Occupational Therapy Burnout: The Ugly Truth No One Talks About

Mar 3, 2019
10 min read
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“You chose this career.” “That’s just the way it is.” “Suck it up.” “Take it or leave it.” These phrases, and countless others, plague occupational therapists and other healthcare professionals experiencing burnout.

Is burnout a ‘rite of passage’ for healthcare professionals? Does being vocal about burnout mean there’s something wrong with you? Is burnout just a part of the package? Just because things are a certain way doesn’t make it ok, and it doesn’t excuse a faulty system and the aforementioned victimizing statements. If we bring up that we’re feeling overworked, miserable, anxious, or exhausted to our coworkers, we might experience one of two things: 1. we are joined in camaraderie with those who feel similarly and we create a massive “work sucks” party OR 2. we are made to feel weak, stupid, or even become targets of workplace bullying.

Burnout is not new to occupational therapists or healthcare professionals. What’s new is the increasing number of people recognizing it to be a serious problem and an unacceptable way to move through your professional career. Unrealistic productivity expectations, long shifts, over-burdensome documentation, and bureaucratic red tape from payers are some of the outside factors, but there are internal factors too. Things you can change about your mindset, your mood, or even your daily routine. You can't slay the burnout beast by tackling one and not the other. Change is needed, beginning with a micro movement in the right direction all the way up to massive policy shifts at the institutional level.

Let’s take a look at how burnout is harming us as clinicians. According to a study on practicing OTs in Ontario by Gupta et al. (2012); 34.8% reported high emotional exhaustion, 43.5% high levels of cynicism, and 24.6% low levels of professional efficacy. The variable that predicted the highest level of exhaustion? Burdening workload. Conversely, what may surprise you is that burnout can happen to anyone; even those clinicians who are considered to be highly engaged in their work. Another study by Pouslen et al. (2014) found a significant relationship between high burnout and high work engagement, indicating that the positive effects of high engagement (energy, dedication, vigor) can change over time into negative effects, such as work strain.

But what does burnout even mean? Stressed out? Depressed? Tired? Well, yes and no. Burnout can occur as a result of being exposed to chronic stress. You can be stressed out but not burned out, whereas someone experiencing burnout arrived at that point due to a buildup of chronic stress and they have no hope it will ever end. There’s no light at the end of the tunnel. Burnout occurs in a job-specific context and depression is context-free (Cooper & Quick, 2017).

It should be noted that burnout can cause depression, but there are other factors too. If you wanted to cook a burnout pie, these are the main ingredients you would need: emotional exhaustion, cynicism and depersonalization towards patients and/or the profession, and a low sense of personal accomplishment. Basically the worst tasting (and completely burnt) pie ever.

The development of burnout in a worker arises from a complex interaction between personal and environmental factors. Let’s debunk some myths right now: burnout does not lie solely on the individual, but rather points to a bigger issue in our healthcare system and institutions. The ‘workload’ aspect contributing to burnout is characterized by unrealistic caseloads, balancing clinical and non-clinical duties, forced overtime and weekends, time constraints, and spillover of work into non-work hours. The struggle of healthcare organizations to maintain profitability in an ever changing (and usually worsening) reimbursement environment has lead to tactics that cause conflict between the needs of the business and the needs of the worker. Disconnects between employer and employee values and expectations such as high productivity standards, lack of adequate orientation and onboarding, being pressured to discharge or keep patients on for longer than necessary, or even sign off on notes of patients you hadn’t seen (true story, it happened to me) may create a distance between your values and the values of your organization, which then creates a disconnect between you and work.

So what do we do? Traditional “burnout prevention” methods have included mostly internal locus of control and individual worker strategies such as resilience training, mindfulness, journaling, yoga, cultivating optimism, etc. While this first line of defense may improve health and work performance outcomes, they aren’t going to fully solve your burnout puzzle. You need to be an advocate to change some of the external factors that contribute to burnout. Even if you are not in a policy making position, I’ve boiled it down to four easy things we can do ASAP as professionals to get things moving forward.

  1. Unplug
  2. Celebrate self-care
  3. Level up your team’s energy
  4. Teamwork makes the dream work

Unplug

Psychological detachment from your job is one of the biggest components in recovery from work stressors (Cooper & Quick, 2017). It includes not only refraining from completing job-related activities after work and mentally switching off during off-hours, but it also means actively engaging in other activities (for example, sports, interests, joint activities with friends and family). For example, avoid the urge to send ‘urgent’ emails to your coworkers during their off hours, and instead encourage them to enjoy their well-deserved time off.

Celebrate self-care

If we can celebrate productivity levels, publications, and patient outcomes, why can’t we acknowledge and celebrate our personal and professional self-care? Our lives are an ongoing journey. Once we enter the healthcare field, the daily grind can turn into an aimless rinse-and-repeat for the rest of our careers. Creating room for the celebration of professional well-being victories, including sharing affirmations, humor, personal health goals, and personal interests may give a boost to one another and thus create a positive spiral upward for your team.

Level up your team’s energy

“Misery loves company.” Did you know that burnout is a social group phenomenon? Burnout is contagious. As mentioned in the second tip, promoting the celebration of self-care will move your team forward and in the right direction. People just want to be seen, heard, and understood. Understanding your team members’ personality, what makes them tick, and their preferred ways of being appreciated is a testament to your desire to create a thriving team. Also, delegating roles according to people’s strengths and preferences creates a stronger connection to a person’s work. For example, you work in pediatrics and the COTA you supervise is an extrovert, loves serving others, and is low in conscientiousness (meaning they prefer a summary instead of a detailed manual). How can you play up to this person’s strengths? You build an obstacle course together for your kiddos and engage in joint therapy sessions when appropriate (since she is extroverted); you can suggest she plan the welcome party for the new therapists on board (since she likes to serve others); and you can provide her feedback that is brief, yet to the point and avoid bombarding her with unnecessary details (since she is low conscientious.) You get where I’m going? This way, you can help build trust, which then adds to an overall unity-in-the-community feel by supporting the needs of the people you work with.

Teamwork makes the dream work

Feel like you can’t make a difference because you’re not in a leadership position? WRONG! Many team meetings center around an “us vs. them” mentality, one-way ‘dialogue’ that omit any form of open discussion and collaborative brainstorming. We all have the ability to lead and role-model desired behaviors for others in our organization. Empower each other to promote positive, powerful change. Glancing back to number 3, assessing your team’s collective energy can say a lot about where you’re headed as a business. For example, do you feel like your workplace’s progress is stagnant? Or maybe moving too fast in too many directions? There are different types of organizational energy and thus different energy traps. Having the conversation with your supervisor or manager about implementing new strategies can be scary. If you see a solvable problem in your workplace, don’t put off chatting with your management. Most often the conversation is not as scary as you think, and they will be grateful and even applaud your initiative. If it’s a well thought out solution that will benefit the team, there’s no reason your voice shouldn’t be heard. If you happen to be management, promote dedicated time each week to informally and openly discuss challenges and brainstorm ideas with your team; this doesn’t include a gossip/complaint session, but rather a time to see and describe things for what they are, actively listen, and problem-solve together.

Occupational therapy burnout doesn't have to be like this!

We all have the responsibility as a healthcare professionals to advocate for the change that is needed. That’s why my husband Mike and I created Joy Energy Time. We’re dedicated to building a better healthcare industry through promoting greater work well-being and banishing burnout. Bash the Burnout for Healthcare Professionals is our continuing education course that goes DEEP into the serious problem of burnout in healthcare, the costs, internal and external factors/causes, and most importantly what the heck to do about them, and how to best advocate for the changes you want to see to your clinic's policy makers. Healthcare professionals across the board experience their own unique set of stressors and are crying for help. Unfortunately, the consequences of burnout range from headaches all the way to suicide. Every clinician must be equipped with the knowledge to prevent it or manage it if it has already occurred.

“We can change the world and make it a better place. It is in your hands to make a difference.” — Nelson Mandela

References:

  1. Poulsen, A.A., Meredith, P., Khan, A., Henderson, J., Castrisos, V., & Khan, S.R. (2014). Burnout and work engagement in occupational therapists. British Journal of Occupational Therapy, 77(3), 156-164.
  2. Gupta, S., Paterson, M. L., Lysaght, R. M., & von Zweck, C. M. (2012). Experiences of burnout and coping strategies utilized by occupational therapists. Canadian Journal of Occupational Therapy, 79, 86-95. doi: 10.2182/cjot.2012.79.2.458 https://nypost.com/2017/11/08/americans-check-their-phones-80-times-a-day-study/
  3. Cooper, C.L., & Campbell Quick, J. (2017). The Handbook on Stress and Health: A Guide to Research and Practice. Hoboken, NJ: Wiley Blackwell
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