I recently had a conversation with a Hospice Nurse, I’ll call Mary, who loves what she does as a nurse, but recognized after being in the profession for several years the harm she was doing to her body. She is a single mom working, raising her children and running a household. However, because of the stress she was experiencing, she knew something had to change. And so she consciously worked to teach herself how to take care of herself. Nurses she confirmed (because this wasn’t the first time I heard this) from the time they come out of nursing school are conditioned not to care about themselves; adopting the mentality that they don’t have time to eat or attend to any of their personal needs during their shift. The idea that the patients are more important than themselves is beyond reasoning to me. To me that type of thinking is an oxymoron. Those in the health industry not promoting the health of their employees do not make sense to me.
I understand that this isn’t across the board, but this train of thought does give one pause. But maybe this explains why there are nurses and doctors who are overweight and out of shape, have heart conditions and other diseases from stress. It also explains why there is a high rate of burn out and turnover among those in the medical field. You can only do what your experiences have taught you.
Mary went on to say that as a nurse your intentions to take care of yourself are good going into the job, however, once you are on the job because of the case load and pace of your day, those intentions go out the window. The caseload of this particular hospice organization more than tripled in 12 years. The caseload of the “case manager” nurse climbed from approximately 10 to 20 patients. So, the case manager nurse typically visits five to six patients each day with the day ending about 8 PM frequently not including paper work. Therefore, “keeping up” becomes the priority and the norm. But one thing that has slipped their minds is their personal health; if they don’t take care of themselves their bodies will rebel with sickness or dis-ease. Who wants that kind of wake-up call?
I decided to do some additional research to obtain background information on the subject. What I surprisingly found had information on doctors as well as nurses. The following is from articles published on the burnout rate of physicians and nurses. According to the most recent studies (2013 and 2015), the rate of burnout among physicians increased from 40% to 46%1,2,3. The result of this is that the likelihood of the physicians leaving their practices is high. According to the most recent data for nurses, the overall burnout rate is 34% to 43%, with rates varying according to several factors.4,5,6 Some of these factors for after-hour hospice care nurses are:
- Long shifts and on-call hours;
- Emotional strain of caring for dying patients; and
- Personal stress of supporting distressed family members and caregivers.
Mary didn’t fault the patients for her discontent, but the administration because of the rapid growth of the industry and the objective to cut costs. Mary’s answer for why she was thinking of leaving the industry followed that of the research done for typical dissatisfaction in the position.
According to other reasons burnout is directly linked to work-related stress pertaining to job dissatisfaction. A systematic review demonstrated that work-related stress is significantly related to job satisfaction, with higher stress levels associated with less job satisfaction.7 One of the reasons for dissatisfaction this nurse said was with the rapid growth of the industry, specifically the rate in which “medical organizations” were merging smaller hospitals into one large conglomerate, and the industry itself becoming impersonal, contributing to the feeling of being unsupported and alone. Even ongoing training (which is very little) no longer is done face-to-face, but using computers.
Mary saw the shift occur while working in the hospice field for 12 years. It went from her department heads reading and monitoring the signs of distress and being concerned that breaks were in fact taken during the day, to the opposite extreme of no time for anything but work. What I don’t believe our administrators and workers understand is that taking a proactive stance for taking care of oneself is a way of implementing preventative measures instead of reactionary ones. I know it is easier, more cost effective, and helps with retention of those valuable employees.
One of the things that is important to understand, and mentioned in my book, Nurture Your Soul, is about energy exchange. For those who don’t believe in this concept, let me say just because you don’t believe it doesn’t mean it isn’t so. In Nurture Your Soul it reads, “Those in need of care (patients and clients) are doing all they can to maintain their own healing energy, which is unknowingly done by taking the healthy energy from those who are the caregivers.”
It goes on to say, “We are energy beings who need energy to sustain ourselves. Those who are having health challenges, of any type – physical, mental or emotional – will take the healthier, dominant energy from those who are stronger. Energy pulls come from every direction as we go through life, whether we are in the hospital, restaurant, classroom, lecture hall, on the bus, plane, train, or in the car. Wherever people are, energy is being exchanged. Only when you are aware enough to recognize the symptoms of energy depletion will you know to call your energy back to you or take time to replenish yourself. But to get to that point, takes time and know how, which begins with techniques that will teach you how to rejuvenate yourself.” It is critical that you do something to “refill your tank.”
Refilling your tank includes rest, but it also refers to
- keeping your body hydrated with water;
- feeding your body proper food so your cells can rebuild themselves;
- intentional movement to keep your body flexible and strong;
- doing things that reduce or remove the stress from your body, mind and emotions;
- the language (internal and external dialogue) you use when communicating your needs to others and to yourself;
- staying detached and objective while performing this heart-felt service.
Mindful living or self-awareness is truly what taking care of yourself is all about. It’s a mindset. Unfortunately, many organizations don’t offer this type of training or individuals don’t take the initiative to perform or be taught this important habit from a practical and relevant standpoint. AND taking care of yourself is a positive proactive habit to maintain in your daily life. You are your greatest ASSET!
After meeting with Mary, I couldn’t stop thinking about our conversation. I have experienced hospice services with my family and it is an awesome compassionate service. It literally pained me and brought me to tears to hear how these hospice nurses, those who are dedicated to taking care of families dealing with end of life, a highly stressful position, are not taking care of themselves. I wanted to scream! But again, this is why I do what I do. If you are ready to let me assist you, contact me immediately. I am here to serve you.
Theresa Cloud Eagle Nelson is a Professional Transformational Speaker, Soul Success Strategist™, Coach, and Author who has been in the Holistic Profession for over 30 years. She created The Soul Success System™ to help Hospice Professionals and Entrepreneurs do what they know to do to take care of themselves. She is available for Training, Workshops, Keynotes, Individual and Group Coaching. Her topics are applicable for nurses Continue Education Units. http://TheresaCloudEagle.com.
1) Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(19):1377-1385.
2) Peckham C., Physician Burnout: It Just Keeps Getting Worse. Available at http://www.medscape.com/viewarticle/838437_1. Last accessed October 1, 2015.
3) MDeverywhere, e-MDs Insights- MedScape Physicians Lifestyle Report, MedScape: An Epidemic of Physician Burnout January 30, 2015. Available at http://www.mdeverywhere.com/medscape-epidemic-physician-burnout. Last accessed October 1, 2015.
4) Neff DF, Cimiotti JP, Heusinger AS, Aiken LH. Nurse reports from the frontlines: analysis of a statewide nurse survey. Nurs Forum. 2011;46(1):4-10.
5) McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood). 2011;30(2):202-210.
6) McHugh MD, Ma C. Wage, work environment, and staffing: effects on nurse outcomes. Policy Polit Nurs Pract. 2014; [Epub ahead of print].
7) Khamisa N, Peltzer K, Oldenburg B. Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review. Int J Environ Res Public Health. 2013;10:2214-2240.