Recently, I had the pleasure of interviewing Lucy (actual name protected), an oncology exam area registered nurse (RN), about nurse burnout and her struggles as a working mother in healthcare. Lucy is employed by a large academic medical center in a major metropolitan city.
Although Lucy is a nurse practitioner (NP) by education, she decided to work as an RN instead. As an NP, despite increased pay, she felt she would have more responsibilities and more stress. Money was not a factor in her decision, rather, workload and work-life balance were key determinants. She was so glad that I took the time to hear her stories. Lucy said we hear a lot about physician burnout in healthcare, but rarely do we hear about the nurses. Lucy claims nurses are waiting to be heard and she wanted to tell her story.
Lucy has a 5-year-old son. She shared her challenges with me, both, as a wife and a working mother in the healthcare industry. As a standard practice, Lucy returned to work in just about 4 weeks of maternity leave, the entire leave allotment she was given. Lucy takes pride in the oath she took to care for her patients. She had been feeling extreme fatigue since her son was born. By the time when her son was 6 month old, Lucy had dropped 39 lbs. She looked fit physically, but she found herself so tired that she couldn’t function at work. She shared, “Sometimes I wished I would get hit by a car, but, I didn’t want to end up in the hospital, I just wanted to rest for a week.”
She finally seeked medical attention, and was diagnosed with severe depression. Lucy does not think her depression was a result of postpartum depression (PPD), rather, but caused by her inability to manage work and her new baby. She felt sleep deprived, tired and overworked. She felt inadequate as a mother and also as a nurse, she felt she couldn’t do anything right. She continued, “My depression was from my workplace.” She even questioned whether she could even perform her duties as an RN. As a new mom, she felt she needed more support because she was struggling.
When asked about the number of patients for which she was responsible daily, she said, “It’s about 20 patients a day. In addition to triage of the patients, I am also responsible for sending emails, answering questions from patients, their families, and their doctors.” In addition, she spoke about having to manage care partners (CPs) and medical assistants (MAs). She described her role essentially as the buffer between the entire care team, the patient and their families.
Lucy works with and supports multiple physicians, resulting in more care coordination and communication. Newer employees also need double the oversight to prevent any mistakes. Managing the team is time consuming; she can never finish her job. Most of the time she does not take her allotted breaks and even after clocking out for lunch, she finds herself continuing to work. Sometimes she gets judged if she asks another nurse to cover for her, because “everyone is busy and everyone works through lunch.” After nearly 25 years in healthcare, she has figured out a system that works well for herself. Over the years, she has had to educate the physicians and the entire care team to effectively assist her so she could best serve her patients. It does not come easy, she describes, “Physicians may not like it because it means more work.” She went on. Some health care providers are often territorial and do not understand the value of clear communications. But at the end, the team works more efficiently, and the patient receive better care.
She also said, “Patients are also demanding customer service and rightfully so. However, because the job responsibilities have been highly specialized in current healthcare industry, patients often reach out to nurses for help because nurses usually offer “one-stop shop” such as scheduling, prescription refills, referrals, medication and symptom management, etc. Nurses carry a heavy workload and responsibilities, and often get pulled to many directions. It leaves more room for mistakes and puts their license at risk. She lamented that the current system is stacked against the healthcare employee.
Lucy suggests that training the care team to communicate effectively by asking the required questions with understanding and care would be helpful. “Teach them to be great listeners so they can connect the dots collectively. Let’s remind everyone that we all have one goal and that is patient care,” she said. She also suggests that healthy boundary setting between clinicians and the team is critical. This will allow both constituents to focus on the entire workload and disallow egos and hierarchy to get in the way so egos and hierarchy do not get in the way of being productive.
Being a working mother is not easy for Lucy. As Lucy continues to work as a full-time nurse, she also has many other roles after work. Although she gets great support from her spouse, many of her colleagues are single mothers and have multiple stressors. When nurses are not being supported, they bring stress from home to work, and from work to home; a vicious cycle. She finds that when she brings stress to work, she becomes uncaring. She explains, “When a caregiver becomes uncaring, that is the worst thing that can happen to a patient.”
She recalls that after the birth of her baby, she was sleep deprived and desperately needed help. She did not want to call a friend or talk to a colleague; everyone around her seemed busy and she felt she would be perceived as a burden. She was also afraid of being judged. One time, a friend came in to visit and dropped off food and a few essential things which brought tears to Lucy’s eyes. This was the concrete help she needed, not just a verbal offer, and it was very helpful.
She remembers things were different when she felt more balance in the workplace. She says that over the years, healthcare tends to over work more, causing much imbalance and burnout. Usually, very little opportunity for learning and development is offered. She also says the reimbursements are so little that most people cannot afford to take time away from work and family to invest in their own growth or wellbeing. She says the hospital offers a plan for work and life balances, but, most people do not take advantage because most of the benefits are temporary, superficial, inconvenient and do not offer concrete solutions.
To summarize my thoughts from interviews with Lucy and other healthcare providers, there is much to be done to bring balance for working parents and caregivers. There are many stories like Lucy’s waiting to be told. If employers ignore these sentiments, there are negative consequences including, health risks for employees and financial risk for employers. Change will come when we deliberately take action to focus on our wellbeing. And it’s time we make this our priority for the sake of all.