Nurses Are in Dire Need of Better Mental Health Care

Nurses Are in Dire Need of Better Mental Health Care

Last month, Washington state Senator Maureen Walsh argued against a legislative action that would provide mandatory, uninterrupted rest times for nurses. Senator Walsh stated that such a provision could negatively impact patient outcomes in certain circumstances, and further insisted  nurses had ample downtime, and claiming that they “probably play cards for a considerable amount of the day.”

Her statement did not go over well within the nursing profession. The sound bite traveled fast and the senator’s office was quickly inundated with protesting phone calls and decks of playing cards.

Although Sen. Walsh was speaking strictly about specific nurses in specific facilities, one takeaway from professionals across the country was clear: nurses are overwhelmed and they need their concerns to be heard instead of dismissed by lawmakers.

However, serving this need is more difficult than may be evident at first glance. My company recently conducted a nationwide study of the challenges facing modern nurses, and learned that nearly half of all respondents (49%) had considered leaving nursing in the past two years.

This surprising and problematic statistic has many drivers, but one of the most pressing is a need for better mental health care for nurses. More than 35% of respondents reported that the state of their mental health had a negative impact on their work, with an equal percentage (35%) believing it is taboo to discuss mental health struggles with other nurses.

Far from enjoying idle time playing cards, nurses face heavy workloads and significant stress. Here are three factors that contribute to mental health struggles for nurses, as well as where the industry should focus its efforts to improve mental health care.

1. Burnout

Burnout has long been a significant issue in the medical profession, and in our study, 62% of nurses reported feeling regularly burned out. Nurses typically work long hours with heavy responsibilities, a demanding formula that can harm anyone’s mental health. Nearly a quarter of nurses (24%) reported taking medication for job-related anxiety and depression, with three percent of nurses reporting suicidal thoughts. 

Burnout also affected work performance for 44% of respondents, which was a contributing factor for the 49% of nurses who contemplated leaving their profession. If even a modest fraction of those nurses had actually abandoned their careers, the impact on the country’s already-understaffed health care system would have been catastrophic.

2. The Nationwide Nursing Shortage

The problem that compounds all other issues is the persistent nationwide shortage of registered nurses. The Bureau of Labor Statistics predicted 1.2 million vacancies would emerge between 2014 and 2022, and 91% of nurses reported that their hospitals were understaffed.

In 2016 we issued our first study on the welfare of modern nurses. At that time, 62% reported that the growing shortage had negatively affected their workloads. In our recent study, the number had skyrocketed to 88% of nurses.

This widening gap continues to progressively harm nurses’ mental health, with more than half (54%) reporting that the increased workload negatively affected their mental health. Patient care is also impacted, with 62% of nurses reporting that the shortage is diminishing the quality of care they could provide.

Administrators and government can do more to help alleviate the shortage, according to nurses. Responding nurses recommended using temporary staffing, offering government subsidies for schooling, and creating new nursing programs. Temporary staffing and travel nursing, in particular, were highlighted as a potential source of immediate relief in areas of greatest need.

3. Harassment and Bullying

Workplace harassment and bullying are a significant and widespread problem in nursing, just as they are in many industries across the country. Almost 40% of nurses reported experiencing harassment during the past year, a stunning number that demands a need for immediate attention.

Nurses battle this abuse in all areas of their work. Bullying and harassment come from other nurses (30%), patients (25%), physicians (23%), and administrators (22%). Reports of sexual harassment were less common than other forms of harassment, but 21% of nurses still face it, with the majority of incidents coming from patients.

If there is a silver lining, it is that incidents of workplace hostility may be decreasing for nurses: In 2016, 45% of nurses reported bullying and harassment, compared to 40% today. As the medical industry continues to address and eliminate this damaging behavior, the efforts will pay off in significant benefits to nurses’ mental health.

Senator Walsh’s comments may have come across as ill-informed, but they did spark a nationwide conversation about the heavy workload nurses carry and the negative impact on their mental health. Even as the senator retracted her comments, there were productive and crucial conversations taking place about improving work conditions and mental health care.

Reducing burnout, addressing the nursing shortage, and stopping harassment and bullying are issues that require attention from individuals and organizations across the entire medical industry. If we all work together to create solutions, we will take much-needed steps toward improving mental health for nurses.

Compassion Fatigue and Burnout in Nursing

Compassion Fatigue and Burnout in Nursing

Compassion fatigue and burnout—it’s a popular topic in nursing. It’s tough to know how to maintain a good work/life balance and show compassion for patients while still preserving your own mental and physical health.

Vidette Todaro-Franceschi, PhD, RN, FT, Professor, The College of Staten Island & Graduate Center, both of the City University of New York, is also the author of Compassion Fatigue and Burnout in Nursing. As the second edition of the book recently published, we asked her questions about how things have changed.

What are some of the biggest changes that you’ve observed regarding compassion fatigue and burnout in nursing since the first edition of the book?

Since the first edition in 2012, a greater emphasis is being placed on the relation between nurse well-being and patient care, as evidenced by the growing body of research and practice literature. There are more studies being performed in the area of professional quality of life, and the significance of having a “happy” as well as “healthy” workforce is finally getting proper attention.

A number of nursing organizations have advanced various programs to foster a healthy work environment and promote work-life balance. For example, in 2013 the American Nurses Association (ANA) launched an initiative with the development of a professional issues panel to address nurse fatigue. Since then other professional issues panels have been formed to focus on moral resilience and workplace violence, among others. In 2017, the ANA began a critical initiative called the Healthy Nurse, Healthy Nation Grand Challenge (HNHN GC), which is geared toward enhancing both nurse well-being and the health of the nation—a win-win for all.

Lastly, years ago I would have been tarred and feathered for saying that no one coming to work should be asked to leave their baggage at the door, or that it was ok for a nurse to say, “I need a mental health day” or “I just cannot do it.”  Today, I think, there is recognition that we—nurses—are human beings; we feel, we hurt, we cry, and it’s ok.

What are the biggest challenges for nurses experiencing poor professional quality of life?

The biggest hurdles for nurses who are experiencing professional quality of life issues (related to: compassion fatigue, moral distress, incivility, lack of preparedness to care for patients who are dying, death overload, PTSD, burnout, unhealthy work environment) are: acknowledging that there is a problem, recognizing that there are choices and actions that they can take, and lastly, turning toward self and other(s) in ways that foster health and contentment. These three things form the basis of ART©, a mindful awareness model, which I developed to assist nurses and other carers to enhance their professional quality of life. 

Mindful awareness is the key to acknowledging how one feels (the A of ART). However, this can be challenging, since the majority of nurses work in fast-paced, chaotic places and are not paying much attention to how they feel as they go about their work. In fact, coworkers, friends, or family members may identify that there is a problem before the suffering nurse becomes aware. Hence, nurses should engage in mindfulness at work (and at home) in order to acknowledge both the good and the bad feelings associated with their work (with the goal to maximize the good and minimize the bad).

Once a problem has been acknowledged, it is essential to figure out what choices one has and what actions can be taken to fix whatever needs fixing. This can be another difficult hurdle for some nurses. A nurse might think that she/he has no choice(s), or may be fearful of change. Nurses need to recognize that there are always choices (doing nothing is a choice), and then intentionally choose and take action to change their work circumstances (the R of ART).

The last part of ART is turning toward self and other(s) (the T of ART), which entails connecting and/or reconnecting with the things that contribute to health and happiness, whatever those things might be. Nurses need to put the oxygen mask on their own faces first, figure out what makes them happy, and what will contribute to their well-being. Of course, this is easier said than done because nurses are typically self-sacrificing and altruistic. But nothing good can come from self-sacrifice that results in an unhealthy, unhappy person, especially one who is responsible for the health and well-being of others.

Making changes in eating, drinking, sleeping, and exercise habits can be difficult. Motivating oneself to go out with friends or family, or even to go out for a walk around the block may seem incredibly daunting when one is physically or emotionally exhausted and unhappy. Turning towards self and other(s) has to be taken one small step at a time, mindfully. Eventually, new good habits can replace old bad ones.

What improvements have occurred for nurses who experience professional quality of life issues such as compassion fatigue and burnout?

With greater awareness of the importance of nurse well-being for patient care quality, in many settings, health care administration is focusing efforts on creating a healthier, happier workforce. For example, many workplaces now have wellness, meaningful recognition, and resiliency programs.

What do you think is most surprising to people and/or nurses regarding compassion fatigue and burnout?

The fact that many individuals are compassion fatigued or burned out (or other things), without realizing it. Whenever I teach and/or talk about it, there seems to be this reverberating AHA! 

Anything else?

People who work with all living beings (humans and animals) should be educated about professional quality of life issues. They should know how to identify compassion fatigue, moral distress, death overload, PTSD, and burnout as well as the effects these things can have on their health/well-being, work productivity, and patient safety. 

10 Things Nurses Need to Know about the Measles Outbreak

10 Things Nurses Need to Know about the Measles Outbreak

From New Years’ Day 2019 through April 11th, the United States has reported 555 cases of measles in 20 states—the second largest measles outbreak reported since the disease was eliminated in 2000. Keep reading to learn the 10 things nurses need to know about the measles outbreak:

1. Measles is brought into the U.S. by travelers who’ve been in foreign countries where the disease is prevalent—countries in Europe, Asia, Africa, and the Pacific. It is then spread in U.S. communities via contact with pockets of unvaccinated populations.

2. Measles outbreaks, defined as three or more reported cases, are currently ongoing in Rockland County New York, New York City, New Jersey, Washington state, Michigan, and the counties of Butte County California. In addition, new cases have recently been identified in New York’s Westchester and Sullivan counties.

3. Once a person is exposed to the measles virus, it may take up to two weeks before symptoms begin to show. A person is contagious four days before the tell-tale rash appears and for four days after. Measles is an airborne virus that can be shed by those infected long before the symptoms arise.

4. There is no available antiviral therapy to cure measles—only supportive therapy for the symptoms, among which are those similar to the common cold: fever, cough, runny nose, sore throat, followed by conjunctivitis and body rash. Measles can sometimes lead to more serious and life-threatening complications such as pneumonia and encephalitis.

5. New York City Mayor Bill de Blasio has declared a health emergency in the neighborhood of Williamsburg, Brooklyn and is mandating unvaccinated residents to become vaccinated. Those not complying could receive violations and fines of $1,000.

Actions Taken

6. Mayor de Blasio has sent a team of “disease detectives” into the Hasidic Community in the Williamsburg neighborhood of Brooklyn, where nearly half of the U.S. cases reported are identified.

7. Coincidentally, the New York State Nurses Association just reached an agreement with the NYC Hospital Alliance to hire more nurses to fill vacancies and add new positions.

8. Detroit is urging those Michiganders vaccinated prior to 1989 to receive a booster vaccination.

How Nurses Play a Role

9. The role of nurses in these outbreaks is education and the promotion of vaccination.

10. It is critical that frontline health care professionals are vaccinated themselves in order to prevent the further spread of the virus, particularly when treating those patients infected by the disease.

Anti-Vaxxers: Singular in Focus, Varied in Argument

Anti-Vaxxers: Singular in Focus, Varied in Argument

Four distinct types of anti-vaccination content seen in Facebook posts

Anti-vaccination messages on Facebook could be divided into four distinct themes: trust, alternative, safety, and conspiracy, according to researchers who analyzed comments posted in response to a pediatrics clinic’s pro-vaccination video.

A small sampling of these messages on Facebook found that “anti-vaxxers” had qualitatively different types of arguments that cater to a wide variety of audiences, reported Brian Primack, MD, of the University of Pittsburgh School of Medicine, and colleagues.

However, the one commonality was that all were distrustful of physicians and the medical community, the authors wrote in Vaccine.

The World Health Organization (WHO) lists “vaccine hesitancy” as one of its 10 threats to global health in 2019, and indeed, Primack and colleagues cited the “considerable rise in the rate of nonmedical exemptions from school immunization requirements” in the U.S.

They noted that while prior research has focused on either anti-vaccination content on Twitter, comments in response to celebrity posts, and Facebook groups, the characteristics of individuals posting anti-vaccination content on Facebook has not been thoroughly examined.

“We want to understand vaccine-hesitant parents in order to give clinicians the opportunity to optimally and respectfully communicate with them about the importance of immunization,” Primack said in a statement. “If we dismiss anybody who has an opposing view, we’re giving up an opportunity to understand them and come to a common ground.”

Primack and colleagues examined the profiles of 197 individuals who posted anti-vaccination comments on a Pittsburgh pediatrics practice’s Facebook page in response to a video promoting the vaccine against HPV. These were among “thousands” posted over a period of 8 days considered anti-vaccination, “which we defined as being either (1) threatening (e.g., ‘you’ll burn in hell for killing babies’) and/or (2) extremist (e.g., ‘you have been brainwashed’),” the group explained.

Among the 197 randomly chosen for analysis (“in order to feasibly conduct in-depth quantitative assessment”), they found a large majority of these commenters were women, and almost 80% were parents. About 30% reported an occupation and a little under a quarter reported a post-secondary education. Of the 55 individuals whose political affiliation could be determined, 56% identified as supporters of Donald Trump, while 11% identified as supporters of Bernie Sanders.

There were 116 individuals who had at least one public anti-vaccination post from 2015-2017, with posts about “educational material,” or claims that doctors are uneducated and parents need to educate themselves were the most popular (73%), followed by “media, censorship, and ‘cover up'” or the suggestion that pharmaceutical manufacturers, government, and physicians deliberately fail to disclose adverse vaccine reactions (71%) and “vaccines cause idiopathic illness,” claiming kids who are not vaccinated get less illness (69%).

The four overarching themes were more specifically:

  • Trust: emphasizing suspicion about the scientific community, concerns about personal liberty
  • Alternatives: focusing on chemicals in vaccines, use of homeopathic remedies over vaccination
  • Safety: perceived risks and concerns about vaccination being immoral
  • Conspiracy: that government “hides” information that anti-vaccination groups believe to be facts

Co-author Beth Hoffman, BSc, also of the University of Pittsburgh, said that these groups “caution against a blanket approach to public health messages that encourage vaccination.”

“Telling someone in the ‘trust’ subgroup that vaccines don’t cause autism may alienate them because that isn’t their concern to begin with. Instead, it may be more effective to find common ground and deliver tailored messages related to trust and the perception [that] mandatory vaccination threatens their ability to make decisions for their child,” she said in a statement.

Limitations to the data include that these only reflect commenters who responded to a single pro-vaccination video, and do not necessarily reflect “broader discussions of anti-vaccination issues on Facebook.” Demographic data was self-reported, and could not be authenticated, they noted.

The authors disclosed no conflicts of interest.

This story was originally posted on MedPage Today.

Addiction and Nursing: How the Epidemic Affects Nurses

Addiction and Nursing: How the Epidemic Affects Nurses

When my buddy Jason first got into his nursing program, I was excited for him. Nursing is an honorable profession, one that is constantly in demand and provides certain stability that other career paths may not.

His first few semesters were rough, understandably. The competitiveness of his nursing program, the long clinical hours, and the constant full exertion required eventually took its toll on him.

By the time he became a nurse, I hardly saw him at all. He began to ignore our invitations to go out with friends and to get defensive whenever we gave him a hard time about it.

When we finally did see him, he was always on edge, flighty, and nervous. Many of our friends began to question his mental health but I knew what had happened.

Jason was struggling with addiction.

All of the signs and symptoms were there, as were the growing pressures that led him to an addiction.

It didn’t take long for my friend to seek help and eventually sober up. He was committed to his role as a nurse and even more committed to providing the healthcare that he promised to provide once he received his license.

But with my work in addiction recovery, it became apparent to me that this was a real epidemic both in the general population and among nurses. If you’re not sure whether or not you or someone you know is struggling with addiction, then read through for symptoms of addiction and withdrawal to find out.

I’ll also outline some ways to provide support so that the nurse in your life can get back to the job they love so much without the dangerous effects of an addiction.

Substance Abuse in the Medical Profession Versus General Population

Surprisingly, dependence on alcohol and drugs for nurses isn’t too far off from that of the general population. While some may assume that nurses would stay away from an addiction, about 10 percent of nurses struggle with an addiction of some sort.

Considering that there are about four million nurses in the US alone, roughly four times the amount of physicians we have, it’s a staggering number of medical professionals who are in the throes of addiction.

As the shortage of nurses continues to rise, so does the job stress and lack of resources to support them.

Nurses have been tasked with roles that are traditionally performed by physicians and are expected to work long hours in constantly rotating shifts, making the work environment for nurses especially challenging.

Plus, they have easy access to virtually any prescription pill on the market.

But because they work with medications so regularly, many of them have intellectualized use and abuse to the point of failing to recognize when they themselves are addicted.

Symptoms of Opiate Addiction and Withdrawal

There are several different things to look for, though signs and symptoms can generally be broken down into two categories: signs of intoxication and signs of withdrawal.

Signs of opiate intoxication generally include:

  • Feelings of euphoria
  • Pinpoint pupils
  • Sweating
  • Nausea or vomiting
  • Poor memory and concentration

If any of these signs appear when they were previously absent, then it’s possible that this person is battling an addiction.

Signs of opiate withdrawal include:

  • More vomiting and nausea
  • Diarrhea
  • Muscles aches and pains
  • Intense anxiety and/or panic attacks
  • More sweating
  • Extreme irritability

While some of these symptoms can be present due to lack of sleep and stressful situations, they tend to be a bit more extreme in those experiencing withdrawal.

Another thing to watch out for that is super specific to nurses is whether or not this person is offering to cover more shifts than usual. While most people would try to get out of work, an addict in the medical field might ask for more work opportunities so that they have more access to their drug of choice.

In either case, whether intoxicated or experiencing withdrawals, an untreated chemical dependence such as this can impair judgment, slow a person’s reaction time significantly, and increase life-threatening errors that may harm a patient.

How to Support Someone With Addiction

Nurses have had to work exceptionally hard to get to where they’re at professionally. Understandably, many nurses have a touch of perfectionism. Though this makes them excellent students and even better nurses, it can sometimes make the recovery process a little challenging.

Perfectionism in addiction recovery is actually a pretty common issue, according to (Detoxes) . And though perfectionism is generally a helpful trait, it can get in the way of recovery.

Rather than expecting perfection out of your friend or colleague, try a few supportive approaches, instead. Consider that nurses addicted to drugs have unique cases where a recovery program may prevent them from continuing to work as a nurse, at least during their recovery period. Also consider that there might be a lot of shame surrounding the addiction, or that the person may not recognize the addiction at first.

Approach the topic gently and explore all options for a full and safe recovery.

For full support and guidance, the Substance Abuse and Mental Health Services Administration (SAMHSA) has put together a handful of resources to help you navigate the recovery process.

My buddy Jason was fortunate to be able to heal from his addiction and I hope for the same for all nurses struggling with addiction. The first step to ensuring this is to recognize that the risk exists right in your own station.

The author, an addiction recovery advocate, requested anonymity for publication of this piece. Names have also been changed for anonymity.

Exhaustion and Cynicism Drive Burnout

Exhaustion and Cynicism Drive Burnout

From 2014 to 2017, physician burnout increased by 5% at the Massachusetts General Hospital Physicians Organization in Boston, according to a recent analysis.

Other research indicates that nearly half of physicians nationwide are experiencing burnout symptoms, and a study published in October found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction. Burnout has also been linked to negative financial effects at physician practices and other healthcare organizations.

The research published in JAMA found exhaustion and cynicism were the primary drivers of increased burnout at Mass General. The research was based on survey data collected from more than 1,700 physicians.

The survey data showed exhaustion increased from 52.9% in 2014 to 57.7% in 2017, and cynicism increased from 44.8% in 2014 to 51.1% in 2017.

The exhaustion finding was particularly troubling, the JAMA researchers wrote. “We found physicians were more vulnerable to emotional exhaustion than any of the other subscales of burnout. Physicians reporting high levels of exhaustion were more likely to reduce their clinical schedules, reduce the number of patients in their practice, leave the practice, or retire.”

The researchers noted that physician turnover has several costs including patient and clinician distress as well as the expense of replacing physicians, which can be as high as three times a doctor’s annual salary.

Primary care physicians reported higher levels of exhaustion compared to medical specialists. “These findings may be associated with the amount of time primary care physicians spend documenting on the EHR and serving as the clinicians responsible for the management of patients’ multiple complex medical and social problems,” the researchers wrote.

Burnout data points

The JAMA article has several other key data points:

  • Early-career physicians who had less than a decade of practice experience since their training were more susceptible to burnout than veteran physicians.
  • The higher burnout rate in 2017 may be linked to implementation of a new electronic health record system because average time devoted to administrative tasks increased from 23.7% in 2014 to 27.9% in 2017, and increased time spent on administrative tasks was linked to higher burnout.
  • Several favorable working conditions were associated with lower odds of burnout: workflow satisfaction, positive relationships with colleagues, time and resources for continuing medical education, opportunities to impact decision making, and having a trusted adviser.

Addressing physician burnout

The lead author of the research, Marcela del Carmen, MD, MPH, explained that the physician group has implemented several efforts to reduce burnout.

“We have allocated funding to each of our 16 clinical departments to develop and institute initiatives to mitigate burnout in their departments. We have central efforts including sponsoring social events to enhance connectivity amongst the faculty, efforts to improve our use of the electronic health record through personal- and practice-level training, and funding to support peer-to-peer coaching programs, yoga, and meditation sessions.”

Del Carmen’s research team also suggested that burnout prevention efforts could be tailored for early-career physicians, who reported relatively high dissatisfaction with department leadership, relationships with colleagues, quality of care delivery, control over work environment, and career fit.

“These findings point to potential opportunities in this vulnerable group to mitigate burnout, such as initiatives that promote community building and networking and harnessing effective leadership,” the researchers wrote.

This story was originally posted on MedPage Today.

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