Why Nurses Stay in Toxic Workplaces and How To Get The Right Help

Mental health has become a huge topic of conversation for healthcare workers—for heartbreaking reasons, as we hear of more healthcare workers losing their battle fighting mental health challenges—and for practical reasons, as we near the end of the COVID-19 pandemic and now face a new one: millions of healthcare workers who are exhausted and burned out. 

How can healthcare workers get the mental healthcare they need? And how can they recognize when it’s time to move on from a toxic workplace? Nurse Alice discussed some of the intricacies of mental healthcare with psychotherapist Michele Finnerman, Ph.D., a licensed professional counselor in Coral Springs, Florida, specializing in individuals, couples, marital counseling, group therapy, and family therapy for those who are 12 and older. 

Finnerman has a Ph.D. in conflict resolution and dispute analysis, recently published a book after conducting studies on domestic abuse survivors and helps her community by providing mental health support and services to local officials and first responders—she's even worked closely with some of the Parkland School shooting survivors by providing them with the necessary treatment and support afterward. Here’s what they had to say. 

Listen to this episode on the Ask Nurse Alice podcast

 

An Endemic of Burnout

Dr. Finnerman shared that the two main issues she is seeing in first responders right now are burnout and compassion fatigue.  

“Fatigue is the cost of caring; it's the cost of caregiving,” she said, adding that psychotherapist Charles Figley coined the term and wrote a book about compassion fatigue. “It is a cost when you are giving so much of yourself in a professional sphere and not getting it back. It leads to burnout and leads to feeling completely exhausted and emotionally drained, with no motivation.”

And while you might think that the solution to burnout and compassion fatigue is a complicated one, Dr. Finnerman shared that sometimes, it boils down to simply ensuring that nurses get their basic needs met: making sure they’re sleeping, making sure that they're eating appropriately, and making sure that they are resting their bodies. 

“The thing about nurses’ positions is that they are very physical, very emotional, very mentally and very traumatizing,” she explains. “Those things are very important for nurses to understand. You're in a position and a sphere that is thankless and expected, but then your own self-care gets jeopardized and your own basic needs start to become compromised.”

Once those basic needs are met first, said Finnerman, then the next steps of healing can take place. Dr. Finnerman also pointed out that when nurses and other healthcare workers are in such an extreme state of burnout, the physical act of setting aside 1-2 hours per week to see a mental health professional can be part of the necessary self-care needed to heal. 

“That’s why for the nurses I was seeing, it was mandatory that they see me once a week and if need be, twice a week, because that is their time—the session is for them. It's their time to kind of figure out their own self-care needs and not just get the basic needs met.”

Help From Above

According to Dr. Finnerman, mental health for nurses needs to begin with hospital administration. 

“I'm finding a disconnect with bedside nurses and managers and hospital administrations,” she stated. “I think if we had more support with hospital administration focusing on the needs of the nurses and their mental health. Instead of like, punching numbers, and making sure the finances are in order, making sure that their nurses’ mental health are in check.”

“There needs to be more of a connection for the hospital administration and the bedside nurses, managers, directors—I think that's really, really important,” she added. 

She also noted that law enforcement agencies—another group of professionals in high-stress situations—have contracts with her to use her mental health services when needed. “They understand the need of having somebody in their back pocket as a mental health professional,” she said. 

So if law enforcement agencies can have a contract with a mental health professional, why not hospitals or nursing staffing agencies? In fact, Dr. Finnerman sees the need for help for nurses to come from the top, because nurses themselves may be too busy or too far into survival mode to actually reach out for help on their own. 

“They're doing so much and they're seeing so much and they're feeling so much, so it’s not something that they're going to do,” she said. “They may need to be pointed out to them.”

Seeking the Right Help

Nurse Alice and Dr. Finnerman also discussed the difference between the types of mental health professionals you may encounter. As Dr. Finnerman explained, psychiatrists, psychologists, psychotherapists, mental health therapists, and social workers are all very much in the same field, but they all do different things within the field.

Here’s how Dr. Finnerman broke them down: 

• Licensed mental health therapist/psychotherapist. The title that Dr. Finnerman holds means she took a test to be granted a state license and get certified in the state of Florida and to counsel by the Department of Health by Tallahassee, the capital.
• Psychiatrist. A psychiatrist is someone who went to medical school and is able to evaluate patients and prescribe medications. They are able to offer in-depth insight into the side effects of medications and assess with patients on if those medications are working for that particular patient.
• Psychologist. A psychologist is somebody that does talk therapy and can perform psychological testing.
• Social worker. Social workers are aligned with mental health therapy, can tap into the resources of the community and offer talk therapy as well.

As a licensed mental health therapist, Dr. Finnerman (who holds a doctorate in philosophy), is not able to do psychological testing and can not prescribe medication. What she can do, however, is straight talk therapy with therapeutic intervention and modalities. And of course, like other medical specialties, she can work with other healthcare mental health professionals as patients need, such as if medication or testing is needed. 

Speak Up When It’s Appropriate

Nurse Alice then brought up the somewhat difficult challenge of knowing when to speak up about a workplace that may not be healthy as a nurse. She pointed out that when the unit is short-staffed, managers are just trying to get nurses to fill the shift, and patients are crashing—well, that might not be the time to speak up about any issues you see. But during a staff meeting? Well, then, it’s time to speak up and speak out; and yet, many nurses are too scared to do so when the time is right. 

To help you gain confidence in speaking up and out when the time is right, Dr. Finnerman suggested bringing solutions to the table instead of just pointing out a problem. “If you are going to come to your administrator as a nurse, brainstorm some solutions with yourself before presenting it,” she said. “There are problems everywhere…so come to the table forward-thinking about some solutions and some ideas to brainstorm with your nurse manager.”

If you’re thinking about becoming a nurse, are a nursing student, or are a current nurse who is ready to transition careers - this guide will help guide you to make the best professional decisions.

Self-Care Means Caring for YOU

Finnderman also explained that because being a nurse is a form of caregiving, any change you take away from that caregiving role—such as leaving a bedside position, switching units, or leaving nursing altogether—will come with feelings of guilt that can be difficult to navigate. 

“When you're a caregiver whether you're caregiving for your parents, your children, or your patients when you decide not to do that, there is a sense of guilt,” she noted. “There is a sense of guilt and a feeling of abandonment that you're leaving your patients high and dry.”

But she assured nurses that there is no stigma or shame in doing the work of self-care, even if that means taking a big step such as leaving a workplace that is no longer healthy for you or reaching out to a professional for mental health care.  

“There's no stigma anymore,” she explained. “This is self-care. This is you taking care of yourself—you're taking steps to care for yourself when you reach out for support. And a lot of caregivers don't have that time. [But it’s necessary to have] a devoted time just for them that makes it about them, and it’s important for your own self-care to have that implemented in your life as you care[to] give.”

Stay Protected at Work

One of the issues that have impacted mental health for nurses at work is the increase of violence towards healthcare professionals, and Dr. Finnerman and Nurse Alice touched on some strategies that nurses can use to try to stay safe while working in bedside care. 

For instance, Finnerman suggested that nurses should:

• Always be aware of any patient’s family or friends who are in the room.
• Pay attention to verbal and non-verbal communication, such as body language.
• Never turn your back on a patient—always keep the patient in sight. 

“This is what makes it hard for nurses,” Dr. Finnerman noted. “They're assessing so many different devices and they have to be able to think on their feet in terms of intervention and medical treatments, and they have to be vigilant with their surroundings; there are so many things going on when you walk into a patient's room. It’s super hard to tap into all those things that are necessary to tap into, but don't have your eyes off the patients that long. Because you just don't know if your back is turned, what could happen.”

“Your safety comes first,” added Nurse Alice, which FinDr. Finnermannerman wholeheartedly supported. 

She noted that if you ever feel unsafe as a nurse—regardless if something has actually happened or it’s just a feeling you have—you should speak up. If something has happened, then it’s time for an incident report. And no matter what, document as much as you can. Even if nothing has happened, but you feel unsafe or uncomfortable, it’s crucial to document because then alerts the administration that it could turn into a problem. 

“That gut feeling that nurses have…don't ignore it,” she advised. “Tap into it. Don't make excuses for what you're feeling. Tap into it because your gut will never leave you the wrong way. It will never lead you down the wrong road.”

If you are a healthcare professional in need of help or support, Dr. Finnerman encourages you to reach out to her. She returns every single phone call that is made to her and you can also learn more and contact her via email on her website.