As nurses, we're responsible for retrieving, retaining, and recording complex information from people, devices, and clinical systems. When we take in more information than our working memory can handle, our brains go into a state of cognitive overload, impacting our well-being and creating a breeding ground for errors. So, how can you protect your brain power and keep patients safe? Let's find out.
In our profession, working memory translates to how many diagnoses, allergies, vital signs, and test results you can manage for every patient in your care while still performing your duties. It's akin to how many rings you can successfully juggle while tap dancing. You reach cognitive or mental overload capacity when you've got too many rings to keep up in the air.
Multiple Demands on Nurses During a Single Shift
Consider an average day shift in a medical nursing unit. Two nurses called in sick, making you accountable for 10 or 12 patients instead of your usual eight.
Whether you're the team lead or the primary nurse, you're responsible for getting report from the night nurse, assessing each patient, answering physician questions, keeping track of new orders, and receiving laboratory results.
On top of that, you're administering medications, communicating with other healthcare disciplines, doing several dressings, and responding to emergencies. Meanwhile, unit phones are ringing, family members are asking questions, and your cell phone is buzzing in your pocket.
And don't forget charting—the icing on your mental overload cake. You chart on one system, retrieve vital signs on another, and record a blood glucose reading from a third. Then adding insult to injury is that your electronic health records and medication delivery systems don't interface and require separate sign-in passwords.
There's a lot of mental processing going on in this day-shift scenario, which can be broken down into three cognitive load types:
1. Intrinsic cognitive load is the mental effort you need to expend to complete a task. Personal factors, such as poor sleep hygiene, can negatively impact this cognitive load.
2. Extrinsic cognitive load is the mental effort your work environment demands. You have little control over this cognitive load, resulting from factors such as noise levels and physician demands.
3. Germane cognitive load is the mental effort you must expend to make sense of new information. For example, a germane load is receiving a lab value with no context and using another system to retrieve past values so you can understand the full picture.
Did you know you can only retain about three to five chunks of information pertinent to the task you need to execute? Is it any wonder you're suffering from mental overload and find yourself making mistakes or missing nursing care?
Long-term Effects of Mental Overload on Nurses
The worst part of mental overload is knowing you don't have enough mental capacity to do your job well, which causes emotional and mental distress and may lead to burnout.
There is both a personal and professional cost for mental overload. Nurses walk away from the job they love, their physical health is negatively affected, and it may take months or even years to recover from mental burnout.
Mental overload also impacts patient safety, with distraction playing a role in approximately 75% of medical errors and that cognitive overload is a cause in 80% of medical device user errors. In addition, nursing procedures are poorly executed or missed altogether.
6 Tips for Managing Mental Overload
You don't need to succumb to mental overload. You can learn coping strategies and stress management techniques to help you better manage your work memory and preserve your brain power.
1. Plan your day. You cannot keep every patient's name, diagnosis, allergies, and required care in your brain. Does your healthcare organization allow tablets and patient management apps? If not, use a pen and paper to list patient names and pertinent information. If a physician has a question, you'll have the answer at your fingertips instead of trying to retrieve patient data from memory.
2. Decrease memory burden. Don't overload your mind with information that can be charted promptly. This way you don't have to remember numbers, details, or context several hours after an incident. If you don't have bedside charting, write the vital signs on your tablet or paper.
3. Put your cell phone on ‘do-not-disturb'. By doing so, you won't feel obligated to look at your phone every time it buzzes, but your family can still reach you if they have an emergency. Don't look at your phone unless you're on a break. Each message you read becomes part of the information swirling around in your working memory, using up the memory bytes you need for your job.
4. Advocate for your team. If you're a nurse manager or team lead, it's your responsibility to recognize and reduce the burden of cognitive/mental overload from your staff. Reduce triple charting. Advocate for bedside charting or provide quiet areas for nurses to chart.
5. Practice self-care. You need to take care of yourself. Take the time to exercise, eat healthy, and hang out with friends. Take your days off to rest and recharge. Refuse extra shifts if you're feeling overworked and stressed.
6. Seek mental health support. Learn to recognize burnout symptoms and practice stress management strategies such as joining a peer support group. Consider hiring a career coach to explore other channels of nursing if your workplace isn't a good fit.
Mental overload in nurses is very real and needs to be acknowledged. It contributes to nursing errors, emotional and mental distress, and can lead to burnout. However, recognizing it is the first step to finding a solution. Raising this topic in a group of nurses will spawn some excellent conversation and an opportunity to develop a plan of action.