Kadoorie Centre Critical Care Research Blog: Burnout
Matt Rowland and Jody Ede gave a talk to the group about the importance of recognising the signs and symptoms of burnout and how to deal with them.
"Physician, heal thyself"
One in three of us working in healthcare is burned out. That’s right, look to the left, look to the right. One of us is burned out. Is it you?
Common signs and symptoms of burnout include feeling tired most of the time, frequent headaches, back pain, or muscle aches, a change in appetite or sleep habits, and persistent feelings of apathy and irritability. You might find busy public places like the supermarket or the train station overwhelming. You might also be less productive than you have been in the past. If you recognise any of these signs in yourself it’s probably time to take a step back and think about how to refuel your engine. “You can’t pour from an empty cup” is a phrase that is often spoken, and it’s true. If you are mentally exhausted you simply can’t find the energy to care for others. When things get really bad it can be hard to find the energy to even care for yourself. Stop. Breathe. It’s OK. You can get through this.
What actually is Burnout? Burnout is an umbrella term for symptoms such as anxiety, depression, lack of empathy and depersonalisation. It is a real and tangible problem within the NHS and now that staff are starting to talk about it, it is clear that this is something that affects a lot of us. Burnout develops because the environments in which we work are subjecting us to chronic environmental stress; these could be considered adverse (some call them toxic) environments. When the natural stresses of healthcare work are not dealt with adequately these symptoms can persist, develop, progress and worsen (Weber & Jaekel-Reinhard, 2000). Burnout can limit our lifespan, reduce our ability to care, and make us unsafe. Associated problems can arise such as substance abuse (self-medicating) and chronic insomnia, along with psychosomatic disorders including headaches, hypertension, cardiopulmonary diseases, musculoskeletal problems, gastritis, stomach ulcers, and dizziness (Maslach, 2001).
How big is the problem of burnout in Critical Care? Critical care is a specialised environment caring for the sickest patients in a hospital. The illness severity and psychological stress this puts patients and relatives under is enormous. Subsequent effects from this are that the clinical staff who work within the area are also placed under extreme conditions, for long periods of times working in demanding situations. The incidence of burnout in critical care staff is significant.
- 25-33% of critical care nurses manifest symptoms of severe burnout
- 45% of physicians report burnout (paediatric ICU physicians are at highest risk with incidences of up to 70%)
- Up to 85% of all staff members have at least 1 of the 3 classic symptoms - exhaustion, depersonalisation and reduced personal accomplishment.
Critical care has come to attention along with the emergency services as a result of terror attacks such as the London Bridge Terror Attack and the Manchester Arena Bombing. The effects of these attacks have rippled through the country and our healthcare system. Specialised injuries and extreme psychological trauma has been experienced by the direct families of the victims and also the frontline staff dealing with these incidents and subsequent carnage. This may be a much needed turning point in the psychological care provision and investment for healthcare staff in the UK and beyond.
How does our wellbeing affect patient safety? The NHS has historical problems with staff absences, back complaints and recruitment/retention issues. Absence rates are 27% higher than in other public sector organisations. Estimates from Public Health England put the cost to the NHS of staff sick leave at £2.4bn a year. The well-being of clinical staff therefore has a significant financial impact on resources. There are also safety implications. The National Patient Safety Agency estimates that 850,000 patients come to actual or near harm in the NHS every year. This is not because physicians or healthcare workers are bad or act poorly. This is because healthcare is inherently chaotic and staff are under huge amounts of pressure, often working to the limits of their physical and mental abilities.
Improvement in staff health, well-being and engagement impacts on infection rates, patient reported care measures, staff reported care measures, improved cost efficiency and morale. Well-being is viewed as an antecedent rather than a precedent to good quality care. Educating our staff about tools to manage and recognise stressors and symptoms of stress is vital, both financially and ethically.
What can you do about it?
Understanding Stress and distress A certain amount of stress in any situation can be of benefit. Stress can lead us to be more productive and more alert. Problems arise when stress is chronic and exceeds the individual‘s coping strategy. Understanding where we are on the stress to distress curve gives insight and allows us to develop and use strategies to help manage stress levels and maintain our productivity and emotional resilience.
What is emotional resilience? Resilience is derived from the word resilliens which means to have an elastic or pliant quality. When referring to personal characteristics it means the ability to bounce back when faced with challenges. Over the past decade the NHS has set out to monitor its staff health and wellbeing using the NHS Staff Survey and has instigated some organisational changes designed to improve staff wellbeing. Several government reports, including the Black Report and Boorman Report (2009) have provided solutions to allow the NHS to embed staff wellbeing into its culture and organisation.
Although the idea is new to the NHS, organisations such as the military have been providing resilience training for some time. Resilience Training is based on the belief that resilience is a modifiable process. With appropriate training and education staff can learn to learn emotional resilience and improve their coping strategies. Resilience training courses aim to provide resources and techniques by which one can manage stress and mitigate its effects on our emotional and mental health.
One solution to minimising burnout levels and maximizing our resilience are simple strategies. Being ‘simple’ does not mean they are ‘easy’. These take practice and an allocation of our conscious time, but can be achieved even in our busy working day. Health Education England (HEE) have developed some resilience testing tools such as the Wheel of Life or their i-Resilience Test.
Matt has developed his own resilience checklist “BE CALM”which is simple and easy to remember during times of stress and anxiety.
- Breathing space – try mindful thinking
- Exercise regularly – a fit body can lead to a fit mind
- Communicate/connect – at work and at home
- Allow time to do a hobby – enjoy doing something you enjoy
- Learn something new each day – big or small, expand your horizons
- Mindset is key – aim for growth not fixed
Conclusion Developing a good strategy for resilience may be the Philosophers Stone and key to our longevity within the profession we have chosen to care so much about. This is a tool which we need to adopt whilst undertaking the rocky ride that is the NHS; ensuring that we and our patients come out the other side as emotionally intact and human as possible.
Why do ICU professionals ignore the warning signs of burnout when pilots don’t? Because the pilot is also on the plane. “Who cares if one more light goes out? Well I do” We all do. Stop. Breathe. It’s OK. You can get through this.
Matt Rowland, Clinical Lecturer
Jody Ede, Research Nurse