Stress & Burnout
“Stress is a normal reaction the body has when changes occur. The body responds to these changes either physically, mentally, or emotionally Stress is a normal part of life.”
As a healthcare worker, you are likely aware of the impact of stress on the body—but many of us work in a culture that wants us to believe that we are immune to this stress response and that stress only impacts the bodies of those in your care. But while you have years of training and have learned to shift your attention away from your body and towards the task at hand, your body is still having an experience of stress. And it can affect you just as negatively as it does your patients if not addressed.
Signs of stress response (when not a symptom of another condition) can include:
dizziness
aches and pains
grinding teeth
muscle tension, especially clenched jaw or shoulders
headaches
upset stomach, acid reflux, or indigestion
increase or loss of appetite
sleep disturbances, including trouble falling or staying asleep
racing heart
cold and sweaty palms
tiredness or exhaustion
trembling or shaking
unexplained weight gain or loss.
sexual difficulties
What is burnout?
Ongoing stress at work can lead to burnout and burnout syndrome. Burnout is a state of emotional, mental, and physical exhaustion brought on by prolonged or repeated stress in a work environment.
What is Burnout Syndrome (BOS)?
Burnout has classically been characterized by three key features:
Emotional Exhaustion – emotional fatigue is caused by devoting excessive time and effort to a task that one does not see as beneficial. In healthcare, this might involve providing aggressive treatment to a patient who you feel has no hope for recovery. During COVID-19 this may be related to the ongoing expectation that providers work increased hours caring for more patients than they feel able to care for safely or the long periods of time that patients may stay on a ventilator or in the hospital with minimal improvement.
Depersonalization – a distant or indifferent attitude towards work. Examples of depersonalization could be blaming patients for their medical issues or being unable to empathize with a grieving family. During the COVID-19 pandemic, this could be related to the inability to console families of dying patients due to their inability to visit.
Lack of Personal Achievement – a penchant to negatively evaluate the worth of one’s work. This can manifest as a feeling of being insufficient to do one’s job or that one’s efforts do not really matter. For COVID-19, this could stem from the feeling that patients may not improve in a timely manner and may stay in the hospital for weeks to months. This could lead providers to feel that their efforts do not make a difference.
Burnout has been seen in multiple professions ranging from business professionals to lawyers to teachers. Burnout in healthcare was reaching epidemic levels even before the COVID-19 pandemic. In some studies, up to 80% of nurses and more than 50% of critical care physicians reported some symptoms of burnout. Burnout impacts providers on multiple levels. It contributes to both physical and mental health problems, increases the likelihood of substance abuse and addiction, and leads to much higher levels of job turnover. Healthcare provider burnout has negative impacts on the wellbeing and safety of our patients. In multiple studies, the risk of safety events or medical errors is higher among providers who are suffering burnout.
Burnout, stress, and moral distress can all overlap. Burnout tends to describe work-specific issues. Stress and moral distress can stem from work or home experiences. For example, political discord, people not wearing masks where mandated, or verbal or physical attacks on healthcare workers can drive stress and moral distress but may not affect work-related burnout.
Coping with & Reducing Stress
Keep a positive attitude.
We know, this is sometimes easier said than done. But our thoughts can have a big impact on our mood. Below are some strategies, drawn from Cognitive Behavioral Therapy, to support you in keeping (or developing) a more positive attitude:
Reframing negative thoughts: Write down your negative thoughts. Now try to identify all the evidence for and against this thought. Based on the evidence, write down a more balanced thought.
Use visualization. First thing in the morning, imagine your day going well. At the end of the day, replay any positive events that happened. This way, prior to falling sleep, you have filled your mind with positive imagery, which lets your mind entertain positive possibilities while you’re sleeping.
Schedule a positive activity every day. Make an appointment with yourself to spend 10 minutes a day doing an activity that you enjoy. This can be as simple as listening to your favorite song, drawing a warm bath, or reading a few pages from a novel. This positive break can help recharge you, gives you something to look forward to, interrupts negative thinking, and makes you feel good, even if only for a few minutes.
Find more tips for reframing your thoughts towards positive thinking here.
Accept that there are events that you cannot control.
Covid- 19 has created circumstances for many healthcare workers where so many things are beyond our control. This can be disempowering and lead to feelings of helplessness and hopelessness. One way to regain control or to feel empowered is to focus on the micro choices you can make every day around self-care and self-expression. Here is a great article about finding ways to express the self.
Be assertive instead of aggressive.
Often, stress makes us feel irritable and causes us to react in ways that create conflict—and that creates more stress! This is not to say that you shouldn’t speak up for yourself. Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
Mindfulness and curiosity are two superpowers that can help us cope. And we can access them without spending money or investing too much time. Click on the link for a short video that explains how you can utilize mindfulness to help regulate feelings of anger and aggression.
Seriously. Mindfulness is a powerful tool for combating stress.
Still not sure about this mindfulness stuff? This video helps walks you through a quick two minute breathing exercise that can help you to feel grounded and connected to the present.
Learn and practice relaxation techniques; try meditation, yoga, or tai-chi.
Relaxation techniques like meditation and the meditative movement of yoga or tai-chi affect the body in the exact opposite way that stress does. There are many different types of meditation. You might develop a mantra that you repeat in your mind as you take slow deep breaths. Or, you might take a few minutes to simply pay attention to what you see, hear, taste, touch, and smell.
Headspace, a meditation app, is offering free access to all healthcare workers during the COVID-19 pandemic.
Exercise regularly. Your body can fight stress better when it is fit.
Down Dog is offering free access to healthcare workers until January 2021, with yoga, barre, and 7 minute workouts delivered to your phone.
Yoga Glo is one example of an online community that offers yoga, meditation, and pilates. The classes offered include beginner classes, restorative yoga, and yin yoga. Membership is 18.00 a month. Glo is compatible with most smart telephones computers, and televisions.
Even a 15 minute walk has been shown to have a big impact on reducing stress.
Eat healthy, well-balanced meals.
Healthcare workers during Covid-19 are stressed to find time to work, parent, and food prep. An affordable and easy source of recipes is Budget Bytes. You can follow budget bytes on Instagram or go directly to their website.
Develop your time & task management skills.
If you are working in the healthcare field you may find that you are busier than ever. Taking breaks, prioritizing and delegating can be especially crucial during Covid-19 to reduce unnecessary stress. Learn more about time management skills here.
Get enough rest and sleep.
Your body needs time to recover from stressful events. Not getting enough sleep has been shown to make changes in our brains and bodies that can lead to memory difficulties, anxiety, and increased aggression. One of the best ways to get enough sleep is by practicing good sleep hygiene—developing habits and creating an environment that supports good rest.
Don’t rely on alcohol, drugs, or compulsive behaviors to reduce stress.
Alcohol and other drugs shift the way your brain perceives stress. They interrupt your sleep and suppress your immune system, which can make you more vulnerable to illness. While the short-term relief from stress may be appealing, alcohol and other drugs prevent you from accessing your coping skills and processing difficult events, which can lead to developing symptoms of PTSD (needs link to internal PTSD page). If you or someone you love is struggling with alcohol, drugs, or compulsive behaviors click here for more resources. (Needs link to addiction resources)