The health care system has been in crisis for a long time, which has led to nursing burnout, compassion fatigue, and even post-traumatic stress. But nurses can’t wait for the system alone to address the problems. It’s incumbent on individuals to devise ways to thrive in the workplace. That entails, among other things, cultivating protective factors like hope and compassion.
That was one of the main messages of the keynote speech delivered by Judy Sheehan, MSN, RN-BC, at the Fall Nursing Conference on December 9. Sheehan is director of nursing education at Butler Hospital in Providence, Rhode Island, and primary editor and a co-author of “Inpatient Psychiatric Nursing, Second Edition: Clinical Strategies and Practical Interventions.”
The COVID-19 pandemic exacerbated many of the system’s problems—in particular, nursing shortages—creating an environment in which stress levels skyrocketed, according to Sheehan.
“People would come into the hospital with no symptoms but then develop them. The whole unit became contaminated, many nurses got sick, and we took on a lot more work because of how many of our colleagues were ill,” she said. “We’ve been called heroes, but we’re exhausted and isolated from one another.”
While it’s tempting to wait for institutions to come up with solutions for burnout, it’s important that nurses have a sense of agency.
“If we wait for health care institutions to change, it will take a long time, and the cost may be an increase in helplessness, hopelessness, and despair—a perfect recipe for depression,” said Sheehan.
“The most important thing for a person is to feel that they have hope, that they have some control over something, that there is something that can be done.”
So, what can individual nurses do?
A Systems Perspective
Sheehan looks at the burnout problem from a systems perspective, a theory that stresses interconnectedness and the careful balancing of inputs and outputs. For her, one of the first things she does to combat burnout is decrease her own output.
“When I get overwhelmed by the demands made on me, I intentionally forget my phone, lose my calendar, and go to bed for a while,” she explained. “I decrease my output so I can strengthen my resources.”
Minimizing negative input is another strategy for maintaining equilibrium, according to Sheehan. “Reduce your interaction with negative friends or co-workers. Avoid turning on the news before going to sleep, be careful what you view online, or put yourself on a media diet altogether,” she said. “I don’t watch programs that make me tense. I listen to knitting podcasts.”
On the hospital side, increasing resources like staffing and decreasing demand by lowering patient census are also solutions.
“But we can’t control that,” said Sheehan. “All we can do is take care of ourselves.”
According to Sheehan, tending to one’s own needs can be broken down into three elements, mind, body, and spirit.
“We need to feed our bodies, rest our bodies, and exercise, but that’s hard when your belly’s in a knot and you can barely get home without falling asleep in your car,” she said.
When it comes to the mind, positive reframing, mindfulness, and engaging in hobbies are healing activities. Meanwhile, the spirit encompasses much more than religion, said Sheehan.
“How do we get inspired? Where do we find the meaning in life? How much of this inspiration comes from why we wanted to be a nurse to begin with?”
Cultivating Compassion and Hope
Sheehan spoke about hope and compassion as critical to nursing work. She cited the scholarship of Jud Brewer, MD, PhD, from Brown University’s Center for Mindfulness, who distinguishes between compassion and empathy.
“He talks about how empathy is putting oneself in another person’s shoes, feeling the other person’s suffering,” she said. “But the danger is becoming part of their story.”
Compassion, on the other hand, assumes a more protective stance.
“Instead of merging with that person and walking in their shoes, you’re walking alongside them and listening to their story, without taking on their pain,” Sheehan said. “When you’re compassionate, you have the space to think of what to do and how to help.”
Interestingly, Brewer’s work using fMRI imaging shows that compassion makes the pleasure regions of the brain light up while empathy activates the pain centers.
Hope is another buffer against burnout, said Sheehan, but it can be hard to hold on to in today’s world.
“Hope is the currency that nurses use to work their day. It’s that thing that gets us up in the morning to get us into work,” Sheehan shared.
Hope is especially important in a psychiatric setting, she added. “Psychiatric nurses are so special because they hold hope for the patient in front of them, who is without hope at the moment, and that is a dangerous place to be.”
Other Strategies
Tapping into the initial inspiration for becoming a nurse reignites the hope that is so critical to combatting burnout.
Sheehan told the story of encountering a young man weeping on a bench outside her hospital and telling him that she would escort him to the admissions area where someone would be able to help him. They walked together and he told her his story and after they said goodbye, she reflected on the encounter.
“I left knowing that I became a nurse because I wanted to comfort people,” recalled Sheehan. “I could forget all the other stuff, the COVID stuff, angry staff, sick staff, frightened staff.”
Make sure you have constant reminders of the origins of your choice of vocation, she advised. “Put it on sticky notes so you can see it first thing in the morning and look at it before driving home.”
Carve out mindful moments during your day when you can recharge, suggested Sheehan.
“I was working in a stressful environment, and every time I had to walk across the unit, I would focus on my feet and imagine I was leaving a footprint as I walked,” she said. “That calmed me and I could refocus on myself.”
Creating rituals to transition from work to home can also be helpful. “Open your car window and blast out music on the way home,” she said.
“Sit in your car in your driveway before you go into the house and jot down notes about how you felt about the day or something you want to hold on to—something positive.”
Other strategies for combatting burnout can include:
- Pray, meditate, or simply relax
- Join a peer support group or create one on your unit
- Attend professional trainings
- Actively practice and internalize gratitude
- Support a colleague
- Vary the work you do
- Do something pleasurable
Self-care is not an option, Sheehan concluded. “It’s an ethical responsibility,” she said. “If we do not take care of ourselves, we can’t take care of others.”
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