tennis court bring you joy? Maybe you have been so busy that you have forgotten how wonderfully distracting it can be to become enveloped into an activity that you love to do.
Research has shown that finding a joyful outlet can enhance your mood, increase energy, lower stress levels, and even make your immune system stronger. Find out what makes you happy outside of the nursing profession.
7. Consider new options
Do don’t have to stay in the same place throughout your entire career. If fact, one of the greatest benefits of becoming a nurse is that there are so many types of nursing careers out there.
Have an honest discussion with yourself about your career. Are you a med/Surg nurse who has always dreamed of working in the ICU? Or maybe you are an ER nurse with interest in becoming a flight nurse. A change in specialty might be what you need to tackle your compassion fatigue as a nurse.
On another note, nurses don’t have to work in a hospital. Perhaps working in a dermatology office or as a home healthcare nurse would be a better fit. There are so many nursing careers to choose from. The sky is the limit. Find your passion!
It turns out that nurses may not be getting the same respect and care that they give to their patients and employers. As a result, many nurses are looking for alternative ways to practice nursing or are even leaving the nursing professional altogether.
I became a nurse as a second career. Nursing called to me because I genuinely wanted to help people, and I thought that a nurse’s schedule would work better for me as a mom. Now, seven years into my nursing career, my passion for nursing is still high.
Yet I, like many other nurses, struggle with burnout. I have even started looking outside of patient care for alternative ways that I can practicing nursing to deal with my struggle.
(This post may contain affiliate links. You can find my disclosure page here.)
Reasons Why Nurses Quit
#1. Not having control over work schedules
Hospital nurses are expected to work all hours of the day and night, holidays, and weekends. And on top of that, many nurses don’t even have control of their schedules (unless they work per diem – which has been a game-changer for me). I can’t tell you how many times I have missed Christmas, Thanksgiving, New Year’s parties, Easter Sunday, Fourth of July weekend, and so many other special events with my family.
Now that I have my own kids, missing these events is so much harder for me, especially if I have to work on one of their birthdays. This past Christmas, I was lucky enough to NOT work on Christmas Day, but I worked the entire two weekends before, the two days before Christmas, and the day after Christmas. I missed several Christmas parties, and I was so tired on Christmas day that I could barely keep my eyes open.
Thankfully I am not working graveyard shifts anymore, but if I did I would have quit being a nurse a long time ago. Working night shifts literally made me feel like I was going to explode. I felt sick all the time, I was in a constant fog, and I even started to get a little depressed.
Here is an idea that can help: Work per diem or switch to another nursing position that requires a more regular 9 to 5 work schedule such as occupational health or the Cath lab.
#2. Bullying in the workplace
You have probably heard the phrase “nurses eat their young.” That is just a clever way of saying that there are many experienced and burned out older nurses bullying less experienced nurses. It’s also a primary culprit as to why nurses quit working inpatient care.
I remember one of my own experiences with bullying very clearly. When I was a new nurse grad, a nurse I gave report to at shift change would question everything I had done for my patients that day, and drill me about why I didn’t do things differently. Her attitude was awful, and I could tell she hated her job and being on the unit. She had been there for many years, and she treated several other new nurses the same way.
There were days where my shift had gone great – until I had to deal with her at the very end. Then I left the hospital feeling defeated and inadequate just because of some unhappy, grumpy nurse. I did my best to hold my ground and keep my reports as simple as possible.
Eventually, (and thankfully) she quit and we never had to deal with her again. Things got better for me, but unfortunately, there are still nurses “eating their young” who are lurking within the hospital.
Here is an idea that may help: I took a course called “Crucial Conversations” during my second year as a nurse, and it was so helpful for me. It taught me how to deal with difficult situations with other co-workers. Sometimes addressing a bully head-on or finding a way to avoid them entirely is the best way to handle the situation.
#3. Abusive patients or family members
By and large, most patients and family members in the hospital treat the medical staff respectfully. However, that is not always the case.
In my seven years career as a nurse, I have been kicked, swung at (thankfully never hit head-on!), had a full urinal thrown at me, been cussed out, and told I should “kill myself.” And that’s just the tip of the iceberg. There are patients who, despite having full capability to execute all activities of daily living by themselves, take advantage of nurses and other medical staff by asking that everything is done for them. It’s as if we have nothing to do all day except be a personal butler. At least it can feel that way sometimes. I’d rather not be a character from Downton Abbey, though!
Often when people are in the hospital, it is because they are sick and need to be there. Nurses are happy to bend over backward to give the best patient care we can for those patients. Unfortunately, some people take advantage of the caregivers, and over time, it leads to decreased morale and, ultimately, burnout. This is another big reason why nurses quit the profession.
Here is an idea that can help: Nurse abuse is never okay and can be traumatizing for nurses. Communicate with management any time a patient or family member is abusive. Ask for help. Call security if you feel threatened. Ask for another assignment or take turns with other nurses giving care to extremely difficult patients. Talk to staff, family, and friends to help talk out your experience. All of these things can help make dealing with difficult patients and their families a little easier.
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If you are considering leaving the nursing profession altogether, here are a few ideas to help rekindle your nursing career:
