The problem of nursing burnout has been in a state of evolution for years. For many of these years, the 12-hour shift was the primary focus. However, 12-hour shifts provide nurses time away from the bedside necessary for rest, family time and self-care, allowing for a rested and refreshed start to new shifts.
Several stressors lead to high levels of pressure and nurse burnout. These include:
- High patient acuity (years ago, these patients would have been in the ICU)
- High nurse-to-patient ratios (not acuity-based)
- Multiple discharges and admissions (many nurses will discharge and admit an entire team of patients during their shift)
- Lack of ancillary support and resources
- Leaders who assume that nurses “can take one more patient”
- Physicians who expect nurses to drop everything and attend to their needs
- Interruptions while on their break
- The expectation that nurses are all-giving.
However, the most important stressor includes an old mindset held by organizational and nursing leadership: Nurses who voice concerns related to patient safety and workload are viewed as complainers. As nursing leaders, we must recognize the demands placed on our nurses, validate their concerns, and through best practices and common sense, use our leadership to provide support.
The most important skill of a nursing leader is the ability to listen to nurses. The nursing leader must be engaged in the discussions and have a physical presence in the department. Engaging with nurses allows for an open dialogue and a discussion of ideas, and provides validation.
Validation, in turn, lowers nurses’ stress levels because they know they are being heard. Open dialogue provides the nursing leader a forum to foster best practices, find workable solutions for departmental issues, and teach leadership skills through mentoring sessions.
Nursing leaders must hold nurses accountable who are not carrying their load. Modifications in behavior by the nurse will indicate action and support from the nursing leader. In addition, nursing leaders must know, understand and demonstrate a deep caring for their nurses. This is why having a presence on the unit is so important. Actions always speak louder than words, and we must model healthy, professional and supportive behaviors for our nurses.
Staff meetings can be of great benefit and should include discussions regarding new organizational policies, processes and outcomes from higher leadership meetings. One way to engage nursing input in staff meetings is to post an agenda and ask for additional items the nurses would like to discuss or present. Allowing nurses to create ideas, and to volunteer according to their interests and passions, fosters a sense of belonging that is necessary for engagement.
Imagine nurses researching best practices regarding care of a complex patient diagnosis new to your unit. The nurses present their research and provide the education to the nursing staff. Recognition encourages more nurses to contribute to improving the unit.
As nursing leaders, we must teach and empower our nurses to lead. Self-care has become a buzzword in nursing. Nurses are expected to care for themselves, but are sabotaged by the stress and the demands of the patient care environment. However, nursing leaders must provide supportive environments that foster self-care. For example, a competent team can handle discharge and admissions paperwork and patient education, allowing nurses to attend to their patient loads.
Finally, and most importantly, nurses need to be told that it is OK to take care of their own needs during their work shift. They need to feel confident that the nurses who are covering their team are knowledgeable and competent.
Self-care is included in many of the BSN and master’s-level nursing programs. Nursing programs are teaching leadership skills focusing on professional communication and how to achieve self-care in the work environment. Using best practice and leadership practices learned in nursing programs, nurses should present new ideas and evidence-based models to their nursing leadership.
By communicating in a professional fashion with the leadership, nurses will feel empowered and validated by having a voice. This new refreshing outlook is a far cry from the old, when nurses were expected to give up their chairs for physicians.
Carrie Silvers is a clinical instructor and course chair in the RN-MS program at the University of Arizona. Her professional nursing background has focused mainly on critical care, nursing leadership and safety.