Self-Care Isn't the Cure to Burnout, Managerial Support Is
My new column in Cancer Nursing Today
As promised, my newest column in Cancer Nursing Today, which has the title above. My editor and I agreed on this column being about burnout, and specifically about hospital managers’ attempts to respond to nurses’ and physicians burnout with “resilience training” or “wellness programs.” I put both terms in quotation marks because they are promoted as quick fixes when the truth is that building resilience takes time and effort, as does creating a culture of staff wellness. A sustained focus on improving the health care work environment is needed to help struggling nurses and physicians, but many hospital administrators don’t want to put in that work, probably because they don’t want to spend the money required to literally invest in their workers. However, as the graph below shows, and as I argue in my article, change is needed now.
The column begins here:
Several years ago, before the COVID-19 pandemic, I attended a workshop on nurse burnout. A small group of nurses, health care managers, and policy types had been brought together to discuss how to best help nurses build resilience and manage work stress. “If nurses would just take a cleansing breath every time they use the hand sanitizer,” one manager suggested, offering this recommendation as a timely form of relief that nurses simply failed to take advantage of. I am not a violent person, but I suddenly wanted to punch that person, not out of anger, but to make the point that Zen practices are useless against real threats to personal safety, whether that’s one’s own safety, or the safety of our patients. Nurses’ stress comes from an often-unsupportive work environment. Full stop. Until hospital administrators grasp that reality and address it, nurses will continue to suffer moral distress, burn out, and quit.
I lay the problem of the current nurse staffing shortage at the feet of hospital administrators because, intuitively, that seems appropriate. Recent research by Linda Aiken, of the University of Pennsylvania School of Nursing, validates that apportioning of blame. In an article published in JAMA Health Forum this July, Aiken et al report on a multisite study that found that to reduce staff turnover and improve hospital outcomes, nurses and doctors prioritized “interventions to improve care delivery” and, specifically, nurse staffing. They saw little value in “instituting clinician wellness and resilience programs” to address the high levels of burnout that nurses and doctors were experiencing.
(Click the link to keep reading).
Please leave a comment if you’d like. I’m interested. Acknowledging and discussing these problems is an important step toward addressing them. Also, to learn more about Debriefing the Front Lines, visit their website (embedded link)o9.
Hugs to all,
Theresa
This is an excellent and needful essay, Theresa. Burnout is about the moral conditions of work. To say that “moral resilience” and “wellness” programs are the solution is to absolve management of treating nurses immorally. By the way, I don’t know what “moral resilience” is. “Resilience” is a word borrowed from metallurgy to describe the maximal pressure under which an alloy can be placed before losing its elasticity. Is that what we want to find out from anyone, much less people whose profession is to care for the vulnerable?
Nursing students have a much higher baseline of childhood trauma than the general population (Clark, 2021). This makes them vulnerable to tolerating unacceptable situations for too long, and possibly believing that if they try harder, things will improve. Unfortunately, this creates a financial benefit to the broken system! In the trauma course I teach at Pitt, I teach my social work students what a toxic workplace looks like and feels like, so they can get out rather than try harder! I also happen to teach Mindfulness Based Stress Reduction, which promotes the ability to see things clearly and act skillfully. Any good wellness program will make it MORE likely that a person will abandon an oppressive and abusive situation.