Coping with burnout in healthcare

Tackling stress in the workplace will lead to healthier and more committed employees, writes SYLVIA THOMPSON

THREE OUT of 10 health professionals have symptoms of burnout, according to Ursula Bates, principal clinical psychologist at the Blackrock Hospice in Co Dublin.

Bates says that burnout has three identifiable characteristics: exhaustion, depersonalisation – where the stressed person seeks to distance him or herself from emotional contact with others – and the loss of personal accomplishment at work.

“Burnout is on one end of a continuum and resilience is on the other end. Those who suffer from burnout are physically and emotionally exhausted,” says Bates.

“They have trouble getting out of bed in the morning. They have a poor sense of self at work and in a healthcare setting, there is a loss of empathy in that they lose the capacity to feel for the patient.

“The problem is when you are stressed out, you keep your eye on the negative. It’s a survival instinct really: when we are tired or in danger, we scan for negative information. But long-term stress leads to burnout and indifference.”

Research has shown that young female doctors are the most stressed out health professionals. “This is mainly due to juggling roles of wife and mother with working in a competitive profession,” says Bates.

“We need to mentor young people in the workplace and these mentors shouldn’t be those with a managerial role,” she adds, suggesting that older, more experienced nurses are well placed to provide emotional mentorship to young doctors.

Prof Ciaran O’Boyle, head of the Institute of Leadership and Healthcare Management at the Royal College of Surgeons, says that managers need to level with their staff in tough and uncertain times.

“When work is unpredictable, it’s more stressful. Managers who learn how to lead, motivate, handle conflict and plan ahead will significantly reduce stress in the workplace. The payoff is that the individual’s health is a lot better as is the quality of their working life,” says O’Boyle.

Bates says that stress and burnout need to be dealt with on a personal level and at organisational level with employment assistance programmes, communication training and clear and transparent management processes.

Researchers have found that workers with high levels of resilience are the ones who have personal goals and a sense of purpose, which is often helped by one key relationship.

In the broad area of positive psychology, there is even a psychological theory of resilience. It suggests that life with all its ups and downs is to be embraced and that coping with risk and bouncing back from adversity are positively good for us.

One researcher, Karen Reivich, defines the seven learnable skills of resilience as emotional awareness, impulse control, optimism, causal analysis, empathy, self-efficacy and reaching out.

Bates says in these current difficult times, people will stay well if they set themselves small, achievable personal goals and have clear intentions about their work.

“We need to look ourselves in the mirror in the morning and say, ‘I choose to go to work today and I feel I will do a good job’. My experience in the health services now is that – in spite of all the negative media stories – there is greater co-operation and role blurring. People are supporting each other more.”

O’Boyle says that the most important issue is that the workplace provides people with a sense of meaning and that it plays to their personal strengths. He points to the growth of the positive psychology movement (authentic happiness.com) in the US and how it has influenced approaches to stress management.

Writing recently in The Irish Times’ Innovation magazine, management consultant, Marc Timmerman says that workers nowadays are suffering from economic battle fatigue.

“Employees are asked to work harder, perform better and deliver more in order to help the company survive and save jobs. It could be compared with sending your best soldiers to Iraq in 2009” and then on to Afghanistan, he writes, adding that employers should be wary of pushing their top performing employees too hard.

Meanwhile, back on the real battlefield, the US army is teaching its soldiers resilience skills before they are deployed. The programme will provide training across five key areas: physical, emotional, social, spiritual and family. The aim is to prepare soldiers for the psychological challenges they will face and ward off rising rates of suicide, substance abuse and post-traumatic stress disorder among the military.

In the healthcare area, a study of resilience and wellbeing among nurses working in palliative care found that those who were most resilient had high levels of commitment and sense of purpose about their work.

The key thing to remember, according to Bates, is that resilience can be learned and learning it opens up possibilities of greater personal self-mastery and freedom in these challenging times when work is becoming more stressful.