Not Just a Personal Problem, Practitioner Burnout is a Public Health Issue

What can you do if you are feeling burned out?

Dr. Marnie Loomis Dr. Marnie Loomis This is not just a personal question; it's one that has profound implications for patient care. As research reveals more about the negative effects of professional burnout on patient outcomes, medical mistakes, practitioner health, turnover rates and even practitioner suicide, it is increasingly evident that burnout poses a serious risk to patient safety.

In a profession where altruism is highly valued, it can be easy to fall into a pattern of self-sacrificing behavior. It's a slippery slope. Self-sacrifice, especially within a stressful working environment fraught with heavy workloads, emotional trauma and administrative hassles, can lead to damage that puts us and others at risk.

We can no longer afford to think of burnout as an individual problem. As a profession, we already follow universal safety precautions designed to protect us as well as our patients. We wear gloves, we properly dispose of sharps, we wash our hands. What if there were similar safety precautions to prevent clinician burnout?

Many articles focus on the prevalence or the financial impacts of burnout, but it can be difficult to find information on the steps an individual can take to prevent or recover from it. Articles like Massive Survey Shows Many Clinicians at a Breaking Point and Why America's Nurses are Burning Out are helpful, but without practical tools to combat the problem, it will inevitably persist.

Like any medical condition, learning to diagnose the problem is an important first step. If every practitioner learns to recognize the patterns of physical and cognitive fatigue, depersonalization, cynicism and reduced sense of self-efficacy associated with burnout, they can at least say to themselves or their colleagues, "I'm burned out."

But then what?

It was this question that sparked a conversation between myself, a naturopathic physician, and Beth Genly, CNM, a former nurse-midwife and nutrition expert. We had both experienced burnout. We had both worked in clinical, educational, and administrative roles and had watched many of our best and brightest colleagues leave the profession due to burnout.

We reviewed the literature and found a trend: there seemed to be key aspects within an individual's control that determined susceptibility or resilience to burnout. These appeared to fall within five major areas. If someone is strong in these areas, they can insulate themselves against burnout. If they were weak in these domains, they are much more vulnerable.

The five "burnout insulators" are:

  • Reflection and Recognition: How often are you reflecting on accomplishments and the meaning inherent in your daily activities?
  • Self-Care: Are you meeting your basic health and hygiene needs? This can include adequate sleep, good nutrition, hydration, and management of physical and mental health problems.
  • Coping Styles: Are your coping styles suited to your situation? Do your current coping styles reduce overall stress or simply distract from it? Will your coping methods ultimately add new stressors to your overall stress load?
  • Community: How are you interacting with others in your professional and personal communities? Are these relationships supportive or do they add to your overall stress load?
  • Structure: Are you aware of the burnout risks inherent in your current situation? If you are a high-risk individual in a high-risk environment, then the factors that are within your control become even more important.

These five "insulators" are distinct from the well-documented Areas of Worklife described by Michael P. Leiter and Christina Maslach. In their book, The Truth About Burnout, they define the main qualities of a work setting that play a role in determining whether employees experience a sense of engagement or burnout.

While it is certainly helpful to know the Areas of Worklife, and therefore which aspects of a work environment most contribute to burnout, this information seems most useful within a large organization.

We believe that a person's life outside of the workplace can contribute to burnout or help insulate someone from it. Therefore, we want to focus on these other essential aspects. Most of us in healthcare can't afford to wait for our work environments to change for the better!

The Reflection and Recognition insulator highlights the important role that reflective versus reactive brain function plays. Neurologist and educator Judy Willis, MD, gives a beautiful overview of these details in her article How to Rewire Your Burned Out Brain, Tips from a Neurologist. Dr. Willis explains how the act of recognizing accomplishments and reflecting on what we find meaningful rewires our brains for resilience.

Along these lines, multiple studies have shown that a mindfulness meditation practice can help reduce the incidence or severity of burnout. Even a short daily practice of reflection, for example, asking oneself, "What happened today that reflects the reason I went into this field in the first place?" can make a significant impact.

Self Care can be especially hard for healthcare workers to face. A good image to keep in mind is the oxygen mask on an airplane. The instructions from the flight attendants are always the same: place the oxygen mask on yourself before attempting to help anyone else. The same is true for the care of our own bodies. It is essential that we take good care of ourselves so that we will be able to continue taking care of others.

Of all the areas of self-care, sleep seems to be one of the most important. Insufficient sleep is one of the main predictors of the development of burnout, so preserving sleep quality and quantity is extremely important for protecting oneself against burnout.

Coping Styles, like any other skill-set, can be learned and targeted. Individual coping styles are sometimes difficult to define as "good" or "bad" because their usefulness really depends on the individual and the situation.

One type of action-oriented coping style involves addressing a problem and creating a plan of action.

This can be helpful in many situations, but for someone who is already overburdened, the addition of one more "action" item only adds to the stress. This person might benefit more from reframing the problem so that it doesn't have the same emotional impact.

In burnout research, one coping mechanism stands out as a clear negative: venting.

The study Coping with Stress and Types of Burnout: Explanatory Power of Different Coping Strategies goes as far as labeling venting, or the perception of continuous complaints by colleagues, as a type of "contagion mechanism" for spreading the burnout syndrome to others.

Community is an essential element in our protection against burnout. The people around us can offer perspective and assistance with the problems we face, as well as moral support, and a sense of belonging. On the flip side, if we are in conflict with coworkers or with people at home, we are more likely to feel exhausted and develop burnout.

Some questions to ask yourself in relation to your community: Am I comfortable asking for help? Do I know how to delegate tasks when appropriate? Do I have effective conflict resolution skills? Do I have a mentor or peers?

Structure On an individual level, you may be more likely to burn out if you are introverted, highly sensitive, and if your sense of self is strongly tied to your work performance or work identity.

On an organizational level, there are many factors that can increase vulnerability to burnout. You may be more likely to burn out if you are given an excessive workload without the resources necessary to do that work. Likewise, burnout risk increases if you don't feel your workplace is fair, if you don't feel your personal values are aligned with your organization, or if you are simply not clear about what is expected of you.

These structural aspects may be outside of your control, but your awareness of them is important. Knowing these things is like driving in bad weather. It is helpful to know details about the road conditions as well as the type of vehicle you are driving. This information affects how you choose to go forward.

As you start to develop your own plan for burnout insulation, consider how well you are protected in these five areas, then test different strategies and make note of the effectiveness of your strategies.

We encourage a dialogue among our colleagues and look forward to a greater recognition of burnout and the importance of protecting the medical workforce against it.

We have a responsibility to ourselves and to our patients to adopt a culture of safety around the prevention of our own professional burnout. Each of us is too important to burn out!

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Dr. Marnie Loomis and Beth Genly, CNM, are cofounders of Burnout Avengers, LLC, a consulting group that identifies the ways professional burnout may be affecting organizational productivity, safety and turnover rates. We guide employees through our unique training programs designed to empower the individual to create practical work/life strategies that insulate against burnout, resulting in a more resilient and cost-effective workforce. Before founding Burnout Avengers, Dr. Loomis was in private practice in Aloha, Oregon and was an instructor and administrator for the National College of Natural Medicine in Portland, OR.