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.
As s a nurse I have been exposed to so many stressful situations. I’ve been cussed at by angry patients (more times then I can count), swung at, kicked, had a full urinal thrown at me, been exposed to, been in the middle of dozens of violent patient situations and take-downs, and been the victim of nurse bullying.
In addition, I see other nurses being treated poorly from patients, family members, doctors and even sometimes other nurses. In fact, it’s not even unusual. And, like other nurses, I am expected to continue giving compassionate patient care without regard to my own well being.
This sacrificial attitude of putting myself last on a very long spectrum of compassionate care is just not going to cut it anymore. The thought of spending an entire career with this amount of wear-and-tear is frightening. Something has to give before I completely fizzle and burn to a crisp.
Nurses need to have compassion for themselves too.
I came out of nursing school with equal parts compassion and adrenaline to save lives and make a positive difference in the world! In fact, I left a very lucrative 10 year medical equipment sales career so I could do just that. I was determined to advocate for and serve my patients to the best of my ability. Compassion was one of my greatest strengths.
As an overachiever for most of my life I have always maintained the attitude that I can do anything as long as I try hard enough. And now, after 7 years as a registered nurse, I am discovering that I am failing at the one thing that actually defines a great nurse: compassion.
The nurse burnout is real.
What I am currently experiencing is a state of physical and emotional exhaustion that is more extreme than anything that I have ever experienced in my adult life. I started my nursing career with the determination to give amazing patient care and here I am, 7 years later, losing my compassion.
(And just so you know – this has been hard for me to acknowledge because I have been a “yes” person my entire life.)
There is beauty in the breakdown.
My nursing burnout amplified after the birth of my first child in 2015. Then, it got even worse after my second child in 2018. In fact, I started writing regularly again out of desperation to find an outlet for the exhaustion and overwhelming fatigue I was feeling as a nurse and new mom. My goal was to find more effective ways to take better care of myself and make my life a little easier. And it actually has helped me find a little reprieve.
But most importantly, it has opened my eyes to the fact that I need to make some huge changes in my life. Most of all, I need to find my compassion again. But this time I am unapologetically focusing my compassion on myself, first.
So, in light of this discovery, I am 100% accepting and honoring these uncomfortable feelings. I am using them as a catalyst to make changes in my professional and personal life. My mental and physical pain will be an opportunity for growth and finding self-compassion.
I rarely take the time to do nothing and reflect. This is a good year for more of that.
I am on a mission for self-compassion.
You know how when you fly in an airplane, there is the safety warning before take-off? Passengers are instructed to put the oxygen mask on themselves first, then help others around them. Because if you pass out from lack of oxygen, you’re not helpful to anyone!
So, here is me putting the oxygen mask on myself first. Some of the changes I am making are professional and some are personal. But they are all things I have been wanting to do for a really long time but haven’t because I was thinking about others’ needs before my own.
Here are my new personal nurse self-care and self-compassion goals:
#1. Work two 12 hour shifts a week instead of three
This one is hard for me because it equates to a significant decrease in pay (and I really like money!). With two toddler age children, child care is our biggest expense (besides housing) and it’s not going away any time soon. But fortunately, we are in a position to afford it for the time being and I want to use the extra day off to spend more one-on-one time with my adorable babies.
In addition, since most hospital shifts are 12 to 13 hours I don’t get to see my children at all on the days that I work. I am also staying away from working back-to-back shifts because I just don’t want to be away from my children for more than one day at a time.
#2. Work fewer holidays and as few weekends as possible
After I had children I really hated having to work on holidays. I have missed so many birthdays, Easters, 4th of Julys, Thanksgivings, Christmas and New Years to be working at the hospital. At some point, I started to resent missing that time with my family. Working on holidays is the norm for many nurses, and I expect to work some. But since I will be working a little less anyway this will also equate to working fewer holidays as well. The same goes for weekends.
Self Care for nurses is more important now than ever.
#3. Continue working per diem
There are a lot of benefits and drawbacks to being a per diem nurse. For example, I love that I can schedule myself to work on the exact days I WANT to work. However, it also means that if I am not needed then I get canceled at 0400 and then I don’t make any money for that day. And since I end up paying for a nanny regardless, that’s a double whammy.
The best part of being a per diem nurse is that it offers me a much better work-life balance. When I worked as a career nurse it was almost impossible for me to secure childcare because my work schedule was always changing. Some weeks I got the schedule I needed and others I didn’t. So on the whole, being a per diem nurse is the right choice for me and my family.
#4. Continue writing and growing my website to help other nurse moms
In 2016 I became a nurse blogger. My venture was born out of my frustration with burnout as a registered nurse and my desire to create a more flexible work-life balance. Writing about nurse lifestyle topics that interest me and exploring ways that nurses can take better care of themselves helps me to take care of myself better too.
My little blog is even starting to make a small monthly income, which absolutely thrills me. I have a dream that if I keep working hard my website will make enough money that I can work one day a week instead of two.
#5. Take a comprehensive course in website management and blogging
Last week I signed up for a comprehensive blogging course that will probably take me the next 6-8 months to complete. I honestly haven’t been more excited to do something for myself like this in a really long time. In fact, I can’t wait to see my progress over the next year!
#6. Explore other medical-related career options
A few weeks ago I interviewed for an aesthetic sales position. Although I didn’t end up working for the company, it did open my eyes to the fact that there are so many other great opportunities that I could be interested in and also fit my skill set as a nurse. A nursing practice can take many forms and I am giving myself permission to continue learning about other nursing career options.
#7. Focus more energy into my family and friends
One of my New Years resolutions this year was to “choose fun.” So many studies have shown that spending quality time with family and friends is incredibly helpful in decreasing stress and improving burnout symptoms. Since I will be working a little less I will have more time to focus my energy on the people who matter most to me.
#8. Enjoy my new fancy gym membership (with childcare on site!)
In the spirit of investing more in myself, I started 2019 off with a gym membership. It has been a complete game-changer for me. In fact, the old me would never have never splurged on a fancy gym membership. Making regular time to work out always makes me feel great, clears my head and gives me more stamina. And my 1 year old loves the Kid’s Club, so it’s a win-win.
As a nurse and mom, my life basically revolves around caring for everyone else, and I am SO GRATEFUL to be able to do that. But if there is one thing I have learned through my own compassion fatigue it is that I need to put the same care into myself as I do into my patients and family. So in the spirit of self-compassion, I am metaphorically putting on my oxygen mask first, before helping those around me.
#9. Practice more yoga
I have been regularly practicing yoga for 14 years. Finally, in 2o15 I completed Yoga Works’ 4 month Urban Zen Integrative Therapy program for medical professionals. I learned how to teach simple yoga, do guided meditation and perform Reiki. It was amazing!
However, in recent years I have not been practicing as much as I would like, and that is going to change. My goal is to incorporate yoga into my busy schedule every single day. Even if it’s just for 10 minutes. Yoga helps me stay balanced in times of great stress, gives me flexibility (both physically and mentally) and has been extremely grounding. In fact, I recently started teaching my 3-year-old daughter a series of yoga poses and it is bringing us both great joy!
These two are already happy about self-care goal #1: Work two 12 hour shifts a week instead of three. Job flexibility has never been so important to me.
Nurse self-care matters. If we don’t care for ourselves then how can we expect patients to listen to our health advice and education? I am taking this opportunity to give myself compassion and hopefully lead others by example.
If other nurses find themselves feeling as unappreciated and burnt out as me I encourage them to find ways to care for themselves first. Otherwise, we are perpetuating a broken system that does not acknowledge that nursing burnout is a real issue and ignoring nurse health and well being.
So nurse, what are you going to do to take care of yourself today? Leave a comment!
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:
(This post about simple stress management for nurses may contain affiliate links. See our disclosure page for more information.)
Nurses are more stressed-out than ever.
It is no surprise that prolonged stress damages the body. Yet many nurses are dealing with unchecked, chronic stress for years, or even decades. Still, the passion that many nurses have for helping others drives them to continue forward in their nursing careers. But who is helping nurses?
The unfortunate truth is that nurses themselves are the ones who must take care of themselves first. Nurse safety and well-being are not being taken seriously by the very own hospitals where we work so hard and strive to give only the very best patient care. Nationwide, it appears that hospital administrator’s main priority is making money for the hospital, and the health and well-being of their nurses doesn’t even make the list.
Simple stress management for nurses
Do some hospitals see nurses as indispensable?
For some nurses, it may feel like it. Even I have felt that despite my own dependability, clinical knowledge, and positive attitude that it wouldn’t matter in the slightest if I left. The feeling is disheartening.
For example, I became a per diem nurse after the birth of my first child because a unit director stated that they were “unable” to give me consistent scheduling so I could plan daycare for my child. Per diem nursing gives me the flexibility to schedule my days to fit my childcare situation; however, now I have no benefits, no disability, no retirement, and no maternity leave – and I had another baby this year! Needless to say, it was a hyper-expensive year for us and caused a lot of stress for me.
But, they knew another nurse would come along and fill my spot. So why be flexible with my schedule so that I could stay?
I still have a passion for nursing, despite the stress.
Workplace stress in nursing is common. I am not leaving the profession soon because my children are still very small, and I still do have a strong desire and passion for helping others. So in the meantime, I make stress management a huge priority in my life.
If you are a nurse who feels like me, keep an eye out for nurse burnout symptoms that could be wreaking havoc on your overall health and happiness. And start taking simple steps to help keep stress in check, so you don’t end up as a patient yourself. Nurses shouldn’t be creating unhealthy habits to cope with their stressful nursing careers. And if it becomes too much where your health is severely being affected negatively, then consider other nursing options away from the bedside. Nurse, you need to take care of yourself first!
Simple Stress Management Techniques For Nurses:
1. Watch a funny movie
When was the last time you had a good laugh? Do you even remember how good it feels to laugh out loud? Watching a funny movie is a great way to passively tune out and focus on something more light-hearted. Especially for nurses who deal with immense stress in the workplace.
Studies show that laughter is so good for your health. A good laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after. Also, laughter increases your immune system by decreasing stress hormones and increasing immune cells and infection-fighting antibodies, thus improving your resistance to disease.
Laughter makes people feel good, which is precisely what stressed-out nurses need. It releases endorphins, the body’s natural feel-good chemicals. Studies show that laughter has the power to promote an overall sense of well-being and can even temporarily relieve pain.
2. Get moving: endorphins are natural stress reducers
Get your heart rate up on your days off! The benefits of exercise have been well documented is essential for nurse self-care. It is no secret that regular exercise helps control weight, boosts overall energy, improves your mood, and helps decrease stress levels. Not only does exercise benefit the nurse personally, but it also allows nurses to have the stamina to give better care to patients as well.
Need to blow off some steam after a stressful day? A brisk 30-minute walk can help. Physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed. Which, in turn, will help manage caregiver burden and help you feel your best.
3. Yoga: learn the art of how to relax
Yoga is a great stress management tool for nurses. Compassion fatigue can be overwhelming for nurses, and learning how to use yoga for relaxation can help.
A study published in Workplace Health & Safety on yoga for self-care and burnout prevention of nurses found that yoga participants “reported significantly higher self-care as well as less emotional exhaustion upon completion of an 8-week yoga intervention.” While the control group demonstrated no change throughout the course of the study, the yoga group showed a significant improvement in scores for self-care, mindfulness, and emotional exhaustion outcomes.
Nurse self-care in the form of yoga is scientifically proven to be beneficial:
Stress management. A study published in the National Institute of Biotechnology Information investigated the effects of yoga on stress coping strategies of ICU nurses. After only eight weeks of yoga, the results showed that the participating ICU nurses had significantly better focus coping strategies and a significant reduction in perceived mental pressure. (If that is what can happen after only eight weeks, imagine the impact a regular, permanent yoga practice could have on stress management levels!).
Prevent or eliminate chronic low back pain. Chronic back pain in the nursing population is a common ailment. An evidenced-based review at the Texas Women’s University reported that estimates of chronic low back pain among nurses range from 50%-80%. Yoga not only increases flexibility but increases muscle strength and prevents injuries such as chronic lower back pain.
Good friends can help you manage chronic stress. It is essential to find balance when you work as a nurse, and that includes making time for friendships and a social life outside of the hospital.
Nurses with strong social support have a reduced risk of many significant health problems, including depression, high blood pressure, and an unhealthy body mass index. Talking with other nurses who are struggling with the same stressors, you are can help provide support when you need it most.
Having a good social support group can help in many other ways:
Increase your sense of belonging and purpose as a nurse
Boost your happiness and reduce your stress
Improve your self-confidence and self-worth
Help you cope with traumatic situations in the workplace, such as patient deaths and abusive or combative patient situations
Supportive friendships can encourage you to change or avoid unhealthy lifestyle habits, such as excessive drinking or lack of exercise
Meditation is the practice of focusing your mind on a particular thought or activity to achieve a mentally clear and emotionally calm state. It is claimed to reduce stress, anxiety, and burnout, and enhance resilience. And stressed-out nurses working long, arduous shifts with often changing schedules need this more than anyone.
A few benefits of meditation:
Better focus and ability to ignore distractions
Happier state of mind
Headspace is an app for your phone that has many different meditations, each lasting 10 to 60 minutes. If you can find 10 minutes in your day, then you have no excuse not to meditate! Meditation is attainable for even the busiest of nurses!
Like yoga, meditation is a practice. There is no good or bad. It is just what it is at the time. You can keep practicing to train your mind to do better the next time. And then eventually your brain is rewired by the habitual repetition of meditation, and it becomes easier.
It is not uncommon for hospitals to have a space for spiritual prayer or meditation for patients and their families. However, nurses should also be offered a meditative space to clear their heads and have a quiet moment to themselves. This would help nurses return to their work environments with renewed energy and focus on giving better patient care.
6. Eat nutritious foods
Nurse break rooms are notorious for having sugary snacks like donuts, cookies, or other unhealthy junk food all within an arms reach. Sweets are so tempting to nibble on when you are tired and need a little extra energy. But then a few moments later you crash and are even more tired. On another note, eating nutritious and easy snacks will keep you energized during a 12-hour shift.
Pack snacks like these in your lunch bag to help keep your blood sugar levels balanced during your shift:
Baby carrots, broccoli or other veggies & hummus
Celery and almond butter
Granola and yogurt
Almonds or cashews
Sliced apples and peanut butter
Cottage cheese with pineapple or banana
Tips for nurses to make healthy meals fast: Try making a big batch of quinoa, brown rice, or black bean pasta to have handy in the fridge. These are a few great staples that you can build a nourishing meal around. When you get hungry, you can mix in a protein, veggies, nuts or seeds, dried fruits, or even just enjoy them with a little olive oil and sea salt. The key is to have healthy food that is easy to prepare BEFORE you get super hungry.
P.S. HEY, NURSES! Remember to grab your FREE E-Book “The Nurse’s Guide To Health & Self Care” below! (scroll down)
(This post about nurse burnout symptoms may contain affiliate links. You can find my disclosure page here.)
The nursing profession tends to attract the most compassionate and empathetic people alive. For that reason, nurses are also the most susceptible to experiencing “burnout.” Eventually, chronic overwork and stress can lead to nurse burnout symptoms such as exhaustion, anxiety, physical injury, or even depression. If you have been a nurse for a while, then you probably know exactly what I’m talking about.
Nurse burnout symptoms don’t start right away.
A novice nurse is so fresh. The happiness to be done with nursing school combined with the excitement of having the title R.N. after your name moves the new nurse optimistically through each 12-hour shift.
Yet, many nurses find themselves experiencing nurse burnout symptoms, sometimes after only a year or two in the profession. Still, they continue working with the same rigor and determination without taking good care of themselves.
Here are a few nurse burnout symptoms to look out for:
1. Chronic exhaustion
Have you ever gotten 8 hours of sleep yet still felt exhausted when you woke up? Or, are you so tired that you can’t imagine how you are going to make it through another 12-hour shift? If so, you may be experiencing chronic exhaustion.
Nursing is a caring profession, and compassion is one of the essential elements of patient care. However, constantly caring for others’ needs before your own can lead to compassion fatigue. Symptoms of compassion fatigue include emotional exhaustion, irritability, and poor job satisfaction. You simply cannot be a good nurse if you begin to dislike your job.
If you find yourself feeling like you are losing compassion for your patients because you are experiencing this nurse burnout symptom, then you owe it to your patients and yourself to take a break. Go on a vacation, play a round of golf, take a yoga class, or find a way to get some quality alone time to recharge your batteries.
3. Losing your passion
When many nurses are asked why they decided to go into the nursing profession, they say it was because they had a “passion” for helping humankind. Passion is exactly what drives us to do good work. So, if you feel you are losing your passion, then it may be a good time to find it again.
Stagnation is the killer of passion. Do you feel like you are no longer learning within your specialty? Perhaps it is time to become certified within your specialty or even find a new specialty altogether. Nursing is a career for lifelong learners. Learning keeps us educated, and it can also help you find your passion for nursing again. It’s a win-win!
More is expected of nurses than ever before.
Nurses need to find a work-life balance more than ever. Heavier patient loads and the physical demands that come with working arduous 12-hour shifts are killing the spirit of many R.N.’s. To top it off, it seems as if hospitals are trying to save money in any way they can, and unfortunately, that usually translates into less and less resources for nurses.
The bottom line is this: when nurses take care of themselves, they can give the best possible care to their patients. This scenario is a win-win for everyone involved: nurses, patients, and the business people who are managing healthcare.
As nurses, we simply cannot continue to burn the candle at both ends and expect a good outcome.
If you are experiencing nurse burnout, there is hope! You can beat nurse burnout and even rediscover your passion for nursing. A result of my own nurse burnout was that I became a nurse blogger to vent my frustrations and help find solutions for my own burnout. However, it is your responsibility to figure out why you are unhappy within your career and find your nursing passion once again. You too, can beat nurse burnout!
P.S. Sign up to receive your FREE COPY of “The Nurse’s Guide To Health And Self Care” at the bottom of this post!