Nurse burnout: When passion isn’t enough

By Carrie Sue Halsey | 05/11/2015
Three actions saved this nurse's career.

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When I was 16, I joined the millions of teens scraping grease and taking orders at a fast-food chain. I went on to become a restaurant manager. I have spent time working at a gas station, as an in-home childcare provider, and as a librarian assistant. These occupations were hard work and paid poorly. I was tired and sweaty, but happy. I think back to that freckle-nosed sprite wearing a purple visor with a burger embroidered on it, and I realize I have come a long way.
 
That young woman would never have dreamed that, someday, her minimum-wage paycheck would grow to become what her professional nursing salary is today. Standing behind that fast-food counter, she could not have guessed she would save someone’s life, deliver babies, or hold someone’s hand as that person let go of this world. When I think about how amazing it is to be a nurse, it is hard to imagine that anyone would get disenchanted with the profession, but I did.
 
All the jobs leading up to nursing school were like romantic flings. I never took them too seriously. I accepted them for what they were—steppingstones to my “real” career. Nursing is what I decided to marry, professionally speaking. I fell in love with it, we dated for several years during nursing school, and we made it official when I passed the NCLEX. The honeymoon period was both exciting and terrifying. After the first few months, we settled into a comfortable rhythm, and life seemed perfect. All my romantic ideas about becoming a nurse were realized.
 
After the honeymoon
Over time, the newness wore off. I had issues with the hours, charting, constant alarms, staff meetings, new products, new policies, staffing shortages, belligerent patients, and backbreaking, emotionally taxing work. All the flaws I had ignored during my infatuation with nursing became reasons to be unhappy. A few of my friends left nursing in the first two years after graduation. I considered taking the same route, but felt guilty for wanting to leave.
 
Halsey_Carrie_ID_embed_SFW2A common perception in nursing is that bedside nursing is the “real” nursing. Leaving the bedside is tantamount to abandoning your ideals. At my former position, I was directly involved in empowering bedside nurses, improving patient outcomes, and increasing nursing education and satisfaction. All of these efforts, supported by hospital administration, did not prevent me from wanting to drive my car into a ditch on the way to work. I was experiencing Grade A, certified nursing burnout.
 
Nurse turnover and burnout are hot topics in health care. With nursing positions predicted to increase 1.5 million by 2022, it is vital that nurses remain in health care. Turnover is expensive. For the average U.S. hospital, it costs more than $4 million a year. The number of hospitals that have implemented retention plans is increasing. These strategies are important and, it is hoped, will increase nurse satisfaction and prevent compassion fatigue, burnout, and exiting of nurses from the profession.
 
Up to the nurse
Ultimately, hospitals are not responsible for keeping nurses engaged. As employers, they have a vested interest and should be applauded for encouraging nurse engagement, but each nurse needs to discover what motivates him or her to be the best possible. Provision 5.2 of the Code of Ethics for Nurses addresses the moral responsibility nurses have to themselves. The nurse is responsible for preventing, managing, and recovering from nursing burnout.
 
I did not drive my car into the ditch that day, or any of the days I was working through my disenchantment with the profession. Eventually, I grew tired of complaining about all the reasons I was unhappy with my job. My face hurt from forced smiling, and I did not want to pretend I was happy taking care of patients. My family started to notice I was not acting my happy self. I did not want to leave the house on my days off. I had let my job suck all the good energy out of my life.
 
The stress and fatigue did not originate solely from nursing. I had personal struggles that were compounded by my dissatisfaction at work. When nurses have stressors outside of work that are unmanaged, it is difficult to draw on the inner strength it takes to guide others through illness and recovery. We give until there is nothing left to give, and then, like an undernourished plant, we wither.
 
A qualitative study found that nurse burnout is caused by 1) short staffing, 2) not being able to care for patients as well as the nurse would like, and 3) feeling that there is no advancement potential. Many nurses spend their entire careers at the bedside, loving to care for and directly serve patients. However, for those who want to step away from the bedside—temporarily or permanently—there are options. Nurses are needed as leaders, scholars, advocates, writers, legal experts, board members, inventors, teachers, entrepreneurs, and more.
 
A choice
I had a decision to make. As in marriage, I had a choice: cut my losses or rededicate myself to what I had fallen in love with all those years ago. When I examined my strengths and desires, I realized I needed more from nursing. I love taking care of patients. Patients have taught me more about compassion, patience, tolerance, service, and bravery than any school could have. My personal passion is guiding women throughout the birth process. It is an honor to care for women, babies, and families. But, despite my passion for the work, I allowed myself to admit I did not want to be a bedside nurse long-term. I considered other options, including leaving the profession.
 
Three actions saved my nursing career.
 
1) I followed my dream.
A colleague who knew I was struggling with burnout asked me a question that changed my path. What would make 8-year-old Carrie happy? It sounded silly at first, but, as I gave the question weight, it made perfect sense. The answer was simple: Eight-year-old Carrie wanted to be a writer.
 
I started writing. My first modest writing accomplishments were press releases and a no-byline, trade-magazine article. I started my own nursing blog, focusing on my passion for perinatal education. My writing has allowed me to reach more nurses and women than I thought possible. Using the knowledge I gained at the elbow of my patients, I educate and uplift people all around the world as a freelance nursing writer and blogger.
 
2) I became board certified.
Two years had lapsed since I graduated with my master’s degree in nursing, and I had not yet become certified or licensed as an advanced practice nurse. My intense burnout caused me to feel it wasn’t worth the effort. After a particularly bad month, I decided it had been long enough. Revisiting what I learned in school helped dispel the myth that true nursing occurs only at the bedside. I knew I had the potential to expand my nursing scope, and I made the appointment to sit for the board. I took the exam. I passed. The sense of accomplishment was energizing and changed my outlook on my career potential.
 
3) I quit my job.
For months, I wrestled with leaving my job. I liked my colleagues and patients. There were parts of my job I knew I would miss. I knew my job, and I did it well. I wanted to stay to work on quality and safety projects that would positively affect patient care. I wondered if I should weather the storm and hope for the changes I wanted to see. In the end, I decided to move on to a different hospital. Transitioning to a better-fitting role was the key to ending my burnout. I stopped questioning if I should leave nursing.
 
Nursing and I are back on good terms. I enjoy the many ways I am able to use my nursing talents, and I am looking forward to a long career as a nurse. RNL
 
Carrie Sue Halsey, MSN, CNS-AD, RNC-OB, ACNS-BC, is a clinical nurse specialist and natural birth and breastfeeding advocate who resides in Houston, Texas, USA. She teaches childbirth classes for expectant parents and assists mothers with breastfeeding goals. Her experiences as a mother-nurse—of pregnancy, labor, and birth—have made her passionate about perinatal empowerment. To learn more, visit http://perinatalempowerment.com.
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