“Empathy is one of our greatest tools, but it must be replenished and sustained through self care”…

The Nurse Break is excited to have Lisa from thewholenurse.com in the United States to write for us Australian nurses about her career in this QnA and her area of interest ‘burnout’ and why we should focus on it more!

You can find Lisa on instagram and her website thewholenurse.com

About Lisa

Hey everyone, my name is Lisa and I am a nurse in the U.S. I’ve been a nurse for 15 years and have primarily worked hematology/oncology, specializing in bone marrow transplant. My path to nursing isn’t exactly a straight path. I ended up becoming a nurse about 7 years after thinking about it. When I was 16 years old, I was in Anatomy and Physiology class in school. I realized I really like science and I was good at it.

My teacher had a job board in class with possible careers related to the class. Nursing was on the board. The thing about that moment was that I was also pregnant. This is part of the reason it took me a little longer to become a nurse. Along the way I worked various jobs including one as cleaning staff in a hospital. But by the time I was 26, I graduated from nursing school on the Dean’s list, took my state boards, and starting a job at a nationally designated Comprehensive Cancer Center working in pediatrics.

In the U.S. all nurses get education on paediatrics and maternal health as part of their curriculum, so it’s not unusual for them to go straight into these specialities. Usually the hospital will have additional training for new graduates to support them in this speciality. My hospital had a 13 week didactic plus preceptored shifts. This really provided my foundation in paediatric hematology/oncology.

What different areas of nursing have you worked in

In my nursing career, I have worked mostly in hematology and bone marrow transplant (BMT). I spent five years doing pediatric haem/onc and BMT. After that, I switched adult BMT at another Comprehensive Cancer Center. Soon after starting there, I was asked to become an interim transplant coordinator. It was a small transplant program that was about to expand. With the expansion, I was asked to become the educator and to design education for all of the staff. I worked for six years as an educator.

What are you doing at the moment with your career and what’s your future plans

Most recently, I left the hospital after obtaining my Master’s Degree to teach in nursing schools. I have been a clinical nursing instructor and currently I teach a research writing class for nursing students. I found myself struggling with burnout and compassion fatigue in nursing.

Nursing school did not prepare us as students for managing loss in our careers and compassion fatigue is the result of cumulative loss. This was compounded by the death of my mother in law after battling esophageal cancer. All of this prompted me to take two months off of work and to reevaluate how I manage the stress and loss in nursing. I researched burnout and compassion fatigue and realized most if not all schools are not preparing nurses for the effects of an emotionally labour intensive job. Now I also speak at events and write about burnout.

What is some advice/thing’s nurses can do to better prepare themselves to get a job and work in your field?

Remember that the biggest component with your work is the emotional labour that you do.

Empathy is one of our greatest tools, but it must be replenished and sustained through self care.

This includes taking care of yourself holistically, emotionally, mentally, physically, financially, etc. Use a plan or checklist at the end of your shift to transition from the seriousness of your work back to your home life. This includes reminding yourself what went well, what you learned, and what you can let go of. Sometimes my pre-work music playlist and drive home playlist helps me transition. Have a spiritual practice (not necessarily religion) like meditation. It can be hard to reconcile with the cumulative grief of losing patients and the difficult end of life scenarios that nurses face.

Can you share some night shift tips?

I recommend checking out The Power of When and figuring out your chronotype. Sometimes the only job available is the night shift, but you need to understand how this impacts you individually. A lot of the research points out that light has a big impact on sleep.

Tips:

Sleep in a dark place, wear sunglasses on the drive home, avoid watching TV or looking at your phone before sleeping. Keep your room cool to sleep more comfortably.

What do you carry on you during a shift?

When I worked the floor, I always had a nursing “brain” in my pocket. It was a one sheet to do list organized by hour for my patients. I am a to do list kind of person and need it to stay organized. The current Electronic Health Record just doesn’t organize my tasks in an easy visual to do list like my paper did. I always like having a permanent marker (for marking fluid levels on suction or chest tubes) and a pen. I also always had my stethoscope, alcohol swabs, and my compression socks. I’m not big on having full pockets or lots of stuff to carry around.

What’s in your lunch box!

In most hospitals here in the U.S., cafeterias are closed at night, so I always packed a lunch and a water bottle. I usually got coffee on the way to work, but I didn’t drink it during my shift. I preferred to stay hydrated as I tend to get a little orthostatic when I am dehydrated. My lunch was usually something simple. Sometimes I make a large veggie/legume/rice type dish and divide it into containers to take to work. That plus a piece of fruit or granola bar works well for me. Even when I work days, I like to spend less of my lunch time getting food than actually sitting down (cafeteria lines can take half of your break).

What is one piece of advice for students you would give who are worried about starting a graduate year?

My advice to nurses feeling stressed about transitioning to work is to remember you are human. We all are novices at first. None of us are perfect. Perfection is the enemy of progress. Your goal is safety followed by gradual improvement, not perfection. Don’t compare yourself to others. Compare yourself to you last week, last month, or last year. And when you make a mistake, because we all do, be accountable, be reflective and look at the system problems that led to it.

Burnout

Recently the World Health Organization updated their definition of burnout as an occupational phenomenon. “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.

It is characterized by three dimensions:

● feelings of energy depletion or exhaustion;

● increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and

● reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” (WHO, 2019) This occupational phenomenon is something often experienced more by new nurses, younger nurses, and nurses who work in high acuity areas like the Emergency department, ICU, etc. Most studies estimate burnout to exist in about 30% of nurses surveyed.

The outcomes of burnout include high turnover and increased medical errors. Developing strategies to prevent this are an essential part of nursing. Nurses cannot care for others while simultaneously caring for themselves. In fact, according to the Green Cross Academy, an international, nonprofit humanitarian organization that responds to those in crisis following trauma, compiled standards of self care including the duty to perform self care. They recognized self care was essential in working with people who have experienced trauma. These concepts apply to nursing as we care for those who experience suffering and trauma. Burnout doesn’t mean you are a weak person or a bad nurse. It means you need to take back more time for yourself and your own wellbeing.

Lisa LaBrie, RN, BSN, MAT