Nurses, I see you out there. I know that your job can be a lot. Some days are better than others, but sometimes it feels overwhelming. Certain fields such as ER nursing, ICU nursing, and oncology nursing can be particularly stressful. What is burnout? What are the signs of burnout? Is it avoidable? Let’s explore this a bit.

What is burnout?

Burnout is a sequence of events that occurs in reaction to an ongoing stressor. First comes the emotional exhaustion. Then, if not unchecked, it progresses to depersonalization. Depersonalization is when someone seems “checked out” with regards to their patients and their coworkers. The person tries to distance themselves. Finally, there is a sense of reduced personal accomplishment and the ensuing low self-esteem.

Signs of burnout

Signs of impending burnout could be dreading going in to work in the morning, irritability at home, or restless nights due to stress. Books such as Burnout Immunity by Kandi Wiens can be helpful. She has a burnout risk assessment in the book that gives you a rough idea of where you land on the burnout spectrum. (I was relieved to find that I’m only at a moderate risk for burnout). However you might not feel like reading a book if you’re dealing with burnout and feeling rather, shall we say, crispy. Sometimes you just need some help- fast. Here’s some ideas on preventing it.

Think layers

Start thinking of ways to work with those things you can actually control- during your shift, and long-term.

During your shift

Learn to be compassionate without being a human sponge. You can tell a patient, “I’m here with you” instead of trying to fix everything (which is impossible!)

Take micro-breathing breaks. Even 60-90 seconds in the supply closet where you’re doing some deep breathing can make a difference. Have you tried box breathing yet?

Learn how to save some time (if possible). Think about ways to group tasks, or work on efficiency. Even saving a minute here and there gives you a little bit more literal breathing room.

After work

The hard stop. Think of a way to switch off from work mode to home mode. For me, I park a little bit further away than most people. This gives me a minute to walk to my car while doing some deep breathing. I get into my car and take off my watch and badge, putting it in the glove box for the next day. This has been one of the best ways for me to “switch off.” For a while, I was having a really hard time doing it. Some days I need to walk after work for a little before going home. You might find that taking a shower when you get home is your “switch” off. Some people get to a certain stop sign before their house and that’s their signal. If I think of something at home after a very busy day that I don’t want to forget for tomorrow, I write it on a little post-it. This gets it out of my head.

Limit rumination. Sometimes after a very difficult day, I’ll find myself replaying a situation that was complex or high-stress. By giving yourself a limited amount of time to think/journal about it, you can stop the cyclical thinking and get on with your evening.

Do something physical. Here’s where my walking comes in. Sometimes you just need to do something to get rid of that extra energy and reset.

Long term

When there is an aspect of grief at work, there needs to be an outlet. Journaling, talking with coworkers, and reflective practices can help.

Moral distress can drive burnout. Sometimes you can’t give the care that you feel is right due to time/staffing constraints. Calling this what it is can help reduce the emotional burden.

Practice healthy detachment. You can’t get heavily involved with every single patient. That’s okay! You can be a good nurse without being super involved with everyone.

Advocate

If possible, ask for reasonable patient ratios.

Make time to debrief after codes, reactions, or other serious events.

Rotate the heaviest assignments, if possible. Where I work we rotate through patients, meaning we never know who we’ll get that day. Some patients are a lot more work than others, and it’s a good thing to rotate those patients through as much of the staff as possible.

Long Term

Take actual rest and recovery days. Not just days where you’re cramming in a million errands and trying to scratch off 100 things from your to-do list!

Cross-train, move into another position, precepting. These can all be ways to lessen the stress. Work on breaking up the intensity and the monotony.

Therapy and support groups can help.

If, in spite of working on it, you’re still feeling the effects of burnout, it might be time to make a switch. And that is okay! It’s healthy to recognize that a change needs to be made. Advocating for yourself is always a good thing.