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.
Additional recommended reading:
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
Additional recommending reading:
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 post contains affiliate links. You can find my disclosure page here.)
The benefits of green tea have been touted for decades. But I recently discovered a new shade of green tea that I’m pretty obsessed with called matcha.
I initially tried matcha green tea because I was tired of the caffeine highs and lows that I got with coffee. As a nurse and new mom who works 12 hour shifts in an emergency room I need caffeine, but coffee can be intense. So as an experiment, I decided to switch out my coffee habit entirely with matcha green tea for 30 days to see if I noticed any differences. (And by the way, this was a huge step for me, as I am a coffee addict and a coffee snob!).
I put my Kuerig in the pantry and set my electric kettle in its place. I didn’t want the temptation to brew my regular coffee in a moment of weakness.
And guess what? It has been several months and I’m still drinking a cup of matcha green tea every morning. I feel better when I drink matcha than I do coffee – and I can see a noticeable improvement in my skin as well!
What is Matcha Green Tea?
All green teas, matcha included, are derived from a plant called Camellia Sinensis. As opposed to regular green tea that comes in a tea bag, matcha is 100% green tea leaves that have been ground into a fine powder. That is why matcha is so concentrated and why you only need 1/2 teaspoon per cup!
In addition, matcha is higher in caffeine than
regular green tea so you don’t need to add more then 1/2 to 1 teaspoon per cup of tea. However, you can vary the amount of caffeine based on how much powder you add.
Matcha green tea offers many health benefits compared to coffee.
4 Reasons Nurses Should Drink Matcha Green Tea Instead Of Coffee:
#1. Matcha is healthier for you
Like other green teas, Matcha contains a type of antioxidants called catechins. It is specifically high in a type of catechin called EGCG (epigallocatechin gallate), which is known to prevent cancer in the body. Many studies have linked green tea to a variety of health benefits such as weight loss, preventing heart disease and preventing type 2 diabetes.
As a nurse who practices evidence-based care, I know it is important to create healthy habits to help prevent illnesses in my future. Matcha is just another way for me to take better care of myself on the job.
#2. Matcha is high in vitamins
Compared to coffee, matcha scores significantly higher in nutrition. It contains vitamin A and C, iron, calcium, protein, and potassium. In addition, the high chlorophyll content in matcha also makes it an effective detoxifier that helps the body rid itself of toxins and heavy metals.
Coffee does not even compete with the nutrition that you get from matcha. By starting the day off on the right nutritional foot with a cup of matcha tea nurses can help meet their nutritional needs. Not to mention, many break rooms are fills with sweets like donuts and cookies. Adding a cup or two of matcha can help nurses get the nutritional fuel they need to continue giving great patient care.
#3. Matcha creates a sense of calm alertness and concentration
As opposed to the highs and lows that many people get with drinking coffee, matcha provides a less jittery caffeine high. That is because Matcha contains L-Theanine, an amino acid that helps your body to process caffeine differently than coffee. As a result, matcha contains much less caffeine than coffee yet has a more sustained energy boost, without the crash later on.
As front line workers in the hospital, nurses need to stay calm in stressful situations. Our patients lives depend on us to make critical decisions that effect their overall health and well-being. In addition, nurses need to be able to focus clearly, often for hours on end without breaks. A slip-up , such as a medication error, could be deadly.
#4. Matcha gives you whiter teeth
And better oral hygiene as well. Matcha has antibacterial properties that provide vital protection to the teeth, prevent plaque build up and improves oral health. On the other hand, coffee stains the teeth and causes bad breath – a major turn off for patients.
Most nurses I know don’t brush their teeth after drinking coffee or eating meals at work – even if they had the time. Drinking matcha helps eliminate coffee breath and keeps nurses’ oral hygiene healthy to boot.
What you need to make your own matcha green tea at home:
Making matcha green tea at home is an easy as making a pot of coffee. Just add 1/2 teaspoon matcha to 12 ounces hot water. Add sweetener and milk if desired. Enjoy!
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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!
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