In nursing, we can be a tiny bit ambiguous in the way we describe each other, don’t you think? Take, for example: “She cares too much.”
On the one hand, that’s not the worst insult in the world, is it? Being too kind, too engaged? On the other hand, it implies a vulnerability or a lack of boundaries or maybe even something unprofessional.
How about “you’re very efficient”? That’s a good thing, right? You help get things done without fuss. When you are around, the service runs smoothly. But those thank-you cards rarely praise efficiency, do they? In a certain tone, being called efficient can perhaps suggest you are a little bloodless. Unemotional. Disengaged.
Even being described as “lovely” is a double-edged sword, depending in part on the tone. “Thank you nurse, you were lovely to my mum” can be “your decency stood out” or it might be “you tended to tilt your head and smile a lot but were otherwise pretty pointless”.
And this is before we get anywhere near the more loaded stuff like burnout.
Burnout is interesting. We may see it in the way people nurse - being irritable or slow to respond, or with reduced emotional congruence. Or the way people manage themselves, sometimes being late for work or taking more time off sick, more tutting and loud sighing, maybe some muttering. We may feel their burnout in our increased workload as we pick up the load they drop - we may even become infected in some small way by their mood or demeanour.
Burnout may be a bad thing but is it essentially a descriptive term? If you have met a nurse who appears worn down by the job, willing but not quite as able, with reduced emotional labour skills but still efficient, you might think they were a little burnt out. Would you tell them? Isn’t it likely to be received as an insult not just a describer?
You may just be pointing out the effect of nursing in difficult circumstances and not getting support in the same way that you might point out to someone who has a high temperature, is listless and weak, with a reduced appetite, that they have flu. Yet burnout is more loaded a term than flu. To call someone burnt out is to accuse them of nursing poorly, of failing in some fundamental way.
Being burnt out suggests something moral as well - a failure of not only professionalism but also your sense of good. It is, it seems, a label.
Yet burnout is available to all of us. We know it can happen, we see it, we understand it conceptually and we have seen the research.
Maybe it doesn’t matter. Perhaps we are dismissive of the burnt-out nurse because they make our working day harder. But, given we are trained to be non-judgmental in the face of our patients, is it too hard to retain some sort of empathy for our colleagues? Might it not be worth noticing that if burnout is inevitable, we need clear strategies to offer something more helpful than blaming?
Nursing needs, above everything, to invest in strategies that rejuvenate, support and genuinely attend to the energies and capacities of nurses to maintain their energy, engagement and emotional labour. Putting that into place properly would - and I hate to resort to economics to make a point - save money in terms of sick leave, staff retention and wellbeing and patient satisfaction. I remain very curious as to why that isn’t the primary response to the Francis report.
Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe