1. Bartol, Tom APRN

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Healthcare has been changing. The way we perform our job is different and, for some, has felt less rewarding. Electronic health records (EHRs), patient-centered medical homes, meaningful use, accountable care organizations, and ICD-10 have influenced how we practice, with more outside forces telling us what we must do. The efforts toward improving quality, cost, and patient experience have sometimes resulted in the collateral damage of decreased clinician job satisfaction or burnout.

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Technology has changed the way we work as well, adding a computer to the clinician-patient relationship and affecting how we interact with each patient. EHR has also invited work into our home life, enabling and facilitating working at home after hours, something that was not as feasible in the days of paper records. Technology has positively and negatively changed the balance between work and personal life for many clinicians.


Challenges to job satisfaction

Healthcare can seem less autonomous and more directive, with formularies, protocols, and prior authorizations that influence our practice. Financial pressures have led to pay-for-productivity models, in which our salaries are calculated based on the number of patients we see. This can be a motivation to try to see more patients in shorter visits. Clinicians are "watched" more, tracked more, and evaluated more. Administrators measure what we do and how we do it. "Data fatigue" can set in, as we are given many reports showing different statistics about our work and performance. In the past, our biggest challenge may have been seeing a difficult patient, but now, it may be the latest EHR upgrade.


The challenges to happiness and satisfaction at work may also come from a coworker, colleague, or administrator. We may find it hard to work with some people. Personality differences, practice styles, job demands, or feeling unappreciated can challenge our job satisfaction.


It is tempting to walk away and find a different job, and some NPs do that. Sometimes, the new job is no better than the old one. Burnout in healthcare has become a major issue. Our patients can tell when we are not happy. It is hard to facilitate hope and healing when we do not enjoy our jobs. Not feeling happy at work can even affect our health.1 One of the things I ask every patient at a physical exam is, "Are you happy?" Not being happy is probably a greater health risk than high cholesterol, high BP, or obesity, and it may be a factor in causing them. So how can we take care of ourselves and find happiness in our own work?


If you are not as satisfied or happy with your work, consider making some changes of your own. A change in your attitude or perspective may be the single best thing you can do. It is easy to grumble and complain about what is wrong. Oscar Hammerstein II, the well-known lyricist once said, "It's a modern tragedy that despair has so many spokesmen, and hope so few." He goes on, "The unhappy man is more communicative. He is eager to recite what is wrong with the world, and he seems to have a talent for gathering a large audience."2 Negativity can metastasize throughout an organization, and our own negativity only brings us down. It is important to avoid negative talk and complaining and to instead look for the positive, for the strengths and solutions, even in the changes or in the people we might not find so positive, which can lead to more positive feelings and changes. By focusing and speaking on positivity, you will find your own attitude and perspective change.


Relationships can be similar. If your personality, practice style, or philosophy grate with a coworker, it is easy to complain and criticize. Try to eliminate defending, blaming, justifying, comparing, and criticizing from your interactions. The energy is better spent on finding solutions and building connections. Try to find something you appreciate in every interaction, and share that with the other person. The words, "I appreciate..." will be a gift to the other person but will also change your perspective. The more we appreciate, the more we find to appreciate.


Opportunities to make work meaningful

When your work is challenging, try to look for opportunities to make it more meaningful. These opportunities are all around us, though they may not be obvious at first glance. It is easy to "follow the herd," as I call it, doing what everyone else is doing, rote work, without understanding or questioning the implications. If we all keep "following the herd," we may all one day fall off the big healthcare cliff together! Instead, look at what is happening, look at the goals your practice is seeking, and see if you can find creative and innovative ways to achieve them. Ask questions, try to understand the evidence behind what is being asked, think about the patient's perspective, and consider different approaches. Keep your focus on the patient. Ask each patient, "What matters most to you?" at each visit. It is easy to get wrapped up in what we are "supposed" to do, and we may miss out on what the patient really wants or needs. Dare to try new things that help you to provide better patient care and bring more meaning to your work.


Autonomy brings job satisfaction as well. In these days of quality measures and care guidelines, our work may feel routine, rudimentary, and almost like following a cookbook. But when cooking, I find the food tastes better when I use the recipe as a framework rather than following it exactly. Each patient is an individual with individual goals, values, and needs. Sometimes, it is ok to just leave a box unchecked and to connect with your patient based on what is happening in his or her life at that time. Our patients need so much more than disease care and are open to new and unique ways of helping them to be healthier. Patients thrive on a relationship with their healthcare provider, a relationship that goes beyond the medical issue. Use your autonomy to build relationships with patients. It is the relationship, instilling hope, and confidence that motivate and heal.


Autonomy and increased job happiness may be found in learning a new skill, technique, or procedure as well. If anemia has always confused you, consider learning more about it and becoming the expert on anemia in your practice. Maybe it is a new procedure you could learn and offer. Identify what you want to do, learn about it, find a mentor, take additional continuing-education courses, and build your own niche where you become the expert.


Beyond our paycheck

Tangible rewards are also a key to making our work meaningful. Compensation has changed, and it is easy to get wrapped up and set back by today's compensation systems. For many, there is no more salary, and the paycheck is based on the number of patient visits or a percent of revenue generated. This can get us hooked into a system of trying to see more patients in less time, which leaves us feeling hurried and pressured. I bought into this for a while and was a top "producer," but I found my job incomplete. Something was missing. I felt tense and did not really get to know my patients or get to the heart of their issues.


The pay structure then became an opportunity for me. I was not required to see a certain number of patients, so I chose to see less, changing to 30-minute appointments, effectively taking a pay cut but finding more satisfaction with patient care. I got to know my patients better, had time to hear their stories, began using more shared decision-making, and involving patients more frequently in their care. The tangible reward came from my patients. They were grateful for the time and care they received, and I began to see them making more positive changes in their lives and becoming healthier, more active participants in their health.


Finding passion in our work

Healthcare needs something more-it needs passionate NPs who love their work and offer something unique in their practice. We can fall into the rut of healthcare, or we can create a future that is different. It is easy to continue the status quo, but we need to do what we do as nurses: Assess the problem and come up with a plan and a solution. Each of us working in new and unique ways will help transform healthcare. When we do this, we find more meaning in our work.


It may not be the time to look for a new job when our job satisfaction is decreasing. Perhaps we should change our attitude and perspective and seek the passion that brought us to become NPs. Look at these changes and challenges as opportunities for growth, transformation, and for discovering a new perspective. The challenges (as well as successfully navigating them) can bring us joy and satisfaction. Dare to be different, creative, and to find new ways to practice-to make your work meaningful. Healthcare transformation and innovation will happen because we find passion in our work and keep the patient, the patient needs, values, goals, and desires at the center of our work.




1. Graham C. Happiness and health: lessons-and questions-for public policy. Health Aff (Millwood). 2008;27(1):72-87. [Context Link]


2. PRX. This I Believe-Oscar Hammerstein II. [Context Link]