Nurse Burnout, adrenaline junkies, and secondary stress, part deux

Q: What kind of bird are – you?

note; the underlined words or phrases are hyperlinks to related background material. be sure to to click on these.  especially the one related to my book about Nepal.

Burnout happens.

Got a lot of responses to my last blog posting about Burnout, Marlene Kramer and stress. It got mentioned in the AJN blogroll of nursing blogs which is titled “Off the Charts. At that location, they keep a list of blogs by nurses. Some are quite good.

The editor there called me “peripatetic” –  not a word I use every day. Moi? Come to think of it, I don’t spend a lot of  time trying to describe myself.  The words that come to mind are handsome, witty, charming, emotionally available, and compassionate.   :-)   and of course, humble!

Urban Dictionary

so naturally I went to the Urban Dictionary. For those of you in search of eternal youth, this is a terrific site. I would have never learned the meaning of “4-20 friendly” for example, if I had not used that resource. And of course, the place includes current commentary on issues of the day, such as this gem.  (Like the vast majority of Americans I don’t think we should elect male legislators who think they are the only ones qualified to tell women what to do with their bodies. I have spent too much time with too many crime victims to laugh at their expense.)

1) The act of, relating to, or given to walking about;
2) Moving or traveling from place to place to freekin place;
3) Snooking around touching every damned thing around;
4) Cant sit still or settle down; and
5) Constantly, without rest, surveying, reconing, and otherwise annoying the hell out of everyone by any of the above actions.
Okay, well – I don’t have just one theme for this blog. I get up and think new thoughts every day. Or try to.
Today’s thought about Burnout, Secondary Stress, OCD in nursing, codependence in nursing,  and self-care in nursing
In the past blog, I reviewed Marlene Kramer’s four stages of burnout, and I focused on assessment of yourself and others. I didn’t really get into detail about some of the other things I think can help you if you are having problems with this.
Riding the Dragon is a book by Bob Wicks, a professor at Loyola College in Maryland.  It’s about developing resilience in every day life despite uncertainty. Pretty simple wording that you could use to meditate upon, I suppose.  My two cents? when you are health care professional, sometimes your work calls you to deal with a darned big dragon!
He’s written a bunch of other books.  I met him and heard him speak when he visited the Catholic Campus Center of the University of Hawaii.  I had the opportunity to speak with him afterwards, and was delighted to receive a copy of one of his other books in the mail two weeks later. This one was titled Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional Resilience and Personal Well-Being.
My review of this book:
In my experience as a critical care nurse and also as a hospital manager and  teacher of nursing, I have dealt with issues of secondary stress for many years
and I have seen many victims of this problem. And so, I stay abreast of this issue.On Page 5 of the book, the author says:”it’s a ‘one-sitting book’ designed to distill current clinical papers and research; provide proper guidelines to avoid and/or limit unnecessary distress; strengthen
the inner life of physicians, nurses and allied health personnel; and offer recommendations for further reading on the topic. If nothing else, its goal is
to raise awareness that secondary stress is a danger..”and I think this nifty little tome fills every one of these these goals and more. In a survey  book, Dr. Wicks has managed to distill the best suggestions, on a very practical level, into something that’s readable and deceptively simple. I say deceptive, because he has a way of describing the profound thoughts of stress, death,
burnout, and spirituality into an engaging style.It is readable and has many anecdotes to which a clinician will relate. He makes excellent use of summarized bullet points, and checklist style formats to present ideas. I found myself thinking of all the people who need this as a christmas present.

in short: highly recommended!

There are gradations of burnout.
I gave my copy of the secondary stress book to one of my best students, who is a perfectionist and highly “driven.”
The phrase “burnout” gets thrown around a lot and can lose it’s meaning. Sometimes a person simply needs to talk with a coworker for a couple of hours away from work; other times they need a two-week vacation; but in extreme cases the person gets a glimpse of the horror that life can be for some of the people we meet, and goes into a state of full existential angst.  we can all benefit by creating a work environment that sorts through these issues.
Perfectionism as a related problem or symptom
I do think there are nurses who bring an insidious type of emotional baggage with them, who are more at risk of the total-despair variety of burnout. These are the ones who are needy about proving their worth by being excellent caregivers, but they get it mixed in with caretaking. Also known as co-dependent, experiencing co-dependency. Manifested also by perfectionism and OCD on the job.  For these persons there are a couple of really good books. One is an oldy-but-goodie “I’m dying to Take Care of You: Nurses and CoDependence.  The other is Codependent No More: How to Stop Controlling Others and Start Caring for Yourself.
Work Environment
a final point: the books above mainly deal with how to identify stress and burnout within yourself but do not really go into the management skills and sensitivity needed to create a supportive work environment.  If you have a manager who tries to suppress the staff’s ability to deal with stress collectively, you need a new manager. Honesty is a key to effective problemsolving.
Let’s be realistic: if you deal with trauma and sadness all day at work, you need help from those around you. period. If  the team is one which gives you the message that you are on your own or that somehow it’s your fault,  your stress will be magnified.
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