What Burnout Isn’t

We often talk about burnout like it’s something that can be cured with a little self-care. Take a day off, get a massage, listen to nature sounds during your break — you’ll feel better and then you can keep working. The ugly truth is that there are stages to burnout, and for many, the final stage hits a point of no return that takes years to heal (if ever).

I used to counsel new nurses to watch for near misses as a sign of burnout. When it’s hard to focus on work because you’re too tired, or it’s tough to remember important details a patient just shared with you, it’s a sign that you are exhausted and need to recuperate. This is a stage that can be reversed with a short break and some intentional recovery.

But there is another stage that many, many healthcare workers are experiencing. In this stage, there is severe moral injury or even despair. It’s the stage where exhaustion and anger turns into depression that paralyzes the professional so they feel like they can no longer cope with even small challenges.

Drivers to this despair-level burnout are often systemic, where the problems seem so big that no amount of compassion or human effort seem like they could help.

And speaking of systems, another driver is the lack of people. How many times have you asked for advice and found that you were the most experienced person on the floor? It makes you feel so alone. And guessing about patients’ lives can definitely cause moral injury.

Or when patients are angry because no one answered their call light to help them use the bathroom, and you feel angry with them — even though you know you can’t be in two places at once. You feel it in your gut that it’s wrong for a patient to bear the disgrace of soiling themselves because no one was around to answer their call for help. And when you feel like you are part of the problem — an enemy who fails patients — it becomes a whole new level of trauma.

This kind of burnout is not temporary.

It’s not just fatigue.

It’s not treated with self-care.

But it could end healthcare as we know it because self-care only turns inward, and the kind of burnout we’re seeing has left many healthcare workers empty inside.

So before our workforce hits bottom, I believe we need to shift some priorities as though lives depend on it. (Because they do.)

For one thing, non-bedside entities need to take a backseat. Nothing else is a priority right now. Not billing, not coding, not informatics, not policy, not quality (gasp!) and not even management. Tasks that do not directly serve patients may need to just pause for a while so bedside staff can catch their breath and check their patients.

There is no alternative in a moral universe: The vulnerability of patients makes it necessary to adjust how we accomplish other goals as we prioritize basic human needs like bathing, toileting, and the bedside assessment. If we fail in the basics, it won’t matter how organized the medical record looked, how fresh the logo, or how “well-staffed” the unit appeared to be on paper.

It won’t matter because patients will stop coming if we do more harm than healing.

I’ve heard the phrase, “the hospital is where you go to die” too much in recent years.

When the dust settles and the unnecessary tasks are removed, maybe we can remember what it means to be human and vulnerable. Maybe healthcare workers could dip their toes into feeling some kind of empathy for patients again. Maybe hospitals could be a place where people go to get better again.

I write a lot about resilience in healthcare and try to give practical tips. But when my work made me feel heartbroken and helpless, I had to find meaning in something bigger than myself and what I could physically do. My faith was the practical solution.

I think this is why so many hospitals were founded by churches. People like Mother Teresa could ask God for strength to care for “the unwanted, the unloved, the uncared for” when she faced limited resources and overwhelming needs.[1] People like Dr. Kent Brantly could see a spiritual purpose in treating suffering people because of his faith and it helped him manage the fear of contracting Ebola.[2]

In the end, we’re all human. We all get sick, and we will all die at some point. We need to refocus on a culture of putting patients first before we’re the ones calling for help in an empty hospital hallway.

Because there is a deeper purpose to the work of caring for people.

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[1] Biography.com (Feb. 24, 2020). Mother Teresa. Famous Religious Figures. https://www.biography.com/religious-figures/mother-teresa.

[2] Samaritan’s Purse (April 11, 2017). Dr. Kent Brantly Continues to Share Good News. Health & Medical Ministries. https://www.samaritanspurse.org/articles/as-new-film-debuts-march-30-dr0kent-brantly-continues-to-share-good-news/.