Tom Sharon
The inability to cope with continuous stress


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Nurse Burnout

Many people have told me that at some point in their lives they ran across a nurse in a hospital who seemed indifferent to human suffering. While investigating malpractice cases I have occasionally come across clear evidence of nurses who demonstrated a wanton disregard of the patient's safety. While such situations are uncommon, the question remains, "How can such a person go to nursing school and spend so many years devoted to caring for other people only to end up being indifferent?" One possible answer is burnout.

We can define burnout as the inability to cope with the continuous stress that a particular job produces. The effects of this phenomenon in the nursing profession should be of special interest to you because when you are in the hospital, the people you most depend on are nurses. The implications are dangerous. Nursing is an occupation that brings on a high level of tension and emotion. Add to that the corporate executives' abuse in creating larger workloads to reduce the cost of operations.

Even though we should always hold individuals accountable for their actions, the hospital managers have to bear some responsibility for creating work environments that add to the emotional stress of dealing with catastrophic trauma, illness, and death. The worst offenders are those who layoff dietary aides, housekeepers, and nursing attendants with the idea that the nurses can perform all the ancillary functions. In many hospitals with budget problems, you will find nurses setting up food trays, emptying garbage cans, and mopping floors on the evening and night shifts in addition to shouldering a full patient load. Moreover, the mass exodus of nurses from the hospital scene increases the workload for those who stay behind. This often leads to being forced to work sixteen-hour shifts with heavier burdens. This type of abuse if unchecked will quickly dampen the enthusiasm toward helping others that all nurses start with.

Although many progressive medical centers have employee assistance programs that offer counseling and group meetings to deal with burnout, you will occasionally come across a nurse who seems curt, rude, or indifferent. It may be burnout, or it may just be an off day, but whether you are the patient or visitor in this instance, you will be stuck with this situation for the duration of that shift. Your understanding of the nurse's undesirable response as a symptom of either a bad day or chronic problem can make a difference in the outcome of your care. Of course, the advice given earlier regarding urgent or emergency problems remains the same. If the nurse is committing malpractice as described, you still need to take appropriate action to obtain the services that you need.

Thus if there is no problem requiring immediate intervention, then you can try talking to the nurse who is responding in a negative way with an opener like "Nursing is tough. I understand that you have a difficult job with a great deal of stress and strain." If this does not change the course of your relationship with this person, then there must be a serious problem with burnout. In that case, you will need to contact a supervisor and insist on changing nurses. Until that happens, you will have to maintain a constant vigil, watching and questioning the nurse's every move. This may exacerbate the nurse's agitation, but your safety or that of your loved one comes first.

Burnout does not come about suddenly. It is a process of deterioration that for nurses usually takes seven years. The warning signs are as follows:

- increase in lateness and absences
- insubordination with superiors
- irritability with colleagues and clients
- increase in medication errors
- slower responses to call lights
- failure to assess changes in clinical condition
- making patient observations less frequently
- failure to maintain safety
- failure to provide routine nursing interventions

The nurse suffering from burnout has lost the ability to care about the results of good work and the consequences of errors and failures. Nurse-managers and their corporate executives are responsible for identifying those who are experiencing such problems and taking reasonable actions to improve performance. If you perceive these problems in a nurse, it's your duty to report your concern to a manager.

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