Suffering from burnout? A little bit of kindness can go a long way
When I teach the NAEMT Safety Course I make the point that back injury is the most common cause for leaving EMS. Someone invariably disagrees and says burnout is the main culprit. There are statistics for back injuries, but none for burnout. The concept of burnout became popular in the early 1970s. Although not rooted in EMS, early articles by Maslach and Freudenberger described idealistic young professionals in health care and social services who were working too hard while not given adequate resources to do their jobs well. Over the years research has shown that burnout has three components: exhaustion, cynicism and inefficacy.
Burnout occurs when idealistic professionals work hard, but were not given adequate resources to do their jobs well. One component of burnout is exhaustion. Exhaustion often occurs when busy schedules and shifts cause sleep deprivation. Fatigue wears people down, not only physically but also emotionally. Sleep deprived people have difficulty in concentrating on tasks. They forget important things. An on-going exhaustion can quickly leads to poor performance. People who perform poorly then battle with excuses and finger-pointing, creating cynics over time.
Cynics are people who are distrustful of human nature and motives in a contemptuous manner. That's a roundabout way of saying they think people stink, therefore can't be trusted. They also believe nobody cares about anybody else. Money issues may be a contributing factor to cynicism. We all know people who struggle with money every day. Business owners fight to keep the doors open. Workers battle just to pay their bills. However, money issues aside, I think part of the reason for cynicism is that people just aren't nice to each other anymore. What happened to common courtesy? Bullying continues in the EMS industry. The turnover is very high, even 40% is not uncommon. I'm told that people would leave one private service for another in a “lateral transfer.” But how many times can you look for greener pastures before you realize you're on the same farm?
The third component of burnout is inefficacy, meaning the lack of power to produce a desired effect. Inefficacy occurs when there is a mismatch between the person and the job. We entered EMS with specific concepts of how we would care for patients. What happens if the bulk of our patients are non-emergency transfers, and we don't get to use the skills we worked so diligently to acquire? How do we feel when we learn about new equipment, techniques or drugs that we don't get to use? What's it like for an owner or Medical Director to get requests for things that may or may not have proven effects on patient outcomes?
Burnout occurs when someone have become exhausted, lost trust of other people, and believe they no longer make a difference. Would you like working in a place full of burnout people? How long do you think such an organization would last? For those of us who have experienced burnout, how was the experience? Was your misery confined only to the workplace? I have experienced burnout, but I learned from it. What I learned is that, for me, burnout occurred when I externalized the responsibility for my happiness. I made bad decisions which put me in the wrong place at the wrong time. It was my fault—not the job's, because nobody can make me happy but me. I needed to change mentality and reprioritize.
What can we do to avoid burnout? The first step is not to become exhausted. The American Nurses Association (ANA) cited research which shows obesity, diabetes and cancer occurs more frequently in people working long hours. The patient and worker safety issues are well-established. The ANA recommended that work schedules should be determined with input from the people who will be working them. Mandatory overtime should be eliminated. Work weeks should be limited to 40 hours and shifts to 12 hours. This is not just a management issue. We have a personal responsibility to sleep properly, manage stress, consume healthy foods and exercise. Although we work for somebody else, we need to think of ourselves as a “company of one.” Our mind and body are the roots of our business. If we don’t take care of them, we will fail.
What about cynicism and inefficacy?
The Veterans Health Administration (VHA) developed an intervention called CREW, Civility, Respect and Engagement in the Workplace. It is a method for identifying tension in the workplace. How much tension is caused by behaviors? Studies have shown that civility and its corollary, respect, decrease burnout! Is anybody surprised that when people are nice to each other, the workplace is more pleasant? Isn’t it easier to trust nice people? As a “company of one”, we are effectively private contractors. As such, we can do job crafting. Think about what you like about the job and what you don’t like. Decide if there is a way to maximize the time spent doing what you like. If not, is an attitude adjustment in order? We own our business and the business is us. It is our job to maintain a sustainable work environment. We must have serious self -management in which we stick to a routine, even when pressured to do otherwise. We must plan for recovery time. Work life and personal life are intimately connected. Don’t let one burn out the other.
ExhaustionDo professionals in EMS get enough sleep? Do they have work schedules that allow seven to eight hours of sleep, which is the optimal amount for people? Studies from all over the world describe the noxious effects of inadequate sleep. A Finnish study showed folks who slept five hours or less, or 10 hours or more, missed five to nine more work days than those who slept the optimal amount. Research from France shows years of shift work can impair brain function. Shift workers were shown to have poorer performance in memory, processing speed and brain power. Those who worked rotating shifts had even poorer performance. Fortunately, once people stop shift work their functions improve, but the improvement can take up to five years. An English study revealed sleep disruption can actually alter the genes which control our sleep wake cycles. Researchers in Philadelphia used mice to show that chronic sleep deprivation causes a neuron loss of 25% in the locus coeruleus. This loss makes it more difficult to stay alert.
What are some signs that you're not getting enough sleep? A study from the Journal of Occupational and Environmental Medicine addressed the concept of fatigue risk management in workplaces and identified the following signs of sleep deprivation. Physical signs include: frequent yawning, drooped head or eyelids, rubbing one's eyes, and the scariest one, microsleeps. Microsleeps are defined as unnoticed periods of sleep or as brief, unintended episodes of loss of attention that may be accompanied by prolonged eye closure, lasting from a few seconds to a few minutes. Has anybody experienced microsleeps while driving? Have some not lived to tell about it? Mental and performance signs include: difficulty in concentrating on tasks, inattention, memory or recall defects, forgetting to communicate important information, and incorrectly performing tasks. Not surprisingly, there are Emotional and Behavioral signs. Sleep deprived people become uncharacteristically quiet, withdrawn or moody, have low energy and lose the motivation to perform work well. When you are chronically sleep deprived, you lose the ability to accurately assess your need for sleep. Stop and think for a moment about these three types of signs. Are any of these applicable to you? Do you think if you have them you may become cynical? In the next Vitals we'll discuss the other two cause of burnout: cynicism and inefficacy.