A 'Critical' Nursing Problem
Finding a solution for stress and nurse burnout in the ICU.
By Beth Puliti
For many critical care nurses, stress and burnout come with the territory. Research has even proved that stress has far-reaching effects for nurses not only in their clinical practice, but their personal lives as well (Gillespie, M. & Melby V., 2003, Journal of Clinical Nursing).
"Today's nurses face more and more challenges because of supply-and-demand issues, regulatory requirements, conversion-to-computerized documentation, fast-paced working environments, long hours, constant changes and adaptation, high stress levels and greater physical demands than ever before," noted Terri Poole BSN, RN, nurse manager in Saint Agnes Hospitals' Adult ICU/Cardiac Care Unit, Baltimore.
Continuing to work without tackling these issues will result in burnout. That's why critical care nurse veterans like Poole employ coping skills to overcome stress so they can better care for their patients.
Physical Challenges in the ICU
When it comes to obstacles of the physical kind, Poole - a critical nurse for 14 years - noted that one challenge all nurses face are long shifts on their feet. Consequently, legs and feet become tired and nurses are physically exhausted by the end of their shift, she said.
Moreover, as the obesity rate continues to increase every year, caring for that patient population presents many physical challenges for nurses.
"In the ICUs, patients must move frequently due to the high risk factors of skin breakdown and complications associated with immobilization of the critically ill patient," said Poole. "The physical demands on the staff after repeatedly lifting and moving patients are a real problem that nurses face daily."
Joanne Bergeron, RN, medical ICU nurse at Rhode Island Hospital, Providence RI, concurred.
"As an older nurse, one of the physical challenges I have found is that the patients are getting larger, which makes it more difficult to move and do all that is necessary to help in their care," she explained, noting she is lucky to work on a unit where her co-workers help her when she needs them.
Because critically ill patients require 24-hour monitoring, nurses must help transport them by pushing beds to other areas of the hospital for tests and procedures, which also proves physically demanding on the body.
Day-to-Day Emotional Challenges
In addition to the physical challenges of the job, nurses face emotional challenges on a day-to-day basis. Critical care nurses, in particular, are exposed to a lot of death and dying, which is difficult at times to manage emotionally, said Theresa D. Bress, BSN, RN, CCRN, NE-BC, nurse manager in the critical care-intermediate care units at Mercy Medical Center, Baltimore.
"Not only are we caring for our patient, but we are caring for the family as well. A very delicate approach must be taken with the family when providing support during the end of their loved one's life. I often try to envision if this was my life partner/spouse/child/etc., which helps my understanding and any acceptance of a reaction the family needs to work through," said the 34-year critical care nurse veteran.
She added that another emotional challenge nurses experience is the feeling of not being able to do enough or get all of their work done.
"It is very difficult to leave your shift knowing that you just didn't have enough time to hold your patient's hand or spend time with the family due to conflicting priorities," Bress said.
Bergeron has found her role has changed on an emotional level over the years, from a new young nurse afraid to speak up, to a "mother hen" figure who treats patients as if they were her own children and family.
"I love to teach and explain what I am doing and why. I like getting family members involved in patient care no matter how small a task. I find they are appreciative of being active in their loved ones' care. Sometimes it is the last thing they get to do for their loved one before they die," she explained.
Nurses, especially those who work at the bedside caring for patients day to day, need to be creative in developing different patient care delivery models to both meet the many demands they face and to retain nurses at the bedside, believes Poole.
Some nurses have dealt with the physical demands of long shifts by splitting their shift with another nurse, which works well for those who want to keep bedside nursing but are unable to work the long hours physically.
"I personally became a nurse to make a difference, and that has helped me to work through the many dilemmas and demands of the nursing profession in general," she explained.
To better cope with the emotional challenges, Poole is a member of the ethics committee at Saint Agnes Hospital.
"Being part of the committee is very helpful, not only educating me but also allowing me to educate the nurses, and reach out to them as a resource when dealing with difficult emotional situations," she said.
Saint Agnes Hospital, which is a faith-based hospital, offers patients as well as staff support from the on-staff chaplains when dealing with difficult, emotional situations. Poole acknowledged this it is a tremendous support that is utilized and appreciated by all staff at Saint Agnes Hospital.
To avoid burnout, Bress said nurses should ensure a good work/life balance, hold post-event meetings to debrief and foster good working relationships with the entire team, including the physician, nurses, technicians and secretaries.
She advised veteran critical care nurses to stay fresh both physically and mentally by reminding themselves why they entered this profession, what a special gift it is to have the ability to care for people, how proud they are to be a critical care nurse and asking themselves if they would miss work if they stopped.
Bergeron revealed that she has never had an issue with burnout, but believes that may have something to do with working 20 hours a week. A critical care nurse for 38 years, she stays fresh by keeping on the move.
"My co-workers laugh at me, but I tell them I come to work to lose weight. I do not stop walking for the 8 or 12 hours that I work. Keep moving!" she said.
Ultimately, nurses need to be open-minded in realizing things are always changing in the way they care for patients, concluded Poole.
"Nurses need to be part of the change and be solution-focused to make changes that are needed. Who better to know the best way to care for patients than the staff nurses? Be proactive. Get involved! It will help you feel content knowing that you are making a difference," she said.
Beth Puliti is a frequent contributor to ADVANCE.