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any people have trouble in relationships, both at home and at work, because they do not express their needs, and they get angry when others do not meet those unexpressed needs. Many surgeons fail to communicate their needs to nurses. They expect the nurses they work with to know exactly what they need at ail times, and they get angry and lay blame when nurses are unable to provide this. Nurses who believe they should know what every surgeon wants at all times and strive to provide it could be setting themselves up for burnout.

place simultaneously, low morale, disharmony, interpersonal conflict, decreased productivity, absenteeism, tardiness, job insecurity, mistrust, lack of teamwork, loss of creativity, stress, and burnout also may occur.

Characteristics That Lead to Burnout


Signs, Symptoms

urrent research shows a correlation between people who grow up in highstress environments and those who eventually seek high-stress jobs. The survival characteristics these people used for coping with stress during childhood and adolescence

here are many signs and symptoms of work addiction that lead to burnout in the perioperative nurse, including a need to control, hurrying and staying busy (ie, “motion emotion”), perfectionism, difficulty with relationships, work binges, difficulty relaxing and having fun, “brown-outs” (ie, doing something and having no conscious memory of doing it), impatience, irritability, feelings of inadequacy, and self-neglect. Physical symptoms include headaches, fatigue, allergies, indigestion, stomach aches, ulcers, chest pains, shortness of breath, nervous tics, and dizziness. Behavioral symptoms include temper outbursts, restlessness, insomnia, difficulty relaxing, hyperactivity, irritability, impatience, forgetfulness, boredom, mood swings, and difficulty concentrating. If several people experience these symptoms in the work-

Gail Vaughn, PhD, LPC, is ownerldirector of Reforming Feelings Counseling and Consulting, Liberty, Mo, where she also supervises a private practice. She earned her BS degree in nursing from William Jewel1 College, Liberty, M o , her MA degree in human relations from Webster University, St Louis, and her PhD in psychotherapy from Golden State University, Sun Diego.




eventually show up in their work and can contribute to burnout. Some of these survival characteristics follow. Tenacity. Tenacious people have difficulty compromising and letting go of situations. They tend to have trouble asking for help and delegating responsibility. Because these people feel responsible for so many things and do not delegate tasks, they often overwork themselves for fear the job will not get done unless they do it. This behavior can lead to the employee feeling overworked and underappreciated. Diminished self-worth. Feeling underappreciated and inadequate can lead to binge working (eg, long hours, double shifts, overtime) and perfectionism. People in this situation take full responsibility when situations do not go well. They have an extreme need for approval and feel anger and resentment if their extra efforts go unnoticed. Preoccupation. People often become so preoccupied with their work that they neglect their social needs and their families. They are unable to leave work problems at work, and nursing becomes what they are rather than what they do for a living. Very few helping professionals ever talk about who they are. During the seminars that I give, I often encounter this problem. When asked to complete the sentence, “I am ,” most answer with what they do (ie, they answer, “I am a nurse” rather than “I am a caring, giving, intelligent individual”). When people identify themselves with what they do, they become human “doers” rather than human beings, and they lose themselves to their jobs. Lost sense of normalcy. When people develop a great tolerance for the unusual, they lose the sense of what is normal. They engage in compulsive activity and become over involved with coworkers. They often have trouble setting professional boundaries, and they disclose personal information inappropriately. Their high tolerance for unusual situations allows their employers to exploit them. These people expect changes immediately, and they are very critical of flaws in others and in the organizations where they work. 874

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Intensity. The need for intensity draws people into high-stress situations (eg, anesthesia, management, perioperative nursing). When the intensity of a situation diminishes, these people may unconsciously create intense situations because their bodies are used to dealing with crisis and stress, and they do not know how to function without stress. Responsibility. When people have overdeveloped senses of power, they tend to try to control things not within their control. They feel a responsibility to make things happen, which leads to feelings of responsibility for the actions of others. Not being able to control all situations leads to frustration and is the most frequent cause of burnout. Fear of loss and abandonment. When people become “married” to their work, they become rigid. They believe their jobs provide security and stability. Any change in their jobs or in the organization where they work means a change in their stability, and fear of instability causes them to oppose change of any kind. Denial. People tend to deny negative consequences. They often blame and judge others, and they build up resentment rather than taking responsibility for their feelings. They tend to join cliques that support these negative feelings, and they find a sense of comfort in this support. One negative consequence of denial is forming triangles (ie, suppressing feelings by avoiding them, taking them out on uninvolved individuals, or transferring them to another situation). For example, a nurse is upset with a surgeon because of his or her abusive language and actions. Instead of discussing the issue with the surgeon, the nurse either suppresses the feelings with food or drugs, takes them home to her family, or talks badly about the hospital where he or she is employed. To avoid forming one of these triangles, the nurse could go to the surgeon and explain that he or she is not willing to accept the abusive behavior, and that if it continues, the nurse will report it to the appropriate person. The nurse must learn not to abuse himself or herself or his or her family members by repressing these negative feelings.

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By realizing that they are not what they do, nurses can overcome self-destructive behavior. These characteristics of compulsive caretaking and workaholism may eventually lead to burnout. One way to combat burnout is for the nurse to learn to care for himself or herself as well as he or she cares for others.

Learning Self-care


elf-care is not easy. The traits of workaholism are learned and practiced through an entire lifetime and can be difficult to overcome. Learning self-care can be especially difficult for women, because in addition to learning the traits of workaholism, women learn to take care of others first and to put themselves last. Taking time to indulge the self is a foreign concept to many women caregivers. Although nurses may know how to do things differently, they do not always have the emotional and spiritual freedom to do things differently. This freedom comes from shifting paradigms (ie, change, reform). People have “maps” for life based on their education, experience, and history. If the current map is creating pain for a person and the people around that person, he or she needs to be willing to gain new education and change the map. With new education comes the need for a support system within which the person can practice what he or she learns. People who want to change their maps need to realize that changing involves trial and error and that, with practice, error becomes easier to accept. Strategies for learning self-care follow. Learn about yourself. Some people live life through other people and have no idea what they like and dislike. A person must have priorities and must learn his or her limitations, likes, and dislikes. A person must seek out those things, events, and feelings that encourage pos876

itive feelings and creativity. Separate the being from the doing. A person needs to learn to take responsibility for his or her efforts rather than for outcomes. Realize that perfectionism does not negate feelings of low self-esteem. Doing more and being responsible for more does not necessarily make a person feel better about himself or herself, and this in itself can trigger more feelings of inadequacy. By realizing that they are not what they do, nurses can overcome this cycle of self-destructive behavior. They must ask others for what they need and what others need from them. Make time for yourseu. Each person must schedule time for exercise, eat healthful foods, get enough sleep, and learn to play. Learn techniques for mess reduction, be aware of all feelings, and learn how to release them constructively. Set aside time each day to write in a journal, meditate, and engage in creative play. Improve the family climate, and celebrate life’s rituals. Investigate things and ask questions. Learn about healthy physical, emotional, intellectual, and spiritual boundaries. A person must learn to set boundaries to protect himself or herself from abuse, to protect others from being abused by him or her, and to gain a greater sense of self-identity. Spirituality is about being a positive and creative person. People lose their spirituality when they begin thinking negative and destructive thoughts, experiencing negative feelings, and engaging in negative behaviors. Nurses should seek out those things, events, and feelings that encourage them to be positive and creative. Remember that life involves continuous change. Learn how to assess realistically what is happening. Look at the options and decide what can and cannot be done about a situation. Learn not to overreact. If an issue cannot be resolved within a short amount of time, the issue is not about what is happening


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at that moment but rather is something that one person brought into the relationship.



aregivers must learn to care for themselves if they are to remain productive. Workaholic tendencies and burnout can be overcome, but nurses must be willing to educate themselves and learn techniques to help them slow down, relax, and pamper themselves. 0 Note 1. B E Robinson, Work Addiction: Hidden Legacies of Adult Children (Deerfield Beach, Fla:

Health Communications, Inc, 1989). Suggested reading Fassel, D. Working Ourselves to Death: The High Cost of Work Addiction and the Rewards of Recovery (San Francisco: Harper and Row,

1990). Hart, A D. Healing Life’s Hidden Addictions: Overcoming the Closet Compulsions that Waste Time and Control Your Life (Ann Arbor, Mich:

Servant Publications, 1990). Lasater, L. Recovery from Compulsive Behavior (Deerfield Beach, Fla: Health Communications, Inc, 1988). Snow, C; Willard, D. I’m Dying to Take Care of YolcNurses and Codependence: Breaking the Cycles (Redmond, Wash: Professional Counselor

Books, 1989).

Reeder, Applegeet Elected to Academy Jean M. Reeder, RN, PhD, CNOR, LTC, and Carol Dungan Applegeet, RN, MSN, CNOR, CNAA, have been elected as Fellows of the American Academy of Nursing (FAAN). Dr Reeder is the immediate past President of AORN and a nurse researcher at the Nursing Research Service, Walter Reed Army Medical Center, Washington, DC. Applegeet was President of AORN in 1989-1990 and now is the director of AORN’s Center for Practice. To be elected as a fellow, a nurse must be sponsored and cosponsored by fellows of the academy. Names are referred to a membership committee that selects qualified individuals who are listed on a ballot. The ballot is sent to all fellows, and a majority vote determines who will be elected. Fellows are elected to membership in the academy based on their contributions to the nursing profession and health care. Dr Reeder and Applegeet were among 113 fellows who were inducted into the academy at its annual meeting, which was held in October in St Louis. The American Academy of Nursing is a working body of nursing leaders and scholars in education, practice, administration, and

Jean Reeder (left) and Carol Applegeet

research. The academy identifies emerging nursing and health care issues, promotes their scholarly explorations, challenges the status quo, and proposes creative solutions.


Workaholism. Learning self-care to prevent burnout.

NOVEMBER 1992,VOL 56, NO 5 AORN JOURNAL Workaholism LEARNING SELF-CARE TO PREVENT BURNOUT Gail Vaughn M any people have trouble in relationships,...
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