Everyone I know in nursing has said it. We think it pretty often. We feel like we are getting burned out, are already burned out, or in danger of being burned out. While patients are in the hospital for a couple of days, we spend the better part of the year in there. Every year. Granted, we are (hopefully) not ill. However, hospitals are stressful environments on the very best day. They are even more stressful with chronic understaffing, insane patient satisfaction scoring systems that can cause our hospitals to lose reimbursement because a patient’s soda wasn’t cold, and nurses being expected to document everything 3-4 times. Oh, and don’t clock out late, either please. Finish that charting while you are taking care of 8 patients on telemetry. Did you remember to post your strips?
When I was in the Navy, we had a saying. A Dead Corpsman is no good to anyone. This was naturally a reminder to keep yourself safe, because if you get shot, burned, stabbed, etc you cannot help the wounded. In the Nursing world, we need to follow this sage advice, given to my by one Master Chief Conyers in 1991. If you are injured, mentally or physically; you are no good to your patients. You can make deadly medication errors, and suffer compassion fatigue that completely destroys the quality of your care. It can also decimate how you relate to your family and friends. Burnout is no good.
And yet, it is an epidemic.
Recipe for a retention disaster:
Recently, we have been understaffed at my job. For the past year, actually. I came home today feeling completely exhausted, and thinking about a change. Considering the pains it takes to hire someone at my hospital; the extensive federal background check, and the 9 months it took to hire me, this is bad (and expensive) for the organization. I work in Cardiac Electrophysiology. It is easy to hire a procedural nurse; and hard to hire one who even minimally understands what is going on in my specialty. I have also recently taken on additional responsibilities to cover another nurse who has been ill. So, doing the job of two people, shorthanded for a year, and rarely taking breaks. This is not going to turn out well in most situations.
Luckily, I work with a good manager and ‘sister’ department who assist us whenever they can, but this is only a band aid. A small, not very sticky off-brand bandage, holding back a flood of hard feelings and desperation. No amount of temporary help can fix a badly-staffed department; and it makes me hesitant to ask for time off because I know there is a small possibility it could impact patient care. Departments like mine need stability, and people who know what to do in the instance of a (very rare) serious complication. It concerns me that we are short-staffed, and it makes me hyper-vigilant. I worry about failing to notice signs of decompensation during a procedure, or breaking the sterile field, or stimulating the heart to pace inappropriately. It hasn’t happened yet, but what if it does? It is exhausting, and makes it hard to ‘turn it off’ when I get home.
Unfortunately, What draws us to nursing is the thing that makes us so susceptible to burnout – we have a desire to care for others, even at the expense of our own well-being. This is why so many nurses are leaving their first nursing job within a year. High turnover rates have a huge negative impact on quality of care. This is not good for anyone. It is always less expensive to keep nursing staff happy, with a sense of accomplishment about the care they give; but healthcare organizations do not seem to be able to do this very simple math. Retention is cheap, turnover is expensive, period. And it is not only expensive in salary and training dollars. It is expensive in medicare reimbursement penalties for procedural complications, bad outcomes, poor patient satisfaction, and lawsuits.
So what is the answer?
It seems like a majority of the problems we have in healthcare can be fixed by appropriately staffing all clinical areas. We, as nurses keep saying this. Our voices must be raised as a united profession to protect our patients. I encourage you to share this post with everyone you know, including laypeople. Make sure they know that we are worried about them, and that we are fighting for them. It is time for the general public to fight WITH us. A short and simple list of things they should worry about:
- Nurses who are exhausted from poor staffing and mandatory overtime make more errors; possibly fatal errors.
- Nurses who work in a poorly staffed environment are more likely to leave the profession.
- Departments with lower turnover give a better quality of care.
- Nurses who are fresh and engaged will notice your deteriorating condition much faster than a burned-out nurse.
- The hospital wants nurses to keep the staffing level a secret. That says it all.
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