No Smoke Without Fire: The Badness of Burnout
by Linda-Jayne Mottram, Consultant in Anaesthesia and Intensive Care
Burnout: exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.
Who is at risk from burnout?
You may have heard the expression – ‘the flame that burns twice as bright burns half as long’, or similarly the colloquialism ‘to experience burnout you had to be fired up in the first place’. It suggests that only the highest achievers in medicine and nursing get burned out. I’ve started to think that this is an oversimplification.
For instance, you might not readily identify with the critical care super doc who skips around the Intensive Care Unit like the Duracell bunny on steroids, whipping in lines and tubes like they’re going out of fashion. In fact you might struggle to remember a time when you felt enthusiastic about medicine at all.
Burnout is a bit like that … hazy… detached…. exhausting.
What is Burnout?
The term can be used generically as a nebulous descriptor of someone who is unhappy in their work …. but is burnout really such a poorly defined concept?
I would argue that it isn’t.
Burnout is a tripartate psychological phenomenon comprising:
- emotional exhaustion = unrelenting tiredness
- depersonalisation = feeling detached and cynical about work
- reduced professional accomplishment = “what’s the point in this anyway?”
It can be measured using the Maslach Burnout Inventory, but it isn’t necessarily easy to identify in yourself or in colleagues.
If there’s only one message, it is that burnout is staring you in the face. Either when you look in the mirror, or when you look at a colleague standing next to you on the ward round.
As ICU doctors we shouldn’t expect to defy the statistics. One in two ICU physicians will experience features of burnout at any one time. So the question should cease to be “is burnout present in my unit?”, I can answer that – IT IS. The question is rather, “how widespread is it and what areas of work does it affect?”
Consider where burnout may be present in your unit:
- It is present in the morale and culture of your department
- It is reflected by absenteeism rates
- It contributes to the subtle underperformance of presenteeism
- It affects quality indicators like patient satisfaction or infection rates. It could be argued that ‘burnout rate’ is a quality indicator itself.
- It affects physician cognition and decision making – in fact there is now functional MRI evidence that this is the case.
CAUSES & CURES – the BURNOUT BIG SIX
There are SIX domains of work that cause burnout but if addressed positively, can act as solutions for burnout within our intensive care units.
– ICU is demanding, mostly because of the emotionally and physically burdensome nature of our jobs. The work itself can be both a ‘demand’ and a ‘reward’.
– the hallmark of a profession is a high level of skill and a certain degree of professional autonomy. When empowerment is given back to staff, the department gets much more back in return.
– most of us strive to do our jobs well because we appreciate the significance and purpose in what we do. Social reward is when others acknowledge the value we bring to the workplace. This has untapped potential in healthcare as it costs nothing to express gratitude, on the other hand it costs dearly when value is eroded.
– our ICU team could be our greatest resource. It can also be our greatest ‘job demand’, if it proves to be dysfunctional. We don’t need those kinds of demands when the job is already stressful enough. The creation of a great team is an active decision and is unlikely to happen by chance.
– if you feel you aren’t being treated fairly at work it fuels a deep sense of cynicism about your workplace and contributes to burnout.
– when your own personal values conflict with those displayed in your unit, over time this causes burnout. Moral distress is one example of this and has been highlighted as a cause of burnout in nurses
If you wish to measure burnout in your unit using the Maslach Burnout Inventory or measure the BURNOUT BIG SIX you can do so here.¹
Solutions for burnout involve the wider healthcare organisation, local departments, and the individual themselves. The excessive focus on personal endeavours might explain the many negative studies thus far, as recent evidence suggest wider system changes have more to offer. See, for example this paper in the JAMA.²
The first step is recognition of the problem. Remember that burnout is staring you in the face. Now is the time to acknowledge it and work towards reigniting the fire.
- Maslach Burnout Inventory http://www.mindgarden.com/117-maslach-burnout-inventory