Q: I work as a bedside nurse in a hospital. What are some solutions that I can implement at work to help my team with burnout?
A few weeks ago, a nurse submitted this question during my Monday Instagram Q+A. As a former ER nurse and recent nurse leader, this question is one I've asked myself many times over the last few years. I love that this nurse is looking for solutions and eager to step up. Kudos to her. Let's go into it.
What is burnout?
If you work in healthcare - or really anywhere in the year 2022, you’re familiar with the term ‘burnout’. According to the Mayo Clinic, job burnout is a form of physical and emotional exhaustion thanks to work-related stress. Common symptoms include cynicism, difficulty concentrating, and being overly critical and irritable. Each of these present challenges to providing complex team-based healthcare to patients. But particularly alarming is the erosion of personal identity and sense of meaning experienced by healthcare workers who are burned out. Not only are nurses’ ability to care for patients at risk - but also their desire to, aka compassion fatigue.
Until recently, burnout had been characterized as a personal problem, one that can be prevented and mitigated with sufficient rest and relaxation. However, the rapid acceleration of nurse burnout in the last three years has made it clear: burnout is a systems issue.
Burnout is a systems issue.
Burnout is both the product of a dysfunctional system - and a contributing factor. Many factors (an aging patient population, healthcare worker shortage, increasing technological demands, and corporate greed, to name a few) contribute to healthcare workout burnout. And, as burnout among these professionals rise, more call in sick, leave their job, or leave the professional altogether resulting in short-staffed units, high turnover, and - you guessed it - more burnout. In systems thinking terms, we call this a reinforcing feedback loop, or a vicious cycle.
The burnout and related compassion fatigue your own team may be experiencing are likely symptoms of greater systemic stress. Adding the Covid-19 pandemic on top of an already strained U.S. healthcare system has resulted in system failures at every level: organizational, regional, state, and national.
What can nurses do about burnout?
Conversations about how to address burnout have largely focused on how to manage burnout as a symptom, rather than going deeper to understand the greater system dynamics making it a problem in the first place. Unfortunately, interventions focused at the individual- and team-levels (self-care, team-building, gifts of appreciation) simply will not protect healthcare professionals from burnout-aggravating factors originating at the organizational level and beyond. This is classically what systems thinkers mean when we say: ‘We must go upstream.’
Symptom management is a very different task than healing an underlying disease process. We're nurses; we know this. And right now, so much of nurses' and nurse managers' energy is being directed towards managing symptoms that are only intensifying while the systemic disease spreads. No wonder we're tired.
Healthcare worker burnout, like other complex systems challenges, will not be solved by any one of us. To address healthcare worker burnout is to address fundamental problems with our U.S. healthcare system. Problems of this nature are the work of generations: they require cooperative efforts directed towards a few key areas over time. And I can't say exactly what that will look like.
But there is hope. While you or I won't single-handedly resolve the burnout problem on your unit, we CAN make an impact. And if there is one strategy to use - one skill to build to be successful - it's systems thinking.
Nurses can become systems thinkers.
Systems thinking is a language, framework, and set of principles we can use to understand the complexity and interconnectedness of the world and systems we live and work within. Nurses are actually primed to think in systems, by nature of our training. We see patients as Whole People whose health is impacted by multiple factors other than the healthcare they receive.
When nurses commit to consciously building the skill of systems thinking, their capacity to solve problems and lead change rapidly expands.
When you can ‘see the matrix’ of how broader systems challenges are impacting you at the department-level, you can take 3 important actions:
Become aware of how broader system dynamics intersect with you and your teams' behavior
Help your leaders see these same connections
Identify possible solutions
Changing complex systems isn't all on you. However, it IS your responsibility to engage with the systems and environments in which you choose to work - for the wellbeing of your team, your patients, and you.
Sometimes people hear ‘it’s your responsibility to engage’ and take this to mean ‘let organizations off the hook and enable harmful business practices’. That couldn't be further from what I mean. Systems thinking is actually a critical tool to hold organizations accountable.
When you can see the fail points in complex organizations and articulate them to its leaders and stakeholders, it's a lot harder for decision makers to pat you on the head and defend the status quo. This is the power systems thinking can give nurses.
There is no one-size-fits-all solution.
Like any other complex systems challenge, burnout is impacted by many forces outside of your direct control.
I can't and won't give you specific solutions to implement on your unit for a few reasons. First, I don't believe solutions are prescribed. Solutions emerge from within the community that needs them. Second, without knowing anything about the specific challenges, context, or current efforts, a meaningful solution from me is unlikely. Finally, you are capable of becoming the change maker you need. That includes analyzing the current challenge. That includes ideating and testing solutions. That includes partnering with your coworkers and leaders to make change.
I also invite you to frequently and without apology recommend your leaders and teammates practice ‘Systems Care’ in addition to ‘Self Care’. We need healthy people, and we need healthy systems. One cannot exist without the other.
Becoming a systems thinker is the most strategic move you can make on your way to leading change. If you’d like to learn more about systems thinking, I send out free tools for developing nurse change makers every Sunday. Sign up here to get next week’s lesson.
And if you’re fired up and ready to go, check out my signature program, Change Maker Essentials, to learn the systems change fundamentals.