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Self-Care Management and Professional Burnout Reduction Strategies

Self-Care Management and Professional Burnout Reduction Strategies
Mira Rollins, OTR/L
July 19, 2022

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Editor's note: This text-based course is a transcript of the webinar, Self-Care Management And Professional Burn Out Reduction Strategies, presented by Mira Rollins, OTR/L.

Learning Outcomes

  • After this course, participants will be able to:
    • Identify symptoms of professional burnout.
    • Identify formal and informal resources for health care providers.
    • Identify specific self-care strategies to decrease the level and frequency of professional burnout.

​Introduction

As a native and current Texan, I always start my talks by saying, "Hey y'all, I am so happy to be here with you to discuss self-care management and professional burnout reduction strategies.

Before I start, I want to give a quick story as a wife and a mom of three. One of my many duties and responsibilities is to be a vacation planner. That entails selecting the place, making the reservation, pre-trip packing, and snacks. When it was time for us to go on a trip, I made sure my daughter had her favorite snuggy that she sleeps with, my middle son had the charger to all his devices, my older son had swim trunks, and my husband had his medication. And then, of course, I am responsible for myself. I told everyone to get their bags and set them by the door. I also put my bag by the door. While everyone else was getting comfortable in their seats in the car, I made sure that the lights were off, the doors were locked, and the alarm was set. My husband had the nerve to beep the horn, and I wanted to scream out of the door, "Are you kidding me?" But I take a breath and continue doing what I am doing. I get to the car, and we begin our road trip. Again, I am the coordinator making sure we are making the right stops, coordinating bathroom breaks, having snacks, and being referees to my kids in the backseat. We got to our destination, and according to my planned schedule, we would go for a quick swim. Everyone else gets their bag and pulls out their swimwear. I then noticed that my bag was nowhere to be found. Even though my bag was sitting right in the center of everyone else's, everyone grabbed their bag, and no one thought to grab mine. So after I blew my top a little bit, I jumped in the car and went to the local Walmart to replace all the things I needed for this trip as well as to vent and decompress. During this time, I realized that even though I care for so many people and make their care my responsibility, it is ultimately my responsibility for myself.

I tell this story to set this presentation up. We are often excellent at caring for others but neglect to care for ourselves. This presentation is not going to be anything groundbreaking. It is going to be a gut-check reminder that you must take care of yourself or you will burn out.

What is Burnout?

  • Work-related stress syndrome
  • Related to chronic job stress
  • Physical and emotional exhaustion
  • Cynicism and depersonalization
  • Reduced professional efficiency
  • Reduced personal accomplishment

What is burnout? It is a work-related stress syndrome and related to chronic job stress. We all have stressors, some more than others, but we reach burnout when it is consistent and regular, and we cannot correctly handle the stress. Physical and emotional exhaustion are also manifestations of burnout. There can also be cynicism and depersonalization, which we will get into a little bit later, and then reduced professional efficiency, which we will discuss. And we also see reduced personal accomplishment of feeling from yourself that even though you're working hard and maybe even working well, you have this reduced decreased sense that you are accomplishing the things that you want to achieve.

  • "Burnout is the result of too much energy output and not enough energy self-invested. In other words, it's burning too much fuel than you've put in your tank." — Melissa Steginus

Stages of Burnout

There are several stages of burnout, and we will go through each one because each step has some classic signs. As we move through these five stages, consider what stage defines your current state of mind.

Stage 1: Honeymoon/Enthusiasm 

  • Productivity
  • Creativity
  • Commitment
  • Energy
  • Optimism
  • Accept Responsibility 

The honeymoon stage is also known as enthusiasm. This is when you are productive, your creative juices flow, and you are committed to the work, people, and task. You have a good amount of energy. You are also very optimistic and accept responsibility, often not just for your job but also for the environment around you. I hope many of you are in this stage, but because you are on this call, I suspect that not many of you might not be. You can spend most of your days in this stage of professional honeymoon and enthusiasm by implementing many of the steps we will discuss today.

  • It takes 10 times as long to put yourself back together as it does to fall apart." — Suzanne Collins

I put that quote here because, as we have just talked about, I want to stress that anytime you feel yourself even slightly moving from that honeymoon stage, you want to intentionally, consistently, and aggressively figure out what is moving you from that stage. The further you move through the steps (two, three, and four), the more energy it takes to move back to stage one.

Stages two and three are when things are starting to shift from that honeymoon stage as stress increases. 

  • Research shows that 30% of employees (across all industries) are in the following two stages:
    • Onset of Stress
    • Chronic Stress

Stage 2: Onset of Stress

  • Stagnation
  • Irritability
  • Anxiety
  • Decreased Focus
  • Lower Productivity
  • Periodic Headaches
  • Decreased Sleep Quality 

Stage two is the onset of stress where there is stagnation, irritability, anxiety, decreased focus, lower productivity, periodic headaches, and reduced sleep quality. It is difficult for you to initiate a task at this stage. You are still checking things off your list, but it is taking you a little longer. You have to correct things more than you would have in the past. More minor irritations you would have let roll off your back in the past are now starting to bother you. Typically, you are a team player, but now you are a little more disagreeable.

Stage 3: Chronic Stress /Frustration  

  • Apathy
  • Persistent Fatigue
  • Procrastination
  • Cynicism
  • Chronic Exhaustion
  • Resentfulness 

Stage three is chronic stress or frustration. This is where you have moved from being irritable to being apathetic. You do not care anymore, may have persistent fatigue, procrastinate, and be cynical when you feel that new things and procedures will not work. If you do care, you do not believe that efforts are authentic. You are starting to doubt positive change or efforts. Chronic exhaustion is beyond having a day or two of being tired. This is waking up every day tired. You can also be resentful of the people with which you work. Where it used to be irritability, you are upset that specific behavior is still occurring. 

Now, we are going to talk about stages four and five. Research has shown that 15% of employees live in either one of these two stages.

  • Research shows that approx.15% of employees (across all industries) are in the following two stages:
    • Burnout
    • Habitual Burnout 

Stage 4: Burnout 

  • Pessimistic
  • Self Doubt
  • Social Isolation
  • Chronic Headaches
  • Neglect of Personal Needs
  • Obsession with Others  

Stage four is burnout. You are pessimistic, and this is beyond cynicism. When you were cynical, you may have thought, "It may work but probably not." When you are pessimistic, nothing is going to work. You also do not believe that a situation or person will change.

There is self-doubt with your self-efficiency and capability and social isolation. "Do you want to go to lunch with us?" "No, I'm going to go sit in my car." Sitting in your car is something I will bring up later as a point of self-care. But at this stage, when you sit in your car, it is not to decompress but rather to vent and stew in your thoughts. You do not want to be around anyone at any time.

Headaches that were occasional in the earlier stages are now chronic. You may neglect your personal needs, whether essential self-care or health maintenance routines.

You may also have an obsession with others. "I'm not sure why my boss allows her to do that. She doesn't do that for me." It is a constant obsession with what you believe are disparities and discrepancies among other people.

Stage 5: Habitual Burnout

  • Chronic Sadness
  • Chronic Mental Fatigue
  • Chronic Physical Fatigue
  • Depression 

The last one is habitual burnout. This is when everything in stage four is exacerbated and longer lived. There is chronic sadness, mental fatigue, physical fatigue, and depression. As we move through the rest of the presentation, you can identify where you believe you are. Identification of your stage will help you to make a plan for yourself.

Measures for Burnout

Here are some measures for burnout. I am not going to go over each one individually, but I wanted to give you the names of some resources. You can find most of these online.

The first one often referred to as the MBI, is the first scientifically developed measure. It was created in 1981 and is now in its fourth edition. It separately assesses three dimensions of burnout, which I found interesting. It looks at burnout not as just one bucket but in terms of exhaustion, depersonalization, and personal achievement. You can see where you are on the burnout scale within each category. Each section takes about 10 minutes to complete.

There is a shorter companion survey called the AWS, Areas of Workplace Survey. If you want something a little more concise and quick, you might want to start with AWS.

The burnout assessment tool (BAT) is another. I have also listed two other online resources.

7 Dimensions of Well-Being

  1. Physical – A balance of strength, flexibility, and endurance in your body. Helps prevent disease and adds quality of life and length of life.
  2. Intellectual – Engaging in creative and stimulating activities that maintain and increase the function and capacity of your brain.
  3. Environmental – Sense of safety, comfort, and connection with your physical surroundings. 
  4. Vocational – Using your gifts, talents, and experiences to produce income, provide a service, and to impact others.
  5. Social – Fostering personal connections and nurturing relationships that establish social networks and support systems.
  6. Emotional - Overall positive state of being that encompasses satisfaction, meaning, and purpose
  7. Spiritual – A connection to a set of core beliefs and values that provide you with structure, boundaries, and peace 

There are seven dimensions of wellness. How is burnout affecting your physical well-being? Do you have headaches or tension in your neck or your back? Is your blood pressure being affected? When you develop your plan to help you back down from these stages of burnout, you want to build these steps strategically. If you see your burnout manifesting more in your physical well-being, you will focus more on the physical suggestions.

If your burnout affects you intellectually, like you have stopped playing piano, listening to podcasts, or reading, you will focus on the intellectual tips and strategies I provide. The same goes for all the areas of well-being.

The following dimensions are safety and comfort with your surroundings. If you feel like your desk at work and your home is in disarray frequently, that is a manifestation of being burned out vocationally, socially, emotionally, and spiritually.

On your own time, look at those definitions to see if you fit in any of those categories.

Figure 1

Figure 1. Graph of negative to positive state of wellness.

This graph is a quick and easy way to gauge where you are when it comes to burnout and well-being.

3 Primary Causes of Provider Burnout 

  • Toll
  • Tension
  • Transition

I believe there are three causes of burnout: toll, tension, and transition. It is essential to define the cause of your burnout before you begin to implement strategies.

3 Primary Causes of Provider Burnout: Toll

  • Personal  – Factors in your life (unrelated to work such as family, health, finances, etc.) affecting your overall well-being
  • Professional  – Factors directly related to your job affecting your overall well-being

Professional factors are directly related to your job, while personal are those life factors affecting your well-being. Step back and see where you have the most stress. Many people identify their job as causing them burnout. They report hating their job. However, we often see that there are also personal factors driving their burnout, making their job more difficult.

You want to ask yourself, "How close to the edge am I at work? Or, would I feel less burnout if my personal life was calmer?" I want to stress that your personal and professional tolls should have an inverse relationship. For example, if you have small children, a sick mom, your husband or wife is traveling for work, or your kids are in many activities, you may not be at the time in your career to take a promotion. There should be strategic and intentional inverse relationships in your personal and professional relationships.

We do not have a crystal ball to make those line up that way, but we may want to look at whatever is within our control. Can you take another role at work that will allow more margin in my life? Or conversely, are you getting ready to take on a new promotion and need to review your obligations? Perhaps instead of having kids in two activities simultaneously, you can pare that down to one. Can you also decrease your participation in community and school groups? This is not groundbreaking information, but these are intentional decisions to adjust your life to reduce burnout.

I would pose that question for you in your personal and professional life. Are both of them taking a high toll? What steps can you take to lower the toll in one of these areas so that the other one can be accomplished without placing such a tremendous toll on you? 

Contributing Factors

  • External
    • High Demands
    • Leadership
    • Poor Instructions
    • Time Pressure
    • Bad Atmosphere
    • Poor Organization
    • Lack of Resources
    • Lack of Career Mobility 
  • Internal
    • High Self Expectations
    • Professionalism
    • Need for Recognition
    • People Pleaser
    • Suppressing Own Needs
    • Work is your primary Meaningful Activity
    • Work is synonymous for Social Life  

Here are other contributing factors when looking at toll. External factors are your work environment, like high demands, poor leadership, poor instructions, and not knowing what you are supposed to do. Often, you are fumbling through doing your best. Even at the end of the project, you still may not get the response you need to know if you met expectations. There can also be time pressures, a bad atmosphere, toxic coworkers, poor organization, a lack of resources, and decreased career mobility.

Internal factors are things within yourself like high self-expectations, being a perfectionist, and professionalism to a higher degree than what would be considered customary or reasonable. Being a people pleaser, suppressing your needs, and work being your primary meaningful activity are also internal. Your work may be synonymous with social life. Take a quick second and look at these factors as well. What is causing the most stress for you? Is it external factors in the environment? What can you change by being intentional and laser-focused?

Let's say you feel stressed because you get poor instructions at work. One of your takeaways and intentional strategies may be that you are going to meet with your boss to get some clarification on what their expectations are. Perhaps it is poor organization, and you and your coworkers are all going for the same patients simultaneously, producing a lot of frustration. A new system or schedule may help to fix this. For internal, is there something you are doing to cause stress? Are you a perfectionist or have high expectations? What work do you need to do to be more reasonable and fair to yourself? Ask yourself these questions and jot down the factors causing external or internal burnout. Once you write that down, revisit it later and ask yourself what some strategic steps to help mitigate these external or internal factors are.

I am getting ready to go into some specific suggestions and strategies soon. We all have had patients we give a tool to use and hear, "I'm not going to use that. That's just going to get in my way." Or, we may give them a strategy like activity modification. Again, they may not want to do that, and we continue to go in our bag of tricks and give them suggestions. I want to ensure you are not that patient today as I give you many tips and strategies. I am going to provide you with "nuggets." You may think these are too simple, but what if it backed you down that burnout scale two levels? Would it be worth it? These will not change your life instantly, but with intention and consistent use, they will help.

Self-Care is Survival

  • Sleep
  • Stretching
  • Walking
  • Exercise
  • Nutrition 

Self-care is survival. I am sure you have heard that before. When it comes to burnout, the answer is self-care. Physical self-care includes sleep, stretching, walking, exercise, and looking at our nutrition. As healthcare professionals, some of us think, "Duh!" But are you implementing these strategies? I can vouch for myself and others that we are not doing very well in these areas.

Self-Care: Sleep

  • Sleep Statistics:
    • Workers with poor sleep were twice as likely to report symptoms of depression
    • Workers with poor sleep were 50% more likely to report psychological distress
    • Workers with poor sleep were 70% more likely to report anxiety
  • Poor sleep decreases the quality of care and increases errors 

A large portion of your burnout, depression, distress, and anxiety may be due to insufficient sleep.

  • Sleep is essential for:
    • Removing toxins from the brain
    • Strengthening immune system
    • Mood stabilization
    • Repair muscles
    • Manage hormones
  • Sleep affects EVERY type of organ system, including the brain, heart, lungs, and metabolism.

Let's talk about some ways to get some good sleep. 

  • Spend time outside in the sun during the day.
  • Set a schedule – go to bed and wake up at the same time each day.
  • Exercise or move your body throughout the day.
  • Limit your nap time to no more than 30 minutes. 
  • Avoid stimulants and certain foods before bed.
  • Limit your screen time an hour before sleeping.
  • Create a comfortable bedroom environment.
  • Adjust your diet to foods that help with insomnia. (increase calcium and potassium)
  • Consider supplements for better sleep.
  • Pain Management 

One way is to spend time outside in the sun during the day as the sun triggers our circadian rhythms. By the time we get to the evening, our body has naturally wound down and is ready for sleep.

Set a schedule, go to bed, and wake up at the same time. I know this sounds elementary, but if you go to bed at different times, your body cannot get into a natural sleep rhythm. It will then be more difficult for you to get quality sleep.

Exercise or move your body throughout the day. The more you move, the more your organ systems work, including your heart, lungs, and muscles. It organically and naturally makes you more tired and sleepy at the end of the day.

Limit your naps. You want to limit any daytime napping to 30 minutes so that it does not affect your sleep at night. You also want to avoid stimulants in certain foods before bed like caffeine, alcohol, and nicotine. Some people believe that a good glass of wine helps you sleep, and that is true. While alcohol helps you fall asleep, it prevents you from staying asleep. Alcohol affects us all differently, so alcohol, nicotine, and caffeine may need to be avoided before bed.

Limit your screen time an hour before sleeping as televisions, computers, phones, and other devices stimulate our brains and do not allow us to calm down and get into a good cycle and rhythm of sleep.

Create a comfortable bedroom environment, including the temperature, lighting, and mattress. Each of us on this call can probably pick one or two things that, if we changed in our room, would help us sleep better.

We need to adjust our diets to foods that help with insomnia. I am not making any recommendations as these are based on your health so run them by your doctor. Some supplements help with sleep like camomile, melatonin, poppy seed, calcium, and potassium. 

Pain management is another thing to address. Pain affects you more as you are trying to fall asleep.

As a therapist, I am not going to camp out here and preach to the choir, but are you implementing any of these strategies regularly?

Self-Care: Exercise

  • Stimulates the delivery of oxygen and nutrients to vital parts of the body
  • Mood stabilizer and stress management
  • Weight management
  • Cardiac and respiratory health
  • Muscle strength
  • Joint stability
  • Decrease risk of chronic diseases (ex. osteoporosis, DM, hyperlipidemia)
  • Improve sleep quality 

Exercise stimulates oxygen and the movement of nutrients that are vital to our bodies. Exercise is a mood stabilizer and helps with stress and weight management. It also helps with cardiac and respiratory health, muscle strength, and joint stability. It also reduces the risk of chronic diseases and improves sleep quality. Exercise can directly help you where you are on that burnout scale. 

For exercise, you can bake it in or carve it out.

  • Bake It In
    • Parking further away from the entrance
    • Taking stairs
    • Squats during commercial breaks
    • Participating in your children's leisure activities
    • Expanding leisure and social activities

How can you infuse a little bit more activity into your day-to-day? I have listed a few suggestions, and I am sure you can think of more. Taking the stairs instead of the elevator is a simple one. Even if you work on the 20th floor, can you take the first seven flights and then the elevator? Squats or running in place during commercial breaks are other ideas. You can participate in your children's leisure activities instead of sitting in the car. For example, you can walk around the soccer field while your child is at soccer. If you regularly meet your girlfriends for a Saturday brunch, perhaps mix it up and go hiking. Think about how you can strategically bake in a little bit more activity throughout the day.

  • Carve It Out
    • Gym memberships
    • Walking/Jogging
    • YouTube apps and other videos
    • Yoga, aerobics, and other organized workouts
    • Personal Trainer 

Carving it out takes a little bit more time and intention. This includes gym memberships, walking or jogging, downloading fitness apps on your phone, watching YouTube exercise videos, or hiring a personal trainer. All of these activities require more accountability.

Self-Care: Nutrition

  • Process of food being used by the body (nutrients)
  • Increase bone density and strength
  • Improve cardiac health (decrease risk of heart attack and stroke)
  • Improve digestion
  • Improve mental processing and clarity
  • Improve mood (decrease propensity to depression and anxiety)
  • Weight maintenance 

Food is fuel. When we are on the go, we eat out or eat food that is not nutritious. And so, we need to remind ourselves that nutrition increases our bone density and strength. It improves our cardiac health, digestion, mental processing, and clarity, and it improves our mood. We also know that it helps with weight maintenance. A quick rule is that 80% of your food should be fuel, and 20% can be fun.  

  • Fuel- 80%
    • What to Eat:
      • Fruit
      • Vegetables and Herbs
      • Nuts
      • Lean meats
      • Grains
      • Beans
    • How to Cook it:
      • Grill
      • Bake
      • Sear
  • Fun- 20%
    • On Occasion
      • Sweets/Sugars
      • Starches
      • Fried Foods
      • Butters
      • Processed Meat
      • High Sodium 

On occasion, sweets, sugars, and starches are okay if they are balanced with the good food listed above.

Self-Care: Emotional

  • Stress Management
  • Coping Skills
  • Therapy
  • Journaling 

Emotional self-care includes stress management, coping skills, therapy, and journaling. This may include deep breathing exercises, meditation, or going to your car at lunch to take a breather. Thinking through your day via journaling can help you track and figure out stressors in your daily encounters. 

  • "Sometimes the most important thing in a whole day is the rest we take between two deep breaths." — Etty Hillesum

I love this quote because sometimes, being intentional and knowing that you are escalating can enable you to implement self-care strategies on the spot.

Self-Care: Boundaries

  • Boundaries
  • Support System
  • Communication
  • Positive Social Media 

Boundaries are understanding your job role and not taking on much responsibility. There is a difference between being a team player and being taken advantage of at work. Perhaps you are burned out because you have not established good boundaries at work. Your nugget may be to have a conversation with your boss and say you feel like you are taking on some responsibilities outside your job description.

It may have been acceptable at one point, but now you have more of a patient load. You may need to shift some of these to the other team or create a broader support system. It is crucial to have people, whether on the job or at home, help you take some of the burdens of your responsibilities.

Communication may include uncomfortable conversations with a boss or a coworker. You may need to practice a conversation ahead of time.

Try to limit the negative input, like on social media. You must be strategic about feeding yourself with more encouraging things.

  • "Balance is not better time management, but better boundary management. Balance means making choices and enjoying those choices." — Betsy Jacobson

Self-Care: Spiritual

  • Time alone
  • Meditation
  • Prayer
  • Nature
  • Sacred Space  

The next topic is spiritual. Do you take time alone just to sit and think? Do you meditate, pray, walk and experience nature, or have a sacred space at work or home where you can sit to allow yourself some processing and thinking time? This is a balance of personal and people time. Sometimes, you have to step away. Your nugget may be carving out strategic time alone.

Self-Care: Intellectual

  • Hobbies
  • Creativity
  • Reading
  • Podcasts
  • Establishing Goals   

How can you add back in hobbies or feed that creative bug? Are you going to start reading again? You may not have time to read a book, but perhaps you can listen to Audible or podcasts. What goals do you have for yourself in this area?

Self-Care: Environmental

  • Clean space
  • Hire help with organization, errands, and cleaning
  • Be intentional about enhancing the "feel" of home

Next are environmental areas for self-care. Where do you need to clean up or reduce? It is crucial to have an environment where you feel comfortable and provides a calm state of mind. Can you hire someone to help you with errands or cleaning? 

Self-Care: Vocational

  • Create schedules
  • Time management and balance
  • Have conversations with supervisor and peers
  • Change positions, schedules, or roles if necessary and possible
  • Take Time Off 

Do you need to create schedules and balance for time management? The last one is taking some time off. When we shop for jobs, we look at all the perks and the benefits, but many people do not use their allotted time off. Perhaps your nugget is scheduling time off to regroup.

  • Stabilizing your personal state of wellness will drastically change your view of your profession.

Toll of Human Service Occupations

  • Compassion Fatigue – stress resulting from helping people who are experiencing trauma
  • Vicarious Trauma / Secondary Trauma – experiencing trauma through the feelings and experiences of others
  • Indifference. Inability to Empathize. Sympathetic Nervous System Dominance. Emotional Exhaustion

I want to look at toll in the form of compassion fatigue and secondary trauma. We see people at their lowest, which can take a toll on you. We can get to the point of indifference and an inability to empathize due to emotional exhaustion. If this is the case, you may want to look at your current environment to see if the emotional toll is too much at this time.

I have worked in skilled nursing facilities for the majority of my career. Sometimes I have to come up to breathe. Working with clients at the end of life and seeing them in the late stages of dementia can be difficult. I often moonlight somewhere else or only do part-time work in an SNF because although I loved and enjoyed it, it was beginning to take a toll on me. 

Trauma or Stress Responses

  • Physiological
  • Cognitive
  • Cognitive
  • Behavioral

Trauma and stress responses can manifest psychologically, emotionally, cognitively, or behaviorally.

Physiological

  • How your body responds to stress/trauma.
  • Examples of physiological trauma responses include rapid breathing, increased heart rate, headaches, digestive issues, and muscle tension.
  • Typically, the first sign/response to manifest. 

These are some psychological ways that we see stress and trauma in our bodies. For example, if you are having headaches, digestive issues, and muscle tension, this may be a psychological manifestation of trauma.

Cognitive

  • How is your thinking affected by the stress/trauma?
  • Examples: Nightmares, flashbacks, and negative self-talk

Cognitive trauma is when you cannot sleep, have nightmares, and start using negative self-talk.

Emotional

  • How your emotions are affected by stress/trauma
  • Examples: sadness, fear, anxiety, and frustration 

Trauma may manifest emotionally where there may be sadness, fear, anxiety, and frustration.

Behavioral

  • How your actions and responses are formed by stress/trauma
  • Examples: Detach from relationships, impatient with others, argumentative, overly appeasing to others 

For behavioral trauma, you may be impatient, argumentative, or detach from relationships.

Practical and Personal Application

  • What area(s) of wellness have been most impacted in my life?
  • What psychological stress or trauma responses have I exhibited?
  • What cognitive stress or trauma responses have I exhibited?
  • What emotional stress or trauma responses have I exhibited?
  • What behavioral stress or trauma responses have I exhibited?

Here are some practical questions to ask yourself. You want to look at the areas of wellness and discuss specific strategies to build a specific burnout plan.

3 Primary Causes of Provider Burnout: Tension

Tension can manifest in three ways on our job.

  • Categories of Healthcare Conflict
    • Territory
      • Perception of infringing on one's job, schedule, or workspace 
    • Technique
      • Perception of lack of competency, efficiency, or compassionately 
    • Tone
      • Perception of inappropriate communication of needs 

Tension can be seen as categories of conflict in territory, technique, and tone. You may experience a territory conflict. For example, a speech-language pathologist may use a similar goal to yours.

Peers may not believe that you are competent or good at your job. You may not like someone's technique, or they may not like yours.

The last area is tone. This may be the perception of inappropriate communication. "I don't like how she talks to me." Or, "My boss talks down to me." 

Territory Resolution Strategies

  • Clearly establish roles and responsibilities
  • Be aware of schedules
  • Be aware of systems
  • Be an active member of the team

Here are some quick territory strategies. Establish your roles. For example, OT does power wheelchairs, and PT does manual wheelchairs. Be aware of schedules and be an active team member. If you live on an island, you are not actively giving and helping. Due to this, there may be territory battles because the other team does not see you as a part of the team.

Technique Resolution Strategies

  • Be proficient and efficient at what you do
  • Be able to articulate the why of what you do
  • Seek understanding of other roles and responsibilities 

Here are some technique resolution strategies. One simple one is to be good at what you do. You may need to brush up on a technique. I have been an OT for 20-plus years, but if I had a job in pediatrics, I would have to learn some new interventions. I would not want another coworker to think I was incompetent. At your job, is there something you need to do better? This may diffuse some of the technique battles and be able to articulate why and what you do. Perhaps a CNA comes by the OT gym and says, "All you guys do is play all day. I need to get this patient clean." This is a technique battle because she does not understand the importance of the task you have set up to work on the client's memory. Be humble and calm enough to explain that to her. Who do you need to have a conversation with to explain what and how you do things to bring clarity? You also need to seek an understanding of others' roles.

Tone Resolution Styles

  • Passive
    • Avoiding or delaying necessary actions
    • "Handling" conflict covertly
    • Handling conflict at the height of the behavior or consequence 
  • Aggressive
    • Addresses conflict immediately and often 
    • "Handles" conflict overtly 
    • Addresses issues regardless of magnitude or frequency, often with same technique 
  • Assertive
    • Carefully considers conflict to decide how and when to address
    • Handles conflict appropriately
    • Resolution strategies match the level of the conflict 

Then, there might be a tone to communication. Instead of being passive-aggressive, we want to be assertive. Passive is when you avoid or delay necessary actions. Is there a conversation or situation where you feel that you are keeping the peace but avoiding an essential conversation? Your takeaway may be to be intentional and not take a passive approach.

You may have a boss that is too aggressive and handle conflict immediately, often, and head-on. You may need a plan or strategy to sit down and talk with your coworker or boss about their tone. Or maybe you need to work on your tone as the stress is caused by the energy you bring to the environment.

We want to be assertive by carefully considering conflict to decide how and when to address it. We do not want to handle conflict covertly or secretly but appropriately. We also do not want to handle it at the height of the behavior or the consequence of causing a big confrontation in front of people. We want to resolve it with good timing and without an audience.

3 Primary Causes of Provider Burnout: Transition

The last is the transition. Is it time for you to make a change? 

Factors That Lead To Considering Transitioning

  • Overworked
  • Understimulated
  • Overwhelmed 

And you need to ask yourself if you need to make a change due to being overworked, under-stimulated, or overwhelmed.

  • Overworked
    • Schedule
    • Systems
    • Conversations 

If you are overworked, let's look at schedules, systems, and conversations.

  • Schedule
    • Time-Based
    • Goal-Based (write down and prioritize your goals)
    • Written or Typed, no exceptions!
    • Checklist
    • Realistic Day
    • End of Day Assessment

Here is a quick list of how to make efficient, time-based, goal-based, and realistic schedules with a checklist.

  • "A woman who lives with the stress of an overwhelmed schedule will often ache with the sadness of an underwhelmed soul." — Lysa Terkeurst

Systems are a little bit different than schedules. Schedules tell you when, and a system tells you how.

  • Systems
    • Structured Email Checks
    • Strategic Multitasking
    • Schedule Thinking Blocks
    • Weed out Procrastination and Perfection 
    • Communicate your Schedule to Others
    • Reset and Rest Your Brain
    • Delegate 

Instead of checking email throughout the day, maybe do it only twice a day. You want to use strategic multitasking but not two big things at once. We cannot multitask two large tasks efficiently. Schedule thinking blocks. It is important not to procrastinate and try to perfect. Communicate your schedule to others to help set your boundaries and rest your brain. Delegate tasks when able.

  • Conversations
    • Needs
    • Expectations
    • Resources
    • Availability
    • Capability
    • Limitations
    • Situation    

You may want to have some conversations to articulate your needs, expectations, resources, availability, capability, and limitations in the situation. Let everyone know, so there are no questions.

  • "Be brave enough to ask for help when you need it. There is no merit badge for doing all the hard things alone." — Maggie Smith

Are you understimulated and not challenged? 

  • Understimulated
    • Not challenged
    • Repetitive
    • Long-term position
    • You don't like it
    • You want to do something else 
    • Seek out extra assignments
    • Join committees
    • Get energy and ideas from coworkers who enjoy it
    • Get creative
    • Seek out lateral and vertical moves
    • Assess and adjust 

If you are under-stimulated, seek an extra assignment or join a committee and get energy from other coworkers and their ideas. Get creative, stop doing the same treatment plans, read some articles, and find new studies to try something different. Seek out lateral or vertical moves where appropriate and available.

  • Overwhelmed

If you are overwhelmed, go back to some self-care strategies we discussed, like setting boundaries, physical activity, or streamlining your tasks.

  • "Being overwhelmed means that your life or work is overpowering you. Regain control by clarifying your intentions, setting realistic expectations, and focusing on your next step." — Daphne Michaels

Resources/References

Here are my resources. I encourage you to go back through the information and to strategically and intentionally build your specific plan for yourself and how you can move through those stages to move lower on the burnout scale.

Columbia University Irving Medical Center. Sick and tired: Research reveals toll of poor sleep among health care workers. ScienceDaily. ScienceDaily, 29 November 2021. www.sciencedaily.com/releases/2021/11/211129122824.htm

De Hert S. (2020). Burnout in healthcare workers: Prevalence, impact and preventative strategies. Local and regional anesthesia, 13, 171–183. https://doi.org/10.2147/LRA.S240564

Leiter, M., & Maslach, C. (2021, March). How to measure burnout accurately and ethically. Harvard Business Review. Retrieved from https://hbr.org/2021/03/how-to-measure-burnout-accurately-and-ethically

Maslach, C. and Jackson, S.E. (1981). The Measurement of Experienced Burnout. Journal of Organizational Behavior, 2, 99-113.

http://dx.doi.org/10.1002/job.4030020205

Yıldızhan, E., Ören, N., Erdoğan, A., & Bal, F. (2019). The burden of care and burnout in individuals caring for patients with Alzheimer's disease. Community mental health journal, 55(2), 304–310. https://doi.org/10.1007/s10597-018-0276-2

Summary

Thank you all so much. I appreciate and honor the work that you do.

Citation

Rollins, M.(2022). Self-care management and professional burnout reduction strategies. OccupationalTherapy.com, Article 5524. Available at www.occupationaltherapy.com

 

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mira rollins

Mira Rollins, OTR/L

Mira Rollins has been an occupational therapist for over 20 years. The majority of her career has been spent treating geriatrics in rehabilitation skilled nursing facilities. Her clinical experience also includes spinal cord injury and acute care hospital settings. Mira has also had the honor of leading successful rehab teams in her role as director of rehab and regional manager. She now uses her 20 years of experience as an adjunct professor for OTA programs and as the owner of Mira j. Rollins Engagement Programs, a training and consulting company.



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