Thursday, 21 May 2009

Why does caring burn us out?

Found this over at Nurse Ratched's Place.

"Before I sign off, one of my readers asked me to help him out. Edward J Gordon, RN is doing some research for a book and he wants to hear from you. The book is about burnout. I’m sure most of you know what that is. Here’s what Edward said:

I sure would like to understand what’s at the heart of burnout. What is it that kills us about nursing? What is it that makes us so unhappy? Almost everyone I work with is either trying to get into NP school, or CRNA school, or is already taking classes-as if there were some unlimited amount of jobs away from the bedside. I think if I were younger and wanted to leave the bedside, I’d leave nursing altogether, become an IRS agent or something (I like numbers.). It seems like caring kills. It kills us personally to care for others. It turns us into something we are not. But is that a bad thing or a good thing? And is it this kind-of spiritual suicide that’s at the heart of burnout? I’m just wondering.

Please send Edward an email at if you can help him out."

Nurse Anne decided to email Ed. I basically summed up the reason for this blog and made my usual amount of typos due to the fact that I am always in a rush. I know I simply told him things that he already knows, and I doubt that my email is really what he is looking for, but I sent the email anyway.

It went something like this:

Dear Ed,

Why do nurses burn out?

Nurses are expected to take on a ridiculous number of patients. At the same time they are expected to treat each and every patient as if they are the only patient on the floor. It is an impossible task and that is what burns nurses out.

We get the most wicked abuse when we are unable to provide this level of care from patients, families, our managers, the media etc. Here in the UK they will staff a 25- 35 acute medical ward that has a significantly high number of elderly, dependent patients with dementia with 2 RN's only. If we are lucky we may get 2 or 3 care assistants to help. We don't even get a ward clerk to answer the phones anymore as management does not want to pay for it. This is getting normal for general medical surgical floors in the NHS. It is definitely the norm for wards that have a high number of elderly patients.

I cannot remember the last time we had more than 2 RN's on duty for the whole floor.

If you open the newspapers here in England you will read countless articles about the suffering of patients in hospital. They claim that the nurses are uncaring and lazy and that this the whole cause of the problem. They claim that the whole problem is that nurses are better educated these days, and that we think we are above mopping the floors and caring for patient's basic needs. They claim that this is the reason MRSA and cdiff are rampant. This is what people think.

We are often left with critically ill patients during mealtime and 2 nurses and 2 care assistants to feed 18 people. We get a 20 minute window at mealtime to get all the food out and feed the patients. The critically ill patients do not go away at this time. What to do? What to do?

The press and various patient rights groups are claiming that nurses these days think that they are "too clever to do something so menial as feed patients" and say that this is the reason that patients are starving. They hit us up with these insane patient loads and then they say that if we are not sitting at bedsides mopping brows and holding hands it is because we are all cruel. We often work 14 hour days without a break and without stopping and still cannot get anything done. let alone done well.

People do not realise that nurses have life and death responsibility on their shoulders and that every second counts. They place unrealistic and unfair demands on the nurses, and then they lauch direct attacks towards the nurses when their unrealistic demands are not met. This is why "caring" burns us all out. This is why our nurses are running away from the bedside.

I blog about this if you ever want to have a read. I'll just warn you about my language. I do tend to swear like a sailor at times. I don't swear normally, bad language just seems to rear it's ugly head when I blog.



delcatto said...

Too much responsibility with little real power. Therefore damned if we do, damned if we don't.
Sadly, people will only truly realise what they have lost when the nhs is privatised and what they directly pay for or can afford is what they get. My sixteen year old son has seen what nursing has done / is doing to me and he will be training to be an electrician. For that i am truly glad.

Anonymous said...

There are good places too. I recently switched jobs from a Godawful general hospital that suffered from all the horrors Nurse Anne describes to a small specialist hospital with SEVEN (count em SEVEN) RGN's on every shift plus a Ward Manager (not counted in the numbers) and at least one HCA. This on a 25- bedded ward. I was gobsmacked.
Take my advice, find yourself a nice tertiary centre with no A&E . I'm loving every second of my new job.

Glamorganist said...

Delcatto wrote: "Too much responsibility with little real power".

I would add another long-term problem which bears on your comment: this is the separation between nursing education, nursing management and nursing practice. Instead of being an integrated profession nursing has allowed itself to be fragmented into almost antagonistic groups to the detriment of patient care and the profession itself.

Nurse Anne said...

Glam you are so full of crap. Nursing managers who try and help the floor nurses are crucified. Nurse education is very relevant.

Glamorganist said...

Nurse Anne, how thick are you really? You can read, you can write, you can sling abuse but I'm not sure you can think.

I think that if nursing was an integrated profession with no separation between management, education and clinical nursing managers would NOT crucified when they tried to help the "floor nurses." Managers would be leading and managing from the "floor." The matrons you attacked in a previous post would be active in hands-on nursing. As for nurse education, of course it's relevant, but I didn't say it wasn't so what are you on about? My point was that I think it would be better if nurse education, and therefore nurse teachers, could find ways of working more closely with clinical nurses and patients than they do at the moment.

So from your comment it seems that you think that the present relationship between clinical nursing, management and education is OK? Wow... your matrons, your managers, all working hard to support you in your work... all fully informed about your staffing needs... all supporting you when things get difficult... I must have missed those posts.

If you disagree with me try writing a coherent response. You'll find it a bit difficult but it'll be worth the effort.

Anonymous said...

Nurse Anne, how thick are you really?

...sounds like abuse to me...

Glamorganist said...

Yes, I agree Anonymous, it sounds like abuse, or it could be a reasonable question based on the evidence. You can take your pick. In any case, I think I can claim that I was only responding in kind. Having got that out of the way, what about addressing the topic?

Nurse Anne said...

"Instead of being an integrated profession nursing has allowed itself to be fragmented into almost antagonistic groups to the detriment of patient care and the profession itself."

The only real detriment to patient care is management's refusal to staff the wards properly. You are in la la land about the other stuff.

Glamorganist said...

Nurse Anne wrote: "The only real detriment to patient care is management's refusal to staff the wards properly. You are in la la land about the other stuff."

OK and that's your considered opinion - a statement of the totally obvious followed by... nothing.

Happy1 said...

"nursing has allowed itself "

I disagree.

Government targets and hospital management has fragmented groups within nursing. Senior nursing staff develop blurred priorities as they climb the career ladder. Targets become the priority of the day. I have observed good staff nurses become target driven monkeys in charge.

Less staff than ever, but expected me meet ridiculous targets. Thats whats detrimental to patient care.

Happy1 said...

I think Anne writes more than her fair share Glam. Stop continuing to look for an arguement.

Glamorganist said...

Happy1: If I said that I agreed with you, and that I don't see much incompatibility between your comment and mine I'd be called a "twat" and Anne would say that I'm "so full of crap" so I'm a bit stuck for a worthwhile comment.

Happy1 said...

Well Glam, maybe your reputation goes before you...?!

Anonymous said...

Glam's comment is entirely relevant. S/He is correct about the widely differing priorities of nursing education (which teaches ideal practice), nursing management (which chases ludicrous government targets) and nursing practice )us poor buggers on the wards)
Nurses, and there are a LOT of us could potentially be as powerful an organisation as the Police Association but we seem to waste this potential in petty infighting.

I'm surprised Nurse Anne cannot see this instead of dismissing Glam's comments as "crap"

These are legitimate arguments.

Anonymous said...

What is the climate for unions in nursing in the UK? Do you guys have one? Sounds like you may need one. I live in a state in the US that is very anti-union. So I know that's easier said than done. Just wondering what it's like over there.

Glamorganist said...

To Anonymous 17.45 in the US: Yes we do indeed have nursing unions in the UK and in theory they are quite strong, with a number of legal rights. In practice their strength is compromised because members are reluctant to take action against management that could affect patient care.

On the other hand you don't always have to strike to get things done and strong union branches can bring about useful local improvements when members are active. Anne on this blog just says unions are useless; I say that unions are only useless when members allow them to be and the answer to a useless local union is to kick out the existing officers and vote in new ones. As Anonymous 10.48 observes (thank you), nurses have a huge amount of potential power in the NHS, much of which is wasted on petty infighting.

delcatto said...

Glam does have a point although I am not sure I would agree with you re. education..
There are some recent moves to integrate clinical practice and education following concerns that student nurses were lacking basic nursing skills. However, I believe it's up to nurses & tutors to help reduce this gap. I work as the link between my team and the school of nursing. Hence I am up to speed regarding the clinical area and I make efforts to keep up to speed with the latest in the education arena. It does depend upon the individual and the level of managerial support that allows one to do this. But for many of my colleagues the school of nursing is viewed as ivory towersville and lacking in credibility. I see some of the tutors but my colleagues rarely see them. But there is a greater emphasis over the past year to utilise the experiences and knowledge of clinical staff. The latter are also having to take more responsibility for their practice as student mentors. Interestingly, I have seen this smoke out some of the lazier staff who have tended to take a back seat with student nurses. But most clinical staff I know continue to educate themselves, both formally and informally.
As for management....I am currently working in a managerial secondment for six months and it is a different world. There is a real separation between management & clinical practice. The longer one is removed from day to day clinical practice the more one is removed from the realities of the job and it becomes a question of targets, figures, resources, etc...
Happily my role will end after six months and I am choosing to return to clinical practice.
Mind you, I do work in community mental health so that is a long way removed from the general medical ward. Our team was recently accused by a care home manager (general trained:it showed) of being "do gooding social workers" (my colleagues are social workers) my experiences & perspectives will be very different from the average general nurse.

Anonymous said...

I don't know why she's leaving, or where she's gonna go,

I guess she's got her reasons but i just don't wanna know,

'cause for some years now I've been reading the blog of Annie


(apologies to Smokie).

Hope you okay anne - guess just busy? Just remember what happened to Crippen last time he vanished - some troll killed him off!

Anonymous said...

Glamorganist said... stuff.

Actually mate, Anne's right - I get sick of hearing pseudo-intellectual waffle about how nursing has fragmented and so on. The simple fact is, if you work in a nice, well staffed smaller unit the job is great. If you are one of the plebs in the front line in a medical ward they take the fucking piss out of you day after day after day - the matrons etc know but can do fuck all about it and are just glad they themselves are out of it.

Nurse Anne said...

Hi hi,

I'm around. My computer is absolutely fucked but we are about to buy a new one. It actually had smoke coming out of it a few days ago. As soon as the new comp is up and running I will be back. I always have plenty to say!!!

Glamorganist said...
This comment has been removed by the author.
Anonymous said...

Hurry back, Anne. We miss you!

Anonymous said...

Nurse Anne, WHERE ARE YOU? It is nearing a month since your last post! I will send you a check for a new computer if that is what it takes to get you back. . .

Nurse Amn said...

Okay. Hubby just built the new computer. That was the problem. He wanted to build one rather than buy one. To my surprise, he has done a good job.

I am going mad over having 10 different relatives ringing the ward every hour and demanding that the nurse stop what she is doing to speak to them. Why can't they just speak to eachother? If they cannot speak to eachother for whatever reason why should my patient's safety and my registration be put at risk.

I realised that everything I try and do throughout a shift has to be done as a rush job during the 30seconds I have between uncontrollable interruptions.

I will try and get a post up later.

Nurse Anne said...

Don't know what happened there but obviously it's Nurse Anne not Amn.

Medical Spa Job Posting said...

I doubt that the majority hold the opinion that ‘they hit us up with these insane patient loads and then they say that if we are not sitting at bedsides mopping brows and holding hands it is because we are all cruel.’

People are aware of the stress that comes with jobs in the medical field; it’s simply common sense that treating and caring for sick people takes a lot of work.


Nurse Anne going to hit her husband for messing up the pc said...

No they do not understand Dana.

If they did I never would have been driven to write this blog.
I deal with their behaviour day after day.

People have no understanding whatsoever of how many things a nurse has to accomplish during the course of a shift,or how little control they have. Nor do they understand the consequences that can occur when the nurses fail.

If they did understand these things, their behaviour would be different.

Nurse Anne said...

That was "Nurse Anne going to hit her husband for messing up her PC"

Anonymous said...

I work as a consultant in acute geriatrics. My ward nurses are run off their feet and exhausted. I haven't done a ward round with a nurse for 2 years as they are too busy so I don't insist. There are so many communication errors, mistakes and delayed discharges. I have tried writing to managers, complaining to the 'matron' (once my excellent ward sister but she now says she prefers her current role where she seems unable to recruit or support ward nurses), stating that there are not enough nurses per shift. Everyone says either 'it's not affordable/it's not financially sustainable' (ie patient safety and good care is not affordable!!), or that they just can't do anything about it. My last attempt was a 4 page document to the managers putting the case that one more RN per shift would save them money in discharge delays. No one will listen. I get so angry for my patients and nurses, it's like balancing on a tightrope over an abyss all the time.

Anonymous said...

And there's nothing wrong with a ward sister going for promotion to matron, she deserves a pay rise and more recognition, all nurses have the right to seek promotion but I mourn the loss of an outstanding irreplaceable ward sister

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