First described in the 1970s, burnout syndrome is a work-related constellation of symptoms triggered by emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Burnout takes a toll on health professionals, their patients, and their practices. Short visits, complicated patients with multiple co-morbidities, lack of control, electronic health record stress, and poor work-home balance can lead to providers leaving practices they once loved, poor patient outcomes, and health care worker shortages.
- A 2024 observational study of more than 10,300 family physicians published in JAMA Open Network found that physicians’ burnout decreased when they perceived their primary care teams to be efficient and their own use of electronic health records proficient. Other findings showed that collaborating with registered nurses was associated with more team efficiency, and collaborating with PAs was associated with better odds of physicians feeling less burdened by the amount of EHR work they have to do at home.m
- In a 2024 systematic review and meta-analysis of 85 studies, including 288,581 nurses, shows a negative association between nurse burnout and patient safety, patient satisfaction, and quality of care. The association between nurse burnout and these outcomes was consistent independent of nurses’ age, sex, work experience, and geography. The associations and effect size between nurse burnout and quality of care were also consistent with previous meta-analyses of burnout and quality of care in physicians and pooled studies of health care professionals.
- Burnout Syndrome
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Health professionals caring for their patients often face serious illness or death and deal with complex individual and family dynamics. This frequent exposure to distressing emotional situations can lead to chronic stress and burnout syndrome.
3 dimensions of burnout:
• Exhaustion - a result of chronic stress.
• Cynicism/depersonalization - an attempt to distance yourself by developing an indifference or cynical attitude; stems from exhaustion and feeling discouraged.
• Decreased work performance – a reduction in effectiveness that results from negative attitudes and behaviors.Risk Factors
Situational Risk Factors
• Demands of solo practice, long work hours, time pressure, and complex patients.
• Lack of control over schedules, pace of work, and interruptions.
• Lack of support for work-life balance/integration from colleagues and/or spouse.
• Isolation due to gender or cultural differences.
• Work overload and its effect on home life.
• Feeling poorly managed and resourced.
• Managerial responsibility.
• Dealing with patients’ suffering.Individual Risk Factors
• Greater risk earlier in the career
• Insufficient support system, e.g. life-partner
• Attribution of achievement to chance or others rather than your own abilities
• Passive, defensive approach to stress rather than stress management
• Lack of involvement in daily activities
• Sense of poor control over events
• Not being open to change“Psychological syndrome in response to chronic interpersonal stressors on the job” (Maslach, 1982).
“State of mental and/or physical exhaustion caused by excessive and prolonged stress” (Girdin, 1996)
- Compassion Fatigue
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Compassion fatigue refers to a physical, emotional, and spiritual fatigue or exhaustion that takes over a person and causes decline in his/her ability to experience joy or to feel and care for others, or secondary traumatic stress disorder. (Figley, 1995; Friedman, 2002) Compassion fatigue is a one-way street in which you give out a great deal of energy and compassion to others, yet aren’t able to get enough personal support to be reassured that the world is a hopeful place. It’s this constant outputting of compassion and caring over time that can lead to these feelings of total exhaustion (Figley, 1995; Friedman, 2002)
Causes
Compassion fatigue comes from a variety of sources. It often affects those working in care-giving professions such as nurses, physicians, mental health workers. It can affect anyone in a situation or setting where they’re doing a great deal of caregiving and expending emotional and physical energy day in and day out. The stress from helping or wanting to help is the main cause. (Figley, 1995; Friedman, 2002).
Risk Factors
Although those in health care and mental health professions are most at risk for developing compassion fatigue, it is not limited to those arenas. Any caregiver is susceptible. (Figley, 2002; Figley, 1995, Friedman, 2002) This includes taking care of a family member during a crisis, requiring a higher level of empathy, or during a long-term illness that requires constant attention to their needs with compassion and sensitivity.
Symptoms
Compassion fatigue symptoms can present themselves as:
• Biological/Physical - Sympathetic and parasympathetic arousal. Prolonged stress leads to immunosuppression and frequent illness.
• Psychological - Excessive self-concern, loneliness, powerlessness, despair, and stagnation.
• Social - Rejection, separation, loss of control, giving up, destruction, and emptiness. (Friedman, 2002; Figley, 1995) - Stress
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Stress is the body’s normal response to any demand, an outgrowth of the “fight or flight” response. Everyone experiences stress, so how you react to stress is what matters. Under stress, the body releases hormones, adrenaline, and hydrocortisone, which slow some functions, including our immune system, and turn on short-term energy reserves. After the stress is gone, the body returns to normal. Positive stress (eustress) often stimulates necessary survival mechanisms and provides extra momentum and boosts productivity. Examples include preparing a lecture for a class, searching for a new home, or planning for a holiday. Negative stress (distress) can either be acute (short-term) or chronic (long-term). Chronic stress leads to physical and mental dysfunction and disease. Stress management is how we can turn off the stress response and avoid the negative outcomes of chronic stress.
Positive Stress
• Motivates
• Is short-term (acute)
• Feels exciting
• Improves performance
• Is pleasant and beneficial
• Is vital for physical and mental fitness
• Focuses energies and sharpens the mindNegative stress
• Doesn’t fade, but builds (chronic)
• Can lead to: Mental and physical problems: loss of concentration, poor memory, irritability, headaches, muscle discomfort or pain, fatigue, poor sleep, digestive issues, weight gain, etc.
• Or it can lead to diseases: depression, anxiety, addiction, cardiovascular disease, etc.
• Can be curbed with positive “self-talk,” boundaries, and a healthy lifestyle including taking time to relax and rechargeFactors that affect stress levels
• Individual perception of stressors. How we look at stressors determines their intensity, duration, and our responses.
• Personal and family resources. Personal qualities like patience, perseverance, and optimism can affect the way one deals with stress. Family support and engagement can make a difference in your ability to cope with stress.
• Support network. Family, friends, counsellors, and others can help you not only release stress but also manage it well. - Things to Avoid when Experiencing Burnout and Compassion Fatigue
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1. Avoid making big decisions.
• Instead, give yourself time to recover physically, emotionally, and spiritually before making such decisions.
• Don’t quit your job, get a divorce, or spend money on a lavish trip or a new sports car. It might feel great at the time, but a few days or weeks later, the same set of problems will resurface.
2. Avoid blaming others.
• Blaming administration, staff, co-workers, or the “system” is not productive.
• Being adversarial will only create further exhaustion and prevent deeper healing that needs to take place.
• Wait until self-perceptions are more logical and less emotionally charged and until current stress is under control.
• If you do lash out, apologize and take the chance to be vulnerable with your colleague—they may be going through the same thing.
3. Avoid expending energy complaining or commiserating with discontented co-workers. “Misery loves company.” It’s easy to fall into the habit of complaining when experiencing compassion fatigue, but it will only make you feel worse. There are other, more constructive environments to share and express feelings in a more therapeutic environment.
4. Avoid trying a quick fix.
• Compassion fatigue makes you vulnerable to addictive behaviors and substance abuse. Don’t turn to alcohol or drugs to “relieve” stress, they do not manage stress and may add to your problems.
• Many helping professionals try to deal with compassion fatigue by working longer and harder. Instead, take breaks and disconnect to work more effectively. Smarter, not harder.
• The quick fix usually complicates an already overburdened life, escalating the downward spiral to burnout and depression.
5. Reframe
• Determine other approaches to the issue or concern or look at an action/event through more realistic and positive lens.
• Think about creative solutions to challenges that you experience. Delegate or table what you can.
• Rule of Fives
o Have five people you can call on to chat with about your problems.
o They can be professionals and/or personal supports: doctor, counsellor/psychologist, support group, family member, friend, other health workers, colleagues. - Self Awareness & Self Care
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The World Health Organization (WHO) defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.
Consider these strategies to practice self-awareness and self-care:
• Know your own “triggers,” vulnerable areas, and learn to defuse them or avoid them.
• Resolve your own personal issues and continue to monitor your own reactions.
• Be human and allow yourself to grieve when bad things happen to others.
• Remember that “normal responses to abnormal situations” is true for practitioners and clients alike.
• Develop realistic expectations about the rewards as well as limitations of being a health care worker and set boundaries for yourself.
• Become aware of, and alter any, irrational beliefs about the limitations of helping.
• Balance your work with other professional and personal activities that provide opportunities for growth and renewal:
o Just move! Take a walk/jog, do yoga/tai chi, garden, clean/organize
o Read good novels or magazines
o Watch television or a movie
o Go to church, meditate, or pray
o Cook for friends or just for you
o Socialize with family or friends
o Disconnect from work
o Take time off: vacation, staycation, whatever you need
o Leave work at work or set firm boundaries
o (Window) shop
o Do nothing or just daydream
o Get a massage, acupuncture, or take a bath
o Turn music up and let it move youLearn to ask for help and accept help from others
• Develop healthy support system. Seek assistance from co-workers and caregivers who have had similar experience in your field and have remained healthy and hopeful. Learn from their experience and take their advice.
• Delegate responsibilities and get help from others for routine work when appropriate in consultation with your work supervisor.
• Remember that most people do grow and learn from their experiences and so can helping professionals.Live a Healthy, Balanced Life
• Think about the idea that if you never say “no” what is your “yes” worth?
• Find activities that provide opportunities for growth and renewal.
• Take an honest look at your life before a crisis strikes. Find help to identify your obvious risks and work to correct or minimize them.
• Develop sense of humor. Expose yourself to humorous situations.
• Learn to laugh and enjoy life.
• Avoid chaotic situations and learn simplicity.
• Take time to return to decompress activities regularly.
• Learn to set boundaries when
• Review how you are spending time.
• Be consistent with your efforts but don’t beat yourself up if you aren’t. Just recommit and move forward.Spend Some Quiet Time Alone
• Learning mindfulness meditation is an excellent way to ground yourself in the moment and keep your thoughts from pulling you in different directions. The ability to reconnect with a spiritual source will help you achieve inner balance and calm you, even in a tumultuous time.
• Take a bath (after the kids are in bed).
• Get up early and enjoy the quiet of the morning.
• Stay overnight somewhere other than your own home to be alone with yourself.
- Resources
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- Physician Support Line
- Clinician Well-Being Knowledge Hub
- Helping Health Care Workers Cope with Burnout (GW Integrative Medicine podcast)
- Individual Physician Wellness and Burnout Tools (American College of Physicians)
- Physician Health (American Medical Association)
- Nursing Stress and Burnout (American Nurses Association)