This is Part one of a multi-part series exploring some of the root causes of burnout in healthcare professionals. As an occupational therapist, I have experienced burnout early on as a New Grad. This experience was a roller coaster to say the least. I felt like despite the good and bad days at work, I was walking on eggshells hoping something bad wasn’t going to happen. I felt beyond exhausted (physically and emotionally), I was going through the motions and feeling detached from my patients, and the hardest part- I was constantly questioning my abilities, which led to an incredible lack of confidence. In this Part 1, you will learn how an unmanageable workload or lack of autonomy can contribute to burnout.

WHAT IS BURNOUT?

Burnout is a psychological syndrome that involves a prolonged response to chronic stressors on the job. 

Burnout consists of three key components:

  • Emotional Exhaustion: Depletion of emotional and physical resources without any source of replenishment and recovery 
  • Cynicism: Negative or depersonalized view towards those recipients of care. This develops in response to exhaustion and acts as an emotional buffer of detached concern; however, it becomes more than buffer and develops into negative reactions to the job
  • Decreased self-efficacy: Low personal accomplishment reduces a worker to feel incompetent and feel a sense of failure and adequacy; this may lead to loss of confidence and can even develop into depression
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AN UNMANAGEABLE WORKLOAD

Leading researchers in this field Christina Maslach and Michael Leiter have identified six key factors that contribute to burnout. One of the biggest culprits is an unmanageable workload, which depletes a person’s capacity to fully meet the demands of their job. This comes as no surprise because it’s one of the most obvious factors.

What’s occurring more and more is that people are expected to do too much with the same or fewer resources, especially in healthcare. The onset of acute fatigue from high work demands over time becomes the pivotal point in the burnout picture.

Exhaustion from an unmanageable workload is not solely based on the quantity of demands, but also in the quality of demands as well. Demands that employees consider to be outside their scope or outside their expectations are viewed as more burdensome than other tasks. In fact, research as found a direct relationship between unmanageable workload and exhaustion.

CHRONIC STRESS AND BURNOUT

Chronic stress from an unmanageable workload can threaten one’s physical and mental health. Working over 50 hours a week has been shown to increase your risk of developing cardiovascular disease. Chronic stress can lead to burnout depending on a few things:

  • Successful coping strategies
  • Personality variables
  • Personal resources
  • Job resources

The shift from chronic stress to burnout begins with a complex exchange between chronic stressors from work and insufficient recovery processes that take place during work, outside of work, and even during sleep. That is why talking about opportunities for rest and recovery at work and home is SO important.

If you’re looking for resources to help you manage stress, implement wellness practices in your life, and have a safe and supportive community, you can find that inside our private wellness club here.

SO WHAT IS A MANAGEABLE WORKLOAD?

You feel like you can complete your workload and that you have the proper resources to meet the demands of the job.

According to the Job-Demands Resource Model (Bakker et al. 2004): If job demands are high and resources are low, then greater levels of burnout and stress are likely to occur.

Job demands can look like:

  • Time demands
  • Documentation demands
  • Emotional demands
  • Changes in task

And resources can look like:

  • Social support
  • Supervisory coaching
  • Autonomy
  • Performance feedback

If you have high demands at work but you’re low on resources, then that will most likely result in high job strain and low motivation to do your job (because you don’t have what you need to do your job well!) Ideally, you want the resources to match the intensity of demands at work. 

TIPS FOR A MANAGEABLE WORKLOAD:

There are a few handy dandy tips to foster a manageable workload:

  • Take proper rest breaks throughout the day
  • Know what is expected from you
  • Adjust your resources based on your demands

(and I get it- some of this is going to ultimately be controlled by your supervisor.)

TAKE PROPER REST BREAKS THROUGHOUT THE DAY

Did you know that rest breaks incorporating relaxation sessions and respite activities (like napping, relaxing and socializing) are more likely to reduce job-strain and enhance mood than doing chores like running errands and work preparation.

“Did she say napping?” Yes! Napping at work is a luxury and I’ve only done it twice during cancellations, but it was SO needed.

What can help to facilitate proper breaks? Having dedicated documentation time so that you can use a 15 minute break or your lunch break for that- a break instead of having to play catch up all day long to complete documentation.

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KNOW WHAT IS EXPECTED FROM YOU

Understanding the explicit and implicit norms of an organization can help you to understand what is expected of you- even the ‘unspoken rules’ that are assumed but never directly implied. This is especially important for new hires and new grads to discuss with their employers. Even better- shadow for a day if you can so you can pick up on those unspoken rules. You may learn that the expectations around workload are not sustainable even though what was told to you sounds promising.

ADJUST YOUR RESOURCES BASED ON YOUR DEMANDS

This is called ‘job crafting,’ where you can make changes to the demands and resources of your job. This will be a fabulous segway into autonomy, because it will require some of that in order to make this happen. Job crafting can be done by YOU and your employer- it should not be done by your employer for you. If your workload is unmanageable, crafting your job will look like:

  • Decreasing hindering demands (i.e. the amount of evals you have in a week)
  • Increasing structural job resources (i.e. greater autonomy, learning opportunities)
  • Increasing social job resources (i.e. carving out a mindfulness huddle once a week with your team)

You can learn more job crafting here.

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LOW-NO AUTONOMY

Autonomy refers to how much freedom you have at work. Lack of autonomy can lower a person’s sense of mastery. High demands with low levels control is a perfect recipe for burnout. Those that have greater job autonomy also have greater job satisfaction. 

Someone wrote me talking about the lack of job autonomy (some details have been changed to maintain privacy).

“I have been thinking about leaving my job or going to part-time which I don’t think is possible or will give me satisfaction because I would still be on the adult unit with no OT autonomy having to do groups only, zero to none cognitive and functional assessments, breakfast trays, flows, and patient patio breaks or be on the gero unit where the nurse manager just views me as someone who keeps the patients busy. 

Our adult unit is very rigid down to specific times they want OT to do patient flows and patio breaks and when nursing is not organized they constantly come & ask OT to do extra non-OT related “work chores” I like to refer to them as. I know the last OT here told me she had to fight for her time to even do OT assessments ordered by our psych doctors because nursing staff wanted OTs to do these other menial “work chore” tasks. 

My last psych hospital I left was because I did not feel valued as an OT. All administration cared about was hiring more TR’s because they HAD to assess all patients on this 85-bed psych unit & let’s face it- TR is a lot cheaper to hire than OT. I even had one of the administrators ask an OT in an interview for PRN position say/ask: “We are in desperate need for recreational therapists. So if you know of anyone or can think of anyone.” 

 I have been using this time to update my resume and submit apps to PRN and per diem jobs. It’s a tough choice too because I worked to negotiate a good salary and have been working towards a personal goal of buying a home here but in applying and accepting other OT job offers could mean drastic pay cuts but could potentially bring me more satisfaction, purpose, and meaning to me as an OT while enhancing my engagement with patients that I serve.

This case represents a few challenges- lack of autonomy, role ambiguity, lack of respect, and value conflicts (which is covered in an upcoming blog post). 

TIPS FOR INCREASED AUTONOMY

Again, this will largely depend on your supervisor and the culture of your organization.

  • Job crafting (see above)
  • Active participation in decision making
  • Adjusting work strategies accordingly
  • Flexible schedule

Active participation in organizational decision making leads to greater levels of efficacy and lower levels of exhaustion in employees. 

ACTIVE PARTICIPATION IN DECISION MAKING

When communication is a two-way street between employees and employers, that makes a big difference because employees feel seen, heard, and appreciated. There should be a strong sense of psychological safety, meaning people feel like they share ideas- good or bad, without feeling reprimanded, embarrassed, or ashamed. 

As much as possible, employers should involve employees in decision making when it comes to changes that will impact how people work. If you’re an employee and this is currently not the case, speak privately with your supervisor about how you (and the team) would like to be included in weighing on certain decisions being made. Hopefully your supervisor is open to brainstorming with you on how this can be executed.

ADJUST WORK STRATEGIES ACCORDINGLY

Adjusting work strategies is a sub-dimension of job control. I remember in one job where I was an employee and not a per diem therapist, I literally felt like a prisoner. One of my former coworkers told me that in the summers when the season was slow, employees had more flexibility with their hours. I felt like any attempt to adjust my work strategies was ignored. 

Adjusting work strategies can go hand-in-hand with job crafting. For example, you can adjust your lunch time so that you can get your work done during your peak hours of alertness and eat lunch at a later time.

FLEXIBLE SCHEDULE

Free lunches and free Fit-Bits are nice, but sometimes being forced to engage in the company’s wellness initiatives isn’t what employees want. *Shocker.* At the end of the day, we want flexibility in our jobs (the extent of preferred flexibility varies from person to person) that will enhance our quality of life. Being able to adjust your schedule accordingly (i.e. leaving work early to make it to the post office or pick up your kids) can offer you the flexibility to do your best work and also balance the needs of your life outside of work.

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