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Community Health Nurses Stress Importance of Addressing Burnout

Ashlee and Kate.jpg

“Nurses are the front lines of public health,” says Kate Garrison, RN BA, who has been in the field for over two decades, including in her current role as case manager at a small community hospital in New England. Garrison feels the two disciplines—public health and nursing—need to talk to each other more. “Nurses are gathering public health data all day long,” she adds, “but it isn’t seen that way because no one is asking them to share that data.”

Garrison, who is also completing a master’s in Public Health at Boston University, is determined to make sure nurses voices are heard, in public health and also on the rising crisis of nurse burnout. “Instead of focusing only on the care nurses deliver, we also have to look at how we can support nurses themselves. If we don’t, we are not just facing a nursing shortage, we’re going to lose the ones we have.”

Clearly COVID-19, she adds, has compounded existing pressures on already-fragile health systems, and nurses—especially in community settings—are bearing a disproportionate burden. “When we are spread too thin, we can’t provide our patients with the highest standard of care. This more than anything really stresses us out.”

Ashlee Mason is one of the staff nurses Garrison works with. Mason started as a volunteer at the hospital eight years ago and recently graduated with a bachelor’s degree in nursing. As a staff nurse in the hospital’s intensive care unit, Mason has been on the front lines of COVID-19 from the beginning.

Even before the pandemic, Mason says, the hospital was straining to support the increasing numbers of patients seeking help for alcohol, addiction and mental health issues—an alarming problem in a community hit hard by the economic downturn. Garrison agrees. As a case manager, her job is to work with patients and their medical team to ensure a safe discharge and set the patient up for success at home. But too often, she says, “patients are sent back to the same situation they came from and are expected to thrive. Many patients end up coming right back, and that causes frustration for the nurses delivering care.”

These issues are further exacerbated by poverty and inequity, adds Mason. “The poorest of the poor are most at risk for addiction, mental health and other problems. They're the ones who are going to be evicted. These are folks we see every day, and it is heartbreaking when we can’t help them stay healthy.”

Providing care for COVID-19 patients, especially during the early months of the pandemic, was like nothing she had prepared for, says Mason. “You’re trying to provide compassionate care to your patients, but you’re all covered in PPE and your patients don’t even know what you look like. As a health worker you are keeping yourself quarantined from family and friends, and that isolation also takes a toll. There are so many emotional elements that people don’t even realize go into the mix, it felt like a constant tug of war on your brain.”

“You Can't Pour From An Empty Cup.”

Both women also know that selflessly serving others at their own expense is not sustainable.

“We are advocates for the mental, physical and overall health of our patients, but we so often put ourselves on the back burner,” says Mason, who tries to remind herself and her team that they need to take care of themselves too. When she found out a co-worker was taking on a Sunday shift on her birthday, Mason told her to take the day off to celebrate. “It’s those good times and memories with our family and friends that we draw from to keep going. Resiliency can often be confused with stubbornness and not taking a break when you need it. But you can't pour from an empty cup. When you are feeling competent, healthy and happy, you are better at the bedside and can then provide more for your patients.”

This is why Garrison chose to do an internship with the Johnson & Johnson Center for Health Worker Innovation well-being and resilience team as part of her master’s Capstone Project. COVID-19 has brought health worker burnout to the forefront like never before and Garrison says it is exciting for her to share the research going on in the field and initiatives such as the Center’s #BacktheFrontline movement with nurses like Mason.

In the meantime, both Garrison and Mason agree nurses need to stand up for themselves as a profession and own that burnout is an issue that needs to be addressed. As one of the co-chairs for their Nursing Shared Governance Council, Mason tries to speak out about what her fellow nurses are experiencing and raises topics that could benefit from change. “Not everyone has the leadership qualities or feels empowered to make their voices heard. But if you are that person, then do it. We need to just pull everybody together. We owe it to ourselves, our coworkers and the nurses who will come after us.”

They also want to make sure health workers are not forgotten when we are beyond this health crisis. Both women wistfully remembered the early days of the pandemic when health workers were being feted with parades, retail discounts and free coffee. “It clearly doesn’t take much for us to get excited,” they joke, but on a serious note: “we’re not in the news anymore, but we are still in the thick of COVID.”

Despite the challenges, both women love their jobs and the camaraderie health workers experience, and they say there is nowhere else they would want to be.

Mason shared a recent story of one of the most difficult moments as a staff nurse. One of her patients was not improving despite their best efforts and the family was notified that death was imminent. “The daughter was so emotionally distraught about not being able to say goodbye to her mom in person due to COVID visitor restrictions. I promised I would stay with her mom and she would not be alone. And that’s what I did. I tried my best to keep my emotions at bay and provide the care she deserved. I held the phone up to her ear for her daughter to say goodbye, and I stayed. To have a daughter entrust you with the last moments of her mother’s life is incredibly humbling. I was honored to be able to ensure a comfortable passing for her mother. I will never forget.”