Helping Nurses Who Can't or Won't Help Themselves

The dangers of burnout and fatigue, both physical and mental, go well beyond job dissatisfaction or frustration for nurses. Know the signs and intervene before things go from bad to worse.

If there's one thing healthcare leaders can agree on, it's that a good RN is hard to find. But sometimes, the bigger challenge is keeping them onboard once they've been discovered.

Between the constant pressure to do more with less and the long hours and heavy workload expected of nurses, it's no surprise that nurse burnout is prevalent. "Nurses are at risk for burnout due to the demands of the role of a nurse today," says Rusty McNew, RN, regional chief nurse executive for the Texas region at Tenet Healthcare Corporation.

The dangers of burnout and fatigue, both physical and mental, go well beyond job dissatisfaction or frustration for nurses. The Bureau of Labor Statistics ranked nurses fifth of all occupations in 2010 in the number of workdays missed due to occupational injuries and illness, and as many as 20% of nurses are estimated to suffer from a substance abuse disorder.

But there are strategies to stop burnout in its tracks and avoid nurse turnover, and HR can help.

Burnout-Busting Policies
Human resources leaders are in an excellent position to prevent burnout by setting hospital policies that discourage dissatisfaction from brewing in the first place.

One example is the use of overtime and time off. It's not uncommon for some nurses avoid taking vacations and to volunteer to cover shifts at every opportunity.

Instinct might be to think of these people as model healthcare workers, but they might be the most burned out, says Suzanne Waddill-Goad, RN, assistant professor at the college of nursing at the University of Tennessee in Knoxville and author of Nurse Burnout: Overcoming Stress in Nursing, who also runs a healthcare consultancy.

"Sometimes, nurses know no limits," Waddill-Goad told me in a telephone call. "They take on work that will consume them." Although society often equates being busy with success, taking on too much is sometimes a coping mechanism for those who are burned out, she says (and can be a sign of employee drug diversion).

Without time to relax and recover away from work, jobs become more difficult, stress causes fatigue, and physical and mental tolerances weaken, which can lead to burnout, explains Waddill-Goad.

Unfortunately, this kind of overwork is common in healthcare.

"There are nurses working six days a week… What kind of impact does that have [on] safety? I find it to be concerning—not only for employee safety, but for patient safety," says Waddill-Goad.

Setting policies that grant healthcare workers permission to take time for themselves, like a cap on overtime or preventing unused vacation time from being carried over to the following year are ways to make it clear that your organization takes burnout seriously.

Know The Signs
While there are many signs of burnout, a change in appearance should be an obvious symptom that something is wrong, says McNew.

"My scrubs don't always fit me, and I always look like I just got out of bed," he says. "But, if it becomes exaggerated…. that's when the red flag goes up."

 Other common symptoms of burnout include a sudden change in attitude at work, general disengagement, and absenteeism. It's important to distinguish between an employee having a bad day and an employee who is disengaging, but when in doubt, it usually pays to check in and make sure everything is alright.

See Something, Say Something
The most important step toward keeping nurses engaged is to talk to them, say McNew and Waddill-Goad. An HR department that fosters a culture of openness and encourages clinician leaders to engage regularly with their departments will have a leg up here.

Find out what issues nurses are struggling with. For example, if asked, night shift workers might complain that there are no food options other than the vending machines late at night. That could leave them have hungry for employment opportunities where they can get a slice of pizza or a healthy entrée at 3:00AM.

What about concerns around a specific nurse who seems to be disengaging?

It's even more important to open up lines of communication in such times says McNew, who can relate a personal experience he had where he kept a talented nurse onboard by asking her to share the obstacles she was facing in the workplace that were causing her to burn out.

" [She]was working a number of hours, and was the sole supporter of her family," he remembers. The nurse lived a bit farther away from the hospital than was convenient and was raising two teenaged children on her own.

"Her work started to slide a little bit… her appearance was just a little bit different… but the biggest thing was her joy for work and her overall [attitude]."

McNew remembers seeing the nurse's facial expressions while she was working and knowing that something was wrong. He decided it was time to open a dialogue with her. He kept his conversation with the nurse professional and mostly focused on work, but it sounded like "there were a lot of issues at home," he says.

"There's a certain amount of stuff you can talk about and give guidance on as a… manager," he says, but at some point, personal situations must be turned over to a professional who can serve as an objective third party. McNew suggested his employee talk to Tenet's employee assistance program.

Through guidance from the EAP, the nurse was able to resolve her personal issues, and was better able to tackle frustrations at the hospital and re-engage at work.

Not all interventions will be as successful as McNew's, but between sending employees the right message by setting policies that fight burnout and creating an open dialogue with nurses and their leadership, nurses can be more engaged and energized at work.