“You have two more re-evaluations coming up. Can I add them to your schedule this week?” the office manager asked me. “Yes,” I gulped. I’ve had two re-evaluations this week already that took me hours to finish up at home. I can’t turn them in late. And two more?! I mean I could technically say no, but I’ve never heard anyone say no. They need to get done. I guess I won’t work out again this week.
That was me several months into my first occupational therapy job in outpatient pediatrics. At this point, the fire that burned inside me when I graduated from OT school began to dwindle. I felt shaky and exceptionally exhausted, to the point where I would fall asleep still in my scrubs when I got home. I would dream about treating patients in my sleep. I woke up anxious to squeeze in a workout and not get caught in traffic during my 45-minute drive to work.
It was no wonder that I confided in my friend and co-worker and told her I was so stressed that I needed a “wine of glass.” She questioned, “You mean a glass of wine?” I could give this COTA just a look and she would understand. This look meant watch my patient for a few minutes as I run to the bathroom to throw up. Riddled with adrenaline and anxiety for most of my waking hours, my body’s way of responding to the fight or flight response was by throwing up. This was something I was completely embarrassed by because I didn’t want people to assume I was bulimic.
Fast forward a few long, painful months. I left this job because I moved in with my fiancé (now husband). I began to work in an outpatient setting once again, but with the older adult neuro population. I thought, “This could be really fun!” I assumed the burnout I experienced just a few months earlier would just go away. In fact, not only was I throwing up the bathroom, I was throwing up, crying, hyperventilating, and texting my fiancé in the bathroom that I needed to quit.
When I went to my doctor for a yearly check-up and mentioned my stress, she prescribed me anti-anxiety meds. I took them every day throughout this entire journey, essentially putting a Band-Aid on a gaping wound.
I was confounded by the philosophy and values of this facility. You mean, you want me to see a patient with a physical therapy POC and treat them because the PT is busy? And the PT will write the note later? Why am I getting people off the street for an evaluation who don’t actually have a prescription? Wait, the owner says he knows many neurologists so he can get any prescription anytime, to go ahead and just do the evaluation. Am I in the upside-down?
I felt hopeless at this point — I was just going through the motions, trying not to stir the pot. Spending my weeknights and weekends finishing up the seemingly never-ending daily notes, progress notes, evaluations, and discharges.
After many scenarios of what amounted to verbal abuse from the owner along with complete disregard to the struggles of myself and my co-workers, I decided that I was done with burnout, done with feeling like a puppet in this game. It was time for me to do something different.
I quit that job. Now, I work per-diem in outpatient pediatrics, adjunct in the MOT department at the local university, and run my online business. I’m busier than ever but feel more rewarded than I ever was before.
No doubt if you’re reading this, you’ve felt some level of burnout in healthcare, regardless of the position you hold. Long hours, poor flexibility, high production standards, questionable methods, it all gets to be too much and it’s WAY too easy to burn out. So what do we do?
My goal is to tackle this problem through my business, Joy Energy Time. It is meant to be a resource, community, and learning tool for healthcare providers who feel like I did. Hopeless. Lost. Burnt out.
In order to slay this burnout beast, we must first understand what it is and how it starts. Know your enemy and all that jazz.
What is Burnout?
Burnout can feel inevitable when starting a career in healthcare. You start off with a passion to help people to reduce pain, establish and restore function. You realize that you are constantly giving yourself to your patients and have very little left for you.
You cope with the constant giving nature of your work, and the difficulties your patients and their families face, by detaching and growing distant, sometimes leading to cynicism. You may realize that a script has developed in your department that revolves around misery, negativity, happy hour, and Fri-yay. You realize that because of all the hurdles you must jump through to treat your patients and document your work that you start to feel a low sense of accomplishment.
Welcome to burnout, my friends. It can sneak up on you in stealth mode. You may not realize what has occurred until you’re waist-deep in it. Burnout can look like decreased job performance, lack of motivation, and helplessness.
Negative burnout-related health issues include headaches, chronic fatigue, gastrointestinal disorders, muscle tension, hypertension, sleep disturbances, and cold/flu episodes. A person experiencing burnout may show a decline in job performance and effort, job satisfaction, organizational commitment, display absenteeism, presenteeism, or intention to leave the job.
There is a complicated connection between burnout and chronic stress. Burnout is an outcome of a complex relationship between exposure to work and life stressors, and inadequate recovery processes inside and outside of work hours, even during sleep.
So that explains waking up in the middle of the night thinking that I was treating Jimmy or having a nightmare about forgetting to turn in an eval on time.
Burnout is not a one size fits all type of thing. It can present differently for each person. What can start off as some toxic workplace negativity can lead to a complete lack of desire to continue working in healthcare.
The exhaustion dimension equates to a loss of energy, depletion, and fatigue; cynicism to inappropriate attitudes, detachment, lack of concern, irritability, withdrawal; and the efficiency dimension is characterized by reduced productivity or capability, low morale, and inability to cope.
The Drivers of Burnout
Some key drivers of burnout include:
- workload and job demands
- control and flexibility
- work-life integration
- meaning at work
- culture and values
- efficiency and resources
- social support and community at work
Let’s take a look at each individually.
A heavy workload is one thing. Long work hours and dealing with work overflowing into off-hours happens to everyone. I can attest to my inadequate out-of-work recovery time impacting my health and sanity. I recently received an email while I was out of town that was apparently urgent; when I got back to work I had gotten the blame for that action not being completed on time. Whoops. Sorry, not sorry. Did you know that other countries have laws against requiring work outside of work? Wish I lived there.
When I worked from 8-5 PM with an overflow of work into my nights and weekends, I felt like a slave. I wasn’t getting compensated for overtime, but I was expected to “find time” despite having a full caseload each day with no breaks. During my lunch, I was just too mentally drained to document and needed that break to survive the second half of the day. I liked having a set schedule and planning treatments for the day; however, at this particular facility the schedule would literally change 200 times a day (OK, not literally) so I succumbed to being a puppet in a circus with NO control over anything.
Having a sense of control can greatly reduce burnout rates. Those who reported having lower levels of control use ineffective and unassertive coping strategies like avoidance, withdrawal, appeasing, and suppression of differences despite one’s interests.
In addition, having a sense of humor about work responsibilities is among some internal resources to overcome burnout and a fun way to connect with your co-workers. So rest assured, everything’s going tibia OK in the end (where’s your funny bone?! . . . I’ll see myself out).
Let’s move on to WLI. (I just made up an acronym, roll with it.)
Work-life integration is really whatever works for you. Its better-known cousin, work-life balance, was a term invented in the 1980s. Before the major technological advances that keep us more connected than ever, humans focused on fulfilling all duties in life such as work, family, and leisure, relatively equally. Or at least, when someone left the office, it was more difficult to get work done at home. Now, we’re able to communicate and stay connected at all times. We can check our emails while at the beach, take work calls while on a date, or finish a note on our personal computer at home. The lines between work and leisure have blurred, and work has spilled into almost all areas of our lives; evenings, weekends, even vacations.
I am newly married and don’t have kids, so it’s challenging for me to even imagine how a healthcare professional can juggle this constant connection to work, family life, self-care, etc. Is it possible? Absolutely! Is it difficult? I’m sure there are tricky aspects of it, just like anything, that are both difficult and rewarding. Our advice? Disconnect! Work should stay at work AS MUCH AS PHYSICALLY POSSIBLE. That email or call to a patient can wait until working hours.
Our OTs are all about the models! A fabulous model called the Job-Demands-Resources model demonstrates how job demands may exceed work-related and internal resources which leads to burnout. These internal resources include assertiveness and being able to ‘switch off and create that much-needed recovery time.
Next up, finding meaning at work. For me, this one has evolved quite a bit since OT school. I’m not fitting into the nice, safe, traditional clinician OT box and that’s ok. Guess what?! You don’t have to either! You do what lights you up. Being in the clinic 50 hours a week didn’t do it for me. I don't fit there. But there is absolutely nothing wrong with that box if it really gives you fulfillment.
Personally, my meaning in work has evolved into an entrepreneurial role which excites me more than I ever thought possible.
Finding what gives you meaning in work may transform over time, which is natural. You might find throughout your career that you would rather be involved in an education, research, ownership, or leadership role - or not. Again, you do you. Find whatever lights you up and find it fast before it’s too late.
In any workplace, culture is king. The culture of a workplace can make or break an employee. Culture can be anything from patient outcome goals to specific treatment protocols, kickball Sundays, to a general demeanor around the office.
It’s crucial for organizations to 1) figure out what their culture is, 2) figure out how to foster the values that nurture that culture in their employees, and 3) to occasionally take stock of whether these values have changed or if your company is getting away from its ideal culture. This is a perfect opportunity for not only leadership but for everyone on the team to actively shape the work environment for the better.
Improving your efficiency and resourcefulness on the job can also make a huge difference. I 100% lacked resourcefulness in my first job out of school. Fresh out of the ivory tower grind I was highly organized with my work; however, I didn’t know how to prioritize work with non-work things (like making time for myself), which are just as important as developing efficiency at work.
I developed this fear around the idea I had to be perfect at my job (I’m a Virgo, don’t judge), and “being perfect” meant saying yes to everything. “Being perfect” heightened my anxiety that started in high school and only grew worse with time.
Let’s talk community and social support. You can sense when this is a genuine resource at your job or purely forced. You can tell when the Negative Nancys and Debbie Downers make that half-assed effort for positive interaction or talk about how “it’s just not how it used to be.”
Try to avoid an “every man (or woman) for themselves” attitude and see if you can help foster a community of collaboration, teamwork, and helpfulness. Not super busy? Help a coworker with some task to lighten their load. They’ll return the favor and you just might trigger a culture shift.
Unfortunately, burnout is more a group phenomenon than it is an individual phenomenon.
Burnout is contagious.
I’ll talk more about how to turn this around later! For now, let’s discuss some other factors that may contribute to a healthcare provider’s level of burnout.
Different Types of Rewards
Rewards are the reason why everyone works. We’re all aware of the most obvious one: salary/pay. This is what we dream of while we’re in school. Finally making that paycheck. But what about the status-related reward or the socio-emotional reward?
The status-related reward refers to career promotion and job security, whereas socio-emotional reward refers to esteem or recognition. Even a high five or a pat on the back for a job well done. For some, those types of rewards are important too.
In my first job out of school, we had many fun activities to look forward to. Halloween wasn’t just celebrated on October 31st. We celebrated it for the whole week! For our Thanksgiving feast, we had Coquito (the best drink!). Sometimes even small strategies like this can promote an increased sense of job well-being, which could take some of the edge off.
Get ready for another juicy model! According to the Effort-Reward Imbalance model, if you have a combination of high effort and low reward, that predicts high job burnout and poor health outcomes, such as cardiovascular disease, mild psychiatric disorders, and lower subjective health ratings.
A recent study factored in participants' level of income satisfaction; those that reported low-income satisfaction also reported burnout and higher odds of developing cardiovascular disease, whereas those with high-income satisfaction reported higher engagement at work.
So what’s your work “love language”? How do you like to give and receive appreciation at work? It’s important to understand what your language is and what type of reward makes you happy.
Sure, financial rewards are nice. In my case, the money and benefits were actually great, but the socio-emotional rewards were non-existent. I felt as though my mental well-being absolutely did not matter. For some people that may not be a huge issue. For others, like myself, it may be more important than any other form of reward (we’re not robots)!
Is Engagement the Opposite of Burnout?
Research indicates engagement is the opposite of burnout in terms of a worker’s well-being in the sense that it includes a state of high energy, strong involvement, and a sense of efficacy, vigor, dedication, and absorption. However, it should be noted that burnout and work engagement do not represent the two extremes of a single continuum, but rather can co-exist.
High engagement can lead to work strain due to work-life conflicts, health conflicts, etc. Engaged employees are likely to feel tired after a long day, but there’s a difference between feeling tired and emotionally exhausted.
Burnout occurs gradually. Compassion fatigue, which has also been called “the cost of caring,” can occur suddenly. In healthcare, we care a lot. It’s right there in the name. Compassion fatigue can and often does accompany burnout. Compassion fatigue can be described as exhaustion and a significant decrease in the ability to empathize. Some evidence also exists linking burnout to increased patient mortality, so this can be a very costly issue.
Day in and day out, being exposed to trauma and the emotional and physical challenges of our patients can affect our attitude. Too much exposure to trauma can cause us to feel overwhelmed, numb, and thus, can lead us to deal with that overwhelmed feeling in undesirable ways like losing empathy. Tackling this problem can mean focusing on how you deal with these emotions in real-time as well as with self-care and leisure activities out of work.
Sooooo without further ado, let’s get to the good stuff! You came here for tips, right?
Three Tips to Fight Burnout Today
1. Practice self-awareness
I first began to develop my self-awareness outside of work through meditation. There are plenty of online resources and podcasts for this. I use the app Headspace. Over time, I found that I began to unconsciously and involuntarily find myself being randomly mindful throughout my day, and also, having that spill into moments during work as well. I didn’t quite understand how to become more self-aware than I already was, or so I thought. Creating space in my busy schedule for 10 minutes of self-awareness meditation gave me the space in my day to just simply notice what was. What I hear, what I feel, what I see. Without judgment, without rushing off to do something or thinking of what I have to do. Just sit or stand quietly and take in your current moment. Don’t look ahead or behind. This can be incredibly calming and centering. It can give you clarity in an otherwise cloudy and hectic day.
We get caught up in the craziness of our day and before we know it, BOOM, it’s time to go home. Or BOOM it’s Friday. Or BOOM you’re 60 years old. Don't let that happen to you. Practicing mindfulness can have incredible therapeutic effects.
We all have 10 minutes for ourselves, and if you’re thinking you don’t, then you need it even more. Reading this article takes at least 10 minutes! The best part about meditation is that I can use those techniques any time of the day. Especially in those extra stressful moments. Just practice awareness in the moment. What felt like a 99.8% unconscious life has turned into many mindful moments in my day that have led to enhanced well-being. Cheers to that!
2. Foster Meaningful Interactions
You can lead a horse to water, but you can’t make him drink. Although you can’t make everyone be happy at work voluntarily, you can do your part to foster meaningful, positive interactions and improve the workplace culture. How often do we adopt a “normal” script at work that sounds just utterly dreadful?! Any sign of non-dread or dare I say, enthusiasm will get everyone giving you strange looks?
Take baby steps in redefining the go-to script. Go for different. Go for positive. This can be a verbal script or a non-verbal script. Sure, sometimes we can bond with one another with the humor we create out of our negativity. We should consider going for authentic yet positive interactions and actions. Making the day better for someone else goes a long way.
When I was in fieldwork during school, my clinical instructor always taught me to do little things to help nurses throughout the day. This helped develop a reciprocal relationship — I scratch your back, you scratch mine. And everyone was happier for it. Remember, there’s no I in team: fostering a true team spirit will cultivate a greater sense of community and belonging. We’re in this together.
On a related note, do yourself a favor and watch this TED talk from Robert Waldinger, the director of a Harvard study which is the longest-running adult development and happiness study in history. The main takeaway is that your relationships have a WAY bigger effect on your physical and mental health than previously thought. The participants who were the most satisfied with their relationships with friends , family , and co-workers in mid-life were the healthiest in their 80s, and lived the longest out of the whole cohort.
3. Advocate for Change
Many problems and strategies we’ve covered so far need to be top-down initiatives, meaning they come from management first. If management isn’t onboard the train, you’re going nowhere. Do you need more flexibility in your schedule, better supplies, a quiet break space, or a lessened caseload?
Effectively advocating at the organizational and managerial level allows you to take control once again. Have a meeting with your boss or supervisor. Establish that your first and foremost goal is to be an effective employee. If they are a good leader, they’ll listen to you and at least try to be accommodating. If nothing else, you’ll be a thorn in their side and get them thinking about possible changes. We spend a whole section on effective advocacy in our massive burnout prevention in healthcare course.
Bash the Burnout
If you truly are burning out in healthcare, there's still hope. As you have read, I totally understand your situation. I spent the first two and a half years of my career as an occupational therapist telling myself that the way I felt was “normal” and this is something I have to get “used to” because everyone around me was already used to it too. F that. Just because everyone is jumping off a bridge doesn’t mean you should do it too, right?