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Bill Klaproth: Burnout across the bedside nursing profession is gaining more and more national attention as it should. However, burnout in nursing leadership is only now just starting to be recognized as a serious concern. So why is that? And if you are feeling the effects of burnout, what can you do to get out of it?

So let's talk with someone who's gone through it from burnout to success as we talk with Chris Burleigh, Unit Manager, Medical Intensive Care Unit at the University of Rochester Medical Center.

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Chris, thank you so much for spending some time with us. We really appreciate this. So as I said, burnout in nursing leadership is only now just starting to be recognized as a serious concern by the healthcare community. Why do you think that is?

Chris Burleigh: I think there's a few things that contribute to that. I would say one of the biggest things is there's this unhealthy expectation among nurse leaders. And I would say that personally, I would say professionally and even publicly, that leadership is supposed to be able to handle everything. The euphemism out there of "You can't pour from an empty bucket." But I think unfortunately with nursing leadership, the assumption, like you said, across the board is that nursing leadership has a larger bucket than everybody else. And I think there's just the assumption with the mantle of nursing leadership that we can take on more, we can handle more, that we're able to respond to more and be more adaptable. And certainly, over the past couple of years, nurses have had to do that. So I think that's where a lot of it comes from, is there is this unhealthy assumption that we can do more. And I think we're just, especially in light of what's happened over the past couple of years, recognizing our limitations.

And I think part of it too is, with a lot of research that's done out there about burnout and everything, it's done by nurse leaders, it's done by people in leadership positions and they're looking at how to help their staff support their staff. And there isn't a lot of time and focus looking in the mirror and saying, "What's going on with nursing leadership" and it's making us ask these questions and trying to come up with the hard answers to these questions as well.

Bill Klaproth: Yeah, absolutely. As you said, there's higher expectations on nurse leaders, but nurse leaders can also fall victim to burnout as your story tells us. Of course, you're the unit manager of the Medical Intensive Care Unit at the university of Rochester Medical Center. Chris, what's your story of getting burned out? Share with us what you were going through.

Chris Burleigh: Certainly. Yeah. It's probably a fairly similar story to a lot of leaders out there. I was a couple years into my formal leadership journey. I've been a nurse for 13 years now, spent most of that at the bedside. The past four years have been in official leadership and I was a couple years into it and I could certainly feel the weight of leadership and some of the stress that comes along with being unit manager. But thinking that this is all kind of normal and part of the job of handling personnel and expectations for the unit and bouncing metrics and finances and all the normal things that go with this job. Then, this funny little thing called COVID came along and it really turned out for all of us, turned our world on its head. And I think very similar to, again, every leader out there, I was faced with a lot of unknown, a lot of hard choices. Things were scary. Things were hard. It was very difficult to know how to lead a unit during that time.

For me personally, when the first wave started back in early 2020, my unit was actually broken up and disbanded across the ICUs at our hospital. So I didn't even have an actual unit to manage. I still have my staff certainly, but that was its own flavor and all of this, I guess I would say. And that was a really hard couple months of trying to keep some sort of unit identity together amongst the staff. But thankfully, we made it through that. The unit came back together and we were feeling relieved, like, "Okay. We made it to this wave," and there's that adrenaline that got myself and the unit through that.

But then we faced round two of it. And we didn't actually get broken up. The second time, we ended up physically having to move my unit a couple of times, as things unfolded with the next wave at the end of 2020, then the beginning of 2021. After we had come back home and settled back into the unit again, I would take some of the cracks were forming for me, because this wasn't just a one and done anymore. There's this realization that the adrenaline isn't going to carry me anymore, that there's some baggage that came with all this that was already kind of there, again just kind of from the position itself. But recognizing that the past couple of years had been really rough and there's a lot of baggage that I was carrying around from the decisions that I had had to make personally and professionally. Just feeling stretched very thin, like a lot of I'm sure leaders were at that time. That's how I just kind of hit the breaking point for me to, just recognizing and feeling that, "What am I doing in this role?" I think a very similar trajectory to a lot of nurses. But that's kind of what got me into that burned out dark place.

Bill Klaproth: So you said through the pandemic, you made it through the first wave. But then the second wave hit, "Oh, no!" And you said you felt that cracks were starting to form. You said you were carrying around a lot of baggage and, at the end, you're questioning, "Why am I doing this? Why am I here?" Is that right?

Chris Burleigh: Yeah.

Bill Klaproth: Was there anything else, Chris, as far as the effects of burnout that you were going through? Any other outward symptoms and things that you were thinking or behaviorally doing when you felt like, "Man, I am burned out"?

Chris Burleigh: Yeah, I was able to keep that faith. Again, there's the expectation of leadership of still being here, still pulling the insane hours, still doing all the functions of the job. So in that sense, you know, from the outside, things were looking okay. But for my family, certainly that was with me through this and those of my leadership team and my supervisor, they knew the strain that was there and they knew that I was not, again, like in a good place.

A lot of it was just mentally, just not having the ambition, not having the drive. Struggling with sleep, struggling with self-care habits, that they needed to be there but weren't. Just being very distant, even though I would be physically present in a spot, that mentally, I was very not present, I was not there. A lot of the things we hear about with burnout were very much at play in my life, but again, doing a serviceable job, I suppose, masking all of it at work.

Bill Klaproth: So you were still showing up, you're still doing the job, but inside, there were a lot of things going on and, even outwardly, you said sleep was not good, healthcare habits were kind of falling by the wayside. You were distant, right? I would imagine with social interactions and your family potentially, right? So probably things you said, "This is not me. This is not who I am. Usually, I'm up on these things." Was that kind of the case?

Chris Burleigh: Yeah. Especially after that second wave, and I can't exactly put a finger on when it was, but there was that moment where I had enough self-awareness. We hit it a low enough point where I was able to look at it with a bit of perspective. This isn't me. That emotionally, I am snappy and not patient with people as much as I need to be. Certainly, my family took a lot of that. And I hear that from a lot of managers that they can keep it together at work. But certainly, their home lives are where things are hitting the fan. There's a lot of pieces, the sleep, the self-care habits, all that was not in a good place.

Bill Klaproth: So, Chris, having recognized this, having a little perspective saying, "Wait a minute, this is not me. There's definitely something wrong here." How did you come out of it? And maybe you could share some other tips on what people can do, who might be feeling the same thing, maybe other symptoms, more severe symptoms, drinking more heavily. We've heard of those things. Other types of addictions, neglecting social interactions and their family, getting violent at home, those types of things. What can someone do if they're feeling the effects of burnout? Someone who might be listening to this right now going, "Ah, this is me. I need help." What did you do? And what can people do?

Chris Burleigh: Yeah. I think that's why I wanted to kind of tell my story for what it's worth because I think there's a very typical story. I think there are a lot of nurse leaders and bedside nurses that are going through this. And unfortunately, we're really good at caring for others, but we are not the best at caring for ourselves. And the first step for me was just that breakdown of admission that I was not in a good place. And that was on a number of levels. Letting my director know where I was at, having a real honest conversation with my wife about where I was at, with my leadership team and eventually to the unit. It really came to the point where I recognized, after a couple of waves of COVID, that we weren't really sure what was going to happen at the end of 2021. Are are we going to go into another wave of this? And certainly, we did.

So someone with just that ambition with the people and appropriate levels of transparency, I've been able to kind of keep this up for a while, but it's not sustainable. So that was one of the first things. And kind of coinciding with that, I did actually end up taking a leave of absence from work and I'm very thankful that my director was as supportive as she was, of me taking that time away, that my unit was supportive, that my leadership team was supportive of it. Because that really provided me some time to have some perspective to really take that time to reflect and look back on the past couple years, and also look at myself and say, "What do I need?" So that was one of the big steps.

And then, the other big thing that was super helpful throughout all this was having people to touch base and check in with. I was part of AONL's Nurse Manager Fellowship. I was part of the 2020 cohort. And it was obviously not what we had anticipated that was going to happen for us that year. But as the world changed, as things changed, my cohort, we stayed in really close contact with each other. We used GroupMe texting to touch base. We sent emails. We had resiliency check-ins that AONL provided with Deb Gerardi and that was super, super helpful to recognize that we weren't alone in this. And I think that was a big thing for me, because leadership, there is this expectation that you can handle and, if you can't, there's something wrong with you because all the other nurse leaders are able to keep themselves together and do their job. But having that accountability, having that ability to be in touch with nurse leaders across the country and get that, "Hey, they're dealing with the same things that I'm dealing with. Like this is normal." And it's a bit of a euphemism, but it's okay to not be okay right now because this isn't what we signed up for. So those are some big pieces. I ended up going through some counseling as well as part of this. So those are all pieces initially that I took to kind of help reset. And coming back from my leave of absence, a lot of it is I've been having to kind of put some guard rails in place. And for me personally and with regards to my work and recognize where are my limits? What can I do?

I think part of it too is just even tracking-- it's something so simple, but even, probably just trying to track my own hours. I think for a lot of nurse leaders, that sounds kind of crazy. A department nurse may say, like "I work 50-60 hours a week. I can't keep track of that," but even just a little bits of that were very eyeopening to recognize how much time you are spending, how much time I was spending on my job both when I was here at work and at home, but I think that's big killer for a lot of nurse leaders, is even when you're home, you're not off of work. There's still an email. There's still a text message. There's still a phone call to respond to. Even little things like that were really eyeopening and were very revealing.

Bill Klaproth: Well, thank you for sharing all of that with us, Chris. That really is helpful. A couple of things I wrote when you were talking about it, it sounds like one of the first things that's really important is recognizing that you're not in a good place. Not trying to cover it up with things or putting on that brave face, "I'm going to go in there and just kind of smile and grit my teeth and bear it and get through it." No, recognizing you're in a bad place certainly sounds like a step one.

And then you said you took a little bit of time away and really figured it out what it is that you need. And you said the AONL Nurse Manager Fellowship really helped you through that as well. And that is something great and is available for people to tap into if they need help. And you said hearing from other people going through the same thing made you feel good too. "Hey, I'm not the only one going through this. This is normal. Many nurse leaders are going through this as well." And then you said you had some guard rails trying to track your own hours to help you combat future burnout. Any other guard rails that you've put in place, Chris, to help you stay on that even plain and not fall back into burnout?

Chris Burleigh: Sure. Yeah. Other things too is again trying to build up my leadership team and really trying to delegate to them, recognizing the support that I have. As a nurse, we're really, really good to a problematic degree of taking things on and feeling like we can solve these problems. And asking for help. I'm still continuing with some of the things that I've done initially. I'm still with counseling. That's again proven super helpful. I still stay in touch even though our cohort has officially ended for the fellowship. Still staying in touch with people in that program and still bouncing ideas off of each other. Those are relationships that are not going to go anywhere for me personally or professionally because we went through hell together.

And to be able to stay in touch with them. It's been great to have that accountability to be a sounding board for each other to support each other's wins, to support each other in our losses and everything has proven really helpful to kind of keep me kind of on the straight and narrow, I guess, as we were coming back through this. And that's again like something I just want anyone who's going through this to hear. Like there is help out there certainly and find those people that you can trust whether that's personally or professionally. Find those sounding boards, find those people that you can rely on because it's very easy to go to this dark place alone and it doesn't have to be that way.

Bill Klaproth: Yeah. Great advice, Chris. Thank you for that. A couple of things you said you did there, delegate more, ask for help, stay in touch with the people you were involved with in the Nurse Manager Fellowship. So all of that is really good. Any guard rails did you put on at home? "I'm not going to try to answer emails" or "I'm going to make sure that I pay more attention to my family." "I'm going to try to leave work at work when I get home." Anything at home that you tried to do?

Chris Burleigh: Yeah. Trying set that time of, "Okay, when I'm home, I'm going to try as much as possible not the answer emails and phone calls and text messages," because you really do train people how to treat you. And that's something even before the pandemic, I think, nursing leadership, I had to learn because you want to hit the ground running. You want to be available to your staff. You want to show that you're authentic and genuine, that you genuinely do care about your staff. So it's really easy to say, "Oh, I got an email. I got to respond to this," "Oh, they called me or they texted me, I need to respond to this." And it's really hard to shift that needle back and not check out and be like, "Well, I'm not there right now. Like that's not my problem," because you're still responsible, you still need to support them. But just having those guardrails in place, even just mentally saying like, "Is this something really that I need to answer at 5:30, 8:30 at night when I'm home with my family or it's just something that I can touch base with them tomorrow morning?" And I think it's really hard to start to shift that needle, because it feels uncomfortable. It doesn't feel normal, but it's really important for me to recognize, like I have to have some time away if I'm going to do the job well, and thankfully my staff has been super understanding of that. They've been very supportive.

Part of it too is like, that was my communication and doing this with them is recognizing like I want to be here for the long haul to support them, to support the unit. We still have some big things ahead of us. And if I'm going to do my job well, I've got to have some margin. Like I said, they've been tremendously understanding of that. So I feel very fortunate in that regard.

Bill Klaproth: Yeah. So when you say I want to do my job well, I want to be there for my staff, it sounds like what you're saying is, obviously, nurse leaders need to take care of their mental health as well, as there is a strong correlation between the health of bedside nursing and nursing leadership, right? So when nursing leadership is healthy and strong and in a good place, you are there to really help the bedside nurses as well if they're dealing with burnout as well, which is happening too. Is that right?

Chris Burleigh: Absolutely. Going back to the you can't pour from an empty cup. As a nurse leader, we have to be well, if we're going to take care of our staff. And that's something that's really hard for us to do because it feels selfish, it feels weird to do that as a nurse leader, but recognizing that the long-term benefit of it is completely worth it.

Bill Klaproth: Right. So give us the update then, obviously I think we know the answer, but it sounds like things have turned out good for you. So what is your life like today? Have you found that renewed purpose and focus and drive and passion that you said that kind of left you when you were burned out, is that returned? Are you back?

Chris Burleigh: I think depending on the definition of burnout. There are some definitions of burnout that say once you're burned out, there's no coming back from that. I don't know if I totally agree with those kind of definitions. I would say that there is still that understanding that I need to be careful. Certainly, things are better. I do have more of that drive and that focus at work and I'm able to kind of balance things better. There is an understanding of just kind of recognizing where I've been and how easy it is to slide back into that especially as things are unknown.

I mean, right now, COVID, knock on wood, seems to be in our area. Our numbers are doing better. Our rates are doing better. But again, we've been through multiple waves of this now where things kind of ease up a little bit and we think we're out of the woods and then it comes back with a vengeance. So it's hard to pop the champagne and feel like this is over and we can kind of move on, because our experience says otherwise. So it's hard to feel really confident and move forward, but recognizing that we have been through a lot and we have come through a lot of things, again, as a profession. For me, personally, I'm feeling a lot better, but again, recognizing that there's some very real risks out there if I'm not careful and go back to some of those bad habits. And certainly if things take another turn with COVID, who knows what the next evolution of this will look like? So, certainly in a better place, but like I said, at this time to be very cautiously optimistic, I guess, I would say.

Bill Klaproth: Right. So would it be fair to say this is an ongoing process of self-care? Of paying attention to your mental health. It's like you say, you're not popping the champagne. The pandemic is over. Life is back to normal. Who knows what's going to come up? And there still could be stresses and strains and external pressures. So this is something you just on guard about and just constantly always watching.

Chris Burleigh: Absolutely. It's something to be aware of. And this has been underlying nursing leadership, even before COVID. I think COVID again has certainly shed more of a light on it just how dangerous and problematic nursing leadership burnout is. But it's definitely something that's going to be there regardless of a pandemic state or not.

Bill Klaproth: Yeah, absolutely. Well, Chris, this has been fascinating. And thank you so much for sharing your story. Is there anything else you'd like to add?

Chris Burleigh: For anybody who is struggling with this, know that you're not alone. This is not just your problem or your fault or anything like that. This is something that many of us have had to work through and deal with. And there is a ton of support out there and just have the courage to ask for help and have that courage to be appropriately vulnerable to those around you, because there's no reason go through it alone because we're all in nursing leadership and healthcare. We're all in this together right now, and we've got to support each other, we've got to look out for each other.

Bill Klaproth: Yep. There's no reason to go through it alone. Very well said. Chris, thank you again. Thank you for sharing your story. Thank you for sharing your advice and tips and suggestions to help avoid burnout and how to get out of it if you're in a burned out state right now. Thank you again, Chris. We really appreciate it.

Chris Burleigh: Thank you. I appreciate it.

Bill Klaproth: And once again, that is Chris Burleigh. And for more information, you can visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today In Nursing Leadership. Thanks for listening.