Everyone has bad days, the kind that leave us physically spent and emotionally exhausted. Recently, I asked a coworker how her day was going and her answer was mixed, "Today is a good day, not like yesterday ... that was the worst day I have ever had in my entire career!" She went on to explain that the overwhelming needs of patients and families had left her feeling that she should have been able to do more. She stated, "I went home thinking that I couldn't take care of everything my patients needed me to do. If I had that kind of day every day, I couldn't do this. Most days aren't that stressful ... thank goodness!"
When stress continues to increase over an extended period of time, occupational burnout is a real possibility. Occupational burnout is defined as a syndrome resulting from multiple and chronic stressors that manifest in detachment from work, cynicism, and a low sense of accomplishment (Maslach & Leiter, 2016). Although stress may be displayed as overcommitment, burnout is associated with behaviors of pessimism and disengagement. Physical and emotional fatigue can be the underpinnings of feelings of incompetence and depleted motivation. If left unchecked, every day becomes a "bad day."
There has been a resurgence of interest in burnout affecting healthcare professionals. Last year, the National Academy of Medicine (NAM) advanced a call for action to focus on burnout in healthcare. The NAM reports that burnout is prevalent among physicians, with over half detailing significant symptoms. In a 1999 study of over 10,000 registered nurses, 43% had emotional exhaustion. In 2007, a study of 68,000 nurses verified that emotional exhaustion remained widespread at the level of 35% for hospital nurses, 37% for those caring for patients in nursing homes, and 22% for nurses practicing in other settings (NAM, 2017).
There are several features related to the development of nursing burnout. These include workload, work hours, lack of control over work situations, and work-life balance. Powerlessness, lack of control, feeling taken for granted, and absence of support from colleagues are also contributing factors. In the case of the nurse describing her worst day ever, a moral dilemma occurred. We expect to provide patient- and family-centered care, yet it is not always possible. These experiences clash with professional values and result in stress that threatens the sense of integrity and meaning. The cumulative effect of moral dilemma contributes to professional burnout.
Burnout among nurses is a worldwide phenomenon with common themes. When the progression of burnout among orthopaedic nurses in Greece was examined, correlations were discovered in challenges of caring for patients with trauma, advanced age, acute physical disability, pain, multiple comorbidities, and activities of daily living limitations. Difficulty in relating to physicians, who hindered collaboration and created an atmosphere in which nurses did not feel valued or respected, increased the risk for the development of burnout (Panagiotis, Spyratos, Lampa, Aretha, & Sakellaropoulos, 2010).
Nursing burnout is important to healthcare quality. The consequences of professional burnout in healthcare are significant for patient care. Nurses compose the largest portion of the U. S. healthcare workforce. Therefore, the profession is looked upon as crucial in the balance between excellence in care delivery and efficiency of service (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). The influence of the work setting on nurses' job satisfaction and patient outcomes has been outlined through the growing body of knowledge gained from Magnet-designated hospitals. Magnet suggests that environments supportive to nurses and professional nursing practice enjoy a halo effect in lower rates of patient mortality and failure to rescue, fewer central line-associated bloodstream infections, improved patient experience, and decreased levels of nursing burnout (Adams, Zimmermann, Cipriano, Pappas, & Batcheller, 2018). The financial implications are also significant to healthcare organizations. The loss of each registered nurse results in projected turnover costs ranging from one to one and one-third times the nurse's salary (NAM, 2017).
The relationship between teamwork, leadership, participation in decision-making, and growth opportunities is intertwined with the emotional exhaustion component of burnout (Sexton et al., 2018). The culture of an orthopaedic unit can be enhanced by implementing approaches that value nursing input and collaboration with the interprofessional team. For example, the joint replacement unit at my hospital has garnered organizational Tier 1 status in employee satisfaction over the past 3 years. Elements leading to this success have comprised daily Nursing Leadership Walking Rounds and unit-focused shared governance. Weekly teaching rounds with the orthopaedic surgeons are inclusive and rely on bedside input from nurses, therapists, anesthesia providers, case managers, the orthopaedic nurse navigator, and program leadership. The discussion, problem-solving, and learning that occurs during these rounds highlight the contribution of all team members. The National Patient Safety Foundation outlines that healthcare leaders can be effective and supportive through increasing opportunities for autonomy and communication among colleagues, offering timely feedback, and creating meaningful challenges. Orthopaedic nurse leaders can positively affect the outlook of their areas by focusing on these issues.
Orthopaedic nurses can benefit from the power of resilience. Maintaining self-awareness that although it may not be possible to control what happens in every situation one can control, the personal reaction to the situation can be a useful attribute. Resilience is the capacity to apply coping skills in order to decrease the negative effects of stress. Taking the time to connect with those features that give our lives meaning, purpose, and hope cultivates resilience. Pursuits that promote resilience may include physical or mental activities that are enjoyable or help cultivate problem-solving, such as creative arts, play, getting out in nature, exercise, or spiritual practice. Mindfulness exercises are a practice that also fosters coping in a creative way.
Here are a few ways to practice resilience with mindfulness exercises:
* Define what is important to you. What are you passionate about? Spend some time developing your own personal mission statement.
Here is my mission: I am passionate about making a difference for patients through facilitating excellence in orthopaedic care. When I feel as though I am losing sight of purpose, I look inward to focus on my professional mission and reflect on what I can do to meet it.
* Learn and practice deep breathing, visualizing negative thoughts floating away, noticing the small beautiful details in mundane objects around you, or putting on headphones and listening to all of the instruments in a piece of music you have never listened to before.
My visualization is a "tree" that I leave behind at work. The lingering problems that I do not want to carry home with me rest in the branches, until tomorrow.
Remaining alert to the hallmark signs of burnout-chronic emotional exhaustion, disengagement, and feelings of inadequacy-is the first step to recognizing the potential for detrimental effects on physical and emotional well-being. If the distress of burnout is exacerbated and creeping into other areas of your life, seek professional assistance to help you cope. Listen to the nurse in you. That is what you would tell your patients to do!
Consider your professional and personal growth plan. This may mean going back to school, pursuing your certification, getting involved in a professional organization, such as the NAON, or volunteering to make a difference for a cause you care about. Discover a place where you can network with other nurses. The NAON abounds with networking opportunities. The Issues in Practice Forum on the NAON website is a great place to connect with others who have the same questions and challenges that you face. Reignite your passion for orthopaedic nursing knowledge by attending a webinar, local chapter meeting, or planning to attend NAON Congress.
Most importantly, take time out to take care of yourself. Given the high rate of burnout in nursing, orthopaedic nurses are at risk. The good news is we need not let burnout define our nursing careers.
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