Job burnout: You can’t just bubble bath a way out of it
The World Health Organization this week brought awareness to something Banner Health chief clinical officer Dr. Marjorie Bessel has known for years — that workplace burnout is real.
“It’s really important to talk about it,” said Bessel, whose company oversees a burnout prevention program. “This is a long journey. It’s not something that’s going to be fixed overnight, in a week or in a month.”
In its new International Classification of Diseases, set to take effect in 2022, the WHO updated its definition of burnout, calling it a “syndrome” that
results from chronic workplace stress that has not been successfully managed.
Burnout is specific to the “occupational context” and should not be applied to describe other areas of life, the definition adds.
It cites three key symptoms:
❚ Feelings of energy depletion or exhaustion.
❚ Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.
❚ Reduced professional efficacy. It’s not just health-care workers who are at risk for burnout. A 2018 Gallup study of nearly 7,500 full-time employees found that 23% of employees reported feeling burned out at work very often or always, while an additional 44% reported feeling burned out sometimes. That means about two-thirds of fulltime workers experience burnout on the job.
The study found that employees with burnout were more likely to take sick days, and were less confident in their job performance than workers without burnout. It also found that burnout is more likely due to how someone is managed than the way they are doing their job.
The top contributors were unfair treatment at work; an unmanageable workload; a lack of role clarity; lack of communication and support from their manager; and unreasonable time pressure.
Bessel said while no profession is immune from burnout, she has found first responders, front-line health-care workers and any other professionals who deal firsthand with “human tragedy” are at particularly high risk.
In other fields where burnout occurs, time constraints are often imposed by people who do not know how long it takes to deliver quality work or great customer service, the Gallup study found.
“Unreasonable deadlines and pressure can create a snowball effect — when employees miss one overly aggressive deadline, they fall behind on the next thing they are scheduled to do.”
Burnout can be deadly
Among those most at risk for burnout are front-line health-care workers. For them, feeling exhausted and detached can be particularly acute. One physician in the U.S. dies by suicide every day, Bessel said.
Experts say a healthy work environment, trusted colleagues and opportunities to vent are part of preventing the worst from happening.
The simple step of acknowledging that burnout has serious consequences is also key. So is understanding that it’s up to employers and systems to address the problem, not up to individuals, said Lesly Kelly a nurse scientist at Dignity Health and an associate clinical professor at the Edson College of Nursing and Health Innovation at Arizona State University.
“It really is about the organization and the employers. It’s not the individual’s responsibility,” she said. “Organizations are starting to care and to understand how important it is to improve the work environment, and to see it is a workplace phenomenon and not an individual phenomenon.”
Phoenix-based Banner Health, which is the largest health-care system in Arizona, has a formal program called Cultivating Happiness in Medicine that uses evidence-based methods to combat burnout among its front-line healthcare workers.
The program specifically provides support to physicians when things go well, and when they don’t. Banner’s program encourages health-care workers to talk with trusted peers about difficult moments on the job, including the emotional roller-coaster they can endure while caring for patients when something goes wrong.
More than half of the physician workforce in the U.S. has at least one of the major symptoms of burnout, said Bessel, citing national literature.
“If you take a look at those in training, again, more than half of them when they are surveyed, when asked if they would do it all over again, say they might not go into medicine,” Bessel said. “The really most sobering statistic is what happens to physicians as individuals, who suffer from the extreme on the burnout scale with suicide.”
Bubble baths aren’t enough
In 2018, researchers from the Mayo Clinic and Stanford University published a paper in the Journal of Internal Medicine that called physician burnout a “public health crisis” with negative impacts on physicians, patients and health-care organizations and systems.
The 10-year RN Work Project, a national study of new nurses funded by the Robert Wood Johnson Foundation, found 17.9% of newly licensed nurses left their first job within one year of starting. The study, which ended in 2016, found 60% of nurses left their first job within eight years.
Some turnover is good and so is career development and growth, Dignity Health’s Kelly said.
But high turnover is expensive for organizations, and a lack of continuity can affect morale and patient care, she said. That’s why raising awareness of burnout is so important, she said.
“A lot of times we’ll ask about intent to leave and nurses will indicate 15 to 30% intend to leave their position,” Kelly said. “A lot of times they won’t say it’s burnout. They’ll say they want to go back to school or stay home with their kids. We don’t know if that’s because they really do want to do those things . ... They don’t necessarily know if it’s burnout.”
Good communication, collaboration and teamwork all contribute to a healthy work environment, she said. There is also evidence that building personal resilience through mindfulness and eating right is helpful, but it’s a complement to system issues, she stressed.
The Mayo Clinic advises people with burnout:
❚ Talk with their supervisors and to set goals for what must get done and what can wait.
❚ Seek support by taking advantage of employee assistance programs or other services.
❚ Try to relax by doing activities such as yoga, meditation or tai chi.
❚ Exercise, because physical activity helps with stress.
❚ Sleep.
❚ Approach workplace situations with “mindfulness,” or “openness and patience, and without judgment.”
Still, there are some external, system issues that cannot be fixed by an individual who is in a bad work situation, Kelly said.
“When I give presentations, I say you can’t bubble bath your way out of a bad work environment. That’s not going to fix your burnout,” Kelly said.
“If you are in a bad work environment, you can go home and take all the bubble baths you want, but you are going to keep going back to that bad work environment. You are going to keep having poor days and then you are eventually going to leave your job.”