Enjoy this in-depth interview with Dr Naomi Brokenshire from the University of Melbourne, expert in and champion of healthcare worker wellbeing with extensive clinical and academic experience:
We all have bad weeks at work where we feel tired and stressed, less motivated than usual. Maybe we feel underappreciated or overworked. When do these unexceptional experiences become concerning, become clinical burnout?
It is normal to have days at work where we feel overwhelmed; however, if you start to have more bad days than good, you may be at risk of clinical burnout. Clinical burnout is the result of ongoing, unrelieved workplace or job-related stress, which can lead to physical and mental exhaustion, reduced job satisfaction, and increasing detachment from your colleagues and patients.
Signs you may be developing clinical burnout include:
- Apathy towards patients and/or fellow healthcare workers
- Feeling despondent, helpless, resentful, and disenchanted
- Cynicism, particularly regarding healthcare organisations and those in charge
- Reduced attention to detail, leading to increased errors or missed care
- Questioning your future in the profession
Obviously COVID-19 has placed a whole new level of demands on the profession. But even without the additional strain of a pandemic, burnout, mental ill-health and stress are higher among healthcare workers than in the general population. What are some of the key factors driving this, and are these capable of changing or abating?
Some of the key factors driving clinical burnout amongst healthcare workers include:
- Stressful or unsafe work environment
- Low or inappropriate staffing levels
- Feeling undervalued or replaceable
- Increasing responsibility and complexity of patient care
- Lack of support from a managerial and organisational level
The culmination of these factors can lead to an overall feeling of disillusionment and frustration with the notion of healthcare as a business, rather than healthcare as a service.
Through increasing recognition of these factors, organisations are beginning to change the culture of healthcare in order to engage, respect and retain employees. One of the most important steps in that process is to acknowledge the development and maintenance of wellbeing as critical to the ongoing health, efficiency, and success of the workforce. There is still a long way to go, but we are moving in the right direction.
We often publicly praise healthcare workers, which is important of course, but are we doing enough to support the day-to-day wellbeing of healthcare workers? Where are we making gains, and where are we lagging?
Working under the immense pressure of a global pandemic has emphasised some deficiencies in the current model of wellbeing support for healthcare workers, prompting healthcare organisations, and broader governmental health departments, to review and expand support for healthcare workers
Employees may now have increased access to peer support services, professional counselling, free wellbeing activities – such as lunchtime mindfulness sessions and yoga classes – or discounted gym memberships. These are all great examples of positive strategies that have been implemented to support healthcare worker wellbeing.
The continual expansion of these services, plus the growing recognition of the importance of wellbeing for healthcare workers, is where the industry is making significant gains.
However, we are still lagging in one critical area. In all these services, the onus is on the individual to recognise and address their own wellbeing. More needs to be done at an organisational level to change the culture of healthcare – the high-pressure environment, expectations to cope, and the tendency for workers to push themselves beyond what is safe, or healthy.
The drive for change needs to come from an organisational level, where values, attitudes and practices should clearly reflect the importance of healthcare worker wellbeing, and active measures taken to ensure this wellbeing is preserved for all workers.
What are two of the most critical things we can we do at the individual and organisational level to prevent burnout and stress?
Individually, the most important thing we can do is implement and maintain positive wellbeing practices before the signs of burnout start to present. This includes preserving a work-life balance and cultivating strong interpersonal relationships both within and outside of work
At an organisational level, greater promotion of available supports is needed alongside active encouragement for all employees to engage with these supports. This includes ensuring all workers can access or attend wellbeing sessions, which may necessitate multiple sessions running at different times to cater for shift workers.
Furthermore, organisations should start proactively checking in with staff, rather than waiting for workers to access supports on their own.
For both the individual and the organisation, prevention is always better than post-burnout management.
Once we start feeling burnout, what can we do to start to recover? What if we feel we can’t take time off work?
Prioritise your own wellbeing. This may feel like a difficult task to achieve, particularly when feeling overwhelmed and exhausted; however, start by implementing small, achievable goals at work.
Take breaks – leave the ward or department and have a proper break from work. Clear your head. Go for a walk. Have lunch with a co-worker. You will be happier and more efficient when you return to work.
Eat healthy meals – rather than wash down a packet of chips with a diet coke, try and bring (or buy) nutritious meals to eat at work. You will have an easier time focusing, and more energy to get through the day.
Debrief – make it a habit to debrief, formally or informally, with peers and co-workers. Shared experiences are valuable and can help you process stressful events.
Celebrate the wins – healthcare can be a hard business to work in. That is why it is always important to celebrate the wins, no matter how small. Take the time to acknowledge the good and share this with your team.
Leave work at work – at the end of your shift, leave work behind. Choose a landmark on your journey home and when you pass that landmark, all thoughts about work must stop. Give your mind a rest. Work will be there when you return.
If you could say one thing, give one tip, to someone experiencing ongoing fatigue, stress, or inertia at work, what would it be?
Reach out – talk to colleagues and friends; make a time to speak to your manager or mentor; or contact peer-support services. You are not alone. It is only through honest conversations and open dialogue the stress and pressures you are experiencing can start to be alleviated. Telling someone how you are feeling can be incredibly relieving, and is the first step towards rediscovering your joy and passion for healthcare.
Dr Naomi Brokenshire is Lecturer in Nursing at the University of Melbourne teaching in the Master of Nursing Science and Specialist Mental Health Nursing programs. Naomi also holds an Honorary appointment with the Nursing Research Department at the Royal Children’s Hospital Melbourne.
Reviewed 25 October 2021