By Lisa.Ermak HollandSentinel.com

January 26. 2014 7:00A

As educators, caretakers and lifelines, nurses take on several roles as they routinely care for patients day in and day out.

And for some, the strains of the job can eventually lead to physical, mental and emotional exhaustion, otherwise known as burnout.

“It's really stressful," Dawn Kettinger, spokeswoman for the Michigan Nurses Association, said. "You’re taking care of six people when you should take care of four."

That was the case for Debra Nault.

Nault worked as an obstetrics nurse and midwife for almost 25 years at Sparrow Hospital in Lansing. It was a job she loved, but what ultimately did her in, she said, was the cultural change at work. An unnecessary increase in cesarean deliveries and medically induced labor began to make OB nursing feel like assembly line work, she said.

Nault also felt like she was losing control of her schedule, assignments and workload. As a charge nurse, she had the added responsibility of caring for patients while also running the unit.

"(Burnout) caused nearly constant frustration and sometimes guilt. When you’re on the front lines and know what’s needed to provide quality care but do not have the resources of support, it’s very irritating. Your frustration and bad attitude can spill over to your performance and interactions."

Nault’s experience is not rare. Nurse burnout is affecting the health care system and causing high rates of turnover in the field.

lthough colleges and universities in West Michigan are generating 745 new registered nurses annually, the influx still falls short of the projected annual demand by more than 100, according to Grand Valley State University’s report “Health Check: Analyzing Trends in West Michigan 2014.”

Employment of registered nurses in Michigan is projected to grow 19 percent from 2010 to 2020.

But who will fill those jobs? According to a 2013 survey by the Michigan Center for Nursing, 42 percent of all active RNs say they plan to practice nursing for only one to 10 more years.

It’s an issue that affects everyone, Kettinger said. “More nurses are retiring earlier, and that’s a real concern for all of us in the public. We want those experienced nurses to stay on and provide quality, safe care.”

Burnout can be caused by several factors, including lack of social support, inability to control one’s work schedule or assignments, a chaotic or monotonous job and work-life imbalance. But Kettinger said short staffing is often the primary contributor.
As hospitals try to cut costs, that tactic backfires and becomes a patient safety issue.

"You're running around taking care of people's needs," Kettinger said. "People describe going home at night and thinking, 'What did I forget?'"

According to the Michigan Nurses Association, short staffing is connected to higher infection rates, higher preventable falls and higher death rates.

Similar to burnout is the issue of compassion fatigue, the emotional strain of dealing with traumatic and difficult situations on a daily basis. The two are very connected, said Shari Schwanzl, vice president of operations and nursing for Helen DeVos Children’s Hospital.

“It’s a lot like post-traumatic stress disorder. Your response to these emotional things becomes normal, and it shouldn’t be.”

One way hospitals can keep compassion fatigue from setting in, Schwanzl said, is to make sure employee assistance programs are in place. The teams should come in 24-48 hours after a traumatic situation to help employees debrief and deal with the experience.

If that kind of debriefing isn’t in place, then there’s a cumulative effect, Schwanzl said, and staff can burn out very quickly.

The pace of the job is fast and furious, Schwanzl said, and because of that, nurses need to be reminded and encouraged to find time to decompress, sleep enough at night, eat regularly and exercise.

“Our leadership responsibility is to remind people this is tough stuff but you can do a better job when you’re in a better place.”

Kettinger and Nault agree burnout has probably worsened, as the workload of the average nurse is greater today than it was 10 or 15 years ago because of more technology, documentation, electronic medical records and added nursing responsibilities.

In order to reduce burnout, the Michigan Nurses Association is hoping for the passage of a state law that would require hospitals to provide minimum nurse staffing at all times. State Rep. Jon Switalski and state Sen. Rebekah Warren have introduced two bills to address that concern. Currently, both are waiting to be taken up by legislative committees.

If passed, Kettinger said, the bills would keep nurses from working 15- to 18-hour shifts and reaching the point of exhaustion and eventual burnout.

“In a way, it’s a broad issue with lots of subpoints, but in another way it’s very simple — nursing is a hard job, and nurses need support," Kettinger said. “They have a legal and ethical and moral obligation to provide safe, quality care every time.”