Nurse Burnout Won’t go Away Until the Industry Changes. But in the Meantime, Mindfulness can Help Nurses Prioritize Their Well-Being.
This past November I attended a workshop on nurse burnout at the Johnson Foundation at Wingspread in Racine, Wisconsin. Clinical nurses, administrators, and researchers came together for three days to discuss this pressing issue that is epidemic in nursing. One survey found that almost half of nurses are burned out, meaning they’re so overwhelmed by the job that they’ve lost the capacity to really care about it or their patients.
I tend to be suspicious of talk about mindfulness in health care because it seems to place the onus for change on individuals instead of the overall system.
Several of the workshop presenters discussed “Mindfulness” as a way to alleviate burnout. I tend to be suspicious of talk about mindfulness in health care because it seems to place the onus for change on individuals instead of the overall system. I also admit to being unsure of what mindfulness means for individuals, especially when they have highly chaotic and at times dysfunctional work environments.
At the workshop I learned that an important component of mindfulness is the idea that one can consciously pause, be in the present moment no matter how pressing the demands of the shift. At the University of Virginia health center they have incorporated the idea of such a pause into their emergency department. After a difficult trauma or code, the staff who worked the trauma will stand quietly together for up to one minute. It gives them an opportunity to feel a sense of community, and also grieve, be angry, or just empty out their minds before rushing off to the next emergency.
That all sounds good, but from the start of the burnout workshop it was obvious that several of us fell into one of two camps. The bedside nurses (that includes me) felt strongly that changing the system—having enough staff, getting lunch, making the electronic medical record more efficient—was the only way to really reduce burnout among nurses. Others of course, mostly academicians and managers, promoted mindfulness as a way to build mental and emotional resilience among nurses and physicians. They advocated for resilience as preventative of burnout.
Both groups had strong anecdotal evidence for their perspective, and data to support their arguments. (See Aiken et al.,Bauer-Wu and Fontaine.) But I left the workshop convinced that mindfulness would never be more than window dressing for our dysfunctional system. I also worried that it could be used to blame nurses who remained stressed at work despite the lessons they had received on personal resilience. And that deep cynicism is an unfortunate legacy of my hospital work, where clinical initiatives for nurses often resulted in blaming us for not being better employees.
But then, a few weeks after the workshop, I began to notice myself being mindful. It started in the car. I now work in home hospice after doing hospital nursing for several years, so my car and driving are part of my clinical work. At the end of a shift I usually pull into the driveway of my house, hustle together my papers and work bag, and hurry inside to start making follow-up phone calls and finish my charting. I might put the kettle on to make a cup of tea, but, still, I work diligently while waiting for the water to boil.
One day after pulling into the driveway I sat in my car for a few minutes. I waited until whatever song was playing on the radio finished, not because I knew the song and liked it, but because getting to the end seemed important. I looked down the driveway and enjoyed the winter tableau of our neighbor’s pine trees swaying in the wind, towering over our snow-covered garage. I had no thoughts; I just was.
I had not planned it, but I found it gave me a real sense of calm before I headed into the house, and it was a calm that stayed with me.
It happened a few more times before I realized that I was taking a “pause,” creating a moment dedicated to quieting the urge to go, go, go, and do, do, do. I had not planned it, but I found it gave me a real sense of calm before I headed into the house, and it was a calm that stayed with me.
“Pausing” of course did not decrease the amount of charting I had to do and it didn’t make my phone calls go any quicker. But it got me to briefly curb the non-stop pressure of the job, and doing that reminded me that I am a human being, not a machine, and that I needed a minute to be only myself, not a nurse, before finishing my nursing work. That need was not as pressing or dire as those of my patients, but it was a real need nonetheless.
I’ve also maintained the practice of pausing (more coincidentally than intentionally) with growing appreciation. My most recent work pause occurred after I’d already come into my house after finishing my home visits. Our dog, a demanding Shepherd mix, wanted a two-handed, full torso rub. Distracted, I squatted down to her and started to rub, then realized that petting the dog was an opportunity for a pause. For the next three minutes I stopped thinking about work and thought only of the dog, and at the end of the three minutes I felt refreshed. I had remembered my own humanity.
Focusing on the nurse as a human being is a way to connect mindfulness with system change. Nurses want and need a system that views us as people, not cogs in the healthcare machine. Being mindful can remind all of us of our own humanity. Taking a pause will not guarantee safe staffing or ensure that all nurses get a lunch. But it may help us remember that we deserve those things—and for a profession that views self-sacrifice as integral to the job, that’s an important start.