What I Wish I Knew: Prevention of Burnout

What is the big deal about burnout---isn’t stress normal?

At different moments in our lives, we are all affected by stress; and stress is central to the experience of being human. In moderation, stress is helpful. Eustress has been defined as a routine kind of stress that enhances our attention and may keep us motivated towards a deadline. However, beyond a certain point, eustress can develop into distress. If periods of distress become cumulative and chronic in nature, this can lead to burnout.

Burnout is characterized by prolonged or repeated periods of stress where a person begins to feel mentally and physically exhausted by their tasks. Based on work by Christine Maslach, it can make people feel emotionally drained, overwhelmed, and fatigued (emotional exhaustion); manifest as negative, callous, cynical, and impersonal behavior (depersonalization); or feeling insufficient in regard to the ability to perform one's job or generalized poor professional self-esteem (low personal accomplishment). Workplace burnout is not a small thing that people need to just figure out how to get over; it can have negative consequences on an individual’s physical and mental health, on work team dynamics, patient outcomes, and on an organization’s culture resulting in low productivity and turnover.

Who is responsible for addressing burnout?

It is critical that individuals as well as institutions adopt strategies to improve well-being and mitigate risk for burnout. In order to create sustained change, individual self-care strategies are not enough as literature supports that drivers for burnout are system, or organization, factors. Therefore, the National Academy of Medicine Clinician Well-being Collaborative are committed to identifying strategies to improve well-being both at the individual and systems level. Therefore, both institutional leadership and individuals must be intentional and motivated to make well-being a priority as a shared approach. By investing in well-being, individuals benefit by achieving enhanced morale and purpose, improved job satisfaction, improved physical and mental health, and decreased risk for burnout. Employers benefit by increased productivity, employee retention, and decreased errors in the workplace.

What role do I have as an individual to promote a healthy work-life and prevent burnout?

Work-life integration versus work-life balance: Work-life balance involves the minimization of work-related stress and establishing a sustainable way to work while maintaining health and general well-being. Balance does not mean equilibrium between work and life, though one facet should not constantly dominate the other. Examples of work-life balance include catching up on quality time with family on the weekends, and after a long stretch of days working, you take vacation and unplug. Work-life integration, on the other hand, is a method of intermixing aspects of your life, from work to personal, where instead of clear divides of time and energy in one facet, there is more of a blend and constant flow. Examples include blocking time to exercise in the middle of the workday or scheduling an ‘active meeting’, or running errands and taking care of children for half the day then switch places with your spouse or partner for the second half. One approach is not better than the other, but rather people identify which is the best fit that meets their needs and allows them to feel fulfilled and energized in both their work and home life. Below are a few ways to help promote a healthy work-life:

• Block off calendars- Just as you would block off time for clinic or work meetings, look ahead and schedule dedicated time for exercise, spend time with loved ones, or just relax and recharge. If our calendars reflect how we are spending our time, it should reflect priorities in both our work and home life.
• Set firm boundaries- Even with work-life integration, it is important to adhere to boundaries. When it’s time to stop working, honor that time and commitment. Some may find it helpful to remove work-related apps from their personal phone or turn off work-related notifications during personal time, after hours, and weekends. Additionally, it is important to recognize when to say “no” or “thank you, though not at this moment” so you can save your efforts for when you really want to say “yes.”
• Communicate needs with employer- Having open conversations about what you need and what would work well for both you and your employer can be beneficial for both parties. While not all work settings have the same level of flexible work hours, it is important to have the space for employer-employee communication to brainstorm unique work models and solutions.

Other key steps to preventing burnout:

• Prioritize self-care- Remind yourself that making time for self-care is not selfish, it is self-preservation. Getting adequate sleep and exercise and avoiding maladaptive coping mechanisms are a few examples of self-care strategies. Taking care of ourselves allows us to better take care of others, whether that is our patients, coworkers, or our family.
• Shift your perspective- While we may do our best to practice self-care, we will inevitably face conflicts or heavy workloads in the workplace. By understanding that some aspects of our jobs are inflexible but not always insurmountable, this may lessen the impact and allow us to focus on the aspects we can control. Are there tasks you can stop doing or delegate to others to free up meaningful time and energy for other important work, or can you build positive relationships to counter the more challenging ones that drain you?
• Connections- If depersonalization and low personal accomplishment are the areas driving your burnout, seeking out rich connections can be helpful. Finding mutual support, identifying common problems, and ways to advocate for solutions can increase our sense of connection and feel less alone.
• Finding meaning in work- Identifying areas to contribute that pique our interest and are meaningful and motivating can help if burnout is led by low personal accomplishment or depersonalization. Examples are mentoring others, protecting time for special projects, and connecting with patients in ways the make them feel heard and valued. Identifying areas of passion that align with our strengths can keep us advancing toward our goals.

What role does an institution or workplace have in preventing burnout and improving well-being?

Below are approaches employers and pharmacists in administrative and leadership roles can target to reduce burnout and foster a culture of support:

• Modeling- Administrators should evaluate and adopt strategies to reduce factors contributing to burnout and model well-being behaviors. One example is setting email expectations modeled by leadership that maintain good “email hygiene” that promotes boundaries around work and home.
• Workload- During annual evaluations, work together to identify opportunities to align employees’ professional goals and strengths with responsibilities. Identifying challenges to improve workflow or reallocate responsibilities is also critical. Additionally, permit flexibility in work schedules (e.g., job share, hybrid work models).
• Resources and support- Develop wellness programs and/or promote external programs to help employees cope with stress. This could be through Employee Assistance Programs, onsite stress management classes, or peer support groups.
• Assessments- Measuring burnout at baseline and longitudinally using validated scales is important to ensure employers are assessing change over time and impact of institutional initiatives. Quantitative measures along with soliciting feedback will better inform targeted actionable next steps.
• Mentoring- Invest in professional development and mentoring and ensure if it equitable for all. Employees can teach and learn from each other, strengthen collaborative relationships, and boost morale.