Healthcare worker burnout & self-care

This article was written by Dr. Alisa Burpee, a Seattle-based clinical psychologist.  

Healthcare workers on the frontlines face an unprecedented amount of stress in delivering healthcare during a pandemic. How real is burnout and how do you overcome it? Read on to find out about warning signs and symptoms of burnout as well as some tips that may help you avoid and navigate through the challenges that cause burnout.

If you attended a training program that taught you how to proactively address burnout, congratulations, you are one of the few. As I have talked with and lectured to groups of mental health care workers and physicians, we have agreed that burnout is something oft brought up but rarely actually addressed in a real-world sense. I left my Clinical Psychology PhD program with a vague notion that this was a real phenomenon to avoid. However, I had little knowledge or tools to understand how to stave it off much less address once it had already taken hold. So, let’s dig in.

What is burnout?

Burnout is characterized by physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding or stressful work. It can manifest as negative feelings including disillusionment and a loss of meaning in work. Burnout results in a reduced sense of accomplishment and can also reveal itself as skepticism and distrust (e.g. questioning “Is what I am doing even making a difference?”).

Burnout is common. According to several recent studies, approximately 50% of American doctors exhibit signs of burnout (an increase of about 10% since 2011). Overall physician satisfaction rates with work-life balance also declined between 2011 and 2014. The downstream effects of burnout can negatively impact patient care, reduce professionalism, and can be a detriment to physicians' own self-care and safety. Some professionals even make the difficult decision to leave the profession. The viability of the entire health-care system is at stake if more physicians experience job dissatisfaction and decide to leave the field altogether.

Some signs and symptoms of burnout to be aware of include:

• Frequent colds, headaches, fatigue
• Reduced tolerance to pain or patient contact
• Lowered resilience, moodiness, crying more easily
• Sleep disturbance, escape fantasies, taking work home, and substance abuse
• Less empathy, hopelessness, pessimism, dread
• Detachment from patients perceived as “draining”
• Disregard for professional boundaries or ethics

While different for every medical professional, there are some common factors that contribute to burnout. These include:  

• Healthcare reform
• Inadequate reimbursement
• Increased patient volume and insufficient time with patients
• Time spent on complying with the requirements of completing electronic medical records on top of other administrative tasks
• Ineffective technology
• Stress of higher status, perfectionism and ambition

These, and many others, were burdensome enough pre-COVID. The pandemic has significantly exacerbated these contributing factors of burnout, especially for frontline caregivers who put themselves at risk to do what they love – caring for people.

Mitigating burnout

How can we mitigate burnout to ensure a long and sustainable sense of satisfaction in our careers with minor ebbs and flows that don’t leave us longing to relocate to a small cabin in the remote woods or take up work as a yoga instructor? Not that there is anything wrong with a career in yoga or living in the wilderness. I peg this as my long-standing escape fantasy. But alas, I did not take on thousands of dollars’ worth of debt to give up on my dreams of being in the medical field.

So how do we thrive in our work rather than merely survive? While the tactics employed will vary for each individual, here are seven rules that have helped me navigate the challenges that can cause burnout:

1.     Set boundaries: It’s important to work reasonable hours and commit to disengaging from work based on the commitment you make with yourself. This will be different for everyone, but this rule is crucial.

2.     Acknowledge your limitations: We must embrace the fact that we cannot help everyone all the time. As one of my clients put it “I can’t keep burning myself alive to keep others warm.” We must accept there is only so much we can do and that is enough. This acceptance will allow you to be present in both work and play.

3.     Create space for yourself: Take time to relax and recharge, unplugged as often as possible. Learn to ask, “What do I need right now?” At one time it may be solitude and at another time it may be social support.

4.     Be active: We hear it all the time, but it is important to exercise regularly, fuel our bodies with good nutrition, and allocate adequate time for sleep. These are foundational factors for thriving regardless of your profession.

5.     Find non-work outlets: Another critical aspect of sustaining and thriving is creating a life outside of work. This means regular engagement with hobbies, friends, loved ones, creative endeavors, and your interpretation of spirituality. I turned to painting for my creative outlet while sheltering in place.

6.     Utilize your network: If you are in solo practice, find a local consultation group to join. This has saved me in my career to have a group of like-minded colleagues who know me and can provide sound advice and support. We ride the waves or our ups and downs together.

7.     Consider therapy: To the extent you increase self-understanding and development, you will build resilience and relieve stress. A growing body of evidence suggests that even brief mindfulness and self-compassion-based skills training can significantly reduce burnout rates.

Below are a couple of resources to check out and a self-compassion exercise to formulate a plan for ongoing self-care. Take time to express appreciation for the tremendous work you do and when others express gratitude for you, take it in.

Book: Trauma Stewardship: An Everyday Guide to Caring for Self while Caring for Others 

Website: Self-compassion resources

Self-Compassion in Daily Life Exercise (Takes 10-20 min to complete)

Physically – soften the body

How do you care for yourself physically (e.g., exercise, massage, warm bath, cup of tea)?

Can you think of new ways to release the tension and stress that builds up in your body?

Mentally – reduce agitation

How do you care for your mind, especially when you are under stress (e.g., meditation, watch a funny movie, read an inspiring book)?

Is there a new strategy you’d like to try to let your thoughts come and go more easily?

Emotionally – soothe and comfort yourself

How do you care for yourself emotionally (pet the dog, journal, cook)?

Is there something new you’d like to try?

Relationally – connect with others

How or when do you relate to others that brings you genuine happiness (e.g., meet with friends, send a birthday card, play a game)?

Is there any way that you’d like to enrich these connections?

Spiritually – commit to your values

What do you do to care for yourself spiritually (pray, walk in the woods, help others)?

If you’ve been neglecting your spiritual side, is there anything you like to remember to do?

From The Mindful Self-Compassion Program

Providence is pleased to share the stories of great people who have informed and relevant opinions about issues relating to health and wellness. As part of our editorial process, we want to share insights and stories from guest contributors that help bring awareness to common health conditions that affect patients and caregivers alike.

Dr. Burpee maintains a private practice in Seattle, WA. She does not have any financial relationships with commercial interests relating to Providence or its affiliates. Learn more about her services here.