Battling burnout, one nurse at a time

Students, faculty, staff and community members strike a pose on the Lawn.
PHOTO: Barry Fontaine

B-letter urnout exerts an immense toll on care-givers, and in the nursing profession, results in attrition, compassion fatigue, even hardened hearts. The Compassionate Care Initiative (CCI) developed at UVA’s School of Nursing offers a remedy through resilience.  

From yoga to meditation, writing to art, the initiative urges clinicians to care for themselves, says Dean Dorrie Fontaine in a recent talk with Illimitable.

Q: What was CCI’s inspiration? And as it’s evolved, what have you learned?

A. What we knew in 2009 were the disheartening numbers of broken-hearted health-care professionals who were either “working wounded,” giving unengaged, error-prone care, or who abandoned the profession altogether.

American hospitals spend $15 million annually dealing with RN attrition, and while three-quarters of nurses worry about burnout, a third already are, and are ready to quit. Physicians are twice as likely to commit suicide as non-physicians, and in some hospitals, doctor-nurse relations are tense at best and hostile at worst. Most alarming, though, are the 400,000 patient deaths caused by medical errors each year.

So my UVA colleagues and I considered: What might contribute to ailing care-givers’ well-being?

Our programs build on the idea that when clinicians pay attention to themselves, they provide dramatically better care for others. Our initiative grew thanks to champions like Maria Tussi and John Kluge, who endowed a professorship and even hosted nursing students at their home for mindfulness workshops.

With that momentum, six years later, CCI has become our differentiator.


Q: Why is compassion critical to nursing? 

A. Nurses provide that remarkable bridge between the cure and the infinite details in getting there, and are the indelible link to comfort when a cure is no longer possible.

As medicine progresses, how nurses tend the physical, mental and spiritual health grows even more important. More people survive diseases that used to kill them, living longer but less healthy lives, and nurses offer the full spectrum of care. No other single professional does that.


Q: What causes burnout? How does the Compassionate Care Initiative help?

A. Burnout comes from repeatedly watching people suffer, viewing their ailments in agonizing focus along with their effects: rage, despair, combativeness, sorrow. Nurses tread these frontlines beside patients and their families over lengthy, stressful shifts, dealing with powerful emotions in others, and in themselves. They also navigate chaotic situations when the critically ill require life-changing decisions to be made in seconds, or minutes.

The difficult nature of our work won’t change. But even for clinicians tending the sickest, most acute patients there are practices that yield a profound, remediating effect.

Sometimes, all it takes is slowing down. Making sure to eat, and go to the bathroom. Pausing for breath. Taking five minutes to close your eyes in a safe space, or ten minutes of meditation, yoga or stretching.

One CCI ambassador – the incredible nurse Jonathan Bartels – came up with what he called “The Pause.” It‘s a 45-second period after a patient’s death during which care-givers stand silent, breathe, and honor the life that has passed. Before the Pause, ER clinicians would feel the crush of emotion and defeat with nothing to check it. Then they’d move on to the next patient still in that frame of mind. The simple ritual soothed them. Gave them a chance to reflect, to slow down. Many say it’s helped.


Q: Are you achieving CCI’s goal?

A. Students certainly say CCI makes a difference in how they care for themselves, and their ability to stay calm and focused. UVA faculty, staff and clinicians speak of its benefits. And given that resilience is our School’s differentiator – and our applications from prospective students have risen 38 percent in the last four years alone – our work is striking a chord. It’s now up to us to carefully measure its effect, and purposefully and thoughtfully tweak and expand what we do.


Q: What is your vision for the future?

A. Intentional instruction in compassion and resilience has become UVA Nursing’s signature, our brand. Our graduates emerge with a real sense of what it means to be their best self and enter professional relationships with calmness and empathy, and they are better team players, colleagues and skilled collaborators.

My hope is that CCI will grow, and, based on assessment, outcomes and study, eventually become a fully funded Compassionate Care Institute.