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.
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.
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There isn’t much time to relax when you work as a nurse, especially during the middle of a pandemic. Too much time standing takes a bigger toll on our bodies than we may believe, even if we’re not lifting heavy objects or doing vigorous exercise. The physical pain of your regular workday builds up and can affect your mood if you don’t take care of yourself regularly.
Before you hurt yourself or break down, take time to practice these self-care tips for nurses who stand all day at work.
Practice relaxation right after work
Once you leave work, you are absolutely done working. This statement might seem redundant—but I promise that it makes sense if you’re the type who can’t look away from work even when you’re at home. There are some times, especially now, when you need to have your work phone at the ready in case you get called in, but on days when you aren’t on call, it’s time to set the phone down and breathe. You deserve a break from both standing and working. Whether you decide to relax by taking a bubble bath or lounging on the sofa with your family’s favorite TV show is up to you.
Additional recommended reading: 9 Tips To Relieve Foot Pain From Standing All Day
Schedule chiropractor appointments
Sometimes, the tension we acquire from standing at work all day is more than a little at-home self-care can handle. A chiropractor is perfect for relieving back pain caused by standing and even preventing injuries related to tense muscles. If you’re a new mother or a soon-to-be-mother, chiropractors are capable of relieving back and pelvic pains related to your pregnancy as well. Trusting a chiropractor to take care of you can be difficult, but if you look for a chiropractor with trustworthy qualities and certifications, it will be worth every penny.
Purchase specialized clothing
Even though we have strict dress codes as nurses, that doesn’t mean we have to settle for shoes that fail our feet and lack support for our backs. A good pair of shoes is worth the investment and will save your back while you work. If you need extra support on the floor, consider purchasing a knee brace or compression socks or stockings.
As a nurse and a mother, it can be easy to forget that, in addition to taking care of others at work and home, we need to take care of ourselves, too. With these self-care tips for nurses who stand all day at work, you can re-energize yourself after a long shift at work and prepare yourself for the next day.
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Mindfulness Meditation For Nurses
During the coronavirus pandemic, managing nurse stress has become more important now than ever before. COVID has brought extra hours on the job, required moves for some, and caused additional stress due to fears of contracting the virus at the workplace. The behind-the-scenes things nurses deal with bring stress levels that most people cannot begin to relate to.
Fortunately, there are a few stress-relieving modalities that can be done quickly and from almost anywhere (including a nurse’s break area). One of the most important being mindfulness meditation.
What is Mindfulness?
After a long, stressful day dealing with a pandemic, nurses still have to go home and do the same daily tasks everyone else does, such as grocery shopping, cooking, raising a family, and taking care of the home. Like many busy professionals, finding time for self-care as a nurse usually goes on the backburner.
According to the National Center For Complementary and Integrative Health (NCCIH), “meditation is a mind and body practice that has a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being.”
In other words, the goal of mindfulness is to place your attention on the present. That is also the only thing we have control of at any given time – not what happened in the past or what might happen at some point in the future.
By tapping into our selves and being more mindful, we can decrease our own stress and anxiousness to handle each moment as it comes.
Additional Recommended Reading: 8 Ways Nurses Can Take Better Care Of Themselves
Mindfulness meditation for nurses
Mindfulness Meditation For The Beginner: How Do I Start?
When someone hears the phrase, “I’m going to practice meditation,” a common thought is, “What do they mean by practice?”
But that is exactly what it is – a practice – even for those experienced in meditation.
For nurses who already have a ton on their plates, a practice can be as little as 3-5 minutes. The more you make mediation a regular habit, the longer you will be able to sit in meditation.
Find a space, sit in a comfortable chair, or cross-legged on the ground. As you better your practice, you may start to lose track of time (ultimately a good thing), so be sure to set a timer if you are at work. Start your meditation by taking deep breaths and really focusing on each breath, as each breath epitomizes the “now.” Your mind will almost undoubtedly drift again, but catch yourself without any feelings of negativity and focus on the breathing again. Find your center for as long as you can during your allotted time.
If you continue to struggle to find that peace, you can also try guided meditations, which are available as apps or even on YouTube, and with these, calming music and a soothing voice lead you through the steps of breathing and focus and help with your practice.
It’s important to try to do this every day, but just as important to not get down on yourself if you can’t find the time on a given day, or are just too overwhelmed with stress to maintain focus for any amount of time. Pick it up the next day, and if you do it as often as you can, the world around you will seem more at peace and more bearable as you continue to take on your stressful-yet-extremely rewarding job as a nurse.
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About the Author
Sarah Daren has been a consultant for startups in multiple industries, including health and wellness, wearable technology, nursing, and education. She implements her health knowledge into every aspect of her life, including her position as a yoga instructor and raising her two children. When she’s not watching the New York Yankees play, Sarah enjoys practicing yoga and reading a good book on the beach.
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:
- Practice meditation and/or mindfulness exercises
- Make time for relaxation
- 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
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Symptoms of Excessive Stress
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.
The American Psychiatric Nurses Association lists the following crisis hotlines:
It’s Okay to Take a Break
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.
*This article about the best compression socks for nurses contains affiliate links.
If there is one profession that needs to be wearing compression socks, it’s nurses (or anyone who is on their feet for 12+ hours a day). Compression socks are beneficial for leg health for the following reasons:
- Preventing or reduce varicose veins
- Improving blood flow and decrease the risk of blood clots
- Decreasing swelling of the legs and ankles
Since I started wearing compression socks, my legs feel noticeably better and more energized at the end of a shift. I started wearing them out of necessity when I was pregnant and was able to continue working as an ER nurse until I was almost eight and a half months pregnant.
I have always appreciated that my job is not sedentary. But as it turns out, being on my feet for such long hours can be worse for your health than sitting all day. Wearing compression socks is the best way for busy healthcare professionals to prevent some of these insidious, chronic leag health issues.
Medical compression stockings for the treatment of varicose veins.
How do compression socks keep legs healthy?
Compression stockings help increase the circulation of blood flow and oxygen by helping increase the velocity or speed of blood flow. By squeezing on the legs, the veins carrying blood to the heart are compressed.
Think of how when you squeeze a hose; it squirts the water out faster. With compression stockings, the same volume of blood can move up the leg, but it has less area in which to move.
Understanding compression sock levels:
Choosing the right compression socks can be difficult if you do not understand what the levels of compression mean. Compression socks have a range of numbers to indicate how much graduated compression the garment has. Here is a quick and dirty breakdown:
- 15-20 mmHg
- Suitable for everyday wear to help with welling and fatigued legs due to long periods of travel, sitting, or standing.
- 20-30 mmHg
- Medical grade compression. Useful for managing swelling, spider veins, travel, sports, and after some surgeries. Also suitable for pregnant mothers to alleviate swelling and achy legs.
- 30-40 mmHg
- Recommended when you have a blood clot, deep vein thrombosis DVT, or lymphedema.
- 40-50 mmHg
- robust compression for severe venous stasis, wound management, and lymphedema.
(The unit of measurement (mmHg) is called “millimeters of mercury,” which is a measurement of pressure, also used in blood pressure. It is a measurement for how tight the compression on your legs is.)
The sweet spot for medical professionals on their feet all day usually falls in the 20-30 mmHg range depending on how much compression you are looking for. You should discuss compression stockings with your doctor, especially if you have any medical issues.
Keep in mind that you get what you pay for when it comes to good compression stocks. Generally speaking, with all products, if the price seems too good to be true, then it probably is. Trust me when I say I learned this the hard way.
Sacrificing your leg health is just not worth it.
Nurses experience enough occupational hazards during a nursing shift as it is. Make sure you wear compression socks or stockings during every single shift. You can help to prevent future circulation and venous issues and still have a long, rewarding career as a nurse.
Check out this list of best compression socks for nurses:
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COVID-19: Mission For Masks
We need our nurses to be healthy and safe, now more than ever. Yet during the COVID-19 pandemic, in the United States, there have been numerous accounts in the media recently that that is not happening. And some nurses are afraid to speak out.
But Sonja Schwartzback, a critical care nurse and doctoral student from New Jersey, created a Google document called COVID-19: Mission For Masks. Sonja’s objective was to give nurses an outlet to share coronavirus stories anonymously without fear of retaliation from administrators.
Sonja discussed how she started the Google doc after receiving hundreds of questions from nurses and doctors via her Instagram account, where she has over 49k followers. In her eyes, nurses are feeling desperate, and their issues are not being appropriately addressed in the media.
In this article I wrote for nurse.org, I spoke about how many nurses are feeling out of control and need to prioritize their mental health during the COVID-19 outbreak. Suggestion #7 for nurses was to talk to other healthcare staff who can understand their unique struggles during the COVID-19 crisis. COVID-19: Mission For Masks is providing a platform for exactly that.
Some experts also say that healthcare professions are facing an increased risk of anxiety and depression during the COVID-19 outbreak. They need an outlet to communicate frustrations, concerns, and fears with healthcare professionals who understand their struggles.
The COVID-19: Mission For Masks document is an opportunity to serve as a platform for nurses to find strength in numbers, share what is working and what isn’t at their hospitals and give nurses a much-needed mental health outlet.
New York is the epicenter for coronavirus cases in March. But officials state that COVID-19 cases are expected to explode exponentially, with deaths reaching from 100,000 to 240,000.
As a nurse, how are you dealing with the COVID-19 crisis?
Does your facility have the proper PPE for healthcare staff to manage this epidemic? Do you feel that you have reasonable equipment to fight this epidemic as a frontline nurse so that you do not get the disease yourself? Do you need an outlet to talk with other nurses about how COVID-19 is being managed at your facility?
Many nurses have publicly documented quitting their jobs. They were NOT ALLOWED to wear masks because their facilities are unable to provide them, and they were not allowed to wear their own.
Here is the bottom line: If nurses are unable to reasonably protect themselves from COVID-19, and more importantly, aren’t able to communicate with administrators about not having proper PPE – such as having a face mask on COVID-19 units – how can we expect nurses to continue giving adequate care for the sick? Ultimately, our country will lose nurses, and patient’s lives in the wake.
As a mother with two small children, one who was born prematurely and could have increased risk of COVID-19 complications, how could I work the front lines as an experienced emergency room nurse without proper PPE? If I wanted to protect my child from dying, the clear answer is NO WAY!
Nurses need an outlet more than ever. What do you think?
If you are a nurse working with COVID-19 units, and you have something you want to share about your current work situation, but feel afraid because of retaliation, you can find the COVID-19: Mission For Masks doc here.
Feel free to leave a comment.
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