Burnout for Beginners
Taken from “Let’s Talk About Healthcare Burnout: A Prevention and Recovery Guidebook,” by Rev. Patrick Riecke and Dr. Erin Alexander DNP.
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Let's begin by outlining where we’re headed. We'll define key terms like "moral distress" and "burnout." The term "burnout" is frequently used, but it has specific, technical definitions and distinct characteristics, especially in the workplace. We’ll delve into these definitions and characteristics, particularly how they manifest in our professional lives, and bleed over into our personal lives.
As we start to uncover the complex crisis of burnout, it's crucial to understand the emotional toll it takes on healthcare workers. Dr. Erin Alexander delves into this in chapter four, where she discusses vicarious trauma and compassion fatigue in detail.
We'll examine various studies and statistics. Unsurprisingly, burnout, moral distress, and work-related mental health issues have been extensively studied, particularly in the healthcare and education sectors. We’ll review some of these findings to provide a solid grounding.
Next, we’ll discuss examples of moral distress. While having a technical definition is helpful, it’s crucial to understand what moral distress looks and feels like in the workplace. I’ll also share my personal burnout story, detailing my experiences in healthcare during the pandemic and beyond.
We’ll explore the stakes involved. What happens if we don’t address burnout? What are the costs of failing to create supportive systems in our workplaces? We’ll also look at the organizational path: what can leaders do to prevent burnout and foster a supportive culture? This leads naturally into Dr. Alexander's exploration of psychological safety in the workplace in chapter nine.
Finally, we’ll discuss the personal path. If you’re currently experiencing burnout, know that you’re not alone. This conversation is largely for you. We’ll cover practical steps and innovative methods to recover from burnout and offer some encouragement along the way. We want to warn you that this topic is very personal to both of us, and our experiences will be woven throughout our discussion.
In most chapters, the voice will be Patrick's, but Erin's influence is ever-present.
The remainder of this chapter introduces historical voices in burnout study, technical definitions of moral distress and burnout, and studies and statistics around the crisis.
Pioneers in Burnout
Christina Maslach is a pioneering figure in the field of burnout research. Her work, particularly the Maslach Burnout Inventory (MBI), has provided a foundational framework for understanding burnout's core components: emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment.
Maslach's research emphasizes how chronic workplace stress leads to burnout. Her insights have shaped interventions designed to mitigate burnout and promote well-being, making her work essential for anyone seeking to understand and address this pervasive issue.
Johnathon Shay and Andrew Jameton have also made significant contributions to our understanding of burnout, particularly through the lenses of moral distress and moral injury.
Shay's work, especially with veterans, introduced the concept of moral injury, which occurs when individuals witness or partake in actions that violate their ethical beliefs, leading to profound psychological distress. Jameton expanded on this idea within the healthcare context, coining the term "moral distress" to describe the experience of knowing the right action to take but being constrained from taking it. Together, their work highlights the deep emotional and ethical impacts that can contribute to burnout, especially in high-stakes environments.
A Framework
To provide a framework, researcher Amanda Rosen and her team describe a continuum from moral awareness to moral distress to moral injury, often leading to burnout.
Moral awareness is having a sense of how things should be at work—an awareness of right and wrong. This can vary, but it often involves a moral sense of the quality of care, patient treatment, and standards that should be met.
Not everyone starts with moral awareness. Some coworkers are simply trying to avoid trouble or pay the bills and may not engage deeply with concepts like moral distress or burnout.
However, for those of us in helping professions, moral awareness is common and important. Most of us have some sense of “right and wrong” when it comes to our work. That’s good, but it sets us up for dissonance when things don’t go as they should, leading to moral distress—a violation of our internal ethics.
When moral distress is profound or sudden, it can escalate to moral injury, and potentially burnout. So, moral distress occurs when actions or situations violate your personal values. If this distress is severe or prolonged, it can result in moral injury, causing deeper internal harm.
Next, let's explore the characteristics of burnout.
The Three Characteristics
Emotional exhaustion, burnout's first characteristic, is not just tiredness after a long day. It is a deep-seated fatigue that persists even after rest. For self-reflection, recall the last time you returned to work after some time away (for vacation, a holiday, or medical leave). What feelings did you have? If the only feelings that come to mind are anxiety, dread, and fatigue, then you might be emotionally exhausted.
The second characteristic of burnout, depersonalization, involves a loss of connection to others, often manifesting as cynicism. Cynicism is something deeper than sarcasm. In fact, sarcasm can illuminate truth. But cynicism is a deeper level of hopelessness, a sense that nothing will ever improve. When we are in this state, even good news is received with a subtle sense of dread and defeat.
Lastly, a lowered sense of accomplishment occurs when you no longer feel your work makes a meaningful difference. Perhaps you took the job because you believed that you could make an impact. Now, things have changed, and you’re just trying to survive.
People who are burned out feel like their actions don’t matter much.
Statistics and Studies
Burnout is a common experience, particularly in healthcare. And while the COVID-19 pandemic did not introduce healthcare burnout, and its end did not resolve it, the impact from 2020-2022 is clear. Between 18% and 25% of coworkers left their jobs in the first year and a half of the pandemic.
Many nurses and physicians have left their fields entirely. A recent survey found that 2.7 million US nurses are currently experiencing burnout, representing 15% of the entire healthcare workforce.
Burnout symptoms are prevalent among nurses: at least 25% report symptoms like stress, anxiety, and depression. One study found that 95% of nurses felt burned out at some point in the past three years. Additionally, 27% of nurses who quit cited burnout as the primary reason. The annual turnover rate for nurses is over 25%, with nursing homes seeing even higher turnover rates, sometimes exceeding 50%.
An American Association of Critical-Care Nurses survey found that 92% of nurses believe their experiences during the pandemic will shorten their careers.
An article from The Atlantic highlighted that between 35% and 54% of nurses and physicians felt overwhelmed before the pandemic, a situation exacerbated by COVID-19.
Healthcare leaders face unique challenges. Often overlooked in burnout research, leaders experience hyper-responsibility and guilt when taking time for their own well-being. This hyper-responsibility and perceived lack of empowerment can lead to burnout.
For managers, several daily factors can also lead to burnout:
Increased workloads
Staffing shortages
Emotional strain
Insufficient resources
A lack of recognition
For coworkers under their leadership, who are hands-on with patients, there are similar contributors to burnout:
Physical demands
Emotional stressors
A perceived lack of support
High workloads
These challenges are compounded by the emotional toll of patient care and turnover in their work environment.
Conclusion
In conclusion, staffing shortages and employee burnout continue to plague healthcare. It’s unlikely that this comes as a surprise to you. If you are a healthcare worker, you know that morale is sagging, hours are long, and systems are convoluted. But what do we do about it? Can organizations change the experiences of coworkers? Even more importantly, what can stressed out coworkers do to care for themselves before it’s too late?
As we move forward, we’ll explore the concept of moral distress, a key component of burnout, and explore its profound impact on healthcare professionals.
