Now more than ever, health care providers work tirelessly in rapidly changing and stressful conditions to care for patients. Physicians, nurses, physician assistants, nurse practitioners, and other health care providers (caregivers) provide advanced care to their patients, promptly manage administrative tasks, oversee staff, stay mindful of budgetary and efficiency requirements, follow increasingly complex regulatory guidelines, and much more.
The broad "system" in which care is delivered has undergone a seismic shift over the last two decades. There is relentless pressure on reimbursement, healthcare is transitioning from a fee-for-service to a value-based model, patient records management has completely transformed with the advent of electronic health records (EHR), and regulatory and health insurance industry requirements increase continuously.
In that context, caregivers face a Herculean task: maintaining their own wellbeing in the face of increasing and often contradictory professional demands. A true crisis now exists impacting every care continuum stakeholder – from providers to patients – in healthcare systems across the industry. The crisis? Committed, highly skilled healthcare professionals are burning out.
Burnout: What It Is and the Risk Factors
A wide range of studies over the last decade reflect that burnout is widespread – and rising – among healthcare practitioners. Symptoms manifest in many ways, from the physical (exhaustion, impaired concentration, an increased risk for substance abuse) to the emotional (irritability, feeling overwhelmed) and spiritual (no room for stillness, a lack of life balance).
When caregivers burn out, they aren't the only ones who suffer – patient care is also compromised in numerous ways, including: a lower quality experience interacting with caregivers and higher rates of infection and medical error. Studies also show that burned out physicians are more expensive; they make more referrals and order more tests than necessary, and have patients who are less likely to be compliant with prescribed care plans. Burnout has been linked to malpractice lawsuits and even patient mortality.
The July 5, 2017 edition of Perspectives, a National Academy of Medicine publication, describes the extent of physician burnout in the US starkly: "Physicians working in the specialties at the front lines of care (e.g., emergency medicine, family medicine, general internal medicine, neurology) experience the highest risk for burnout. By comparison, burnout is nearly twice as prevalent among physicians as US workers in other fields even after controlling for longer work hours and other factors. Between 2011 and 2014, the prevalence of burnout increased by 9 percent among physicians while remaining stable in other US workers." A 2016 research report entitled Human Experience at the Forefront: Elevating Resilience, Well-being, and Joy in Healthcare, published by Vocera's Experience Innovation Network, identified that 54% of physicians experience at least one symptom of burnout, and a full 50% of nurses described themselves as being emotionally exhausted.
Mission Health's own Vallire Hooper, PhD, RN, CPAN, FAAN and Manager of Nursing Research, and Martha DePaola, BSN, RN, wrote a piece on a compassion fatigue survey they conducted with participation from Mission Health's nurses. Appearing in the June, 2017 issue of the Journal of PeriAnesthesia Nursing, it examined quality of life and compassion fatigue experienced by perianesthesia nurses (nurses who specialize in treating patients who are under or recovering from anesthesia). Compassion fatigue is a type of burnout that is linked to secondary trauma exposure (trauma that is not experienced firsthand by caregivers, but treated by them) and to serving patients who are survivors of direct trauma.
Out of 4,100 nurses surveyed, 1,469 opened it and 1,398 completed it. The majority of respondents were seasoned employees who averaged nine years at Mission Health, with six years working in their respective units. Most were female bedside nurses from Mission Hospital who were over 40 years of age. The authors' findings, not surprisingly, were that these nurses – primarily RNs, APRNs, and CNAs – suffered compassion fatigue that directly and adversely affected their quality of life, and their compassion fatigue scores were similar to the national mean. And it's not just nurses. The December, 2015 issue of the monthly peer-reviewed medical journal Mayo Clinic Proceedings cited a TIME magazine feature entitled "Life Support: Inside the Movement to Save the Health of America's Doctors." It reported that "….as many as 400 US physicians are dying by suicide each year," which, the article goes on to say, "is similar to the number of students in two or three medical school graduating classes." Burnout looks different in each individual, but regardless, leads to a plethora of worrisome and serious consequences for clinicians and team members – some tragic – including:
· Prevalence of depression symptoms such as indifference, lack of engagement and overall purposelessness about work, sleep problems, etc.
· Feeling a lack of control over work and cynicism toward work.
· Leaving the medical profession (nearly a third of primary care providers ages 35-49 expect to leave the industry entirely at some point).
· Experiencing a sense of distance from or depersonalizing patients.
The way medicine is practiced has changed dramatically, but it's critical not to lose sight of the fact that it is practiced in countless micro-environments created by individual patients and not just one circumstance. The drivers of burnout are many, and include:
· A workplace culture where far less attention is paid to achievements than to mistakes; this leads to anxiety about malpractice lawsuits.
· Technology-related stress includes greater manipulation of EHR required by physicians.
· The real-time tracking of physicians' work decisions and their positive correlation with morbidity; this increase in oversight contributes to more acute physician stress and less time spent with patients; oversight is necessary, but the current system is not ideal.
· A societal misconception that oversimplifies the work lives of physicians also contributes to a general lack of empathy toward them; the public often perceives physicians as "having it all" – social prestige, ample financial compensation, and high workplace status. The negative stressors that define a physician's work life are often forgotten: high rates of educational debt, long hours, abundant work stress, and the threat of malpractice, among others.