This Colorado Nurse Is Addressing Burnout Through Art and Action
Nurses are the people we turn to to take care of us when we're not well.
But nurses are often fatigued, emotionally and physically, in their workplaces. Burnout has been described as an epidemic among clinicians. One study estimated that 80 percent of ICU nurses are experiencing some form of burnout. And a study from the Colorado Nursing Center found that about 16 percent of nurses left their jobs in 2017.
Tara Rynders, a nurse at Rose Medical Center and an interdisciplinary artist, decided to explore these issues through an immersive dance performance. With the support of an Arts in Society grant, she staged several performances in late 2018 that took audience members through the halls, rooms, and even the basement of the hospital. The performance considered everything from the piles paperwork to the emotional issues that arise when a loved one has died.
Rynders was recently nominated for the Colorado Nurses Foundation's Nightingale Award for this work, which she said is an indication that the hospital values this kind of work and that the nursing profession values telling stories like this.
In this episode of The Checkup, Rynders talks about burnout and compassion fatigue in the nursing profession and about how her own experiences as a patient, nurse, and artist combined in "First Do No Harm."
Homepage photo credit: DW Burnett
More on First Do No Harm
- First, Do No Harm (A short video from the performance)
- Who Cares for the Caregivers? Raising Awareness About Burnout in the Nursing Profession Through Immersive Theater
- Rose Medical Center is Showing Its Staff Some Extra Love
- Immersive Dance Performance First Do No Harm to Take Place at Rose Medical Center
- This Nurse Is Taking Audiences Behind the Scenes at her Hospital Through Dance
- Nurse Hopes to Show Compassion Through Performance in Hospital Hallways
More on burnout and compassion fatigue:
- New Hope for Burnout Syndrome in the ICU
- Health Systems Battle Epidemic Physician Burnout
- Occupational stress and burnout in the nursing profession. A model for prevention
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This transcript is taken from an automated transcription of the recording. It contains typos. Please reach out to email@example.com for clarifications.
[00:00:00] Hi and welcome to The Checkup, Colorado Health Institute's podcast about health and health policy. I'm your host Jackie Zubrzycki. On this episode, we're going to talk about how we take care of the people who take care of us, especially nurses and how one nurse decided to explore that question through art.
Tara Rynders is a nurse at Rose Medical Center and an interdisciplinary artist created First Do No Harm, an immersive dance performance, after her own experiences as a patient led her to think deeply about compassion fatigue and burnout in the nursing profession. With the support of an arts in society grants Tara and a team of performers staged several performances at the end of 2018 that took audience members through the halls, rooms, and even the basement of the hospital.
It may seem like an esoteric topic but symptoms of burnout like [00:01:00] exhaustion, feeling removed from your work, and depression are unfortunately common among people who work in healthcare. Studies have found that anywhere between 4 and 10 and 7 in 10 nurses report symptoms of burnout. In 2017 the Colorado nursing center reported that more than 16 percent of the state's nurses left their jobs.
There are a lot of reasons why people burn out and we won't get into all of them in this podcast episode, but it's not inevitable. Studies have tied work environments, for instance, to levels of burnout among nurses. Colin Clark the director of the Colorado Nurses Association told me that the most frequent reason nurses reach out to her as to talk about taxing workloads in the shortage of nurses.
She said that burnout often leads people to leave the nursing profession all together, which could then put the nurses who remain in more challenging conditions. And when nurses are feeling burnt out their struggles often affect patients and their care that brings us back to Terra. We spoke in December about First Do No Harm and some of the experiences that have informed her as as a nurse and as an artist.
Jackie: So I asked you to come and join us today after I saw this immersive performance that you put on this fall at the Rose Medical Center. It was called First Do No Harm, and it was part of this artist residency you were doing at the hospital. So you're a nurse at Rose, nd then you had an experience that led you to want to create this piece or that was part of the reason that you created it.
Would you mind telling us a little bit about that?
Tara: Yeah sure. I had an experience where I was a patient and I had an ectopic pregnancy and it burst and I was in a pretty critical care for a bit there. Well when that happened. I just remember being a nurse you're So aware of your surroundings and what's happening and when you're in a hospital setting, and I just remember along the way at the [00:03:00] hospital. I was at the care that I received that was incredible, and then the care that I received that I felt wasn't incredible, and that made me feel bad in different ways. And so and then when it when they called a code yellow which is the code they call before a code blue which is when your heart stops, it's like you're almost there, because I was losing a lot of blood and I didn't have a blood pressure. And so they called a code yellow and everybody comes into the room. There's lab, there's doctors, it feels like there's just hundreds of people in there.
At that point I was passed out but I could still hear everything that was happening around me and I had a new nurse at the time. I remember when I started pass out that I called for the nurse and she came in and I was like, you need to call the doctor I have to go to surgery and she like looked at me and there's a moment she like didn't know what to do. She felt a little Frozen. And then I saw her just like click in and then she called this code yellow and so all these people came in. Then in the middle of that I was [00:04:00] it was just so scary because I knew that I was passed out and something was wrong, but I didn't know how to fix it because I wasn't in control at all and I just remember my nurse came over and she grabbed my hand and she whispered into my ear and said "It's going to be okay. I'm here."
And I just remember just feeling so grateful that she remembered me as a person. Because there's all these scary moments that were happening and you feel very forgotten because everyone's focusing on like the physical body and everything, which you have to but I really appreciated her taking that moment to care for me and yeah, as a person.
Jackie: Yeah, that's such a you know, a personal and intense moment. Has sharing that story been, you know as that been difficult to share that story as part of the origin of of this piece?
Tara: Yeah. I think it brings up. That is it really felt like it was a traumatic event for me. But I do believe that. [00:05:00] Trauma is healed through storytelling and sharing. So so I think every time that I share it there's a part of me that feels more healed by that and that yeah.
Jackie: Yeah. Well, thanks for sharing that because it really is just diving in with a very very bad, you know a personal moment. But so you were able to take that moment and kind of kind of go from that experience to to creating something a little bit bigger. So would you mind telling us a little bit about what this what this performance was all about?
Tara: Yeah. So after that experience, I just I realized how important nurses are. And as a nurse, you know, you're important but from a patient's perspective the nursing care that you receive is just it's everything. And you feel completely out of control and you're in the hands of another person, and you want really want to be able to trust that they are looking out for your best interests and I felt that and sometimes I didn't.
Ao I went on this deep research and what can we [00:06:00] do to give patients the best care every single time, with every experience that they have, how can we create that atmosphere and culture of care?
And what I realized is that for the most part a lot of our nurses are acting on, are performing from a place of emptiness of not being cared for themselves. And so it's really hard to bring that care to patients. So my research then led me into compassion fatigue and nursing burnout and self-care and what can we do to care for our nurses so that they can care for patients.
And so I wanted to bring awareness to it. And this is a really tough topic to bring awareness to because most nurses don't even realize that or they don't want to face that or yeah, so I thought the Arts - and I'm a a dancer and performer - really are the best way to bring awareness in my understanding and from my experience to issues because they break down walls. You don't have to [00:07:00] necessarily use words and I help people feel so I created this show I received a grant through the Arts and Society Foundation, and it was the Arts in Society grant that gave me funds to be able to work with the hospital to create a performance that spoke to these issues of compassion fatigue, burnout, grief, life, loss.
Jackie: Yeah, and something that was new new to me was that this wasn't a performance that was at, you know at a theater somewhere. This was in the hospital and just in those spaces and as an audience member you walked around through parts of the hospital. You don't normally go to you know, what's what sort of the power of having a performance in the space like a hospital where you're not going to normally encounter art.
Tara: Yeah, I think for me immersive theater is so important because you are immersed in the performance and that's why I chose that [00:08:00] medium and and it just felt like the right decision to do it in a hospital where it seemed very real. Everybody has an experience in the hospital and they're usually not great experiences that you bring when you walk into a hospital. It brings back memories of loss.
And so to be able to bring the all of those experiences that we've had alongside this experience that's happening in real time in the hospital and layering that with music and art and dance just those two like really complete opposites bringing them together for me was what I believe brings the healing in or allows people to feel and experience their past Hospital experiences in a new way through the Arts.
Jackie: Yeah. Yeah, I know for me. It was really interesting to be in that space and in a different capacity and just to see you see you through a slightly different perspective. Yeah, so. Over the [00:09:00] course of this performance, you're kind of walking through different species. You might see a dance you might see people act out a scene and some cases people were were speaking. So there were all kinds of different aspects of this performance and there's also a lot of different like emotions and things that were covered over the course and it's a one point you see a woman. Whose husband I think is just a heart attack and she gets a stack of paperwork and I think that's a really familiar moment and is both disheartening in a little bit funny because we recognize it and then there are also moments there's a moment of death in this in this place. So you really are going from like bureaucracy to just you know, the most these profound human experiences in the course of one performance. So, can you talk a little bit about how you decided like what you wanted to include in this and those different just aspects of life that happens in a hospital that you wanted to cover?
Tara: Mmm. Sure. So I partnered with Edith Weiss who [00:10:00] is a playwright in the an actress and director in the Denver area and we sat together and I gave her a lot of - we spoke a lot about the themes that I wanted to get across a lot, and a lot of that had to do with grief and loss were two major themes, but she does an incredible job of making real important issues and bringing humor to them so that they hit even harder and so together. We collaborated alongside two other directors Jad tank and Leah Bonfilio were also a part of creating this project. We had meetings together. We were she would write and then we would talk about it and say, oh we need more of this and she really focused on the relationship between the man and the wife so that Narrative of this wife coming to the hospital and finding out her husband had this heart attack and the intensity of that and then also I focused mostly on bringing in the nurses [00:11:00] perspective what it looks like from the nurses point of view. And then so a lot of the the reality of being in the hospital is the paperwork, is people treating you in certain ways because you're in a hospital but yet we're dealing with these really profound experiences like you said that people are having, but you do have to fill out paperwork and you have to maybe go to this other room way down the hall when they just took your husband the opposite direction and all you want to do is like be with him and know that he's okay, but now you're signing these papers and you don't even care to read it. But I didn't want to create a show in the hospital that was a play show. I wanted to bring up all the issues that we face in the yeah, maybe she does need a sign that paperwork. But is there a different way we can do that? Hmm?
Jackie: Another scene I wanted to talk about was the scene where a nurse is at a vending machine downstairs and she talks a lot about some [00:12:00] things that happen over the course of her day and you see her interact with this doctor and she also talks really directly about this idea that you brought up earlier about compassion fatigue. And so can you tell us a little bit about, you know, what compassion fatigue is and kind of why you had this nurse just sharing this moment at a vending machine and then talking about this, you know compassion fatigue, this big idea.
Tara: Yeah. Yeah, I think compassion fatigue for me is it's it's a buildup of everybody else's stories in life and you as a nurse carry all of that with you and at a certain point you can only carry so much. And can only hear so much, and can only feel so much. And so I think nurses start to stop feeling and so they end at the end of the day fatigue nurses are tired because they're not given ways to let those [00:13:00] stories filter through them or release them or they're not given ways or not finding ways to care for ourselves in the midst of caring for others so you can really only carry so much for yourself in another person.
And so you start acting from a place that isn't really authentic. You're not you. Stop listening completely. You start multitasking you you stop caring really and it's hard to see things from the other person's perspective in those in those times.
Jackie: Yeah. It's kind of an overwhelm and I think. I mean if I think about nurses, I know that as a nurse you're on your feet more than someone like me is in your day-to-day like you're physically tired as well. So that fatigue is kind of lot of components.
Tara: Absolutely. And if you imagine you have like five patients, so you go to your first patient and they have this big event they're dealing with and they talk to you for 10 minutes about it and how hard it is and you sit and you listen and yes and [00:14:00] then you go to your next patient.
You have to give the medicine and then they also unload on you, but you're still reeling from me be that first patient who was may be given five months to live. And then you go to your third patient. So it's just all builds up and you're holding trying to hold space for each person consistently and it can become a lot without given tools to process it all.
Jackie: And so, you know when you describe it it's hard because - that's part of what a nurse does is that listening and you're going to be encountering people at these hard times. So like, but I know you are doing, you're trying to find ways to maybe address that or support support people who are dealing with that is that can you tell us a little bit about what you think like, how can people work with that compassion fatigue?
Tara: Yeah, it's interesting because I think you know nurses that is what we do and we know we're getting into the profession for that reason because ultimately we want to make a difference and some of the research that I've read on compassion fatigue is a [00:15:00] lot of it is Nurses not feeling like they're able to do their job, they're not able to fully make a connection with their patients because of all the paperwork they have to fill out or because they're they have an idea for their patient that would really help them in that get shut down by their doctor or so. It's an also becomes an ethical issue where nurses feel like this is ethically what needs to happen for my patient, they need this to live to die, but there's not the resources. And so I feel like nurses feel shut down a lot from the care that they know their patient needs from all areas and what they're actually able to give them.
So. A lot of that for me is realizing first becoming aware of it. I mean aware what compassion fatigue is because usually by the time somebody realizes they're experiencing that they're already at burnout and when people are at burn out there looking for other jobs new professions there they are done with the nursing profession.
So so yeah, I'm interested in through this through first Do no harm and then also this other portion called the [00:16:00] clinic of how to through workshops work with the nurses to give them tools and resources for the self-care. But also in the moment how they can shifting slightly through mindfulness work and vocal work and working with actors and musicians to infuse the arts into their day as well.
Jackie: So those workshops are part at this is "The Clinic" that you're just going to sort of this series and its that all at rose, right?
Tara: Yeah at for now it is and then once we get this is kind of our this is our pilot. Yeah. Ma'am workshops in Pilot performance and then from here. We're hoping to travel it to other hospitals.
Jackie: Yeah, and so you're in an interesting role there were these are your colleagues probably who you're working with right? You you're working alongside them as a nurse and then your. Coming in and talking about these you know, how do we take care of ourselves? What's what has that been like?
Tara: Yeah. It's a little tricky. I think for the most part people know that it's coming from a place of care that it's not like [00:17:00] that. I really think the nurses -I mean and Rose Medical Center is probably the most incredible place to work like there's so much there. They're creating a wellness center for us a new fitness center for nurses for nurses and for their employees, a fitness center for just their employees. They're putting a ton of money into caring for nurses. So there's a real fertile ground right now and at Rose for this kind of work and I and the nurses know that I really appreciate and care all the work that they're giving and that what I'm trying to do is care for nurses. And that's not really there's not a lot of resources out there that care for nurses that a lot of it comes down to patient care. But so I think they understand that that's my intention and talking coming from a place of what are we already doing really well, which is a lot and how can we continue to do that and have the stamina to maintain that and not get burnt out.
Jackie: Yeah, and I don't so you just talked about something that Rose is doing but I do Wonder like through the research that you've. On [00:18:00] compassion fatigue and just your years of experience as a nurse, like are there things that you wish that or think that hospitals policy makers like people who are kind of looking at this big picture can be thinking about that might help address this his problem that you're seeing.
Tara: Yeah, I think one of the first things that I think every CEO should you and our CEO has done it multiple times and is to Shadow a nurse for a day to do it a or 12 hour shift with a nurse to really see and understand what nurses do because nurses we have it. We haven't developed the language around really describing what we do because a lot of it feels innate to who we are. We're nurturers. We we don't have this common language yet, which I think we're working on and that we need to and order to push the profession forward. But so at this point it feels important for people to know the kind of work that happens and with patience and. [00:19:00] I mean really simple things like making sure nurse gets her break.
So in a 12-hour shift, you're supposed to get a you get a 15-minute morning break a 30-minute lunch. And then a 15-minute afternoon break the morning and afternoon breaks never happen. So really in a 12-hour shift and nurses getting 30 minutes break and during that 30 minutes you have your phone with you at any time you could be interrupted.
So it's again that's to me. That's one way that as a hospital in policymakers could say no like nurses should get at least a 45 minute break within a 12-hour period and they should not have to be they should be able to go away and know that their patients are okay. There should be another nurse who comes in just to take care of those patients.
Yeah. So yeah, I think. For nurses to feel like they don't have time to go to the bathroom or they don't have time to drink water during their shift. It's those small places that I think are huge in making a change and [00:20:00] overall. I think the research I'm doing now, like what we can do to help compassion fatigue and burnout feels a little bit after the fact even though I can give you tools how to deal with it, but if you don't have brakes.
To implement any of this or if you you know, don't feel like you can go grab a quick sip of water. Yeah. How do you make a change in that?
Jackie: Yeah, and we're talking about this with nurses, but I'm thinking of people who I know who have gone through like medical residencies or that like yeah it in general.
It seems like sometimes there is I don't know it's part of the culture. It seems like it is and I that's where I feel like there needs to be a culture change because if we aren't caring for our doctors are you know that. Our nurses and anybody in between then how our patients really being cared for? Yeah, and just yeah it all trickles down this this makes me think of something that I just read recently on sleep in hospitals and how we often like interrupt a patient sleep over the course of the night and [00:21:00] how that might not necessarily be the best for their health, you know? Yeah, and so it's just it's interesting to think about these places for like.
How's the way that we're operating in helping in hurting Mmm Yeah, we're trying to help
Jackie: So I guess we talked a little bit about what you've been hearing from the workshops, but just for that initial performance piece or there any reactions that you got to that from within the hospital from your audiences from your performers that really stuck out to you.
Yeah, I think for me the biggest thing that stuck out was the nurses who came really felt that their that they were seeing and heard that their story was being told and that this compassion fatigue that they feel is real and they felt like the performance did a good job bringing awareness to that and telling their story for them and.
Yeah, and [00:22:00] they they were really moved by it. A lot of there's a lot of Cheers throughout the evening for the for the show in general. But by the nurses just to kind of see themselves reflected back and in the all the positive ways of basically nurses. And being superheroes and running and doing all of this work yet at the same time holding space for people as they're trying to heal and then also get being very tired and having their own families at home that they're tending to and so I think overall the feedback was very positive and nurses felt really seen and heard.
Jackie: Yeah. That's great. So I know there's not like one message to this piece or to the work that you're doing and we've already talked about a lot of the things but like do you feel like this is part of trying to start a conversation on these topics, or was there something that you were really, you know, hoping to communicate through it?
Tara: Yeah, I think. There's lots of things. I was hoping to communicate and [00:23:00] there are so many different narratives happening within the performance that I hope that people who come from different walks of life. Not even the medical field at all are able to kind of hang their hat on something along the way but ultimately it's a story about loss and.
You know, we don't life. So there's a line in the performance that Edith wrote. This is death doesn't need an invitation and that it's so frail Anything could happen at any time in our lives, but also adding that life doesn't need an invitation that a lot of the choices we make our choices the professions we do what we decide not to do and do instead.
That's really our time here can be so short and limited and. To be aware of that and I guess Choose Wisely and how we spend all her time and energy and and. yeah, and at the end of the day when someone's [00:24:00] dying that the wife had a lot of regrets that she didn't really share who she really was with her husband, and she felt like she was pretending a lot and she wanted to redo she wanted to.
You know start again and be able to be more honest and live this you know, what she was thinking could be this beautiful new relationship with her husband, and he was dying in that wasn't going to happen. But I just wonder how many of us, you know, being put in her situation what our regrets would be and and sometimes it feels impossible to know and sometimes I think we do have it an inkling of what that might be and to try to follow that and make some shifts in our life.
Jackie :Yeah. We could just leave the conversation there. But the one other thing I did just want to ask about is this idea of you're a nurse and you're a performer at the same time and I just I just wonder if you have any thoughts on how those [00:25:00] two things have kind of intersected for you. I know that's a that's a big question, but did just any any thoughts that you would want to share on kind of those two parts of your experience.
Tara: Mmm. Yeah, they seem very similar to me. Yeah, especially because the art that I'm interested in through movement and performances immersive theater and immersive performance. So I do a lot of one-on-one performances had a project called you and me that I did for many years and toured and and all of that was based on these one-on-one interactive performances with one performer and one guest at a time and it was based out of a situation had when my sister got sick and I was her sole caregiver for many months.
And we were living in this Rehabilitation Center together and it was like one of the most horrific times of her life and my life but yet there were so many real tender beautiful moments that I was able to share with her and caring for her and she [00:26:00] couldn't move so I would bathe her and she couldn't speak so I would speak for her for to the nurses and all everyone involved in her care.
And so I just I wanted to create a show for this you and me project that gave a glimpse of this. One-on-one intimate experience. So there's a bunch of different installations you go to that great these intimate moments. So in some ways that to me was also setting up like. A almost like an emergency room.
So there's all these little installations where it's just you and one other person. Whereas when you come into the hospital, it's just you as the nurse and the patient having these really intimate experiences around this person's health, but you also find out so much more and so I think immersive theater and nursing.
Really hand and goes hand-in-hand because while immersive theater is so popular now because it's very much the actor coming alongside you you're [00:27:00] involved you're seeing is a performed as a guest your heard your part of the story and that's what nurses do they come alongside their patients. They see them.
They hear them they care for them an audience member feels really cared for an immersive theater. So I think they're very much one in the same. And yeah, I've never thought about it like that, but that's that's really fascinating. Yeah. I'm excited to explore that more. If I don't really think I have the words yet to release a how similar they are but yeah.
There's sounds like there's something there. Mmm.
Jackie: Yeah, and so just speaking of what your I was wondering if there are ways that people who might be listening could either you don't learn more about what you're doing. If you're planning on following up on this work. It sounds like you are about with health and performance around just what should our listeners be like looking out for from you coming up.
Tara: Yeah. We're I'm hoping to have a couple hospitals interested in setting this piece in their hospital. So. We're probably be [00:28:00] shifting it a little bit based on the location in which in the hospitals, but will be resetting first Do no harm for sure. Most likely. Maybe as soon as a spring but most likely next fall and taking the workshops out to other nurses and I just think it would be so helpful to be able to bring this project to all the Denver metro area and hit all the hospitals and just bring awareness to compassion fatigue and care for our nurses and really give them tools and resources to help them care for themselves.
Jackie: So yeah, so hopefully they'll have they'll be more chances to see this performance. Yeah I thank you so much for coming by today. I really enjoyed talking with you.
Tara: Thank you Jackie.
Jackie: Thanks Tara for joining us. She's a nurse and an artist whose performanceFirst Do No Harm premiered last fall at the Rose Medical Center. It's worth noting that there are a lot of efforts to address burnout by nurses and nursing [00:29:00] organizations by Healthcare systems and in some cases by policymakers Rose Medical Center for one has opened a new Wellness Lounge in 2019 for its staff a link to an article about it in our shows.
Colleen Casper at the Colorado nursing association mentioned the Watson caring Science Institute a nonprofit focused on Nurse retention and the magnet Hospital recognition program which helps identify hospitals with better work environments CNA is also hoping to get better data on Nurse turnover and other issues that might come along with it in Colorado and in Washington.
The American Nurses Association has pushed for laws focusing on workplace safety and appropriate Staffing. We're not doesn't only affect nurses a study released this month by the Stanford University School of Medicine the Mayo Clinic and the American Medical Association found that 44 percent of doctors experienced at least one symptoms of burnout.
So these are important questions for people who care about the people who make up our Healthcare System to think about. [00:30:00] Did you see first Do no harm. Do you have thoughts on burnout and compassion fatigue among nurses in Colorado email us or send a voice memo to podcast at Colorado Health Institute dot-org.
You can find more episodes of the checkup at Colorado Health Institute dot org slash podcast, and we're also on iTunes Stitcher Spotify and anywhere you listen to podcasts in the meantime, you can find us on Twitter and Instagram it co help insist. Thanks for listening and Jackie Zubrzycki at [00:31:00] CHI.