Every single class I teach, either at the graduate level or within the undergraduate #nursing program, the issue of burn out comes up either within discussions among the students or within their individual papers and nurses start to open up, venting their overwhelm and frustration. Today I offered a Live Chat in an RN to BSN program and the focus was on better understanding the use of APA. Before the teaching even started though, several of those in attendance were sharing about having to cover at their facility because of #nursingstrikes. One shared a story of a nurse who committed suicide just this past August and among her private items, her parents found a note To Her Abuser: the Healthcare System. Another shared of a nurse who recorded herself grieving a patient she had lost, and the backlash she received from viewers who failed to understand her message, and rather chose to believe she was simply seeking social media attention. Nurses are burnt the duck out and they are begging for your support.
Half of healthcare workers demonstrate symptoms of post-traumatic stress disorder, and even more suffer compassion fatigue, burnout, second victim phenomenon and secondary traumatic stress. Female healthcare workers experience greater intensity of emotions than their male counterparts, and nurses have stronger negative emotions than their physician colleagues (McDaniel & Morris, 2020).
Between 1999 and 2017, essentially the bulk of my own nursing career, the #suicide rate among adults between the ages of 16 and 64 years in the United States has increased by one-third (Patrician, Peterson, & McGuinness, 2020). There is evidence that health care professionals have even higher suicide rates, with female nurses taking their own lives at twice the rate of other women.
The underlying causes of suicide are complex but given that many adults spend much of their time at work, this environment and its impact really does need further evaluation. We know that nurses are experiencing high rates of #burnout (Molina-Praena et al., 2018), and that they are emotionally exhausted, but interestingly, neither major employers or professional nursing groups like the American Nurses Association (#ANA) are tracking suicide rates among nurses (Patrician, Peterson, & McGuinness, 2020).
It doesn't seem as if relief is a priority for either larger employers or our country's political leaders either. Very little training is being offered to supervisors to identify the signs and symptoms of distress in colleagues or even in promoting a sense of connection among employees. In fact, #bullying and dehumanizing behaviors continue throughout the profession and are supported by legislative leaders in some states, like California and Georgia which have laws that prohibit nurses with their doctoral degrees from using their rightfully earned title of doctor. These laws continue to support other professionals who have used the same title for the same reasons for many decades, without controversy, such as our dentists, our audiologists, our ophthalmologists, veterinarians, and podiatrists. Indiana and Florida have both introduced bills that are somewhat similar or threaten the nursing doctor's autonomy, but they have yet to be signed.
Collaboration agreements set practitioners up for being manipulated and controlled, belittled and dehumanized. We don't want to talk about this because not only is it uncomfortable, and calling out men puts women at even more risk, but it is no secret among female nurse clinicians that male #physicians with power over us via legally required collaborations or restrictions can and do overstep the professional line. In fact, women in healthcare share with great openness that we "have to have lunch with our collaborator and let him molest me a bit, so I can maintain my collaboration" (otherwise lose our job or even our business). There is absolutely no support in the evidence for these restrictions, only consequences healthcare consumers suffer, but interestingly, in the state of Indiana, a dentist and even a podiatrist can serve as a nurse practitioner's or nurse-midwife's collaborative provider. They aren't physicians either and have no authority to treat healthcare consumers to the extent that nurse practitioners and nurse midwives do, and their prescribing panel certainly isn't as diverse, but they can certainly charge us thousands of dollars a month to sign a few charts, making us very vulnerable to their authority and power.
After years of being pursued, threatened, and harassed by physician colleagues who felt threatened by my practice growth, I shut down my practice. A few years later, after significant therapy and #EMDR, I opened a small family practice but I really struggled with fear of growing big. I didn't market. I didn't invest in developing its model as I did my previous midwifery program, and many people shared that I presented as if I had a mindset of scarcity, that I didn't deserve success. This didn't seem to resonate, but interestingly, I was frequently making appointments with my therapist, my mental health trainer, for EMDR specific to my own personal medical trauma, my birth stories more specifically, but every time I showed for the appointment, something else would dominate our discussion. Finally, she held me accountable, had me book a two hour appointment, and we really got into it. I saw the connection in it all.
The pathways in my brain about my own #birthtrauma ultimately ended up showing me why I also self-sabotaged myself in my private practice. I felt bullied as a birthing woman; my power and their power were not equal and I was dehumanized. There was no good reason either. It was pure hatefulness. I could write books about the horrendous treatment I endured, each one individually. It didn't matter that I was right, both scientifically and legally, but only that their positions allowed them to overpower me.
This same scenario was true for me as a practicing clinician. It didn't matter that I had great outcomes, that I was an intelligent practitioner, that I was worked to the highest professional standards, or that I was published. It only mattered that I was viewed as an outsider, a rogue misfit. I was treated inhumane so much so that when anyone was kind within the #hospital system, I sent flowers and cookies and lengthly letters of gratitude. However, I worked hard to avoid scenarios that would place me in vulnerable positions, so that I would have to fawn in effort to practice my skill. I developed an inability to talk on the phone.
My collaborators for my family practice turned over quickly for whatever reason I wasn't even always made aware. One died. One moved. One disappeared. Not once was I notified beforehand. The fear of working outside the law, unbeknownst to me even, and losing all credibility was more than I could bear. I even had fear while I did have seemingly dependable collaboration that it would disappear at any moment and all my clients who depended on me would be put at risk with my practice closing overnight. Deeper than I ever want to admit, I feared being manipulated in anyway that would place me in a position of vulnerability. Don't think physicians didn't give me longer hugs, rubbed my back longer than they should have, even asked me to dinner on occasions or that they didn't put demands on me like having to take call for their practice, or even use my home as a site they could care for individuals receiving addiction care.
The required submissiveness, as a woman to men who have long been our predators, our abusers, absolutely did create a scarcity mentality in me. After meeting with my therapist and walking down that neuro-pathway in my mind of trauma and powerlessness and scarcity, I recognized the connection. I was then able to become more active in obtaining my Kentucky license, having just moved earlier this year. Within days I was licensed as a full scope practitioner and for the first time in my career, have both practice and #prescription privileges without restrictions. My excitement and passion has been reunited, but my trauma remains to some degree. I still can't talk on the phone. I still fear every ring is going to be a physician shoving his opinions and threats down my throat, along with his disgust and hate for no other reason that what I represent, a threat to his own ego or profit.
Bedside nursing is a common environment of hostility for which most can't even report violation to police because they won't file harassment or even assault charges. We're told getting spit on, punched, and even stabbed is an expectation of the job. Isn't this true too for #police who have a plethora of self-protective devices they can deploy under any perception of threat but anyone who does come at a police officer gets greater penalty than if they were to do the same to a civilian? Nurses can't even file civil suits against patients who physically harm them because again, this is just part of the job expectation per previous case law. One can't pretend this doesn't tell every cell in our body that our life isn't as valuable as anyone else's and that it is our duty to work and bleed and exhaust ourselves for anyone and everyone else.
When nurses surpass high levels of chronic stress, mental fatigue, and utter overwhelm, it is easy to get lost in the weeds of evidence through your career that made the argument that you are worth being protected, that you aren't worth being paid fairly, that you don't deserve the rights of all other human beings, or even that among all clinicians working their damn asses off to serve their clients to the best of their ability, and that in spite of the last two years of the public finding the nurse the most honest and respectable profession or that nurse practitioners have demonstrated to be safe and effective, at least equal to, if not better than physicians for half a century now, that our legislative leaders, hospital administrators, and physician colleagues feel we can't be trusted to work to the full scope of our training or even use the title we rightfully earned. No wonder nurses are losing hope.
The scientific analysis published in the American Journal of Nursing in October of 2020 regarding increasing rates of nursing suicide states that as part of the work towards addressing the increasing rates of suicide among both female and male nurses, is creating working environments favorable to nurses including enhancing their autonomy and control. They also identify improving "good teamwork between nurses and physicians, participation in hospital initiatives that affect nursing care, and supportive relationships with management," (Patrician, 2020, p 5). If you are a legislative leader and you are in a position to vote on legislature that either supports or restricts nurses, know that working against our autonomy is ultimately going to collapse the healthcare system. Physician unions and lobbyists are lying to you. Nurses need protection.
If you need help, if you are concerned about your mental health or the mental health of the healthcare practitioners in your work setting, the Healer Education Assessment and Referral (HEAR) program may be of assistance. They proactively assess provider's mental health and evaluate associated risk factors through anonymous self-assessments and they offer education about mental health, including suicide risk. There is a clear need for action on the parts of health care employers, our professional organizations, and policymakers, as well as nurses themselves.
Help is available 24/7 at (800) 273-TALK (8255).
References
American Academy of Nurse Practitioners. (2020). Quality of Nurse Practitioner Practice.
McDaniel, L. R. & Morris, C. (2020). The second victim phenomenon: how are midwives affected? Journal of Midwifery & Women's Health, 65, 503-511. https://orcid.org/0000-0003-4804-4697
Molina-Praena, J. et al. (2018). Levels of burnout and risk factors in medical area nurses: a meta-analytic study. International Journal of Environmental Res Public Health, 15(12).
Patrician, P. A., Peterson, C., & McGuiness, T. M. (2020). Suicide among RNs: An analysis of 2015 data from the national violent death reporting system. American Journal of Nursing, 120(10), 24-28. 10.1097/01.NAJ.0000718624.25806.3f
Peterson, M. E. (2017). Barriers to practice and the impact on healthcare: A nurse practitioner focus. Journal of Advanced Practice Oncology, 8(1), 74-81.
Roberts, A. (2023, October). Nurse strike updates 2020, full list. Nurse.org.
Stone, A. (2022). Gallup poll ranks nurses most honest and ethical profession for 20th consecutive year. ONSVoice.