A Sarah K. Wells, MSN, RN, CEN, CNL, and Sarah A. Delgado, MSN, RN, ACNP, reply:
Nursing, in its most basic form, is the act of caring for someone who is sick.[
First, nurses need to know that they are not alone in wanting to leave nursing. In its latest survey on the work environment of critical care nurses, conducted in October 2021, the American Association of Critical-Care Nurses (AACN) received more than 9000 responses.[
To address moral distress, AACN recommends the following steps[
- Examine what you are experiencing. Assess yourself and distinguish among compassion fatigue, burnout, moral distress, and other potential feelings. Depending on the situation, a variety of effective mitigation techniques are available. Determine your level of moral distress. How bad is it? Moral distress can include a wide range of symptoms and severity. Use the AACN's "Recognize and Address Moral Distress" tool to measure what you are experiencing. Identify the causes and constraints. What factors are preventing the action that is right? What situations repeatedly invoke a similar sense of distress? There are internal and external factors to consider, and identifying what you can control and what you cannot control is imperative. Reach out to others and use reliable resources. The AACN tool lists resources for individuals, units, and organizations because success in mitigating moral distress often requires system-level change. Whereas a single person would struggle to create such change, a group of committed and persistent individuals can succeed. Gather a team and identify the strategies that are most applicable to your unit or organization. If support from organizational leaders is needed, consider presenting data that align with their goals. One example is the annual Nursing Solutions Inc report on the cost of nurse turnover.
There are many ways to reconnect with our nursing identity to find increased joy and satisfaction in our profession.
- Understand that systemic barriers to personal well-being are not your fault. In a recent blog post, Jen Barnes, LCSW, wrote about the situations that nurses face and emphasized this point. Barnes, a licensed therapist, also offers strategies to release stress that becomes "stuck" in our bodies. Consider incorporating these into a daily practice. Remember your "why." What lights your nurse fire? Asking this question can be really important when evaluating the path forward. Try to put energy into actions and projects that support your nursing passion. Identify new areas of interest. Your nurse passion may be one thing, but are you interested in other nursing topics or specialties? Is there an opportunity to learn a new skill or validate an area of interest by seeking a new certification? Think about your nurse interests, and consider making a "professional goals" list to pursue. Explore new roles at work such as being a preceptor or charge nurse or joining a new council or committee. One nurse manager found that staff members experienced less burnout when she supported their transition to a dual role, working in 2 different units within the hospital. Set professional boundaries. Feel empowered to say "no" to projects that are not of interest or that may be potential causes of moral distress. Sometimes saying "no" to others helps you say "yes" to yourself. Is your current workplace a healthy work environment (HWE)? A repeated finding on surveys of the work environment is that implementing the HWE standards is associated with a lower incidence of intent to leave among nurses. The AACN HWE Assessment Tool can help you measure your workplace against the 6 HWE standards. Consider building momentum with colleagues to use the tool and then take steps to address the specific areas that need improvement. Is it nursing or is it the job? Toxic work environments, bullying, and incivility are pervasive issues in nursing, and these behaviors should not be tolerated. In some cases these issues can be resolved, but in others, a professional change may be necessary. There is a wide variety of job opportunities in nursing, both in acute care and in other settings. Explore opportunities. Consider a virtual position. Remember that nursing is not limited by geography anymore.
- Join a local chapter of a professional nursing organization. Local professional nursing organization chapters offer members opportunities for leadership, education, and service. Sign up for your local chapter's next meeting to see who is involved and what is going on in your area. Online communities foster connection with other nurses in a safe, virtual environment and provide the opportunity to collaborate with nursing professionals from across the country. One option available to AACN members is the AACN Peer Support Online Community. There is evidence that peer support is an effective strategy for addressing burnout in health care professionals. The online community offers participants the chance to share experiences, support each other, and get advice from peers on a range of topics such as moral distress, self-care, resilience, and burnout. Consider volunteering with a community service or professional nursing organization. Support a local initiative addressing an issue that you feel passionate about, or join volunteers who work to influence, shape, and define the practice of nursing and health care delivery. Unlike paid employment, volunteer roles can require just a few hours a month and provide opportunities to connect with like-minded individuals. Be a speaker. If you are passionate about a health care topic and love to educate others, being a speaker for a nursing event can be a fun and rewarding way to share your knowledge and expertise. There are conferences all over the country, and the way to apply is to look for a "call for speakers" or "call for abstracts" for a conference that is of interest to you.
The final decision is up to you, but the good news is that you have so many options. Nursing is a diverse and dynamic profession with many opportunities for change and growth. Whatever your interests, there is a space for you in our field.
Remember, you are never alone in your journey. Whether you need time to self-reflect, recharge, or reconnect with your nurse self, AACN and the rest of your nursing community will be there when you are ready to reengage.
1 To purchase electronic and print reprints, contact the American Association of Critical-Care Nurses, 27071 Aliso Creek Rd, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected].
2 Financial Disclosures Sarah K. Wells is the founder of New Thing Nurse. Sarah A. Delgado is the coeditor of Essentials of Critical Care Nursing and Essentials of Progressive Care Nursing, published by McGraw-Hill.
3 Ask the Experts Do you have a clinical, practical, or legal question you'd like to have answered? Send it to us and we'll pass it on to our Ask the Experts panel. Questions may be mailed to Ask the Experts, Critical Care Nurse, 27071 Aliso Creek Rd, Aliso Viejo, CA 92656; or sent by email to [email protected]. Questions of the greatest general interest will be answered in this department each and every issue.
"Nurse." Merriam-Webster Dictionary. Accessed October 27, 2022.
Byon HD, Sagherian K, Kim Y, Lipscomb J, Crandall M, Steege L. Nurses' experience with type II workplace violence and under-reporting during the COVID-19 pandemic. Workplace Health Saf. 2022;70(9):412–420.
Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National nurse work environments - October 2021: a status report. Crit Care Nurse. 2022;42(5):58–70.
4 American Association of Critical-Care Nurses. Recognize and Address Moral Distress. 2020. Accessed October 31, 2022.
5 Nursing Solutions Inc. 2022 National Health Care Retention and RN Staffing Report. 2022. Accessed October 31, 2022.
6 Barnes J. Nursing burnout: the solvable problem within your control. American Association of Critical-Care Nurses blog. August 2, 2022. Accessed October 31, 2022.
7 American Association of Critical-Care Nurses. Dual role staffing solution. December 21, 2021. Accessed October 31, 2022.
8 Rhimes S. Year of Yes: How to Dance It Out, Stand in the Sun and Be Your Own Person. Simon and Schuster; 2016.
9 American Association of Critical-Care Nurses. Standards for establishing and sustaining healthy work environments. Accessed October 31, 2022.
Bowman S. Navigating a toxic work environment. Minority Nurse blog. February 3, 2021. Accessed October 31, 2022.
American Association of Critical-Care Nurses. AACN position statement: zero tolerance for bulling, incivility, and verbal abuse. November 1, 2019. Accessed October 31, 2022.
Pereira L, Radovic T, Haykal KA. Peer support programs in the fields of medicine and nursing: a systematic search and narrative review. Can Med Educ J. 2021;12(3):113–125. doi:10.36834/cmej.71129
Cain C. Volunteering in a disaster. American Association of Critical-Care Nurses blog. April 3, 2020. Accessed October 31, 2022.
By Sarah K. Wells and Sarah A. Delgado
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