Managing burnout Increasingly, health-care employers offer help

By Doug Childers

Bonnie Piper, RN, understands the dynamics of burnout. Since 1991 she has helped employees and their family members cope with it through Mary Washington Healthcare’s ASSIST employee assistance program.

A couple of decades ago, health-care organizations were just beginning to understand the need for employee assistance programs. Today, she says, most health-care organizations offer them, either in-house or through a third-party provider.

Piper recently discussed the dangers of burnout and strategies for managing it with Nursing in Virginia.

NIV: How big a problem is burnout in the nursing profession?

Piper: It’s a significant problem. I’m not so much amazed by the number of nurses who burn out as I’m amazed by the number who don’t. It’s not something new, but as we’ve progressed as a profession, we’re able to evaluate it more.

NIV: How many nurses leave the profession because they’re burnt out?

Piper: I haven’t seen data on how many leave the profession. But some of the newest data points to a difference between younger nurses entering the profession and older nurses who have learned to manage their burnout. Newer nurses have a higher burnout rate – one-third of them leave their position in their first year, and 57 percent leave their first position in two years.

I don’t see a lot of nurses leaving the profession, but I see them making changes all the time. It’s helpful to maintain the motivation to do something different. That allows a lot of nurses to advance in the profession. They might go back to school to become nurse practitioners, for example. So those changes help the profession in the long haul.

NIV: How many RNs come to you experiencing burnout in the course of a year?

Piper: Our program sees about a 10 percent utilization rate per year. But it’s not exclusively related to burnout. Some nurses are experiencing burnout, and they have another problem as well. We have to look at their total lives for factors.

NIV: What are the primary causes of burnout?

Piper: Generally, we’ve seen an increase in our nurses’ stress levels. In part, that’s caused by higher acuity in their patients, heavy workloads and the increased complexity of care in this day and age. The health-care system being in flux right now compounds the problems.

More particularly, newer nurses might feel a disparity between their personal standards and what they find in the workplace. New nurses want to provide it all, and not being able to creates a disconnect between their standards and the job.

For established nurses, burnout might be caused by the increasing pace of our lives – patients and their families want instant answers these days.

NIV: What signs of burnout should nurses look for in themselves?

Piper: Symptoms include: constant fatigue; increased emotional reactivity or its opposite, emotional numbing; isolation;. and feelings of helplessness and hopelessness.

Every nurse will experience these symptoms, but for the burnt-out nurse, they become a constant problem.

NIV: When should a nurse seek help in dealing with burnout?

Piper: Early. Things that don’t get talked about get acted out, so frustration goes all over the place. You can talk about degrees of burnout the same way you can talk about degrees of a burn. And it’s best to get help in the first or second degree of burnout, because by the time they’re in the third degree, it’s more difficult to manage it. We’re not going to eliminate burnout. We’re going to help people manage it.

Two things help:

Bonding. Fellow nurses are sometimes a nurse’s best help. They offer a sense of community.

Opportunities for professional development. Nurses who avoid burnout are the ones who go back to school for education and advancement.

NIV: What is likely to happen to the nurse who doesn’t seek help?

Piper: She becomes the walking wounded. She might be there, but she’s not emotionally invested. It’s hard for a burnt-out nurse to show she cares about her patients, but she does. It’s the other stuff that gets in the way. Our goal is to get her back in touch with what she loves about nursing.

(Editor’s Note: Registered Nurse Piper, is the director of Mary Washington Healthcare's ASSIST Employee Assistance Program at Mary Washington Healthcare, parent company of Mary Washington Hospital, Stafford Hospital, and other healthcare services/facilities. She has her Masters in Psychiatric Nursing and is a Certified Employee Assistance Professional. )

In her own words
A nurse shares the story of how burnout drove her from the profession

As told to Doug Childers

Nursing in Virginia asked Mary Ganger, RN, to recount her experience leaving nursing because of burnout, only to return 12 years later. Ganger is the director of Hospital Education as well as the Magnet Program at the Reston Hospital Center.

I was seven years into my career as a nurse when my life became too stressful to manage easily. I had just gotten married, and because my husband was in the Air Force, I moved from Florida to Alaska, where I started school. My new employer wasn’t getting enough business to justify my job in an alternative birthing clinic, so I began working night shifts throughout the hospital.

Eventually, I didn’t want to go to work anymore.

Back then, nobody talked about burnout, and employers didn’t have employee assistance programs that nurses could turn to for help with managing their stress. So I made a rash decision: I quit. And I stayed out of nursing for 12 years.

I wasn’t happy being away from nursing, though. I began to feel like the work I was doing wasn’t important. I wasn’t making a difference.

Eventually, I signed up for a return-to-nursing program, and after a week, my husband looked at me and said, “You’re back.”

I still experience stress in my job. But I take a step back and analyze what’s causing the stress. I ask, What can I do to take care of that stress?

We all have to step back like that and look at our lives as well as our jobs, occasionally. Relieving that stress might come through a support group or regular exercise or meditation. We each manage stress in different ways. Here’s the important part: You have to actively do something.

To take care of our patients, we really need to take care of ourselves.