Imagine being stuck in the middle of a lake in a canoe with a single set of paddles and a life jacket. Now, imagine that your life jacket deflates, and your paddles shrink ever so much with each stroke you take as you make your way back to shore. Now imagine there is a tiny hole in your canoe. You work hard to try and make your way back to shore, but your resources are being depleted. Despite your best efforts, you are eventually underwater.
That is sort of what it has felt like being a healthcare worker during COVID-19. It is the long hours, extra shifts, lack of PPE, and high nurse-to-patient ratios because the unit is short-staffed. It is feeling drained emotionally and physically. It’s burnout. Unfortunately, burnout has been a chronic issue within healthcare and something that hospital leadership has not adequately addressed.
What is burnout? Maslach defines burnout as a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors that can manifest as overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment. Burnout is nothing new in nursing. A quick literature search will show you that. Burnout within critical care can be attributed to many things, including caring for very sick patients teetering on death, high workloads, combative patients or family members, harsh work conditions, and more.
Hospitals have dealt with this problem by investing in mindfulness. Why mindfulness? Well, studies have shown that mindfulness and meditation can help one manage stress and build resilience. In other words, hospitals encourage staff to meditate mental strength and flexibility into their lives. I would say that nurses are already quite resilient. It would be difficult for a nurse to succeed through nursing school and critical care training without coping skills and mental fortitude. While I see nothing wrong with meditation, I find it is quite interesting that institutions are shifting the sole responsibility of managing burnout onto the individual rather than implementing meaningful change within the workplace. Somehow a nurse who may or may not even have an opportunity to fit in a lunch break should dedicate 15 minutes of his or her shift to mindfulness exercises as a way to manage the lack of resources on their unit.
Burnout leads to increased job turnover; turnover of ICU nurses ranges from 13-20% per year. This can cost the hospital a lot of money. The estimated cost of replacing a critical care nurse is about $65,000. Money aside, burnout can lead to poorer patient outcomes and lower quality of care.
Unmanageable workloads coupled with low staffing ratios, working through an entire shift without a break, and lack of support or resources are all too familiar to ICU nurses. These are issues that cannot be “meditated” away. I find it insulting to chalk this up to a lack of resilience when it is partially due to institutional shortcomings. Mindfulness cannot grow another nurse to help ease the workload. Mindfulness does not diversify the workplace. Mindfulness does not heal that black eye from the combative patient.
So, where do we go from here? What steps are hospital administrators willing to take to preserve morale during this pandemic and after? What changes can we make beyond this acute phase of the pandemic to ensure resiliency amongst healthcare workers? It will take resources to do this, and I just hope that the hospital administrators can see the value of adequately investing in their employees.
Chinoye Onyebuchi is a registered nurse in Newington.