Putting the “Care” in Healthcare: Burnout in Healthcare

What is burnout?

Stress is an inevitable aspect of any job. It’s often categorized into distress (i.e., “bad” stress) and eustress (i.e., “good” stress). Eustress is healthy and occurs in moderate, brief amounts. It can happen when we are excited, such as when starting a new job. It also provides benefits such as increased alertness and mental performance. However, when stress becomes chronic, these benefits disappear, turning into distress. Distress can cause workers to suffer from “burnout syndrome.”

Burnout has three characteristics: emotional exhaustion, cynicism, and reduced personal achievement. Emotional exhaustion is when we feel drained due to intense psychological effort, leading to physical exhaustion. Cynicism is a feeling of detachment from a job or job’s purpose, leading to irritability and negative attitudes towards the work. Lastly, reduced personal achievement refers to how one may feel inadequate with their performance, which may lead to a real decrease in productivity.

Although those characteristics are similar to depression, burnout and depression are two separate issues, as burnout specifically relates to occupational tasks. However, burnout, depression, and anxiety often occur simultaneously. For caregivers, this leads to negative quality of life and impaired care. In more severe cases, burnout may lead to further issues, such as alcohol abuse and suicidal ideation.

Why should we focus on healthcare workers?

Healthcare workers face severe stress simply due to the nature of their work, putting them at risk for burnout. For example, some doctors and nurses in hospitals care for critically ill patients for 12-hour shifts. Similarly, professional caregivers in nursing homes may deal with aggressive residents on a daily basis. Other unpredictable health problems may emerge at any moment. Healthcare workers deal with all these stressors while working in understaffed facilities. Outside the hospital, healthcare workers may be dealing with more personal stressors, increasing risk of burnout. Consequently, these factors can lead to emotional exhaustion.

Healthcare workers often interact with patients face-to-face, which can be emotionally exhausting – especially when dealing with suffering or challenging cases – making them more likely to develop cynicism as a way to cope with the stress. This is dangerous, as cynicism can lead to careless acts, endangering patient safety. Consequently, patients may develop distrust towards their healthcare worker, and the healthcare system as a whole. Thus, cynicism negatively affects both the patient and the practitioner.

Finally, reduced personal achievement impacts both healthcare workers and patients. Workers experiencing burnout may feel incompetent regarding their job. For example, one former physician shared that they avoided seeking help for burnout – along with suicidal thoughts and alcohol abuse – because they feared losing their patients’ trust. They also had a “fear of appearing less than perfect or competent.” Eventually, this physician lost their license, because they hadn’t sought help when they needed it. Another physician reported that they “struggled to balance [their] patients’ needs with [their] system’s needs.” This led to the physician temporarily quitting their practice. From these accounts, it’s clear that when healthcare workers feel like they are not meeting everyone’s demands, they can become disillusioned and leave their practice, abandoning their patients. Patients are then forced to look for new physicians, which is often a hassle. Consequently, patients continue to lose trust in the healthcare system.

These dimensions of burnout were seen globally during the COVID-19 pandemic, with studies showing that many healthcare workers reported at least one burnout symptom. Despite the pandemic exacerbating the causes and effects of burnout, not enough has been done to address and prevent it.

What can healthcare workers do?

One recommendation is for healthcare workers to set boundaries. Studies have shown that “higher neuroticism and higher emotion-oriented coping are associated with higher burnout.” This means that healthcare workers who are highly self-critical or who dwell on negative emotions may be more vulnerable to burnout. For that reason, it’s important for healthcare workers to separate their sense of self-worth from their professional performance. For example, they should focus on what they can control, such as providing the best care they can. Additional research recommends that healthcare workers avoid doing work-related tasks during their off days. In fact, they should take their time off to rest and recover.

Furthermore, experts recommend healthcare workers practice resiliency techniques, such as spending time with friends and family, exercising, and engaging in mindfulness. Although these techniques are widely used, they are still important, if not more important, for healthcare workers.

Most importantly, healthcare workers must be proactive about seeking professional help.

What else needs to be done?

Resilience training and setting boundaries are not sufficient for many healthcare workers in the long run. While these solutions provide strategies for coping with stress, they do not prevent the high stress situations that cause burnout in the first place.

Healthcare administrators should, therefore, address the root cause of burnout: high stress situations. They should work on fostering an open, positive, and safe working environment. This includes destigmatizing mental health issues and providing sufficient training and therapy for healthcare workers. Administrators can also promote having support systems that encourage coworkers to assist each other. Finally, administrators must focus on fixing systemic issues by ensuring breaks, shorter shifts, and adequate support are available for healthcare workers.

Conclusion

Burnout in healthcare affects both the patient and the worker. If we want healthcare workers to care for the patient, we must care for them.

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