Vital Views

Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Throughout this show, we've talked about a slew of nursing trends and issues, but one of the biggest themes that crops up in some variation in a majority of conversations is dealing with burnout. It takes on different forms at different times, but the end results are usually the same: nurses are physically, mentally, and emotionally exhausted. They don't have a passion to work, they feel like what they do is a grind, and, naturally, the effect isn't just on the nurse, but on the patient too. Now, obviously burnout isn't limited to the nursing world, but we saw firsthand how extreme pressures like a global pandemic can bring burnout back to the forefront of finding causes and solutions. We're happy to bring back Dr. Susan VanBeuge to the show. She's a professor in residence with UNLV Nursing. She's also the president of the Nevada State Board of Nursing. Dr. VanBeuge is a board-certified family nurse practitioner who teaches both undergraduate and graduate students at UNLV. She's published articles specifically on burnout and how to address it. Dr. VanBeuge, thanks for coming in.

Susan VanBeuge 1:06
Hi Joe, thanks for having me today.

Joe Gaccione 1:08
You've studied and written on burnout previously. What are some numbers, what are some stats that jump out at you when talking about nursing burnout?

Susan VanBeuge 1:16
Well, the numbers are kind of staggering at this point. Before I prepared for this podcast today, I wanted to look at some of the latest numbers, because these numbers have been changing over the last few years. In the last three years, there was a paper that was just published in 2022 that said 95% of the nurses that were surveyed for the study had burnout. 95%. Doesn't leave a lot of people that are in the non-burnout phase. Not surprising. There was a study from 2019 that was done and published right before the pandemic started, and it showed only 15% of nurses were feeling burnout that time, but that number of pure burnout has risen to about 62%. So lots of numbers there. All it is, what I'm saying is that burnout has definitely increased over the last three years, and so it's become more of something that we're talking about. Now, the federal government has had a website for many years on provider burnout, kind of in general, right? Nurses, physicians, physical therapists, all kinds of folks, because people get burned out taking care of people day in and day out. It's hard, and it's hard on your heart too when you see people who are ill and unwell and trying to care for that. But these last three years have really stretched us all very thin. So, those numbers are alarming and some of the recent numbers, too, are finding, this was a study that was just published in January of 2023, and they estimated that 100,000 or more nurses, physicians, nurse practitioners, PAs, those kinds of providers, have left the profession from 21 to ‘20, just in one year's time. Now, that was just one study, so those numbers will bear out over time. So that's, you know, that's something that's staggering, and especially in a time when we have shortages of healthcare providers, we certainly don't want people exiting before it's their time, right? Before their normal retirement time or, or, or when they would normally have left. And when you look at the numbers of people, about 25% to 27%, they’re citing burnout was the number one reason.

Joe Gaccione 3:40
That 95% you referenced at the beginning, as high as that number is, it's almost not that surprising. In fact, it might seem a little low if you had told me a hundred percent, I, I would've believed you. I can only imagine, as a non-nurse, what it's like for, like, quote unquote, “normal” day-to-day operations. As you said the last couple years, what you have to experience on a daily basis, especially that first year when we still had limited information about it and how to treat it, we didn't have a vaccine, overloaded hospitals, patient to nurse ratios I can imagine were just off the charts.

Susan VanBeuge 4:18
Yeah, I mean you just took the, the talking points right away from me there. You're exactly right. You hit the nail on the head. You know, the uncertainty in March of 2020 when we were just hearing this “COVID-19” and still trying to wrap our heads around what that was, we had so much, there was so much fear and uncertainty, we didn't know. “This is this virus. How do you get it? How don't you get it? Who's got it?” I mean, “Will you bring it home to your family if you're there in the hospital with them?” You know, if you remember early on here in Las Vegas, nurses were staying in some of the empty hotels as guests of the hotel so that they didn't have to go home and have, you know, possibly spread COVID to their family members because we were so worried about that. We just didn't know what we didn't know. And, you know, we, when having that, that fear and uncertainty over time, that wears you down emotionally, it wears you down physically, mentally, and it makes an impact on how you do in day-to-day. And if you think about it, it wasn't just one or two people going through their own life experiences at that time, it was every single one of us. And so, that just made the problem, you know, just kind of exponential.

Joe Gaccione 5:38
And then you have the public collectively wanting to get treatment as soon as possible, wanting answers from healthcare providers, like nurses, so there's that added pressure of this demand of, “Why can't you fit us in? We're sick too. Why not us?” I mean, it's like, “Why can't we see our loved ones? Why do we have to be isolated?” And then all of a sudden, the, the nurse or the, the physician, they're the bad guys.

Susan VanBeuge 6:06
That's, that's very true. You know, early on you know, we, we didn't allow people to come into the hospitals. You would have to drive your loved one up to the emergency room door, basically, open the door, put them in a wheelchair, or watch them walk in the door by themselves, and that was it. And who knew if you were going to see your loved one again? And many thousands and thousands of people never got to see their loved ones again. Now, how hard is that for the family and for everyone who's the loved one, but also for those who are caring for those patients? That's a tremendous burden and a tremendous stress that, that all healthcare providers have. And so, we ask a lot of our nurses, and we'll concentrate on the nurses here because that's what we're talking about, but we put a lot on our nurses, and the nurses stood up and did wonderful things. They did miraculous and heroic actions, but they took the toll because we are trained as nurses to kind of, you know, we keep it inside, right? So there's a lot of stuff that we deal with that we don't really talk to other people about it, because it's private information. We're taking care of other people, and that's privacy. And we haven't always been taught to really share those feelings and communicate as well as we should. And so, one of the things that was the contributing factor, when you look at the research, is that we don't communicate, sometimes we don't sit down and say, “Hey, I'm having a hard time with this. This is really weighing heavy on my heart to be able to take care of these people, I'm wearing all this equipment all day long, I'm afraid for my family.” You know, everything. But we don't share that, we just go, “No, I'm tough and I'm gonna do this, okay.”

Joe Gaccione 7:58
We're talking a lot about COVID, but obviously COVID didn't invent burnout. Were there pre-existing factors before the pandemic that would've contributed to this burnout expansion among nurses?

Susan VanBeuge 8:12
Well, I think I, I already touched on one of them, which is communication, and some of the articles that I was reading when I was, you know, just kind of refreshing and preparing for this podcast today was that with nurses, sometimes we aren't as good of communicators as we need to. We don't communicate our needs, right? We, we just go, “Okay, I'll do this,” and, and not say, “Hey, I see an issue or a problem here and I'd like to talk it through or see if we can change a process or do things like that.” So we probably have to work on our communication skills a little bit better and also being empowered to use our voice and to see how we need to make change in the things that we do. There was a paper that I read that was published just many years before COVID, and it talked about, what are those factors that are, you know, kind of key to burnout for providers. It's the work schedules. Are we making them flexible for people or are we saying, “No, you can only work 7:00 to 7:00, 7:00 in the morning to 7:00 at night or 7:00 at night to 7:00 in the morning, that's it, no problems there.”? Are we being flexible with people? Are we allowing for that? Are we allowing for people to kind of come up with their own schedule sometimes? Are we empowering people to be communicating? Are we also helping encourage them to gain more skills and to learn how to deal with those stressors? And are we being kind to each other and knowing that what we do is hard every day, regardless of a pandemic or not, and are we being supportive of that? Do we have mechanisms in place to support each other and our systems so that we can jump in and help each other and keep uplifting that so that we don't, we don't kind of fall down in those dumps a little bit.

Joe Gaccione 10:00
I kinda wanna go a little more into that on nurses not only supporting themselves, but each other. What are proven measures to minimize these feelings? I could hear someone saying, “Just don't stress as much,” or you know, “Take it easy.” All more or less good pieces of advice, but a lot easier said than done.

Susan VanBeuge 10:18
That is a good point, and I think we've all said that to each other, right? You know, who hasn't said that to a child or someone else? “Oh, you can do this. Just go take a nap and come on back. You'll be good.” Well, so I was reading one of the articles I was looking at, it's talked about what are things that we can do to mitigate that, that burnout, and maybe some of these will sound pretty simple and easy, but we have to actually deploy them to actually see that they're gonna work for us. So rest, getting good nutrition, so eating well and taking care of ourselves that way, exercise, I always hear people tell me, “Well, I'm on my feet all day at work. I'm, you know, I'm exercising.” Well, maybe that's not the same kind of thing as going out and taking a walk or going and lifting some weights, but getting physical exercise regularly. Cultivate your personal hobbies and interests. You know, do things that are away from that job that's there every day. Do things, maybe it's cooking, maybe it's art, maybe it's gardening, but cultivate other interests. Take a vacation. I am a firm believer that you should not have leave sitting on the books for years and years and years. People need to have a break. Ask for help. If you do need help, then go to your friends. Seek support of friends or other professionals that can help you if you're having, you know, you're experiencing those signs of burnout and you think, “Gosh, I'm really not, kind of, you know, able to rally on my own?” Don't be afraid to ask for help, that's what we're all here for. And don't feel alone, and don't do it alone. Reach out to your network of people and know that we need to rely on each other. If we've learned one thing from this last three years of COVID is that we need each other. We need the relationships. That's the one thing that we all craved, is having that face-to-face and being around others. You know, when we got kind of pushed into our little cubby holes, we realized we really do need each other. And so, we need to, we need to exercise that and, and rely on each other.

Joe Gaccione 12:28
And that leads into my next question, nurses can’t do all this alone. It also takes organizational mountain moving, so to speak. How can hospitals and other healthcare facilities incorporate these measures to help their staff, help their, their nurses get through this too?

Susan VanBeuge 12:44
Well, there's some simple things that they can do. They can support nurse wellbeing, so that can be through employee programs for them to be able to get help of, of any kind. They can encourage breaks and make sure that, that people who are working in those facilities are actually taking those breaks and that they have unencumbered time to, you know, check out for a moment. I mentioned it before, those flexible work hours, you know, we don't, are we really an, you know, absolute on what we do here? We might be able to find people who might wanna do some flexible hours and it would work better for them. We want to optimize our workflow. So working harder is not, not what it should be. It should be working smarter, not harder. And are we really utilizing the talent that we have in the nurses that are there providing care and asking them what they think? “Hey, what do you think about this process?” “Well, on the night shift, we came up with a different way of doing that, and it's really efficient for us.” Maybe those are things that can be instituted that will show efficiency for everyone and will make a better workplace. Other things too is figuring out ways for us to work collaboratively as a nursing workforce. You know, in our education programs, in our graduate programs, we really stress and underscore how collaborative practice is so important for healthcare providers in our, you know, current system. And that's working together, and nurses need to do that as well within themselves, so really showing that collaboration within the nursing workforce. I mentioned before, and I'm gonna say it again, improved communication. That means between organizations and individual nurses and departments. Transparent, open communication. Just tell people what's going on, that's so important. Knowledge is power, so just let people know. Couple other things here, have programs that support their mental and physical wellbeing in place and think about that there's just no one simple fix, right? It's not just one size fits all, but that you are talking to stakeholders, who are the employees and the people that are there, about the things that they want and how you can kind of mix it together and be the best thing for them, and I think those, if we really authentically listen to people, and come up with some ideas, I think that we can work through this. We're gonna keep going, we still have to do the work we're doing, but I think that we can come up with some good plans and good ideas.

Joe Gaccione 15:25
This is the part of the show where I tell the nursing students out there, listening to this podcast, we're not trying to scare you out of the profession. Hearing all this, as someone who has experience teaching undergraduate and graduate students, how do you prepare nursing students for this part of the job? I mean, you can only prepare them so much because they have to experience it themselves, but are there ways to get them ready that, “There are gonna be tough days, might be tough weeks, but you have to have that resiliency that this is worth it.”?

Susan VanBeuge 15:58
Well, there's a lot of things that we teach and part of it is professionalism, and we do teach students about self-care and looking for burnout and, and working through that. So all those lists of things that we should do, the physical exercise and the rest and eating well and taking care of yourself and doing things outside of work that will give your brain a chance to do, be creative and do other things. But I think it's also important, and you know, you're talking to me Joe, who's a real policy wonk, and I really, you know, this is my thing, but I think that we as nurses, we have to learn how to communicate better and we need to let our voice be known. And so, when we have issues going on in the workplace and we see burnout and the things that have been going, we need to use our voices to look at, “Are there things in policy, is there stuff in legislation that needs to be changed that will make a difference?” And I would hope that we would empower our students to have that voice and to know that they can use that voice. It's powerful and appropriate to say, “How are we going to benefit our organization, our state, nationwide, internationally?” How do we impact our community by really standing up and saying, “These are the things that we need to create the best workplaces that we can have so that we don't have nurse burnout?”. We're not mutually exclusive here in the United States. This is a worldwide problem, but I think that it starts locally and we can empower those students to do that.

Joe Gaccione 17:37
That's all the time we have. Dr. VanBeuge, thank you so much for coming back.

Susan VanBeuge 17:40
Thank you for having me.

Joe Gaccione 17:42
Thanks for listening out there. Hope you have a great day.