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The Tea Room

Burn out and stress among nurses

Posted by on June 18, 2014 at 8:55 PM

There has been some comment in the media of late regarding burn out and stress among nurses. This has provoked many responses from throughout the country, many from nurses empathising with the situation and sharing their own experiences of difficult working environments. The issue is that this not only affects nurses personally (leading to sleepless nights, sickness, anxiety, absence from work and in some cases, leaving the profession altogether), it also affects patients. Because when patients are in a vulnerable place and seeking care from competent, professional nurses, but can’t receive that care because there are not enough nurses or their nurses are vulnerable too, then patients health will suffer.


Nurses who are vulnerable, over worked, stressed and burnt out because their organisation pressures them to come to work when they are sick, won’t replace them when they do call in sick, have too many very sick patients to care for, and are just simply unable to provide the best possible care they want to, will ration the care they can provide. And by rationing, we mean they may be unable to help a patient wash, get out of bed, mobilise, drink sufficient fluids, or eat. Sure, the patient will get their medication, their IV fluids will be monitored, any deterioration in their condition will be picked up on, and they’ll probably make it to surgery on time, but they may not recover as quickly from that surgery if they are unable to mobilise, do not drink sufficient fluids or do not eat. The patient may fall when trying to get to the bathroom because they do not want to soil the bed or disturb the nurse because they can see how busy and stressed they are. They may develop a pressure ulcer or urinary tract infection.


So the upshot of it all? A working environment that leads to burnt out and stressed nurses who feel unsupported in their workplaces, will lead to poorer patient outcomes. And there is plenty of research that shows this. For example here and here.


So why is this and what can we do about it. Well, Jill’s blog below on the 2014 budget shows just how financially stressed DHBs are and will continue to be over the coming years. And one of the cheapest ways of reducing costs is to reduce the cost of labour. Who has the highest cost of labour? Yep, you guessed it, nurses. So if we just hold off for a few weeks on appointing to that vacancy, or not replace a nurse or two who call in sick we should save some money. Oh, and if we appoint a less experienced nurse to a position, we can pay them less as well.


Anyway, it’s one thing to moan about it, it’s another to have some strategies to deal with it. First of all, we need to look after ourselves. Here are some tips:


- If we are sick, then we call in sick and we stay home. We don’t feel pressured to come to work because we know we won’t be replaced, because if we do, not only will we make our patients and colleagues sick too, we’re not going to get better either. And don’t feel guilty about this. It’s not your fault you are unwell.


- Check your rosters, make sure they meet the criteria laid out in your MECA. If you’re not sure, check here. Your rosters should be set up in a way that will optimise your circadian rhythms. See the page on our website about shift work as well.


- Look after yourself. Use the Employee Assistance Programme (EAP) to speak to someone independent and neutral. It’s free and these guys have some good tips for managing stress. Let me say that again, it’s free.


- Speak to someone you trust about what’s going on for you. If you can’t use EAP or just don’t want to, get together with someone you trust to chat or with a group of friends and provide each other with some mutual support.


- Find yourself a mentor. A mentor is someone who can often help you see a way forward where perhaps you can’t see it yourself. It they are a nurse they will at least be able to empathise with you! Check out more information on mentorship here.


What about actually addressing the root cause of the problem. Well, this one is more difficult but there are a few things we know work. Here are some suggestions:


- If you are short-staffed at work – fill in an incident report, file it, and follow up on it. Keep a copy. When you follow up, you can take your wad of incident reports with you and ask what is being done.


- Talk to your manager about how you can help implement the core elements of safe staffing and healthy workplaces identified by the Safe Staffing Healthy Workplaces Inquiry (2006) into your workplace. For those of you who aren’t familiar with them, here they are (remember none of these should be prioritised over any of the others):


     o The requirement for nursing and midwifery care – including appropriate staffing levels.

     o The cultural environment.

     o Creating and sustaining quality and safety.

     o Authority and leadership in nursing and midwifery.

     o Acquiring and using knowledge and skills.

     o The wider team.

     o The physical environment, technology, equipment and work design.


- Don’t keep your concerns quiet. Talk to your charge nurse, manager, colleagues, member of parliament, NZNO delegate, NZNO organiser, NZNO professional nurse adviser.


- Vote for a government that will recognize these issues and bring about change. This year is an election year so make your vote count.


Well, this is a bit of a rant, but hopefully you have some ideas about moving forward from where you are now.


Remember: you’re a nurse, and you’re a good one.


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