Burnout: The Silent Epidemic of Health Care

Infection Control Today topic of the month: Mental Health.

In the relentless health care environment, mental wellness is vital, but burnout is rampant. As the pandemic exacerbates the crisis, a proactive, comprehensive strategy is essential for preventing and alleviating burnout.

“Get up,” my manager said. “Get up and get back out there. We need you right now.”

“I can’t do it,” I said, exhausted by the barrage of patients streaming through the doors of the emergency department.

“Yes. You can. You’re going to get back out there and fake it until you make it,” she said. “That’s what we do.”

So, I rose and returned to the nursing station to finish my shift.

I learned early on in my career that health care was not a job for the faint of heart. I would work 12 hours on my feet, sometimes nonstop, going hours before using the restroom or stopping to drink water. My motto became, “Fake it until you make it.” Although this is a motto that has successfully pushed me beyond my comfort zone a multitude of times, it is also a mindset that led me to neglect my health and ignore signs and symptoms of chronic stress that would eventually lead to burnout. I soon learned we cannot always “fake it until we make it.” We must take steps to prevent and respond to the occupational phenomenon of burnout in health care before we crash into a total state of exhaustion.

The World Health Organization (WHO) defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It is characterized as having 3 separate, co-existing dimensions:

• Feelings of energy depletion or exhaustion
• Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
• Reduced professional efficacy

Although this official definition of burnout is new as of 2019, the experience of burnout is nowhere near being a new phenomenon. In 1979, Herbert Freudenberger, PhD, a German-born US psychologist and psychotherapist, first described burnout as “becoming exhausted by making excessive demands on energy, strength, or resources in the workplace.” His astute observations of burnout in a free health care clinic suggested that prevention must occur individually and at the organizational and systems levels.

For decades, additional research and survey tools have sought to highlight the challenges of preventing and responding to burnout in the workplace. Data especially highlights the higher rates of burnout in health care, even before the pandemic. According to data from HHS, 54% of doctors and nurses were already reporting burnout before 2020. 

A brief review of historical data quickly reveals that our experience of burnout is not new. However, the trajectory of burnout in the workplace in health care continues to be on the rise, made worse by the rigorous strain placed on health care workers during the COVID-19 pandemic. HHS further notes that since the pandemic, 66% of nurses are considering resignation. We are in the midst of a national crisis threatening our nation’s health. Without swift and targeted actions, we face a possible future without enough health care staff to safely and effectively operationalize our health care institutions.

Burnout research and interventions in health care have focused mainly on clinical staff -- doctors, nurses, and clinical support. Minimal research and interventions have been targeted toward the paramedical profession supporting those clinical teams. One supporting paramedical profession lacking data on burnout, but clearly experiencing significant challenges in the aftermath of the pandemic is the job of the infection preventionist (IP).

In a study from the American Journal of Infection Control, self-reported rates of burnout in IPs between July and August 2021 reached 65%. Additionally, IPs reported that the pandemic negatively impacted their physical and mental health. 37.4% of IPs reported increased alcohol consumption, while others reported that the pandemic had a negative impact on their sleep (77%), physical activity (64.5%), and healthy eating habits (61%).

Something must change. It’s evident that this problem is not going away by itself and will most likely continue to worsen before it gets better. We cannot “fake it until we make it” through burnout. Without quick, strategic actions, we risk losing a substantial portion of our infection prevention, clinical, and other health care-related workforces.

But what is the answer? How do we respond to this growing epidemic in our profession? Maybe the answer lies in examining our long-standing approach to preventing communicable and noncommunicable diseases, a multipronged approach developed to address a multifactorial problem.

As IPs, we’ve been strategically tackling health care-associated infections (HAIs) for decades. We’ve learned that focusing on only 1 aspect of prevention and control will not likely yield a significant decrease in HAIs.Instead, because the problem is multifactorial, we must take a multi-pronged approach to prevention, using toolkits to mount a comprehensive response. When preventing Catheter-associated urinary tract infection and central line-associated bloodstream infection, for example, we examine insertion and maintenance practices, staff knowledge levels, and adherence to basic infection prevention practices. Our response to burnout must follow a similar approach. We must address this growing concern using a multipronged, multilevel approach.

Burnout risk factors at 3 Levels in the workplace

Burnout risk factors are evident at 3 levels in the workplace: individual, departmental, and organizational. Roots of burnout are found at each of these levels. An individual with poor time management skills will be more susceptible to being overwhelmed with a typical workload. If the department head is unreasonable in their expectations of their employees, their employees will be set on a path toward burnout. And if an organization does not foster a culture that prioritizes wellness, this will have a trickle-down effect on each employee. If the problem is multifactorial, then the response to preventing and alleviating the problem must be addressed at each level. For the health care workforce to heal from its current experience of burnout and prevent future burnout, we need multiple interventions implemented at each level.

Organizational Leadership

1. Increase organizational mental health support, including access to personal development courses, mental health care, and workplace resources
2. Reevaluate staffing levels and increase staffing when indicated
3. Foster a culture of healing, communication, and connection
4. Speak openly about burnout in the workplace, educating employees on the signs and symptoms of burnout and what the organization is doing to reduce burnout for its employees
5. Prevent workplace violence, including a zero-tolerance policy for gender, racial, and religious discrimination
6. Build in adequate time for vacation, sick, and personal leave
7. Promote a culture of wellness in the organization

Departmental Leadership

1. Break the stigma around burnout. Talk about it as a team!
2. Educate staff on the signs and symptoms of burnout
3. Model healthy boundaries in the workplace (eg Not sending emails all hours of the day, encouraging breaks, etc)
4. Have reasonable expectations of the team and foster a culture of open communication that prevents harmful assumptions
5. Provide access to mental health and burnout resources for direct reports
6. Train department in the soft skills essential for working in high-stress environments (eg Interpersonal communication, relationship building, time management)
7. Provide access to flexible work schedules for employees (eg hybrid schedules, rotating pager schedules, etc)
8. Address cynicism and negativity in the department that can breed resentment

Individual

1. Implement personal work/life boundaries (ie learn to say no)
2. Shift your mindset on your locus of control
3. Reconnect with and invest in your hobbies
4. Prioritize physical, mental, emotional, and spiritual health
5. Explore strengthening soft skills such as organization, emotional intelligence, intrapersonal communication, relationship building, and conflict management
6. Take breaks and vacations regularly to recharge and replenish your mental and emotional capacity for workplace stressors
7. Build personal and professional connections, seek out mentors, and find opportunities to volunteer outside of your organization
8. Ask for help with burnout (eg counseling, peer-to-peer support, organizational resources)

The occupational phenomenon of burnout is not going away on its own. We can’t just fake it until we make it through this one. We need to work together from the top down to combat burnout before burnout steals the best and the brightest in our field.