What is Nurse Burnout? with Christine Diltz, RN

A portrait of Christine Diltz, RN. Christine has long brown hair with dark blonde highlights, and wears navy blue scrubs with light blue BALA Twelves. She is seated at an outdoor coffee table, holding a mug and writing in a notebook.

As the Delta strain of the COVID-19 virus causes yet another spike in infection rates, caseloads in stretched-thin ICUs continue to rise. Nurses saddle that burden; they hold the hands of patients struggling to breathe, administer experimental medications, work ever longer hours to keep the sick afloat. Hence the exodus in headlines everywhere: nurses are leaving their profession. 

Christine Diltz will tell you, though, that this exodus has been a long time coming. She's been a registered nurse since 2012, and has spent the last decade as a first-hand witness to a nurse burnout crisis. In the following interview, Christine gives her analysis of the crisis, shares her own experience of burnout, and offers suggestions to community members eager to support nurses. 

How is nurse burnout different from typical workplace burnout? What's been your personal experience?

I've never really experienced burnout before, so I don't know that I have any comparison to it, but what I'm currently experiencing with nurse burnout is… it's just something that I've been so passionate about for over ten years, that I never thought in a million years that I would ever experience. It's made me feel like I can't contribute 100% to the job. It's a struggle every day to want to fight and advocate for my patients. 

We don't talk enough about the signs of nurse burnout–– you know, fatigue, lack of excitement, depression, feeling ill, body aches. Mel Cortez is a nurse manager who [...] talks about PTSD among nurses and how it's a real crisis–– if we go through another massive surge [in COVID rates] like we're expecting, I think we're going to see an increase in nurses taking their lives. For whatever reason, shareholders in hospitals just don't seem to get that.

What do you see as the underlying causes of nurse burnout?

The New York Times just published a blurb on the nursing shortage crisis and they attributed it to COVID-19, and that's all that they attributed it to, but in reality, COVID is a small part of a bigger picture. Nurses have been dealing with nurse burnout for decades–– there are never enough nurses trained and on the floor, because they're always trying to squeeze as much out of as few people as possible. It all goes back to the almighty dollar.

Hospitals try to cram healthcare into a business, and the two don't create a symbiotic relationship. So you have a lot of C-suite executives who are so far removed from the actual experience, but they're making decisions. On top of that, they're calling us "heroes" and trying to soften the blow of saying you've got to work even longer hours by giving us pizza parties to say thanks. Meanwhile, they're taking away retirement and benefits, so it's the culmination of a lot of things contributing to the burnout. 

There's been a lot of backlash from the nursing community about that New York Times article, because it interviewed one nurse and six executives. And, again, as much as an executive of a hospital can try to understand–– unless you're in scrubs and your hands are in there doing the same thing as us, you don't have a clue. Are you showing up 12 hours, 16 hours a day and having to hold a hand, or tell someone that they can't be with their dying family?

Business in healthcare is destroying our profession. We're so far removed from being able to connect with our patients and help them– you know, a core part of nursing is compassion, and we're being forced into situations where we aren't even able to give that.

There's also this stigma around mental health–– we're supposed to keep it together, while we're asking you how you're doing. We have to keep up this tough exterior. Let's just go back to basic nursing: nursing can be really sad, especially when you're seeing lots of people dying. So now you're starting to see emergency deployment within hospitals of mental health teams, but it's too little, too late. On top of that, a lot of nurses can't even get decent healthcare, or if they have decent healthcare available to them, the costs are astronomical. 

I don't know if this is all happening because our profession is dominated by women, and we've been expected for so many decades to be seen and not heard. Women have that sense of, "We gotta do this, or things will fail." So in my business, I teach nurses how to negotiate and know their value and fight for the work. 

How has the pandemic affected nurses' experiences of burnout?

With this pandemic, we're still dealing with it emotionally at home, away from the bedside. I know I have colleagues who are wrestling with PTSD from just the images they've had to experience in real life.

I'm a NICU nurse but I was on a contract as a travel nurse, which took me out of the pediatric realm and put me into the adult ICU realm. I'll never forget this one instance when there was a nurse at the bedside with this extremely sick patient, and I saw the helplessness and the hopelessness in his eyes. That will always stick with me, because I felt it too. The essence of nursing is to want to help, so it's tough when we can't help.

What do you see as the long-term implications of an epidemic of nurse burnout? 

We're supposedly the most trusted profession in the world but we're treated as if we are the lowest man on the totem pole. We're expected to show up and still care when our own needs aren't even being met, and it's exhausting. Nurses have long been ones to be very dedicated to their profession, but when they're not investing in us, and they're asking us to invest, there comes a point when we just say enough is enough. I know that we're at that point. 

I see nurses getting out of the profession, and then you're going to get left with a lot of new grads who don't have the guidance and the mentors available. Patricia Benner, who's a famous nurse researcher, says you're a novice nurse until about five years in. Right now, the average burnout rate is two to four years after graduation, so we have novice nurses burning out. They're going to be so overloaded that it turns into a disaster triage situation, where you literally can't get to everybody–– where if you have ten patients in an ICU, you're going to have to choose who should live and who should die.

What's scary is, going back to that New York Times article, that the ultimate person who suffers from nursing burnout and shortages is the patient. Honestly, I wouldn't want to rely on the healthcare system myself right now. 

How can folks show up for nurses, especially those dealing with burnout, in their everyday lives?

I think having conversations to start, having family members and friends really try to understand. Then they can educate others. I'm sure my neighbors cringe every time I get out of my car, but they always ask, "How was it at the hospital?" And I'm like, "Do you really want to know?" But they sit there and they listen, and maybe they go and tell their friends about it, and maybe that will have a domino effect–– if we can just start that conversation, and stop looking at nurses as heroes, but as humans...

If you show up at the ER and it's a twelve hour wait, understand that the nurse is doing the best with what they've got. And if a nurse is not necessarily the friendliest, that doesn't excuse their behavior, but understand that we're being pushed beyond anything imaginable. 

What changes do you see being made in the healthcare system to better support nurses?

Dealing with burnout, I was that nurse that showed up with an empty cup, so my mission is to disrupt the healthcare system and make it better in any way that I can. 

I was talking to a nurse executive in Israel–– I asked her, "How are you being received as an executive?" And she said, "One of the things I'm trying to do is actually show up on the floor, and wear my scrubs, and go to different units and ask what can I do?" She doesn't necessarily get her hands dirty, but maybe she'll run a lab, or sit at a bedside to give a nurse a five minute reprieve. So I think executives being present, not in high heels and not in a tie, is a start.

And treating us as professionals and adults, not high-schoolers! I think nurses should be more involved in decision-making. I'm going back to school for my executive MBA so that I can understand the business side of things. I want to bridge that gap, then teach nurses, so that they can be at the table and be part of the conversation.