Medical Professional Burnout ~ part 1

Personal Connection

After two years of working as an Occupational Therapist in a Skilled Nursing facility, I found myself burnt out and unable to keep up with vigorous demands of production, client needs, documentation, and the constant motion of doing. I came to a point where I knew I needed to step away to reassess how I was interacting within my professional role.
After months of extensive travel, I found myself in the Upaya Zen Center’s Buddhist Chaplaincy program. It was there I uncovered the way in which I was engaging with my role as an Occupational Therapist did not serve myself nor those whom I wished to serve.

I completed a thesis paper that discusses my personal experience, alongside current literature, to reveal what leads to medical professionals’ suffering, and eventual burnout. So let’s start today with talking about the nature of burnout.

What is burnout?

Burnout syndrome (BOS) was first described in the 1970s as a work-related constellation of symptoms and signs that usually occur in individuals with no history of psychological or psychiatric disorders. Other conditions may overlap with BOS such as moral distress, perceived delivery of inappropriate care, and empathetic distress, which is also referenced in the literature as compassion fatigue (Moss, Good, Gozal, Kleinpeill, & Sessler, 2016).

BOS occurs in all types of healthcare professionals and is especially common in individuals who care for critically ill patients. In the initial stages, individuals may feel emotional stress and job dissatisfaction, which may lead to the inability to adapt to the work environment and negative feelings toward one’s work. The three classic symptoms of BOS are: exhaustion, depersonalization, and reduced feelings of personal accomplishment. Individuals may feel frustrated, angry, fearful or unable to feel happiness, joy, pleasure, and/or contentment (Moss et al., 2016). These feelings may also be associated with helplessness, where the individual feels hopeless, resigned, or even ashamed (Back, Rushton, Kaziak, Halifax, 2015). BOS may also be associated with physical symptoms including insomnia, muscle tension, headaches, body heaviness, lethargy, and gastrointestinal problems (Moss et al., 2016).

Risk factors that have been associated with the development of BOS are as follows: personal characteristic, organizational factors, quality of working relationships, and exposure to end-of-life issues. Personal characteristics associated with BOS include overly self-critical, engaging in unhelpful coping strategies, sleep deprivation, and a work-life imbalance (Moss et al., 2016). Often, the high-performance professionals are at higher risk for development of BOS due to traits of idealism, perfectionism, and over-commitment. Organizational factors associated with BOS include: increasing workload, lack of control over the work environment, insufficient rewards, and general breakdown in the work community (Moss et al., 2016). Quality of working relationships associated between colleagues and patients vary based on demographic and professional and organization factors such as income, position, education, and work load. These factors are important to address when determining job satisfaction, which influence the development and quality of relationships. Working within end-of-life care can trigger feelings of helplessness that may lead to hypo- and/or hyper- engagement of patient care. These engagement styles are associated with increased suffering among health care professionals (Moss et al., 2016).

A study of 1357 responses from American Academy of Hospice and Palliative Medicine clinician further highlights the contributing factors; researchers found higher rates of burnout from non-physician clinicians originating from emotional exhaustion. Individuals with higher rates of burnout worked for smaller organization, worked longer hours, were less than 50 years old, and worked weekends (Kamai et al. 2016).

BOS is linked to a health-care professional’s choice to leave his or her position. Excessive turnover rates, increased healthcare cost, decreased productivity, lower staff morale, and reduced quality of care since experienced professionals who leave must be replaced. BOS also results in decreased effectiveness and poor work performance, which have a direct impact on patient care. A study in the article An Official Critical Care Societies Collaborative Statement—Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action states, “BOS in nurses is associated with reduced quality of care, lower patient satisfaction, increased number of medical errors, higher rates of health-care associated infections, and higher 30-day mortality rates (Moss et al., 2016) .”

Are you in a healthcare role? Are you experiencing symptoms of burnout? Interested to learn more about the nature of burnout and what you can do to prevent burnout so that you can offer the kind of care you went into the profession wanting to offer? Stay tuned for up and coming articles. Feel free to comment with questions and thoughts. Let’s start a discussion so we can build supportive communities that are able to offer sustainable, effective care!

Reference List

Kamai, AH, JH Bull, SP Wolf, KM Swetz, TD Shanefelt, K Adt, D Kavalteratos, CT Sinclair, and AP Abernethy. (2015). Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S.” Journal of Pain and Symptom Management 51, no. 4; 690–96.doi:10.1016/j.jpainsymman.2015.10.020

Moss, Marc, Vicki Good, David Gozal, Ruth Kleinpell, and Curtis Sessler.(2016), A critical care societies collaborative statement: Burnout syndrome in critical care health-care professionals. A call for action. American Journal of Respiratory and Critical Care Medicine 194, no. 1