Most people choose to work in healthcare because they want to help others, perform meaningful work each day, and earn a decent salary. However, many caregivers struggle with feeling overwhelmed and burnt out. High patient loads, aggressive patients, and dealing with trauma all contribute to nurses and other healthcare providers struggling to cope.
Related: Boundaries and Burnout: Strategies for Nurses to Maintain Self
Workplace stress
Studies show that over 50% of nurses hope to leave the bedside or completely change careers. Many of these nurses state that workplace stress is the primary reason for their plans to leave the bedside. Nurse burnout is more common in units with high patient loads, i.e. where a nurse is responsible for more than four patients. It’s also common where there are frequent traumatic deaths or combative or uncooperative patients.
Dealing with aggressive patients
Aggressive patients are most common in emergency departments, detox centers, and mental health nursing. However, all healthcare providers should know how to de-escalate a situation and keep themselves safe while at work. Of all healthcare providers, nurses are at the highest risk of being endangered by an aggressive or combative patient.
The first priority of any nurse dealing with a combative patient or visitor is to keep themselves safe. Next, caregivers should do their best to keep the patient safe while avoiding the use of restraints or coercion, if possible.
Experts recommend that nurses take the following steps to keep themselves safe:
- Maintain a safe distance from the aggressor.
- Do not allow the aggressor to get between you and the doorway.
- Use a neutral tone and body language.
- Keep the conversation clear and simple.
- Listen more than you speak.
- Offer choices.
- Set clear boundaries.
- Call for help if needed.
Treatment nonadherence
Caregivers are often frustrated when they find that their patients do not follow their prescribed treatment plan or even refuse care. A patient seeking care in the hospital is under no obligation to comply with every treatment, medication, or procedure a provider recommends. While patients do have a right to refuse treatment, many nurses become frustrated when their patients decline a specific medication or procedure. They may fear that their patients are making the wrong choice about their own health.
Contrary to what many nurses believe, medication non-compliance is rarely a result of patient laziness. Treatment nonadherence is typically caused by poor patient understanding, fear of risks or side effects, or difficulty with access to medications or care providers.
Some choices have more to do with personal preferences or belief systems. Nurses may have difficulty dealing with patient choices that do not align with their own value system. Patient medical decisions regarding abortion, organ transplants, blood products, and vaccinations often cause tension between patients and caregivers.
Compassion fatigue
Between 16%-39% of nurses experience compassion fatigue. Compassion fatigue often occurs when someone in a caregiver role experiences mental and emotional exhaustion. They may also feel a sense of isolation and a disconnect between one’s work and their goals.
Related: Compassion Fatigue Primer for Our Current Work Environment
Causes
A variety of factors cause compassion fatigue. These include:
- Feeling hopeless or powerless
- Experiencing frequent patient deaths
- Frequent exposure to trauma
- Poor work-life balance
- Feeling underappreciated or undervalued
- Poor sleep habits
- Unsupportive leadership
- Challenging patient assignments and high patient loads
Symptoms
Symptoms of compassion fatigue are very similar to symptoms of burnout. However, compassion fatigue is more specific to people in a caregiver role. Most often, nurses experiencing compassion fatigue report feeling stressed, overworked, and eventually apathetic about their jobs. Nurses may also experience symptoms such as disturbed sleep patterns, changes in appetite, impaired judgment and behavior, and a negative worldview.
Long-term consequences
Nurses who do not receive help when they experience caregiver fatigue are at risk of developing PTSD or major depressive disorder. They may withdraw from friends and family, fail to fulfill their work and home responsibilities, and start to feel physically unwell.
In severe cases, caregiver fatigue can become debilitating. It can put the caregiver at risk of self-harm or suicide.
Minimizing stress
Feeling overwhelmed with patient loads, dealing with difficult patient scenarios, and experiencing caregiver burnout are common among nurses and other caregivers. However, there are things that can be done to minimize this risk and improve resilience in nurses.
Resilience training
Many hospitals are now offering resilience training to their staff. These trainings help caregivers manage their stress, deal with difficult patient situations, and continue to find meaning in the face of tragedy. Research has shown resilience training to be effective in combating burnout and fatigue in nurses and physicians.
Taking PTO
Because nurses often work only three shifts a week, many nurses like to stack their working hours together before a long vacation. This way, they can avoid using their time off. Cashing out PTO at the end of the year or saving it for an emergency can be useful. However, it’s also important for nurses to take real breaks from work.
Talking to someone
Talk therapy is a very effective tool against many mental health disorders, feeling overwhelmed, and caregiver fatigue. If finding a counselor or therapist feels like too much, nurses can reach out to their friends and family for a listening ear.
Talking to coworkers and having debriefing sessions after particularly difficult shifts can also help nurses face their problems in a productive way.
Changing units
Nurses who work in high-acuity units such as intensive care or emergency medicine are at a high risk of burnout, caregiver fatigue, and feeling overwhelmed. These nurses encounter more death, trauma, and combative patients than those working in lower acuity units. If you are struggling with feelings of burnout or caregiver fatigue, it might be worth changing hospital units, even just for a few months.
