What is Burnout?
The term burnout has been widely used over the past 18 months as our world has been navigating a relentless global pandemic. We often see this term used when referring to the grueling experiences of healthcare workers, caregivers, and frontline workers as they have encountered some of the most devastating and stressful work experiences. However, you can ask almost everyone how the past 18 months have been and for many of us, there has been a point of burnout.
My students and clients consist not only of healthcare providers, but parents, educators, personal caregivers, partners, and wellness professionals. There is no way around it, 2020 and 2021 have been rough for so many of us. However, those in healthcare, caregiving, and human service professions, as well as personal caregivers caring for loved ones, have really struggled at the tipping point of burnout.
Anyone can experience burnout and burnout is preventable. However, it takes both self-awareness, self-care, and support to prevent it or to recover. For employers, preventing burnout also takes foresight, systemic change, and compassionate action steps to help their employees receive the care they need to do their jobs well without negative consequences to their health. It is important to understand that cases of burnout have greatly increased since the start of the pandemic, but burnout is not a new thing. Especially for those in caregiving professions and for personal caregivers.
Let’s unpack a little about burnout and how we can prevent it as well as recover once we are in it.
What is burnout?
A study called, Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies, defines burnout as a “work-related stress syndrome resulting from chronic exposure to job stress.” Dr. Herbert Freudenberger introduced the term burnout in the 1970s and since then it has been studied extensively and is not only applicable to work-related stress.
This study and many others illustrate that burnout is extremely prevalent in healthcare workers. It is really important to note that BIPOC (Black Indigenous People of Color) and LGBTQIA (Lesbian Gay Bisexual Transgender Queer Intersexual Asexual) communities are at greater risk of burnout and are more likely to experience inequities in the workplace leading to burnout and other mental health challenges. It is absolutely impossible to write about wellness without acknowledging these disparities.
“COVID-19 has compounded rates of depression and anxiety among health care workers. The relentless physical and emotional demands of treating patients during a pandemic have exacerbated longstanding barriers to workplace well-being.” -The U.S. Department of Health and Human Services
As I mentioned, anyone can experience burnout, but people who are in human service professions tend to get hit the hardest as well as those caring for others.
“Burnout is an occupational hazard in any profession and in any country.”
-Joan Halifax
Burnout has many stages, here are some different scenarios of how one may experience burnout:
You start a new job, you are mainly focusing on your best performance and high productivity levels while encountering the normal daily life stressors that accompany that. This is often called the “Honeymoon Stage. “ But, as time goes on, you aren’t finding ways to work with these stressors, then stress is activated. The workload is overwhelming and the onset of stress is ignored, it begins to take a greater toll on you, but you don’t address the chronic stress, or make lifestyle changes to support your self-care. You feel overwhelmed, exhausted, cynical, and inefficient. Not to mention the tension headaches and back pain. Your relationships suffer, your mental health declines, and life begins to feel unmanageable.
A loved one becomes very ill or needs a high level of care. The needs and stress become overwhelming and the person caregiving doesn’t have support in place to allow for their own care. The caregiver begins to experience extreme levels of stress trying to manage the daily needs of their loved one. Their own needs are passed over, stress becomes chronic leading to the deterioration of physical and mental wellbeing.
A highly experienced and respected physician, who is a Black woman, experiences microaggressions daily at her job at a prestigious hospital. Although she has reported this to H.R, it continues. This combined with the exhaustive hours and stress of working through a two-year pandemic has left her feeling unsupported, physically exhausted, emotionally drained, and wondering if her work still has meaning.
Health care providers who identify as Black, Indigenous and People of Color, or BIPOC, often carry layers of stress on any regular day. Yet, they have shouldered several more layers over the past year from battling a pandemic while supporting the physical, emotional and mental health of their family, friends, patients, communities and somehow, themselves.
Together, the layers are forming a pressure cooker.
-Dr. Anissa Mattison
A scenario that many may be familiar with was the transition to working from home last year when young children were transitioning to online school from home. Many parents, and from the research, especially moms, were completely overwhelmed and at times unable to manage workload while caring for their children. Depression, anxiety, and stress were prevalent and still are. Many mothers ended up leaving their careers because of role overload. One mother described it in a recent article by Michelle Kondrich for Vox, “It meant my own self-care and basic needs — sleep, exercise, downtime — came dead last.”
Stressors in life, work, and caregiving are very normal. Stress activation occurs depending on how your brain and nervous systems react to stressors, it begins affecting areas of your wellness such as your mood, health, appetite, sleep, relationships, focus, and productivity. If stress still goes untreated, it becomes chronic stress.
When you are in a state of chronic stress, you are physiologically and psychologically in a stress-activated response. All. Of. The.Time. The impact is even greater on your health leading to physical and emotional exhaustion, feelings of isolation, health issues such as inflammation, digestive and cardiovascular disorders, chronic pain, irritability, difficulty in relationships, the use of substances, depression, and anxiety. If chronic stress and overwhelm go untreated, the result is burnout.
Burnout is the index of the dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit, and will
-- an erosion of the human soul. (Maslach and Leiter, The Truth about Burnout,1997)
Three qualitative dimensions of burnout listed in this study I mentioned previously are emotional exhaustion; cynicism and depersonalization; and reduced professional efficacy and personal accomplishment. These are the standards for measuring burnout in the Maslach Burnout Inventory developed by Dr. Christina Maslach. These factors can happen independently of one another and also may be influenced by what type of work one does.
When we become overworked and emotionally exhausted, it is easy to start feeling emotionally drained. For those in caregiving positions, this can often lead to empathy distress and moral injury. The inability to decipher someone else’s pain from your own and not being able to act in alignment with core values and ethics in relation to how care is given. The inability to keep up with the demands of the job or the care is overwhelming and leaves little time to recover and tend to one’s own needs..
Cynicism sets in when there is a disconnect between expectations and reality, a lack of connection to core values as well as not feeling valued, and feeling contempt for either their workplace, coworkers, or those they are caring for. This not only negatively affects the person experiencing burnout, but can also affect the workplace or home environment leading to low morale, less productivity, and more turnover.
Depersonalization occurs when one loses a sense of their own identity and a loss of empathy for and connection with others. One may feel as though their work has no meaning and feel that what they are doing is not making a difference.
All of these dimensions greatly affect physical, mental, and emotional wellness.
“In Maslach’s view, burnout undermines the care and professional attention given to clients of human service professionals such as teachers, police officers, lawyers, nurses, and others.”
(Factor structure of the Maslach Burnout Inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countries)
Now that we understand that burnout is an actual psychological syndrome that can be experienced by anyone, but is most prevalent in people who are in human service professions, as well as personal caregivers, and even more so for BIPOC, LGBTQIA, and women, we can look at how we can prevent and also recover.
Burnout Prevention:
Self-care is all over the media right now because we all need more of it during these challenging times and it is also becoming quite the buzzword in the wellness industry. I am a huge advocate for self-care and have a program I designed that trains and supports caregivers to learn how to create their own unique self-care practices that include: Identifying needs, emotional attunement, movement, self-compassion and mindfulness practices, self-study, healthy boundaries, and gratitude.
However, as important as I believe self-care to be, burnout prevention must be part of corporate infrastructure and our culture. We have to stop the “grind culture and create safe spaces. As long as the expectations are for employees, caregivers, teachers, and parents to put themselves at the end of the line for care, burnout will be prevalent in our society.
Oftentimes, self-care is viewed as an expensive luxury. It certainly can be for those who can choose that path, but it really doesn’t have to be. In some ways, I find the most beneficial self-care practices are not the ones that you pay others to do for you, but rather the ones you learn to do for yourself.
Even though self-care practices may not need to cost dollars, they do take time and time is a precious commodity. Once a person learns what works for them and how to create space for practices, self-care can be self-led and free. Self-care also doesn’t need to be overly time-consuming. Many people only have short bursts of time to dedicate to their self-care throughout the day. Developing routines that work is the most important thing.
Some of the most important aspects of self-care that I believe are effective in preventing burnout are also supported by empirical data, such as mindfulness and self-compassion practices, getting good sleep, exercise, and nutrition.
A sustainable model of self-care may include some or all of the following practices:
Set a Caregiver’s Intention-What is your intention as a caregiver? What is important to you? Let this be your north star.
Schedule time for yourself like any other commitment in your calendar
Mindfulness practices-Non-judgmental self-awareness gives us the opportunity to attune to ourselves with kindness and see clearly what is happening for us in the moment. This allows us to respond to what is happening, rather than react.
Healthy Boundaries- Know where you end and the other begins. Separate but connected identity. Learn to say no.
Self-Compassion Practices-Treat ourselves as we would treat a dear friend going through a challenging time with tenderness, kindness and affection.
Have realistic expectations of yourself and others
Sleep Hygiene
Learn what renews you and practice that-Pay close attention to the things that help you feel less stress and more connected.
Heartfelt connection with safe and supportive people-This helps you to feel that you are not alone and regulates your nervous system.
Movement- Not only is moving your body helpful to mobilize your nervous system when you are feeling the effects of stress and can decrease chronic pain, it also activates your “feel good” neurotransmitters and reward centers in your brain.
Changing your relationship with stress-Developing awareness of how stress manifests within you can be helpful when you begin the empowering practice of cultivating a sense of safety and resilience. See my Blog Post Changing your Relationship to Stress through Awareness
If we develop a relationship with our stress response through awareness, we have the opportunity to recover and create change. This does not mean we won’t ever experience stress again. Stressors are a part of everyday life. However, through awareness of our response to stressors, we can begin to develop a deeper understanding and more tools for regulation.
Success Tip: Find ways to integrate self-care into your life that work, is enjoyable, and will be successful and rewarding. Set attainable goals in short bursts of time to start. This will inspire you to do it again. See my blog post: Self-care for Caregivers
Workplace wellness programs can also create a culture of self-care by creating safe and equal workspaces, allotting time for employees to take paid breaks, especially for meals; paid time off for healthcare appointments such as therapy or vaccinations, supporting employees in managing workloads, and having a wellness check with employees regularly, especially when they notice they might be struggling. In addition, offering mindfulness, self-compassion, and movement classes. Hosting training in diversity, equity, and inclusion, healthy boundaries, non-violent communication, and emotional intelligence all create a foundation of wellness and support. By creating a workplace on a foundation of wellness, trust, and support, the health and vitality of employees will contribute to the health and vitality of the business and ultimately productivity will thrive as well.
How to Recover from Burnout:
So you read this whole article and you are realizing that you or someone you know is suffering from burnout. What can you do? Looking at a list of different self-care practices to do at this point can be VERY overwhelming.
If you are experiencing depression or anxiety, self-medicating with substances, feel your relationships are being harmed, or have difficulty managing anger, NOW is the time to find a really good therapist or mental healthcare professional.
If you are feeling ready to take some steps to prevent and when you feel ready, recover from the effects of burnout, pick just one thing that feels in alignment with your needs right now. Need help assessing your satisfaction with your wellness and finding a good place to start? Go to this link to access my wellness satisfaction scale.
The next steps may include:
Asking for help.
Set boundaries with family, employers, and those you are caring for.
Rest.
Eat Meals. Drink water.
Move your body.
Practice mindfulness and self-compassion.
Take inventory of your core values.
Attune to your emotions.
All of these steps and many are included in my program Cultivation of Care. This program was designed to help you get your well-being back to the front of the line. It is entirely online and can be done at your own pace so you won’t feel overwhelmed. When you join Cultivation of Care you will feel like you have more control, be less burdened by stress, and have a greater connection to the things that are important to you.
In six weeks you will learn how to:
Identify what’s asking too much of you
Learn tangible skills to face difficulty
Manage stress + build resilience
Replenish your well
Become a wellness warrior!!!
Resources:Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical StudentsBurnout in Healthcare Workers: Prevalence, Impact and Preventative StrategiesHalf of health workers report burnout amid COVID-19Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study,Unpacking layers of stress among BIPOC health providershttps://www.thisiscalmer.com/blog/5-stages-of-burnoutWinona.edu- Stress Management Websitehttps://www.psychosomatik.com/wp-content/uploads/2020/03/Maslach-burnout-inventory-english.pdfFactor structure of the Maslach Burnout Inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countriesUnderstanding the burnout experience: recent research and its implications for psychiatryStanding at the Edge, Joan Halifax American motherhood vs. the American work ethic