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FINANCIAL LITERACY IS THE KEY TO SURVIVING NURSING. HEAR ME OUT 

This post is part two of a seven part continuing education series on Surviving Nursing. Click here for part one.

I’m a nurse, and I have a gut reaction when I hear a manager mention “self-care skills.” It makes me want to scream.

It’s right up there with “time management skills” where staff are sparse, patient loads are heavy, and resources are non-existent.

I shouldn’t be like that, right? They’re trying to help. Our jobs are hard. We really do need self-care skills to survive nursing. Mindfulness. Emotion regulation in the moment. Staying physically healthy. Sleeping. Drinking enough water. Drinking less alcohol. Spending more time with friends and family. All that good stuff. It’s baseline to being a happy human, and surviving nursing. Self-care and resilience training does help to some degree. 

Still…

Getting enough sleep and drinking enough water are like proverbial band-aids on a bullet wound. There’s no chance that any of that is actually going to allow us to survive in nursing in the long term. 

When it comes down from administrators at work, the self-care conversation feels like organizational ideology at best, or a form of gaslighting, right? As if the reason so many of us can’t cope with nursing is that we are irresponsible or just aren’t good enough at managing our emotions. As if it’s our own fault at some level. 

No. 

There truly are some life situations that overwhelm your ability to cope, regardless of how good you are at self-care and emotion regulation. 

Nursing puts us in those types of situations regularly.

Maybe this seems out of left field, but this is why I help nurses get their finances right. I believe it’s what you actually need to survive in nursing. 

While administrators and managers continue to “help you with self care,” you can be building your own escape path so that you actually have what you need to survive in nursing. 

WHY SELF-CARE WON'T LET YOU SURVIVE NURSING 

There’s a baseline crisis in nursing. Nurses are leaving in droves and we already don’t have enough nurses to fill essential roles. As a result, those of us still in the profession are being stretched to the brink. If you’re still on the floor, you’re probably stressed out, struggling to cope, and frequently underperforming because you’re exhausted. 

Everyone knows this. It isn’t news. It’s an ongoing problem, and no one has sorted out how to solve it.

“Self-care” is one part of the conversation about how to fix this problem, and it’s not just me who feels like this isn’t working. A systematic review of the research indicates that coping skill training and mindfulness-type approaches have either no positive effect in reducing burnout or a very limited (“nonsignificant”) effect.

(Side note - this isn’t just true in nursing. According to a recent Oxford University study, it seems that worker wellness programs are ineffective across industries.)

And interestingly enough, the types of interventions that are documented to help (for instance, facilitated debriefings that focus on providing nurses with a voice and agency) are practiced inconsistently and incorrectly across the nursing field . (Shoutout to Debriefing the Frontlines, an independent, nurse-led organization that is filling this gap. Definitely check them out if you’re needing to debrief or get support as a result of your nursing career.)

As a nurse, it’s obvious that employer directed self-care isn’t enough. As nurses, we face too much in our jobs. An umbrella is nice if it’s raining, but it’s no use when you’re standing in front of a fire hose. Self-care skills are nice for a stressful day at the office. They aren’t going to solve your problems when you’re managing two crashing patients at once and you haven’t had a break in 10 hours and your boss just denied your PTO because they say they can’t spare the staff. 

Because this is the case, when organizational leadership talks about self-care, it can come off as a sign that they don’t understand (or care) about what nurses actually go through in our jobs.

ENTRAPMENT: A KEY DRIVER OF BURNOUT THAT'S RARELY DISCUSSED 

Beyond just the high level of stress in our job though, there’s a good argument to be made that self-care training doesn’t help prevent burnout because it doesn’t address one of its most significant drivers. 

There’s a feeling that is frequently described by people who experience burnout which gets almost no attention in the self-care conversation. It’s strange that this is the case, but it’s true. 

In research, they call that feeling “entrapment.” Among nurses I’ve talked to, it’s the sense of 

• being stuck in a job they can’t handle 
• or being in a situation that is unacceptable without a clear plan for how to get out.

When I started working on Nurses Investing for Wealth a few years ago, I asked nurses & APRNs I was working with why they wanted to get their finances in order. A lot of things came up, but one repeated theme was the idea that people didn’t want to feel “stuck.”

• “I don’t want to feel like I’m stuck in my job anymore.”
• “I feel like I’m trapped in nursing and I don’t know how to get out of it.” 
• “I feel like I can’t do this my whole life and I don’t know what to do.”

I can relate to that feeling myself. I felt that way for years in the nursing job which eventually did burn me out. I spent years fighting to make a situation better even though it was eating me alive, because I felt like I couldn’t and shouldn’t leave. I felt like I was stuck financially, and I felt like this is just what nursing life is like. I felt like the problem was me - like if I just worked harder and was more persuasive and better at managing my time it’d feel under control. That just made it worse when it didn’t work. In the end, I quit. I felt like I had to or I’d break down. I spent years away from nursing as a result.

It makes sense. We put ourselves in debt to get through nursing school. We build our identities around caring and our profession. Then we find ourselves consistently placed in situations where we are asked to accomplish the impossible. We see patients suffering when we can’t keep up. It affects us when we go home. We see our relationships breaking down, and our lives suffering as a result. But what do you do? How else are we supposed to make money, and how could we leave our colleagues and patients behind in that sort of mess? 

I looked into the research, and sure enough, “entrapment” is a well-documented driver of burnout among healthcare providers. That feeling of being stuck in an unacceptable situation without a clear way out is one of the most unpleasant experiences a human can endure. It’s a significant contributor to caregiver stress and depression. It’s strongly associated with compassion fatigue among nurses. It’s not too much to say that it is literally killing us because entrapment also has a well-documented association with suicidal ideation among nurses.

(Another shoutout here to nurse led organization Don’t Clock Out, a peer support group for nurses who are struggling now and need meaningful mental health support.)

The things that contribute to the feeling of entrapment are similar to the things that lead to burnout. This study identified key predictors of burnout among nurses: 

• high workload, 
• value incongruence, 
• low control over the job, 
• low decision latitude, 
• poor social climate/social support, 
• low rewards. 
• physical exhaustion, 
• lack of “work-life balance” – where work takes more of your time and energy than you want.

In short, nurses burn out because they work in demanding jobs where they are asked to do more than is possible, which are unhealthy and unsupportive, and they don’t have much decision-making power. They really burn out when they feel stuck in that situation with no way out.

Employers are unlikely to address this issue for us.

It’s messed up given how serious this problem is, but it doesn’t seem like there’s much being done about this. Academics talk about entrapment, as evidenced by those studies cited above, and lots of others. But in the nursing profession, you rarely hear about meaningful efforts to address it. 

Call me a cynic, but I seriously doubt that this will ever change if we leave it up to administrators. Employers experience short term benefits when staff feel trapped in their roles, especially during a time when retention is a crisis-level problem. I can’t imagine there are many HR meetings about how to help nurses feel like they can take more time off if they need to, or how to leave their jobs if it’s all too much.

In fact, employers often actively create environments where nurses feel trapped in their roles.

Which of you readers have experienced:

• Pressure to work extra… anyone ever had to work mandatory overtime?
• Threats to your license due to patient abandonment from short staffing? 
• Refusal of time off? 
• Denied pay increase?
• Demands to work beyond scope? 
• Being forced to accept more patients than you can safely care for? 
• Filing an assignment despite objection form with your union?

If you haven’t, please send us the name of your employer so we can all go there. My guess is that you have, and that you could continue adding to this list.

WHAT HELPS YOU ESCAPE ENTRAPMENT? FREEDOM AND AUTONOMY

Maybe this is obvious, but the thing that helps address the feeling of entrapment is freedom and autonomy. 

Employers can do things to foster that feeling in the workplace if they want to. They can give nurses more decision-making autonomy, or more input into the institutional decisions that impact their lives. Evidence says that this sort of thing does help reduce burnout.

Employers can also make work feel less impossible by following safe staffing guidelines and offering more vacation time and higher pay and less hours per week. Sabbaticals should be safe, legal, and common. Hiring managers could treat long resume gaps as healthy and normal for nurses. Workplaces can create a management culture that listens to nursing concerns and works to address them rather than fighting us every step of the way. 

As an individual, you can lobby for those sorts of things. Stand with your union. Write to your legislators. All of that is important. 

The problem though is that all of that is outside of our individual, immediate control as nurses. System-level changes are long-term fights, and we might not win them. (We’ve learned time and again that we can’t rely on decision makers to do what’s right for patients and nurses even when they have the ability to.) Healthcare work probably isn’t going to get less stressful anytime soon. 

SURVIVING NURSING IS UP TO US

It’s easy to go into a doom spiral worrying about all this and deepening the feeling of entrapment. However, there is a path out of this, that you have control over yourself. 

In order to survive nursing and beat entrapment, we have to get back to the issue of money.

For that discussion, head over to part 2 of this article. 

Also, if you didn't catch the first article, this post is part two of a seven part continuing education series on Surviving Nursing. Click here for part one.

I teach nurses how to follow the steps of the evidence-based Nurses Investing For Wealth Method so they can customize their own plan for financial independence, end entrapment, and survive nursing. 

I write about some of the things you need to know on this blog, but what’s most important is not what you know when it comes to finances, it’s what you do. Helping you change your financial behavior and therefore change your life isn’t something I can accomplish just on a blog, but it is what the Ultimate Nurse Investing Program does for nurses and APRNs. 

If you’re a nurse who wants to keep learning, take this free 2 hour training ➡ click here.

If you’re a nursing leader, I am also available to speak on this topic at nursing trainings and events. Email me here: [email protected]. 

STUDIES AND BOOKS CITED IN THIS POST

Aryankhesal, Aidin et al. “Interventions on reducing burnout in physicians and nurses: A systematic review.” Medical journal of the Islamic Republic of Iran vol. 33 77. 31 Jul. 2019, doi:10.34171/mjiri.33.77

Browning, Emily D, and Jourdan S Cruz. “Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses.” Journal of social work in end-of-life & palliative care vol. 14,1 (2018): 44-72. doi:10.1080/15524256.2018.1437588

Cole, Donna A et al. “The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care.” Journal of nursing management vol. 27,6 (2019): 1176-1181. doi:10.1111/jonm.12789

Dall’Ora, C., Ball, J., Reinius, M. et al. Burnout in nursing: a theoretical review. Hum Resour Health 18, 41 (2020). https://doi.org/10.1186/s12960-020-00469-9

Evans, Thomas Rhys et al. “A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers.” Frontiers in psychiatry vol. 14 1078797. 24 Mar. 2023, doi:10.3389/fpsyt.2023.1078797

Fleming, W. J. (2024). “Employee well-being outcomes from individual-level mental health interventions: Cross-sectional evidence from the United Kingdom.” Industrial Relations Journal, 55, 162–182. https://doi.org/10.1111/irj.12418.

Hewko, Sarah J et al. “Retirement Decision-Making among Registered Nurses and Allied Health Professionals: A Descriptive Analysis of Canadian Longitudinal Study on Aging Data.” Healthcare policy = Politiques de sante vol. 15,2 (2019): 20-27. doi:10.12927/hcpol.2019.26074

Höller, Inken, and Thomas Forkmann. “Ambivalent heroism? - Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic.” Nursing open vol. 9,1 (2022): 785-800. doi:10.1002/nop2.1130

Khammissa RA, Nemutandani S, Shangase SL, Feller G, Lemmer J, Feller L. “The burnout construct with reference to healthcare providers: A narrative review.” SAGE Open Medicine. 2022;10. doi:10.1177/20503121221083080

Ramos, A. (2022) Nursing Our Financial Health: Financial Habits for Overall Well-Being. Tampa: Gatekeeper Press 

Salminen, S., Andreou, E., Holma, J., Pekkonen, M., Mäkikangas, A., “Narratives of burnout and recovery from an agency perspective: A two-year longitudinal study,” Burnout Research, 7, 2017, 1-9, ISSN 2213-0586, https://doi.org/10.1016/j.burn.2017.08.001 (https://www.sciencedirect.com/science/article/pii/S2213058617300165)

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. "Prevalence of and Factors Associated With Nurse Burnout in the US." JAMA Netw Open, vol. 4, no. 2, 2021, e2036469. doi:10.1001/jamanetworkopen.2020.36469.

Vogt, K S., Simms-Ellis, R., Grange, A., Griffiths, M. E., Coleman, R., Harrison, R., Shearman, N., Horsfield, C., Budworth, L., Marran, J., & Johnson, J. (2023). “Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions.” Journal of Clinical Nursing, 32, 7125–7134. https://doi.org/10.1111/jocn.16642.

Wyn Griffiths, A., Wood, A.M. Tai, S. “The prospective role of defeat and entrapment in caregiver burden and depression amongst formal caregivers,” Personality and Individual Differences, 120, 2018, 24-31, ISSN 0191-8869, https://doi.org/10.1016/j.paid.2017.08.026, (https://www.sciencedirect.com/science/article/pii/S0191886917305184)

Yaman, F. and Yaman, M. (2023) “The Effect of Job Stress and Feeling of Entrapment on Perceived Task Performance and the Mediating Role of Job Satisfaction in the Scope of Organizational Sustainability.” Open Journal of Business and Management, 11, 11-30. doi: 10.4236/ojbm.2023.111002.