Burning Bright Without Burning Out: Self-Care Strategies for Oncology Nurses

Have you ever heard yourself or a colleague say these things?

“I cannot work like this anymore”
“I am just tired”
“I feel like my life is torturing me”
“Every time I try to recommend something new and innovative, I get shot down”
“I am sorry, I need to warn you that I am crabby today. I didn’t sleep well last night because I kept thinking of this poor patient without health insurance”

I am approaching 37 years as an oncology nurse, with 35 of them in the outpatient area. I have taken care of countless cancer patients and their families over the years. This is what I love about my career—the relationships that are formed, helping patients understand their diagnosis and next steps. Most of all, I love working with a multidisciplinary team to ensure our cancer patients get the most up-to-date, evidence-based care in which the patient is also a partner in the shared decision-making process.

As a thoracic oncology nurse navigator, I must keep abreast of the rapidly changing landscape of treatment options. Since 2017, the treatment for lung cancer has offered patients increasing options, and I often hear the oncologist tell the patients and families, “Lung cancer is not a death sentence; we can control this with our latest treatments.” In addition to chemotherapy, there are targeted therapies, immunotherapies, surgical options, radiation options, and often a combination of these. This what keeps me in oncology nursing, the daily stimulation of keeping abreast of the latest options for lung cancer patients. Celebrating when the FDA approves another treatment for my patients, and ensuring my multidisciplinary team has also heard the good news contributes to my self-efficacy.

How did I get to this point in self-discovery when I was the one who said those very statements above? Healthcare professionals practicing in oncology are more likely to suffer from job-related stress, anxiety, depression, and self-reported moderate-to-high burnout.¹ Being a provider of cancer care, whether you are a physician, surgeon, advanced practice provider, pharmacist, nurse, or social worker, is not easy. We want the best for our patients, but when burnout threatens to take over your mind, body, and soul, you cannot be the best for them, your healthcare system, your family, and most importantly, yourself.

Caring for cancer patients is emotionally draining even though it is incredibly rewarding. In addition, the oncology clinician often endures:

• Long working hours
• Unsatisfying bureaucratic or administrative work
• Work-life balance issues
• Poor flexibility or lack of control over a person’s work or working environment
• Lack of support from a manager or leadership team
• Doing a job that conflicts with a person’s values
• A toxic or unsupportive working environment

The above factors compounded with the compassion oncology clinicians have for their patients can take a toll on us. Healthcare in the United States has become incredibly bureaucratic with multiple insurance offerings, Medicare Advantage plans, various state Medicaid providers, and various marketplace insurance offerings. Prior authorizations, peer-to-peer reviews, claim denials and appeals generally fall on the oncology clinician. These items add to the workload and can cause immense frustration for all involved. Healthcare systems must put in place workflows that are commensurate to individuals’ license and ability. Through all this, communication is imperative within the multidisciplinary team with clear delineation of roles and responsibilities to avoid repeat or overlapping work.

Stress and fatigue must be recognized and dealt with before burnout approaches. The World Health Organization defines burnout as “an occupational phenomenon resulting from chronic, unmanaged workplace stress, characterized by feelings of energy depletion or exhaustion, increased mental distance from one’s work, and reduced professional efficacy.”

Even prior to the COVID-19 pandemic, healthcare organizations were recognizing the importance of providing wellness opportunities and programs to prevent burnout. The Oncology Nursing Society (ONS) and ASCO, among others, recognized the toll burnout takes on the cancer specialists and created resources, road maps, and tool kits to address stressors.²

A pilot study was conducted on ambulatory care oncology nurses implementing physical activity and measuring it against compassion fatigue and burnout. The results were not statistically significant, but the implication is that increasing physical activity and supporting a healthy work environment benefit the nurse, the healthcare system, and ultimately the patients.¹ Taking care of you means finding something that is important to you, and maybe only you, focusing on something that may be good for you physically and/or mentally. When we care for ourselves, then we are better able to care for and about others.

The following are some recommendations on how to take care of yourself. I have learned over the years that you cannot control other people’s actions or inactions, but you can control yourself and your response to them.

1. Find something you can enjoy on your own and doesn’t cost a lot of money. At the beginning of the pandemic, my director of navigation in Nashville had daily Webex as a “check-in” to us oncology nurse navigators working from home. She challenged us to do something for ourselves, set goals for our daily lives. At the time, working from home was an entirely new experience for me. Not seeing my colleagues in person was difficult. Assisting patients and their loved ones over the phone was a challenge. I decided that instead of getting in my car and driving 30 minutes to work (which I couldn’t do), I laced up my tennis shoes and walked my neighborhood for 30 minutes. When I turned off my computer at the end of the day, I laced my tennies up again and walked for another 30 minutes. This gave me much needed exercise for mind and body.
2. Enjoy simple things that are in your everyday world. During these walks around my neighborhood, I noticed many birds I wasn’t familiar with (was living in the Southeast, and I was a Midwest girl). I then learned of an app for bird identification. Merlin opened a whole new world right in my back yard. This app helps you identify birds through prompts you plug in. Now this app has evolved into being able to assist in identification from just hearing the song of the bird.
3. Bring out your inner child. Using sidewalk chalk to draw Easter bunnies, spring flowers, and Easter eggs with the neighbor toddler made me realize that chalk isn’t just for kids.
• Make a word search and give it to family and friends to do
• Do a paint by number
• Try an adult coloring book
• Swing on a swing
• Jump on a teeter-totter
• Roll in the grass and look at the clouds
• Grab a jump rope or hula hoop
4. Try something new. This can be a whole myriad of things: join a Spenga class, a painting class, learn how to knit, or attend a yoga class.
5. Capitalize on social media. Type into Facebook an interest you have and follow and like it. My newfound interest in birds has led me to several Audubon and birding sites. I have attended events this spring on migrating birds and discovered there are more ducks than just mallards and wood ducks.

At work, you can focus on things to improve self-care throughout your workday. We have challenged ourselves to think of ways to break free for a moment or two. I am in an outpatient setting, so these things may not apply to your workplace, but try to incorporate one of these things into your workday:

• Take a lunch break away from your workspace
• Take the stairs when you can and not the elevator
• When walking from one location to another, walk outside if you can
• Find a quiet spot and practice “breathing in through your nose and out through your mouth” for 10 minutes. I was reminded of this during my new yoga class I tried out
• If you park in a parking garage, instead of taking the elevator or stairs, if it is safe to do so, walk up the ramp. Or park the furthest away you can in the parking lot

Professional development and goal setting for such come out of “Taking care of you.” Renewed energy for your profession is a result of self-care and is the antithesis of burnout. Challenge yourself to do something you wouldn’t ordinarily do:

• Work on committees and advisory boards. Volunteer for such. Your voice as an oncology nurse can be heard
• Get involved in your local AONN+ or ONS chapter. Attend the meetings, or better yet, volunteer to be the treasurer. I did
• Attend an oncology nurse conference. Many are virtual as the AONN+ Midyear Conference will be in May. You can often join the chat to feel connected with colleagues even if not in person. Or, if you really wanted to go to the 50th Anniversary of the Oncology Nursing Society Congress like I did (April 9-13), be creative in how you can get there. I applied for our Nursing Excellence Fund and received money to assist with the expenses
• Work with your work colleagues on a performance improvement project that several of you are passionate about. One physical therapy colleague of mine who specializes in cancer prehab/rehab had been frustrated by lack of certain referrals. She spoke up in our lung tumor board, and as the lung navigator I was able to get buy-in from the pulmonary team, CT surgery team, and the medical oncologists. Our first stage I patient will enter the program prior to her surgery
• Think outside the box and engage members of the community in your ideas. You don’t have to work only with those in your healthcare system, you can team with health clubs or YMCAs to offer survivorship exercise classes

These have been difficult years for all of us, but by practicing self-care and focusing on you, out comes an empowered person with a better outlook.

References

1. Murphy CA, Staffileno BA, Hand M, et al. Feasibility and impact of physical activity on compassion fatigue and burnout among ambulatory care oncology nurses. Clin J Oncol Nurs. 2022;26:519-527.
2. Hlubocky FJ, Shanafelt TD, Back AL, et al. Creating a blueprint of well-being in oncology: an approach for addressing burnout from ASCO’s Clinician Well-Being Task Force. Am Soc Clin Oncol Educ Book. 2021;41:e339-e353.

Source

Waddill-Goad S. Nurse Burnout: Overcoming Stress in Nursing. Nursing Knowledge; 2016.