Posted Under: burnout and stress management,burnout and the workplace
In the world of burnout, healthcare workers can have it tough. And nurses can have it toughest.
Jerome Stone knows this well. Being a registered nurse with over thirty years experience (including pain management, hospice care, and ICU), Jerome has seen many a nurse ‘go to the wall’. In fact, Jerome says that there have been times when he’s gone right through the wall!
‘This has to stop,’ Jerome thought. And so he wrote the book: Minding the Bedside: Nursing from the Heart of the Awakened Mind and created a resource-packed website also called Minding The Beside.
Both the book and the site could be called: How to stop nurse burnout – and love your job again.
But Jerome’s answer isn’t just helpful to nurses. It is helpful to anyone in the burnout zone. So what is Jerome’s answer to burnout? Read on to find out…
Have you suffered burnout as a nurse, Jerome?
Yes, I have suffered from burnout. I think that it’s hard not to, even if that burnout only lasts one or two days. As a nurse, there are times when you come into work and say, “Why the hell am I here?” Sometimes it’s because you’ve lost one too many patients in a shift, or because your workload is too high. For me, and this has occurred a number of times in the ICU, my “burn point” has been around having to care for people who I just knew shouldn’t have been in the ICU but should have been in hospice instead. There’s a climate of heroics at all costs in the ICU that can wear down one’s sense of service, replacing it with high-tech heroics. I don’t know if hospitals are aware of how badly these kind of heroics burn their nurses out.
What is it about the job that sees such a high proportion of burnout?
When I graduated from nursing school, all those decades ago, I was paid $0.48/hr LESS than Safeway grocery checkers. And that was after I’d already learned that the ER docs who I worked with were going to hand off the responsibility of informing the parents of a child who had just died to me! Since that time nursing wages have advanced (not to where they should be!) but there’s still a perception on the part of the public that nurses are the “handmaidens” to physicians, nothing could be further from the truth.
Nurses are crucial to all aspects of healthcare but are constantly treated as “renewable resources,” easily replaced and undervalued. Staffing shortages, heavy patient assignments, compounded grief, night shift work – which has been proven in clinical studies to be injurious to one’s health – and being undervalued can lead to a sense of disempowerment. Once nurses begin internalizing this disempowerment, the next step is burnout. It’s a no-win situation.
What happens when a nurse begins to suffer from burnout?
I think that burnout can be insidious, sometimes coming on so slowly that you can miss it. It may start with a laissez-faire attitude about one’s work environment, not giving a damn to help make changes to the system, and gradually lead to caring less about what one is doing. This causes a real sense of cognitive dissonance in the heart and mind of a nurse, whose primary reason for going into nursing was to help others and to be of service. It’s not that one cares less about one’s patients, although that can happen; it’s more like one goes into an automatic mode. I walk into a patient’s room, introduce myself, hand them their medications, and then beat a hasty retreat to the door. What?!?!?
Healing comes from connection, from human interaction. The person in the bed is, in a very real sense, just another “me.” I could be in the bed, I could be the one needing compassion and soothing. It’s amazing how burnout can short-circuit the sense of seeing another’s suffering as one’s own suffering. And in the end, the patients suffer too because patient outcomes are directly related to rapport-based interactions with nursing staff.
You aren’t just a nurse, but also have degrees in Environmental Education and a dual-degree in Comparative Mythology and Depth Psychology. How have these qualifications helped you understand burnout better?
Hmm, I guess that my education, both formal as well as “life training,” has given me a well-rounded sense of who I am. I’m not “just a nurse, “ but am a creative and “mythic” human being. The degree in education helped me to think in terms of my teaching role both in and out of nursing. I LOVE TO TEACH! That’s why I’m working on teaching/speaking gigs for my book, I love to teach. I know of no greater pleasure than of being able to help others to better themselves or to deal with life’s circumstances. That’s what meditation is about too, dealing with whatever comes at you while not losing one’s connection to others, not becoming “burned out.”
The degree in Psychology and Mythology helped me to see, in the words of Joseph Campbell, the “hero’s journey” that we’re all on in our lives. Like, in Homer’s work, The Odyssey, Odysseus would have been SOL if he’d just curled up in a ball after losing all of his men and being confronted with so many obstacles. The hero’s (or heroine’s) journey is about finding meaning in one’s life, in one’s suffering and tragedies, and turning it into strength. Preventing burnout is about taking those things that are burning you out and alchemising them into strengths, taking the deaths of multiple patients and turning them into a reminder of impermanence and change.
What is the key message in your book Minding The Bedside?
Key point? Well, there are quite a few key points. I guess to essentialize it all, it would be that while we can’t change our circumstances, we can change our mind. How we show up at the bedside depends upon our mind. Our patient load might be too heavy, or our pay may be too low. We might be having a crappy day and wonder what the hell we’re doing taking care of others when we should be taking care of ourselves. Minding the Bedside is about showing up with one’s heart and mind intact, regardless of one’s circumstances.
Being happy, being present, and being compassionate are about one’s mind. Attending to one’s patients is about recognizing one’s moment-to-moment awareness and applying that awareness, compassionately, to one’s patients.
It’s often assumed that workplace burnout comes from being overworked and undervalued. But I’m wondering if there is one step further. By being overworked and under valued we naturally begin to feel disconnection and resentment. And perhaps that’s when burnout can happen. Do you agree with this? And is the value of your message creating re-connection and preventing resentment – which can curb burnout?
I think that disconnection and resentment are at the heart of many things that go wrong in healthcare today. And I think that the “re-connection” that you’ve mentioned happens when we begin to reconnect with our inherent goodness. That goodness is found at the heart of meditation, wherein resides compassion. So, yes, the reconnection brings us to our fundamental goodness and this can antidote burnout as well as empower us to experience more fully our commitment to service.
How do people ‘walk your talk’ after reading your book Minding The Bedside?
Meditation isn’t about sitting on a cushion and blissing out. It’s not about chanting a mantra and checking out. It’s not about getting rid of thoughts. It’s about taking one’s formal practice and bringing it into life. So the “walk” is about applying what one has gained through one’s meditation practice – “talk” – and applying it to being more present and compassionate, with one’s patients, one’s spouse, one’s kids or the clerk in the check-out line at the grocery store. Walking the talk is about being present and aware, regardless of the situation or circumstances.
As an example, the book presents techniques on working with one’s breath as a focus of meditation. That’s great, but it’s not just about watching one’s breath while practicing meditation. It’s about coming back to the breath as an anchor of one’s attention when one is in an argument, or is having pain, or is sad. It’s about anchoring one’s attention in the moment and in one’s compassionate heart.
The idea of meditation can be challenging for people who are healthy, let alone those with burnout. How can a person with burnout meditate, given how they feel?
Start from where you are. If you’re burned out, great! If you’re depressed, great! If you’re happy and you know it…clap your hands! Like all aspects of the mind, feeling burned out is a state of mind, a way of thinking, a habit. I know that when I’m feeling fried, I can feel it in my very core. That doesn’t mean that I can’t also experience the joys of taking a walk with my son, sharing a dinner with my wife, or riding my bike in a canyon. Meditation is about discipline, it’s about relearning how to “be” in the world. But it doesn’t have to be serious, we don’t have to furrow our brow, sit like a mountain, and plant ourselves in our meditation practice. It can be about stopping to look at the sky, and really enjoying it.
What would you like to see change in hospitals and other healthcare environments to help prevent staff burnout?
Really? How long do I have? Healthcare has lost site of the person at the bedside. While there’s been a needed and dramatic shift towards patient outcome and satisfaction, it’s still like the people at the bedside are part of that system. Nurses aren’t encouraged to take care of themselves. Here’s a glaring example: as an RN, I’m given a certain number of days or hours “PTO” (paid time off). I get 20 days of PTO a year, sounds great right? Not. Those 20 days include sick days, it’s a bit “pot” to draw from. What this means is that nurses end up coming to work sick just so they won’t have to use up their PTO because they so desperately need a vacation!
So first, take care of your nurses! How, besides giving them REAL vacation time, provide them with the tools (hint: classes taught by people like me – wink, wink) on how to care for themselves.
Do you have a motto for nurses?
Just one?!? Sure, establish a daily routine of working with your mind. Whatever method you choose, stick to it and practice it formally so that you can access it at work. So, the slogan? Care for your mind, care for your heart, the care for your patient will follow.