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Nurse Practitioner Burnout: You Can’t Serve From an Empty Cup


Vanessa Pomarico-Denino talks to AANP about exercise, stress and burnout.

Beginning June 28, nurse practitioners (NPs) who wish to experience the 2023 American Association of Nurse Practitioners® (AANP) National Conference remotely may access AANP’s online-only platform. Through the online option, NPs can earn up to 80 hours of continuing education (CE) while taking in a number of presentations on a diversity of topics from allergic reactions to grief.

If your interests include enhancing NP wellness and preventing burnout, “Caring for the Caregiver: Wellness and Self-care for NPs” by presenter Vanessa Pomarico-Denino, Ed.D, APRN, FNP-BC, FAANP, is one opportunity for CE you won’t want to miss. AANP spoke with Dr. Pomarico-Denino about self-care, stress and the importance of investing in oneself.

Q: Could you tell us how you became an NP and where that path has taken you?

Dr. Vanessa Pomarico-Denino: I took the very long route to become a NP. I started out as a medical assistant and went to an associate degree program to get my undergraduate nursing degree. From there I got a bachelor’s degree, then I became a family nurse practitioner (FNP) and then — after being an FNP for many years — received my doctoral degree in nursing education. My background really was in gynecologic oncological nursing, and while I was in nursing school, I supported myself by teaching group fitness classes and was one of the first spin instructors in the country.

Fitness has always been really important to me, and after I became an NP doing rounds in the hospital, I couldn’t really teach classes anymore — but exercise was something I always did, and always encouraged my patients to do.

Q: What about the topic of stress interests you? Has your understanding of stress helped you avoid stress, or do you still struggle with it?

Pomarico-Denino: Exercise has always been a means for me to be able to control my stress, and I know that when I don’t do it, my body’s endorphin level decreases — and I feel it. But yes, I still get stressed out. When I do get stressed, I find a positive way of trying to get rid of the stress and to defuse it a little bit. I find myself to be calmer when I am exercising on a regular basis.

On days when I travel and I’m not able to get in my regular exercise, I’m the person that’s walking through the airport getting my steps in and trying to get my heart rate up before my flight. There’s always a way of working in your exercise.

When the pandemic hit, I added a different layer onto how I managed my stress. I started doing meditation, which was something I never thought I’d do. I have a pretty Type A personality and for me to just sit quietly…I’d be making grocery lists in my head or thinking of the million things that I needed to do — all the things that were sitting on my desk, all the tasks and projects I needed to complete.

I realized the pandemic wasn’t really going anywhere, so that’s what really made me sit down and start doing some of these meditations. I’m not one to sit and meditate on my own — I need somebody to kind of guide me through it because I’ll get very distracted — but it really made a big difference, again, in how I’m able to manage stress in my day. Sometimes when there’s just a lot going on in my office, I’ll walk away, go sit in a lunchroom for five minutes and do a little bit of breathing. It’s been very beneficial.

Q: Your presentation discusses self-care as a strategy for overcoming stress. What would you say to NPs who might say they don’t have the time for self-care, or who even feel that self-care is indulgent when patients and family members may be in need?

Pomarico-Denino: I always tell people that if we can’t take care of ourselves, it’s really difficult to take care of other people. And let’s face it — we’re in health care, our job is to take care of other people and that can become very draining when we’re giving so much of ourselves.

Eleanor Brown is an inspirational writer from California, and she always says you can’t serve from an empty cup. It’s probably one of my favorite quotes because it’s so true. We give and give and give, but we don’t do anything to refill our own cup.

I’m not telling people that they need to exercise for 60-90 minutes a day. I’m telling people to do something that’s going to take you away, to remove you from day-to-day work responsibilities and family obligations. If you can’t find 30 minutes for yourself three times a week, then there’s something really wrong with the schedule.

I’ve had people say to me, "I have a family, I have elderly parents to take care of, I work a full-time job, I’m going back to school…I don’t have time to exercise." I always tell them that’s the time when you really do need to exercise, because that is what is going to help you relieve your stress.

You have to invest in yourself and realize that you are that person that really needs to take the time to replenish your cup. Take care of yourself and you’ll see how much better your patient care is going to be.

Q: Could you speak about the connection and difference between stress and burnout?

Pomarico-Denino: Stress and burnout are two separate things, but they definitely coexist. Stress can lead to burnout, and burnout is when you get to that point where you don’t find joy in what you’re doing anymore — you don’t get excited about going to work and taking care of your patients, you might be a little short with patients, your staff may start to realize that you’re not quite the happy person you were before. Burnout really can overtake who you are, and that’s when people leave the profession.

I had been at a practice for thirteen years and it was not a good place to be, but the jobs in my area were not very plentiful and I thought that the grass may not necessarily be greener on the other side. I was working a late night, and one of my favorite patients came in. I was going through the visit with her, and at the end she put her hand on me and she said, “I just want you to know that tomorrow is going to be a better day.”

I actually cried on the way home that night, and I thought, “I need to do something different. I need to get out of here because my patients are starting to realize how burnt out I am.” It was because of her that I made a phone call and I found a new job within a matter of weeks — a job that I didn’t even know was around. Had my patient not said something to me, I might have missed that opportunity to be in the practice where I am now, where I feel valued.

After I signed my contract and told my husband that I was leaving the other practice, I called the patient and said to her, “I’m calling you before I even give notice to my job…but thank you. I’m sorry." She said, “I’ve been with you long enough to know that you’re normally pretty happy and outgoing, and I could tell that you were just really broken down.” Now every time she comes in, she always gives me a big hug and says, “It’s so nice to see you back to the person that you are.”

Q: Is there anything else you would like to add?

Pomarico-Denino: I can’t impress upon people enough how important it is to invest in yourself. We all get caught up in schedules and we’re constantly working against the clock, but we have to make ourselves a priority. If we don’t make ourselves a priority, the ripple effect on everyone around us is going to be apparent. You have to do something to carve out that time to invest in yourself, because if you don’t invest in yourself, that’s when stress happens and that’s when burnout happens. We’re losing really great clinicians as a result.

Learn, Network and More at the 2023 AANP National Conference — Online!

Make sure to join your colleagues for educational sessions on NP wellness, burnout and much more at the 2023 AANP National Conference — Online! Earn up to 80 contact hours of CE credit from the comfort of your own home from June 28 to Aug. 3.

Register Now