STAGES OF BURNOUT
A person involved in most professional careers will go through stages corresponding to some, or all, of the following:
In the initial stages of their career, enthusiasm and aspirations are high, and ambition is not readily tempered. At some point in their working life, at a time dictated by circumstance, personality, original ideals and achievements, it is likely that the enthusiasm may start to wane.
As the thrust of the early years wears off, the individual settles down into a routine where there is a tendency to preserve the status quo more than in previous years. Isolation, political dissatisfaction, hierarchical management structures, and lack of defined goals, and objectives can contribute to mounting frustration.
Frustration can cause a vicious cycle of increasing dissatisfaction. Minor hindrances such as administration and paperwork become a major trial and the feelings of being stifled and powerless add to the burden. If the frustration becomes too much, even periods of achievement will fail to restore the previous enthusiasm. The individual will dream of change and usually try to take steps to produce significant change. If this change can be instituted the person will often become re-enthused and may return to the beginning of the cycle.
Edelwich and Brodsky argue that this is the point where burnout becomes an entity, as the fourth stage in the process becomes apparent. This crucially important fourth stage is that of apathy.
If the frustration continues there will follow a self protective attempt to ‘shut it off’. At this point the effect of burnout are becoming intrusive. Shutting off the feelings of frustration will occur at the expense of caring, and there will be increasing emotional detachment.
There is no way out of this cycle of frustration and apathy without the presence of a fifth stage, intervention.
The signs and symptoms of burnoutPhysical signs:
Feelings of exhaustion
Inability to shake off a cold
Feeling run down
Shortness of breath
Behavioural and psychological signs
a) Symptoms reflecting an inability to reconcile the demands of work and social life.
Working harder to accomplish less (perceived or real)
Coming to work late and leaving early
Coming to work early and leaving late
Taking work home
b) Symptoms reflecting the apathy associated with the onset of burnout
A general feeling that something is wrong
Resentment – of clients, colleagues, management
Lack of enthusiasm
c) Inability to come to terms with the new set of feelings engendered by the process of burnout
Loss of temper
Reducing the Effects of Burnout- Stress ManagementBurnout can be prevented from occurring, or mediated if present, because it is a reflection, not of permanent structures and traits, but of situations and environmental factors that open to change. As it is a manifestation of stress, it will respond to many widely acknowledged stress management techniques.
Stress management is not a new field, nor is it a small one. Some of the more common techniques are highlighted in this paper, but there are many others and the interested reader should find no difficulty in following them up.
Recognition is the essential first step to rectify or prevent the symptoms of burnout. Unfortunately, the person in the end states of burnout will often find it difficult to seek help voluntarily for a variety of reasons. A common reason is a reluctance to fact what is felt to be a ‘weakness’ in succumbing to symptoms as a result of stress. Alternatively, factors such as self perception of status or simply an unwillingness to acknowledge the existence of a problem, will stand in the way. Recognition will involve acknowledging the existence of the problem and crucially, the factors which caused the precipitation of that problem.
This is a great mediator of the feelings which are inherent to the process of burnout. It may be difficult because of the taboos surrounding the admission to others of the negative feelings towards clients that are so indicative of burnout.
The process of communication with others in the same position, the advice that will come as a result and the realisation that others share the same feelings, all to help minimise the resentment and emotional pressure which builds up. The tendency to burnout is thus exacerbated in those individuals who have difficulty in communicating, although the difficulty may not be due alone to the persona of the individual. It can also result from their position, the nature of the job or the lack of contact with others in the same position. This last factor is widely recognised as a problems in a variety of health professions, and is one which is very relevant to the community-based, often isolated professional group like podiatry.
Relaxation can be divided into two forms: diverting activity, or complete opt-out of all activity, although there is no solid division between them. In order to derive the best benefit, the form of relaxation chosen must be compatible with the needs of the person involved or it too becomes a stressor.
Coping is both physical and psychological. It involves making a positive effort to avoid factors which lead to increased demands and stresses. There are specific areas to focus on.
Problem solving. Weighing outcomes and solutions and applying thought to situations met in the course of the working day.
Effective time management. Life is planned around time, but time is an inconsistent resource. Eighty five percent of senior nurses feel that they do not have enough time to do what is asked of them. Similar studies suggest that this view will be shared by other health care groups.
Activity does not necessarily equate with ‘getting things done’. Delegation is important, as is sharing of information to enable sharing of work burdens. Time cannot be saved, it can only be better utilised. Tactics to improve the use of time including planning, organising and implementing in an ordered and sensible fashion.
Assertiveness. Learning to take on only what feels comfortable and accepting that there are times when it is necessary to say ‘no’.
Develop ‘altruistic egoism’. A term coined by Hans Selye who stated that all living creatures are and must be primarily selfish. this means that we must look after our own interests, and that others will not do so if we cannot for ourselves.
Change routines. An effort to introduce variety can make a substantial difference. There is nothing to lose by trying.
Institutional causes of burnout
There are a number of institutional factors, specific to health care, and thus there may be specific reasons for the preponderance of in the helping professions.
A factor long held as being de-motivating is that of low pay, and is probably fair to say that public health care workers are generally more poorly paid than similar employees in the private sector. However, the importance of this is in the precipitation of burnout amongst previously well motivated people may be over emphasised, as personal finance appears to be a relatively minor concern to many ‘caring professionals’.
A far more powerful demotivator is likely to be the typical unevenly weighted career structure, common to most health professions, where the only way to further oneself has traditionally been through management. Paradoxically, the current limitation of this through the ‘flattening’ of NHS hierarchy is likely to decrease motivation further, as career planning becomes increasingly difficult. This is compounded by the fact that, contrary to traditional opinion, health care professions are careers, not callings.
Other significant de-motivators include:
Politics: local, district, regional and national;
Instability through uncontrolled change;
Lack of professional identity;
Uncertainty over the future;
Managerial demands incompatible with the best provision of care from provider to patient