This podcast episode/blog post is centered around an email I received a while back about burnout in occupational therapy (OT).
I’ve gotten a few DMs about this too on Instagram from others, sharing that it’s draining to constantly be providing justification or an explanation for their role as an OT. As an OT, I feel like we are unseen and underrepresented across the whole healthcare picture. The good news though is that I have come across people within the past few years that know an OT or have a somewhat accurate description of what OT is.
Regardless of these occasions, the general lack of understanding or appreciation for OT can have a significant impact on work-life satisfaction, well-being, and work performance.
Here is the email I received in regards to this manner:
“I had a question for you. Is it possible to feel guilt from patient related Burnout? I can only advocate for OT so much. I try to get my clients to become more empowered through OT. Many do and appreciate it. Some just ignore and focus on PT instead and look down on OT. I’m referring to that and more of complex dx where no matter how much experience I have, good teamwork and EBP research I do, nothing seems to help. I put my energy and dedication to create interventions, only to have non compliance and resistance. I feel helpless when I can’t solve their issues. After all, it’s my duty. I have clients who are in such financial poverty, and on top of that all these medical comorbidities. A lot of interventions are just unrealistic for them. I get bombarded with medical questions that I have no expertise in. Yet if I don’t answer I’ll feel they won’t trust me. I had a boss who told me ‘Just fake it and think of something, they need to trust you.’ It doesn’t seem ethical. I tend to write a lot. I appreciate your patience and dedication to avoiding healthcare burnout. Just wanted to know if this type of burnout is common for healthcare professionals? I feel guilty feeling burned out in this aspect.”
One study found that a high person– job fit promotes innovation behavior by stimulating the employee’s job involvement. Innovation behavior consists of an individual’s knowledge and skills in a certain field that are key to their creative performance and action in that field.
The study also found that career commitment strengthens the positive impact of person–job fit on job involvement and innovation behavior. Lastly, career commitment was shown to strengthen the positive impact of person–job fit on job involvement and further promotes the formation of innovation behavior (Huang, Yuan, and Li, 2019).
In this situation, there are person-job imbalances or mismatches between this person and the job. According to the Jobs-Demand Resource Model, high demands and low resources is the perfect recipe for burnout. The demands in this case are patient demands and emotional demands, and the lack of support from the supervisor and lack of socio-emotional rewards from the patients are resources that appears to be low.
Resources can be social support, autonomy, and supervisory coaching. This person reports having a great team, so it sounds like there is good team support. However, low support from your supervisor can lead to decreased levels of self-efficacy (Maslach and Leiter, 2003).
The loss of resources may aggravate burnout. We naturally want to preserve our resources and acquire resources to help us do our job well. In a situation in which a person can accomodate more job demands through their access to job resources, that can moderate the effects of the demands on their personal energy (Maslach and Leiter, 2017).
I want to break down some of the parts in this paragraph and expand on some things.
“Some just ignore and focus on PT instead and look down on OT. I’m referring to that and more of complex dx where no matter how much experience I have, good teamwork and EBP research I do, nothing seems to help. I put my energy and dedication to create interventions, only to have non compliance and resistance. I feel helpless when I can’t solve their issues.”
This is so hard because I can relate. It hurts that much more when you have gone the extra mile to be creative and client-centered to have everything crashing down. Albeit that happening on a regular occasion, which can leave you feeling defeated and depleted. You can have all the evidence-based practice in the world, the best team, but have patients that don’t get better. You can have patients that refuse to work with you because they don’t see the value of OT.
THE CURSE OF OT
Something worth mentioning is the blessing and the curse of being an OT. The blessing is what we are all drawn to- this amazing career of helping people be independent and get the most out of life through engagement in meaningful occupations. The curse? It’s not rocket science and so much of OT can appear to be common sense. OTs have historically not done well in marketing the profession, and some people may not see the value in it.
If OTs lack a clear deﬁnition of their professional identity, they will be placed at a greater risk for identity confusion or the adoption of the identity of other allied health professions. This one research study found that lack of professional identity plays a signiﬁcant role in the experience of burnout and a lack of professional status, poor recognition, and the low visibility of the occupational therapy profession contributes to burnout. OTs that experience role conﬂict also had a lack of certainty and self-doubt.
The promotion of occupational therapy in the overall healthcare environment can, therefore, impact work-related stress related to professional identity (Edwards & Dirette, 2010). Occupational therapists have been shown to be susceptible to all aspects of burnout, including emotional exhaustion, cynicism, and decreased self-efficacy and all of these aspects are related to a lack of professional identity (Edwards & Dirette, 2010). Role ambiguity can occur, which is a lack of direction at work, which is associated with burnout (Maslach and Leiter, 2017).
We have the heavy responsibility to advocate for our profession. It’s difficult to see things being preached in school and a completely other practice in the ‘real world.’ This is a whole different discussion, but I believe we have to think about how we are playing active roles alongside our team in shaping the perception of OT to the general public.
WHAT TO DO WITH NON-COMPLIANT PATIENTS
“Non-compliant and resistant patients” is something that can really leave OTs and other healthcare professionals feeling that sense of defeat. Non-compliance can happen for a number of reasons, a few of them being:
- Patients believe you can’t help them
- Patients believe their condition can’t be helped
- Patients are dealing with difficult emotions around their condition
- Patients don’t like you for XYZ reasons
- Patients feel misunderstood
- Other factors (i.e. hunger, sleepiness, medication changes, etc.)
In my experience, the main reason why patients don’t want to work with you is because they are coping with difficult feelings about their condition or they feel misunderstood by you. Here are some things to consider when you’re having a situation of resistance and non-compliance:
- Rule out things that may be the cause of the resistance/non-compliance.
- Consider your approach- are you practicing active listening? As OTs I think we’re pretty good at this, but sometimes this can be overlooked or lost.
- Put yourself in their shoes and remain empathetic. We generally have a ton of empathy in healthcare, but when things are difficult we may become confrontational or resentful because what seems like a simple request that we’re asking of our patients is met with this resistance.
- Break down your ‘why’ in everything that you do with them, especially for the more skeptical ones. What is it they WANT to do and NEED to do? If the activities you’re choosing appear arbitrary, you better have a reason why you’ve selected that activity.
- Learn your patient’s nuances to build rapport and increase engagement. There is no cookie cutter approach to engage with patients. I’ve developed little rituals working with patients, especially with my pediatric patients, to engage them. (Side note: When my kiddos ‘refused,’ I know that that’s very different when compared to adults refusing so keep that in mind. Kids communicate through their behaviors and ‘bad’ behaviors can be a signal that they’re not getting what they need.)
- Make it about the patient. I don’t think patients will care about what you need- you need to see them to hit your productivity, you need to give them a home exercise program, they need to listen to you because you know best, etc. Consider a collaborative approach making it a team effort. Collaborative begins with listening to patients and practicing an effective approach called OARS:
- Open questions
- Reflective listening
- Summary questions
- Know when enough is enough and know when it’s time to let it go and terminate treatment. If you’re not making headway with the patient, or of course if there are other factors present like combativeness, abuse, or harassment, considering ending treatment can be the best option. The patient can be advised in writing that therapy is ending, and every incident should be properly documented and placed in the patient’s chart.
Moving on, I want to highlight another part from the email:
“I feel helpless when I can’t solve their issues. After all, it’s my duty.”
We feel so tied with our professional role because so much of our heart is in it. When we can’t help someone, it is not a good feeling. A little tip I read in the book “No Hard Feelings” by Liz Fosslien and Molly West Duffy, which is to care a little less about work. This doesn’t mean that you are careless with your work, but rather we loosen up our attachment to work.
Also, when we can better understand what is truly in and out of our control, we can have greater piece of mind. What may be contributing to a feeling of helplessness can the guilt and shame that comes with not being able to help someone. I call it Superhero Syndrome, which so many of us in healthcare have. We can take it personally and feel like we failed when we are not able to help everyone. For the greater good of our own mental health and our work performance, we have to take off the superhero cape. We have to develop an awareness that we can do the best we can and still have bad days, still have patients not get better, and still question ourselves.
This is where I find self-compassion being a helpful strategy. Self-compassion has been shown to build resiliency against depression and anxiety and have yielded increases in life satisfaction, optimism, social connectedness, happiness. You can download a free simple and brief self-compassion cheat sheet that easy to remember and easy to practice because it was created with the intention for you to do during stressful times at work.
DON’T FAKE IT TIL YOU MAKE IT
Another important section to cover:
“I get bombarded with medical questions that I have no expertise in. Yet if I don’t answer I’ll feel they won’t trust me. I had a boss who told me ‘Just fake it and think of something, they need to trust you.’
I have a problem with fake it until you make it. When you can admit that you don’t know the answer to something, I believe that shows confidence. I am humbled when OTs or other experts in their field that have a ton of experience admit that they don’t know the answer. No one knows everything! If someone always has an answer and appears to know everything, I don’t believe that. That’s phony-baloney to me. When someone says they don’t know but they will look up the answer, that is so refreshing to me. That means that that person has confidence in themselves and not afraid to put honesty and integrity over arrogance and being the ‘expert.’
Pretending is exhausting! I believe confidence comes from specific factors like being competent in skills that matter to you, rather than vaguely stamping on ‘faking confidence’ which can feel extra fake and forced. Seek authenticity and don’t be afraid to be vulnerable in not knowing everything.
Back to high demands and low resources. It can be beneficial for this person and the team to have a meeting and discuss how to handle advocacy for the OT practice as well as receiving support during difficult situations. Some ideas:
- Create a video, brochure, or some piece of content that provides education about the role of OT. Consider integrating various modes of learning.
- Have an “Ask me about OT” sign on your badge
- Create support huddles where you and your team members can dedicate a weekly or monthly time to discuss work difficulties and establish ground rules (i.e. maintain respect for others, show empathy towards others)
To sum it up, here are the takeaways from this podcast/blog:
- Role ambiguity and role conflict is associated with burnout
- Not being appreciated for your work can leave you feeling exhausted and defeated
- High person-job fit is important for work engagement and innovative behavior
- Get to the bottom of why patients are noncompliant and don’t be afraid to terminate a patient-therapist relationship if needed
- Let go of the superhero syndrome and identify what is in and out of your control
- Practice self-compassion you can download the exercise HERE
- Don’t fake it til you make it
- Receive support at work