By Coverys Risk Management
Although the topic has been receiving more attention recently, burnout is not a new problem. According to Association for Psychological Science
, the term “burnout” was coined by psychologist Herbert Freudenberger in 1974 to describe the problems experienced by volunteers working at a free clinic.
Workers in any industry can experience burnout, but the fact that the term was first used in relation to a clinic might be more than a coincidence. Healthcare providers appear to be especially susceptible to burnout. According to a 2019 study from the National Academy of Medicine
, between 35% and 54% of U.S. nurses and physicians showed substantial symptoms of burnout.
The COVID-19 pandemic has pushed the issue to crisis levels. According to U.S. News
, Dr. Victor Dzau, president of the National Academy of Medicine, says that 60% to 75% of clinicians have been reporting symptoms of exhaustion, depression, sleep disorders, and PTSD since the pandemic started. Furthermore, about 20% of healthcare providers have quit.
Ignored and untreated, burnout can lead to significant personal and professional challenges. Even before the pandemic, burnout in the healthcare industry cost $4.6 billion a year. Fortunately, with the right resources and strategies, organizations can help workers master resiliency and move through burnout.
Understanding Burnout and Its Impact in Healthcare
The World Health Organization
defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
The effects of burnout can be detrimental to a person’s professional and personal life:
- The Mayo Clinic says that potential consequences include stress, fatigue, sadness, anger, irritability, insomnia, substance misuse, heart disease, high blood pressure, type 2 diabetes, and vulnerability to illnesses.
- A survey from Deloitte found that 92% of respondents say that having unmanageable amounts of stress or frustration negatively impacts the quality of their work. For workers in the healthcare industry, this may result in a negative impact on both patient care and the institution. Mistakes and oversights can harm patients and increase liability exposure.
- Workers suffering from burnout may quit. This results in staffing shortages and increases the workload for others, creating a cycle of burnout.
- Workers experiencing burnout may be irritable, resulting in more workplace conflict and lower morale.
Burnout and Compassion Fatigue
The CDC says that chronic workplace stress and exposure to traumatic events during the pandemic can result in burnout and compassion fatigue.
According to the American Psychological Association, compassion fatigue occurs when individuals take on the suffering of their patients. When it becomes too much, professionals can start to become numb to suffering and have a hard time feeling empathy. Compassion fatigue is also associated with burnout.
- Moral Injury: Effect of witnessing traumatic events that impact moral intuitions or judgments
- Moral Distress: Emotional impact of an ethical choice or dilemma
- Moral Disengagement: Justifying immoral acts by diverting blame to the victim or justification: “Sanitize the Act” or “Sanitize the Actor”
Moral Injury, Moral Distress, and Moral Disengagement
Healthcare providers are also vulnerable to moral injury, moral distress, and moral disengagement.
According to the American Association of Critical-Care Nurses
, moral distress is different from compassion fatigue and burnout, and it occurs when healthcare professionals recognize the ethically correct action but, for one reason or another, cannot take it. This can lead to feelings of anger, guilt, withdrawal, and depression, as well as physical symptoms including headaches, palpitations, and gastric upset.
Even when healthcare providers are not required to make decisions, witnessing trauma can result in moral injury. Although these are not new problems, the pandemic has given rise to many possible triggers of moral injury and moral distress. For example, social distancing requirements may mean that healthcare providers cannot let family members visit their sick loved ones. Although they might understand the practical reason for this rule, they may nevertheless suffer moral distress and moral injury.
Moral injury and moral distress can contribute to moral disengagement, when healthcare providers justify unethical acts, sometimes by blaming the victim. According to the Journal of Nursing Regulation
, moral disengagement can be a serious threat to patient safety.
Identifying Burnout and Moral Distress
Burnout is common, but this doesn’t mean it should simply be accepted as an unavoidable part of the healthcare industry. Given the gravity of the problem, it’s important to take burnout, compassion fatigue, and moral disengagement seriously.
The first step is recognizing when there’s a problem.
The Maslach Burnout Inventory is used to measure burnout. This inventory assesses three common signs of burnout:
- Emotional exhaustion.
- Decreased sense of personal accomplishment.
Coverys has developed a Burnout and Moral Distress Checklist and Worksheet for Managers
. This worksheet provides information on the Maslach Burnout Inventory to identify burnout, as well as the classic signs of moral distress. The worksheet also helps managers identify the possible causes and the potential impacts on the caregiver, the patients, and the institution.
Responding to Burnout and Moral Crises
Once you have identified a problem, the next step is to develop a response plan. Possible responses could include:
- A peer support program.
- A wellness program referral.
- An employee assistance program.
- Adjusted work schedules or duties.
- Implementing micropractices into routines.
- Using mindfulness programs or apps.
In some situations, major changes may be needed such as counseling, support groups, or mentorships. When trauma is severe, short-term responses may not be enough, and long-term actions may be necessary.
However, in some cases, small adjustments can make a notable difference, according to Josh Hyatt, Systems Manager for Risk Management & Analytics at Coverys. He recommends that healthcare professionals learn to use micropractices that can be combined with existing processes.
“Micropractices can be added to existing activities both at and away from work,” Hyatt says. “For example, physicians can practice breathing exercises while they are handwashing or while they are logging in to electronic health records. They can visualize the calm presence they want to bring to their patients while they’re walking the dog or waiting at a red light,” he explains.
Micropractices may include breathing and self-soothing exercises to help individuals stay focused and calm, or mental exercises that focus on mindfulness, gratitude, and acceptance. An article published in NCBI
provides additional details and suggestions on micropractices.
In many cases, a combination of responses may be needed, and each individual will respond differently. The Burnout and Moral Distress Checklist and Worksheet for Managers
provides suggestions and gives managers a convenient way to document their assessments and recommendations.
Are You Doing Enough to Fight Healthcare Burnout?
found that nearly 70% of professionals say their employers are not doing enough to fight burnout. The Burnout and Moral Distress Checklist and Worksheet for Managers
can help you take the first steps toward managing burnout and mastering resiliency.
This article was based, in part, on the Coverys presentation, “Emotional and Personal Resiliency: Moving Through Burnout,” presented by Josh Hyatt, DHS, MHL, MBE, DFASHRM, CPHRM, CPPS, HEC-C.
Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.