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How to Prevent Burnout in Healthcare

How to Prevent Burnout in Healthcare

Burnout can occur in any profession; thus, anyone working in healthcare can experience burnout. According to a study by Forbes, healthcare is the number one profession notorious for workplace burnout.  

There are a vast number of healthcare professions, but most discussion on healthcare burnout centers on healthcare providers: physicians and nurses. Out of the 22 million workers in the healthcare industry, 9.8 million served as healthcare technicians and practitioners, according to a 2019 U.S. Census Bureau survey. Without physicians and nurses, healthcare institutions would not be able to offer safe, quality care to patients within their community.  

It should be noted that all employees within the healthcare industry are at risk for burnout – especially after the COVID-19 pandemic. Healthcare leaders and managers, medical assistants, housekeepers and supply managers are also at risk for the physical and emotional aspects of burnout.  

 

What Does Burnout Mean

Burnout is a stress syndrome related to chronic stress from a job, according to the U.S. Department of Health and Human Services (HHS PDF source). One can feel periodic stress from a job that is temporary or situational), but burnout is due to chronic stress and will not ease up without intervention.  

Burnout has three associated qualitative components:  

  • Emotional exhaustion and cynicism 
  • Low sense of professional efficacy 
  • Low sense of personal accomplishment at work 

Burnout can occur in any profession but is extremely common in healthcare. Because burnout is so prevalent in healthcare, Mental Health America has focused efforts on identifying and preventing burnout among healthcare providers. Symptoms of burnout include sleep trouble, physical and emotional exhaustion and work-related dread, according to a study by Mental Health America.

 

Why Employees Get Burnout 

Healthcare providers carry the responsibility of worrying about the demands of their profession – high-stress, high-stakes, and long, stressful hours – but also the complexity that comes with taking physical care of patients and their families. These demands, plus the mental and emotional strain that comes with patient diseases, suffering and death, all take a toll on an individual.  

Dealing with human pain and suffering is difficult for anyone, and healthcare workers encounter this challenge daily, and often bring the emotional strain home. Additionally, healthcare institutions demand cost-cutting protocols that often lead to shortcuts, increased nurse-to-patient ratios and mandatory overtime.  

Unfortunately, untreated burnout can lead to significant mental health illnesses that is increasing the suicide rates among healthcare professionals, thus placing more emotional and physical strain on colleagues, according to an article in Corporate Wellness Magazine.  

The vicious cycle of high turnover leading to short-staffed departments, coupled with the need to provide safe, quality care for acutely ill patients, increases the stress and exhaustion of all healthcare providers.   

 

Burnout Relative to COVID-19 

While burnout was an issue before the COVID-19 pandemic, impacting almost half of physicians and a third of nurses, according to the National Center for Biotechnology Information (NCBI), it is an even more severe issue today, causing the highest turnover ever seen in healthcare. 

Mental Health America surveyed more than 1,100 U.S. healthcare professionals between June and Sept. 2020 about their mental and emotional states. An overwhelming 76% of healthcare professionals reported feelings of exhaustion and burnout.  

During the third major surge in the United States, Stat News argued that healthcare workers were actually past burnout and had reached a new, previously unseen stage that it termed “burnover.” The term is coined from its use among firefighters. When they have burnover, it means a fire has overrun the firefighters, resulting in huge devastation.  

And burnover does not just afflict long-practicing healthcare providers. Since the COVID-19 pandemic, medical students, residents and early-career physicians report feeling symptoms of burnout, depressive symptoms and recent suicidal ideation at higher rates than peers in the general U.S. population.

Many new graduate nurses who entered the field during the COVID-19 pandemic have already left the industry altogether. According to the International Council of Nurses (ICN), the global nursing shortage due to burnout post-pandemic will be upward of 13 million nurses (ICN PDF source).    

  

The 12 Stages of Burnout

Warning signs of burnout can be subtle to begin. Healthcare workers experiencing fatigue, irritability and negative expectations of the institution are all early warning signs of burnout, according to the New England Journal of Medicine,. Other subtle signs include drinking alcohol more frequently, inability to sleep despite fatigue and a lack of interest in doing things that were once enjoyable.  

Psychologist Herbert Freudenberger identified a 12-stage chronological development of burnout called the Burnout Phase Model. These stages are: 

  1. The compulsion to prove oneself  
  2. Working harder 
  3. Neglecting needs 
  4. Displacement of conflicts 
  5. Revision of values 
  6. Denial of emerging problems 
  7. Withdrawal 
  8. Odd behavioral changes 
  9. Depersonalization 
  10. Inner emptiness 
  11. Depression 
  12. Life-threatening physical exhaustion - known as burnout syndrome 

The premise is that an individual begins at the first stage of compulsion to prove oneself (excessive ambition) and progresses through each stage as their burnout increases.  

 

Consequences of Burnout in Healthcare  

While any person within any profession can experience burnout, burnout among the healthcare professional is a particularly serious problem.

Not only does one need to worry about the impact of burnout on a person’s wellbeing, but healthcare providers experiencing burnout can have a detrimental impact on patients and the care they are provided; quite frankly, burnout can be a determinant of life and death.  

The top three notable consequences include: 

  • A healthcare provider shortage 
  • Medical errors 
  • Increased financial burden on healthcare institutions 

Healthcare Provider Shortage 

Healthcare institutions nationwide are already experiencing a vast shortage of physicians and nurses, which can become dangerous and cause a variety of issues for providers and the organization including:

  • A decrease in their work efficiency
  • An increase in the number of medical errors
  • Financial obligations and public relations incidents
  • Healthcare providers leaving the organization or profession

 

Image: cottonbro @Pexels

 

The estimated loss of productivity due to physician burnout is the equivalent of eliminating seven entire medical school graduating classes, according to a study by the Mayo Clinic,. The U.S. Bureau of Labor Statistics projects that more than 276,800 additional nurses are needed from 2020 to 2030, growing the profession by 9%.  

Medical Errors   

John’s Hopkins patient safety experts found that more than 250,000 U.S. deaths each year are a result of medical errors. Multiple studies show that medical errors are the third leading cause of death in the U.S.

All healthcare providers are at risk for medical errors, but healthcare providers experiencing burnout are at a higher risk of making a medical error or failing to report a medical error or a near-miss. Without reporting a medical error or near-medical error, patient safety cannot be protected.  

The American Association of Critical Care Nurses (AACN) studied the prevalence of medical errors by interviewing 800 critical care nurses and found a strong correlation between the prevalence of stress, anxiety, depression and other burnout symptoms and medical errors. Medical errors are not just a nursing issue but a systems issue that can impact pharmacists, physicians, physician assistants and nurse practitioners.  

Medical errors can occur anywhere in the health care system – in hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies and patients' homes – and can have serious consequences. Errors can involve medicines, surgery, diagnosis, equipment or lab reports. In an effort to reduce the number of medical errors and prevent them altogether, the Agency for Healthcare Research and Quality has sponsored hundreds of patient safety research and implementation projects.

Financial Burden  

Burnout among healthcare professionals creates a substantial financial burden on healthcare institutions themselves. According to Harvard Business School, physician burnout costs the U.S. healthcare industry $4.6 billion annually – and that was before the COVID-19 pandemic. 

According to the American Medical Association, each time a physician resigns, it costs the physician’s institution at least $500,000. And according to Nursing Solutions Inc. (NSI), each instance of nurse turnover costs the institution $46,100. Not only does the turnover of healthcare professionals financially impact healthcare institutions, but medical errors resulting from burnout can also carry a heavy financial burden.   

A 2022 study found that medical errors cost healthcare institutions approximately $20 billion per year. In addition, treating patients recovering from a medical error can result in an increased length of stay in the hospital for the patient, often at no cost to the patient. As a result, physicians and nurses are spending valuable time providing care they cannot bill, and the patient is occupying a bed that would otherwise generate revenue. Healthcare institutions then recoup costs by increasing the overall cost of healthcare to U.S. citizens. This makes healthcare burnout an issue for everyone.  

 

Recovery From Burnout  

Approaches to treating burnout begin with identification. If burnout can be identified in the beginning stages, changing personal life habits and work-life balance is essential in preventing worsening feelings of burnout.  

Because burnout is a chronic condition of stress, relieving stress should be instrumental. This is often unrealistic in healthcare – a career that is often of high acuity and stress in the best of times. Unfortunately, this could mean a change in profession is necessary. Healthcare continues to suffer from a mass exodus of providers, among an already devastating healthcare provider shortage.  

 

Image: Jill Wellington @Pexels

 

Alternatively, healthcare institutions should prioritize work-life balance among their employees to assuage healthcare providers from leaving the organization or profession. Examples of prioritization by healthcare institutions could include fitness centers for all employees on hospital grounds, counseling services and ensuing adequate staffing so providers can take mandatory breaks.  

One hospital’s approach was to staff extra physicians and nurses for relief throughout the day. This demonstrates the importance of self-care and promotes recovery from burnout. Ownership of recovery is shared. It must begin with the healthcare institution recognizing the problem and taking actions to support its employees – and then by the individual healthcare provider taking responsibility for their own mental health.  

 

How to Prevent Burnout 

First off, we need to realize that burnout is not inevitable.  

Preventing burnout in healthcare must be made a priority. Individuals must be educated to recognize that they work in a profession with a high risk of burnout. This education should begin in school and continue through healthcare institutions. Understanding what burnout is and how to combat it empowers the healthcare provider. Additionally, they must be able to have crucial conversations with their supervisors and peers and ensure work-life balance and feel safe and competent in their work environment.  

Ultimately, they must be encouraged to speak up regarding unsafe practices without fear of retaliation. Healthcare institutions need to establish wellness programs with incentives to participate, according to Corporate Wellness Magazine. These wellness programs need to prioritize burnout education and allow for wellness-related conversations to take place.  

Workplace culture must aim to increase wellness and resiliency opportunities, including discussions of emotional strain and fatigue in a safe, nonjudging environment. These programs must address burnout, proactively reaching healthcare providers with meaningful interventions. For example, providing education in a hospital newsletter is helpful, but doesn’t actively engage the healthcare provider. Burnout intervention needs to be more concrete and tangible.   

Lastly, healthcare policy needs to be formed to protect healthcare providers from institutions allowing unsafe practices to continue, whether that be long, endless hours, high staff-to-patient [CJ2] ratios or mandatory overtime. Knowing your healthcare institution supports you and cares about your mental health is the first key to preventing burnout.  

According to a Gallup study, leaders should be aware of five components that contribute to burnout, including in healthcare. They include:  

  1. Unfair treatment at work – According to Gallop, feelings of unfair treatment break the bond between employee and leader.  
  2. Unmanageable workload – This is seen across the U.S., with higher nurse-to-patient ratios or physicians being told they are not seeing enough patients during the day to make a profit.  
  3. Lack of role clarity within the healthcare field – Physicians and nurses are asked to wear many hats, even outside their trained roles. 
  4. Lack of communication or support from managers
  5. Unreasonable time pressure

  

Crucial Conversations   

Urgent action is needed to retain and strengthen the healthcare workforce. It is ultimately up to the individual to advocate for themselves to promote change. However, without institutional change, burnout or “burnover” will continue to plague the industry.   

There is an urgent need for government and health system leadership to prioritize the retention of nurses and physicians. Understaffed healthcare organizations lead to overworked providers, which ultimately compounds burnout. Effective policy responses need to be introduced to improve wages, working conditions and support of healthcare providers’ mental health.  

Healthcare centers around patients and their families who deserve safe, quality care. They deserve focused healthcare providers who are happy, content and feel safe in their work. World-class endurance athletes receive tremendous support so they can build upon their strengths and surpass perceived physical and emotional limits. Healthcare providers deserve this same support.  

Everyone within healthcare can help support one another with peer-to-peer coaching and social services dedicated to the needs of healthcare providers. In the first year of the pandemic, more than 3,600 U.S. healthcare workers died.  

Dr. Anthony Fauci, chief medical advisor to the Biden administration, said it best: The deaths of so many healthcare workers due to COVID-19 are “a reflection of what health care workers have done historically, by putting themselves in harm’s way, by living up to the oath they take when they become physicians and nurses.”  

Healthcare workers are an indispensable and resilient part of the nation’s workforce — and have saved countless lives before the pandemic and during it. Understanding healthcare burnout and ensuring strategies are in place at the organizational level to prevent burnout will help mitigate future catastrophes.  

 

About the Author:   

Dr. Crissy Hunter, DNP, RN, CHSE, CNE has been a nurse for over 20 years. She has taught undergraduate and graduate nursing full-time for the past 12 years. Currently, she serves as course coordinator for the MSN nurse educator core courses (Teaching and Learning, Assessment and Evaluation, and Curriculum Design) at Southern New Hampshire University. Additionally, Dr. Hunter is the coordinator, advisor, and faculty for the nurse educator track. Dr. Hunter holds a Doctorate in Nursing Practice from American Sentinel University and multiple specialty certifications in nursing education.