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How to unplug before nurse burnout sets in

The issue remains, so solutions must evolve

By
Karen Schmidt, RN

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EDITOR'S NOTE:
Karen Schmidt, RN, is a freelance writer.

Working in the emergency department is challenging, stimulating and satisfying — and likely to result in burnout for many RNs. It’s not a new problem, but innovative approaches, preventive measures and realistic solutions are decreasing the compassion fatigue and burnout plaguing ED nurses.

Nurse engagement and empowerment are also valuable. “If you’re working to make things better, you’re more likely to stay,” she added. Triantos agres with empowering nurses to feel free to speak about their needs. Her organization has a “very robust shared governance” with nurses finding ways to reduce caregiver stress, she said. One example is a charge nurse who launched a research study on the effect of real time debriefing and its effect on compassion satisfaction, burnout, and secondary trauma. As a result, training now equips all charge nurses to recognize the signs and symptoms of stress in staff members and how to provide tiered layers of support, starting with a five to 10 minute debrief after every code. “Staff said they believe this is emotionally valuable and beneficial,” Triantos said. At St. Anthony, Goldstein promotes and models the same team concept. A “post-code pause” takes place after every code, acknowledging the event and allowing staff to express concerns and feelings. He says this builds resiliency. He also endorses speaking up when the stress builds. “It’s not a sign of weakness, it’s a sign of needing help,” Goldstein said. “It’s empowering our staff to care for each other. Any member of the team can say, ‘Hey, why don’t you take to break?’ or ‘Hey, you’re a little bit stressed.’” Goldstein shared an example. “I saw a nurse bang something down on a desk in frustration,” he said. “ I gave him a few minutes, then in private asked him what was happening.” The nurse let out his aggravation about an interaction with a co-worker. Goldstein recognized, in real time, that something needed to addressed.


Nurses engage in the process
Unique setting fuels the fire
“The fact that the ED is unpredictable is what makes it so unique,” said Lisa Triantos, MSN, RN, CEN, NE-BC, a former ED nurse manager at Pennsylvania Hospital in Philadelphia who is now clinical director, emergency, medical and behavioral health nursing at Penn Presbyterian Medical Center. “The high patient volume and acuity, with the need to make quick decisions in short time frames, creates a high-pressure environment.” This, plus patients who are very sick and terminal, can lead to burnout, she said.
Tailor your approach to reducing burnout
Triantos believes adequate staffing, consistent leadership presence and getting nurses the resources they need can combat potential burnout. One resource the hospital implemented is a ‘care for the care provider’ program that offers three-tiered emotional first aid at the first sign of stress in nurses. Additionally, a “Zen Den" is available 24/7 where staff can get some quiet time and decompress; it offers a massage chair, aromatherapy, adult coloring books — an atmosphere that promotes relief from stress.
Set work time boundaries
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Goldstein commends his institution’s leadership for their commitment to staff’s mental, physical, emotional and spiritual health. “As an organization, we have ‘well’ staffing. We’re adequate staffed which means no overtime because that stresses staff out. There’s a reason we’re working only three 12-hour shifts.” The rest of the week, nurses need time to unplug for themselves and their families, he said. Wolf cited research demonstrating how staffing is a major component in burnout. “Situations that involve ineffective or inappropriate staffing means nurses are reduced to tasks rather than assessments. They don’t have time or mental space to make meaning of information they’re getting from patients.” She said nurses have to stop saying ‘yes’ to extra shifts or to extending a 12-hour shift.            “Take breaks. Don’t work extra. Stand up for your own needs as well as for those of the [work] group.” One useful strategy she’s noted in some hospitals is for staff, at the start of the shift, to map out when each person will take their break. “They get a chance to get off the floor and give their brains a rest. It’s very important.”
“The ED is a completely unique animal,” said Lisa Wolf, PhD, RN, CEN, FAEN, director of the
Emergency Nurses Association’s
Institute for Emergency Nursing Research. “You’re dealing with a population that is unknown, very ill, presenting with symptoms, not diagnoses. The process of figuring out what what’s wrong with them and fixing it is more difficult [than other types of nursing].”
Institutional and individual responsibility
According to
a 2015 research study
, compassion fatigue is emotional, physical and spiritual exhaustion from witnessing and absorbing the problems and suffering of others, while burnout results in feelings of hopelessness, apathy and an inability to perform one's job duties well. Both CF and burnout lead to ineffectiveness, depression, apathy and detachment. The study reported that 65.9% of ED nurses surveyed were at a low level of CF; 54.1% were in the average level of burnout.
At St. Anthony Hospital in Lakewood, Colo., two compassion rooms offer a similar place for nurses to chill. Mark Goldstein, RN, MSN, EMT-P I/C, ED clinical nurse manager, said these are not grieving rooms for families, but places of refuge for staff, whether on a break or after a traumatic incident.
Goldstein points to resiliency as the quality that can enable RNs to overcome CF and avoid burnout. He looks for it when hiring ED nurses and fosters it among staff. “Resiliency is asking, ‘How do we unplug ourselves and each other? How can we take care of our own?’” he noted. Believing he and other nurse leaders have responsibility for
nurse wellness and wellbeing
, he instituted monthly staff decompression options “to work on unplugging,” such as climbing some of Colorado’s high peaks and going whitewater rafting. He said there’s a correlation between taking time out with team members and less burnout. Both St. Anthony and Pennsylvania hospitals are two-time winners of the ENA’s Lantern Awards, which spotlights EDs with “excellent practice and innovative performance in leadership, practice, education, advocacy and research.”
Wolf knows ED nurse burnout is a healthcare system’s problem, but nurses themselves still have a role in thwarting it. “You own your own response,” she said. “You also own your ability to say, ‘No, I can’t work an extra shift.’ That’s the individual piece; it’s the institution’s responsibility to set the tone so that if nurse says no, there’s not pressure, retribution, or peer pressure. People don’t understand that ‘no’ is a complete answer,” She advocates for nurses to work together, with management, in addressing with the larger systemic situation. “Take the long view,” Wolf said. “Covering an extra shift isn’t going to fix the problem.”
Resiliency is asking, ‘How do we unplug ourselves and each other? How can we take care of our own?’” Mark Goldstein, RN
Lisa Wolf, RN
Lisa Triantos, RN
Mark Goldstein, RN