BANNING BURNOUT,
and beating the
Blues
Presenter: Hugh Irons RN., Master of Nursing
(Community Health), MRCNA, Member Australian
Counselling Association : Training 14 December 2010
th
Hugh Irons RN., December 2010
Distinguishing between stress and
burnout
• Burnout is a form of
chronic strain that
develops over time in
response to prolonged
periods of high stress.
(Dollard et al, (2003), Occupational stress in the service professions, Taylor & Francis,
London)
Hugh Irons RN., December 2010
Distinguishing between stress and
burnout
• The state of burnout is qualitatively
distinct to stress. Burnout may include
some of the signs and symptoms of
stress, but it also has its own features
over and above stress reactions.
• Burnout is a long-term process
characterised by “chronic
malfunctioning” and negative and cynical
attitudes towards clients and work in
general.
Hugh Irons RN., December 2010
Distinguishing between
stress and burnout
• Whilst most people will experience
periods of work stress, most people
do not experience the more chronic
and long-term condition of burnout.
Three core dimensions of burnout
have been identified:
Hugh Irons RN., December 2010
Distinguishing between stress and
burnout
• 1. Emotional exhaustion (feeling
overextended and drained of
emotional and physical resources)
• 2. Depersonalisation (negative,
detached or cynical view of one s
work)
Hugh Irons RN., December 2010
Distinguishing between
stress and burnout
• 3. Reduced personal accomplishment
(low sense of achievement, feelings of
incompetence, low sense of
efficiency).
• While the symptoms of stress and
burnout differ, the factors that
contribute to stress, and in the longer
term to burnout, are quite similar.
Hugh Irons RN., December 2010
Hugh Irons RN., December 2010
BURNOUT
• May be mild, moderate or severe which at it’s
most intense combines physical and mental
exhaustion together with
Low morale
Feelings of insecurity
Workplace phobia
Overall pessimism
Defence mechanisms; denial, projection, anger
Reducing ability to cope with stressors
Gradual lack of concern for others, including
colleagues.
Hugh Irons RN., December 2010
OBSERVABLE BEHAVIOURAL
WARNING SIGNS
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BLAMING OTHERS
CRYING
IRRITABILITY
SHORT ATTENTION SPAN
OVERACTIVITY
NEGATIVE ATTITUDE
SHORT TEMPER
TAKING RISKS
Hugh Irons RN., December 2010
EMOTIONAL WARNING SIGNS
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ANXIETY
DEPRESSION
FEAR
FRUSTRATION
GRIEF
ISOLATION
FEELINGS OF
POWERLESSNESS
• FEELINGS OF
WORTHLESSNESS
Hugh Irons RN., December 2010
PHYSICAL WARNING SIGNS
• DIARRHOEA
• DRY MOUTH
• EATING DISORDER
• CLAMMY HANDS
• UPPER BACK PAIN
• STIFF NECK
Hugh Irons RN., December 2010
And, from a Manager’s viewpoint
• Declining performance
• Increasing time at work / lack of
leave requests
• Memory lapses
• Uncharacteristic mistakes
and/or accidents
• Unwarranted criticism of others
• Lack of cooperation
• Declining enthusiasm
Hugh Irons RN., December 2010
Preventing stress from becoming burnout
• Timely interventions are required. Burnout
occurs when stressful working conditions
are experienced over a prolonged period of
time.
• Therefore, it is important to regularly
monitor workers’ stress levels, and to take
action to address stressors or stressful
working conditions at the point when they
begin to emerge.
Hugh Irons RN., December 2010
An interesting finding
• “RN’s had a negative correlation
between burnout and personal
accomplishment….,indicating that as
their lack of personal accomplishment
increased, their burnout decreased. This
linkage may have been based on
detachment of the nurses or it may have
indicated disengagement”
( Kennedy B R.
“Stress and Burnout of Nursing Staff Working With Geriatric
Clients in Long-Term Care” in Journal of Nursing Scholarship,
2005; 37:4, 381-382)
Hugh Irons RN., December 2010
Important point
• If we are to prevent biopsychosocial
dysfunction of nurses, and instead
promote their physical and mental
health ( i.e. a therapeautic
workplace), the predominant factors
contributing to nursing burnout
should be crystal clear. But, they are
numerous, part of a complex
phenomenon.
Hugh Irons RN., December 2010
For example:
• WORKLOAD
• AGE
• HARDINESS
• ACTIVELY COPING
• SOCIAL SUPPORT
• ROLE AMBIGUITY
Hugh Irons RN., December 2010
The Cost of Complacency::
• Decreased level of client care, low
staff morale, increased sick leave,
loss of productivity, increased
workcover claims.
• Minimal Team Spirit.
• Reduction in Staff Loyalty.
• litigation
Hugh Irons RN., December 2010
COST TO PERSONAL HEALTH
• Physical; e.g. sleeplessness, nausea,
headaches, stomach and bowel problems,
skin complaints, lethargy, hypertension.
• Psychological; e.g. Lost confidence and
self-esteem, lost motivation, depression
and suicide, anger and homicidal ideation,
anxiety disorders, irritability.
• Social; disruption to family and friendships
Hugh Irons RN., December 2010
COST TO HEALTH SERVICES
• Victims may waste
between 10% and 50%
of work time.
• Increased sick Leave
• Increased staff turnover.
• Reduced efficiency and
profitability, absenteeism,
low morale, poor performance
levels, increased training
and recruitment costs.
Hugh Irons RN., December 2010
REMEMBER:
• The absence of action (doing
nothing) against workplace
stressors does not ease the
troubled waters, rather it may
be seen as condoning the
problem. Therefore, doing
something is crucial
• So ,consider the….
Hugh Irons RN., December 2010
Twenty Top Tips
Hugh Irons RN., December 2010
Twenty self-help steps
• 1. ACKNOWLEDGE THE
DAMAGE THAT CAN OCCUR
• 2. ACKNOWLEDGE Y O U
• 3. LET OFF STEAM
APPROPRIATELY
• 4. STOP DENYING
• 5. AVOID ISOLATION
Hugh Irons RN., December 2010
Twenty self-help steps
• 6. BE PREPARED TO CHANGE
CIRCUMSTANCES IF NECESSARY
• 7. FIND PRESSURE BUBBLES AND
BURST THEM
• 8. STOP OVERNURTURING OTHERS
AND NURTURE YOURSELF
• 9. LEARN TO SAY NO
• 10. DELEGATE (at work and home)
• 11. REASSESS YOUR VALUES
Hugh Irons RN., December 2010
Twenty self-help steps
• 12. PACE YORSELF
• 13. TAKE CARE #OF YOUR BODY AND
MIND (It’s the only one you’ve got!)
• 14. MINIMISE WORRY AND
• 15 MAINTAIN A SENSE OF HUMOUR
• 16. TAKE ADVANTAGE OF DEBRIEFING
• 17. FULLY UNDERSTAND THE CONCEPT
OF PROFESSIONALISM (more on this
later)
• 18. UNDERSTAND THE CONCEPT OF
“RATIONAL DETACHMENT”
Hugh Irons RN., December 2010
Twenty self-help steps
• 19. Utilise assertiveness
skills as oppo9sed to
possible disrespect.,
• 20.. Learn the Top Twenty
Tips. And use’em.
Hugh Irons RN., December 2010
What a staff member can do:: 1
• As the health care staff shortage
apparently continues, staff are
working harder and burning out
faster.
• For instance, too many battleweary nurses are leaving the
profession.
• Burnout creeps up on you. Look
inside yourself for signs of
unusual fatigue, insomnia, and
general unhappiness in your
practice.
Hugh Irons RN., December 2010
What a staff member can do:: 2
• Recognize how hard you work, how
much you do, and how stressed you may
be.
• Consider your colleagues too, especially
those at the 2- or 3-year mark. They've
worked so hard developing their nursing
skills that they may not recognize how
much pressure they're under. Even if
they do, they probably haven't yet
learned how to cope with the stress.
Hugh Irons RN., December 2010
What a staff member can do:: 4
• STOP DENYING. Listen
to the wisdom of your
body. Begin to freely
admit the stresses and
pressures which have
manifested physically,
mentally, and/or
emotionally.
Hugh Irons RN., December 2010
What a staff member can do:: 5
• AVOID ISOLATION.
• Don't do everything alone!
Develop or renew intimacies
with friends and loved ones.
Closeness not only brings new
insights to stressors, but also
fights agitation and
depression.
Hugh Irons RN., December 2010
What a staff member can do:: 6
• CHANGE YOUR
CIRCUMSTANCES?
• If your job, your
relationship, a situation, or a
person is dragging you
under, try to alter your
circumstance, or if
necessary, leave.
Hugh Irons RN., December 2010
What a staff member can do:: 7
• DIMINISH INTENSITY IN YOUR
LIFE.
• Pinpoint those areas or
aspects which summon up the
most concentrated intensity
and work toward alleviating
that pressure.
Hugh Irons RN., December 2010
What a staff member can do:: 8
• STOP OVERNURTURING.
• If you routinely take on other
people's problems and
responsibilities, learn to
gracefully disengage. Try to
get some nurturing for
yourself. Pamper yourself !!
Hugh Irons RN., December 2010
What a staff member can do:: 9
• LEARN TO SAY"NO".
You'll help diminish
intensity by speaking
up for yourself. This
means refusing
additional requests or
demands on your time
or emotions.
Hugh Irons RN., December 2010
What a staff member can do:: 10
• BEGIN TO BACK OFF AND
DETACH.
• Learn to delegate, not only at
work, but also at home and with
friends. In this case,
detachment means rescuing
yourself for yourself.
Hugh Irons RN., December 2010
What a staff member can do:: 11
• REASSESS YOUR VALUES.
•Try to sort out the
meaningful values
from the temporary
and fleeting, the
essential from the
nonessential.
Hugh Irons RN., December 2010
What a staff member can do:: 12
• LEARN TO PACE YOURSELF.
• Try to take life in
moderation. You only
have so much energy
available.
Hugh Irons RN., December 2010
What a staff member can do:: 13
• TAKE CARE OF YOUR BODY
AND MIND.
• Don't skip meals, abuse
yourself with rigid diets,
minimise sleep, or break
the doctor appointments.
Eat well, sleep well.
Hugh Irons RN., December 2010
13 CONTINUED
• Thank yourself for doing a worthwhile
and sometimes difficult job / task.
• Ensure that regular breaks are taken
and use to relax. Learn relaxation
methods.
• Try not to do too much.
• Take time to carry on with your
favourite activities; walking, exercise,
reading.
• Talk to the dog!
Hugh Irons RN., December 2010
What a staff member can do:: 14
• MINIMISE WORRY AND ANXIETY.
• Try to keep worrying to a
minimum - it changes nothing
after all. You'll see things more
clearly if you spend less time
worrying and more time taking
care of your real needs. Pamper
yourself again!
Hugh Irons RN., December 2010
What a staff member can do:: 15
• KEEP YOUR SENSE OF
HUMOR.
• Bring happy moments into
your life. Very few people
suffer burnout when they're
having fun!!!
Hugh Irons RN., December 2010
What a staff member can do:: 16
• Ensure you ‘debrief’ if
necessary. Talk things
through with a workmate
or colleague
Hugh Irons RN., December 2010
Fully understand the concept of
Professionalism:: 17
• More on this later.
Hugh Irons RN., December 2010
Fully understand the concept of
Rational Detachment:: 18
• More on this later.
Hugh Irons RN., December 2010
Fully understand the concept of
Assertiveness:: 19
• More on this later.
Hugh Irons RN., December 2010
Use the Twenty Steps in your
everyday practice. 20.
Hugh Irons RN., December 2010
professionalism
• Exhibiting a courteous,
conscientious, and generally
businesslike manner in the
workplace. But subject to::
• 􀂄Boundaries: Lines that are drawn to
protect patients from being exploited by
professionals who are more powerful
• 􀂄Communication style and self awareness
Hugh Irons RN., December 2010
WHY CARE ABOUT PROFESSIONALISM
• Network-Grievances often centre
around professionalism
• Employee-Code of Ethics; builds
confidence
• Employer-Prevents burnout and
promotes mutual respect
• Patient is satisfied
Hugh Irons RN., December 2010
The Pitfalls
• over self-disclosure-discussing personal
problems
• Special treatment to a patient-bending the
rules
• Patient giving staff special attention
• Selective communication
• “You and Me against the World”
• Name calling
• Threatening
• Discussing employer/employee issues
(salary, staff errors, etc.)
Hugh Irons RN., December 2010
...and even more pitfalls...
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Moralizing
Ordering
Psychological diagnosing
Gossip
Flirtations
Inappropriate dress
Gifts
Hugh Irons RN., December 2010
...as it should be...
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Encouraging patient self-determination
Providing informed consent
Competence
Not taking unfair advantage of any
relationship
Not having dual relationships
Respecting privacy/confidentiality
Explaining to staff our Codes of Ethics
Empowering patients rather than creating
dependency
Hugh Irons RN., December 2010
Why is professionalism hard in
health care settings the dialysis unit?
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Staff have baggage
􀂄Difficulties at home
􀂄Challenging situations at work
􀂄Time constraints
􀂄Not enough staff
􀂄Multiple losses
􀂄Patients have baggage
􀂄Decreased ability to function independently
􀂄Multiple losses
􀂄Difficulties at home
Hugh Irons RN., December 2010
Why is professionalism hard in
health care settings
• Patients have baggage too!
• 􀂄Decreased ability to function
independently
• 􀂄Multiple losses
• 􀂄Difficulties at home
Hugh Irons RN., December 2010
How do we stop “baggage” from
affecting us?
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MAINTAIN BOUNDARIES!!!
􀂄What is your purpose here?
􀂄Why are you here?
􀂄What is the goal?
􀂄Whose needs are supposed to be met?
HELPING RELATIONSHIPS ARE NOT
RECIPROCAL!!
• PROFESSIONALS GET PAID!
Hugh Irons RN., December 2010
How to Promote Professionalism in
health care settings
• Be aware-if you deny power you
are at risk of abusing it
• 􀂄Be observant
• 􀂄In-service over and over again
Hugh Irons RN., December 2010
What if I am not sure whether I am
being professional?
• Ask yourself these questions:
• 􀂄Would this be allowed in another medical
setting?
• 􀂄How does this activity assist the patient
in their care?
• 􀂄Can this be documented in the medical
record ?
• 􀂄Are you willing to do this for all patients?
Hugh Irons RN., December 2010
The concept of Rational
Detachment …..
Rational Detachment …..
• Rational detachment is the
ability to stay in control of
one’s own behaviour and not
take ‘acting-out’ behaviour
personally.
Hugh Irons RN., December 2010
Rational Detachment
• Staff not able to control baggage, but
can control how they react
• 􀂄DO NOT internalize feelings
• 􀂄DO NOT overreact
• 􀂄This is OUR responsibility, not the
clients’
Hugh Irons RN., December 2010
How do we rationally detach?
• Know yourself
• 􀂄What pushes your buttons? Don’t let
someone find out for you.
• 􀂄Recognize your limits
• 􀂄What is your tolerance level?
• 􀂄Anticipate and have a plan
• 􀂄Positive outlets and coping skills
• 􀂄Our response can either escalate or deescalate the situation.
Hugh Irons RN., December 2010
•THE
IMPORTANCE
OF BEING
ASSERTIVE
Hugh Irons RN., December 2010
What is assertiveness?
• Assertiveness is the ability to ask
questions, express opinions and
criticise constructively
• As a way of having your voice
heard.
• Assertiveness is a right and not a
privilege.
Hugh Irons RN., December 2010
BENEFITS OF BEING MORE
ASSERTIVE
• This approach enables you to:
• Reveal to others the assistance you need to
deliver high quality service
• Be the very best you can be in your role
• Have reasonable enquiries answered and needs
met rapidly and effectively
• Ensure that you work competently and
confidently
• Reduce your levels of stress to manageable and
motivating levels
Hugh Irons RN., December 2010
DISADVANTAGES OF BEING NONASSERTIVE
NON - ASSERTIVE
• This approach will interfere with your
ability to:
• To deliver a high standard of service and care
• Have your confusions clarified, information
given and your reasonable workplace needs
met
• Have reasonable enquiries answered and needs
met rapidly and effectively
• Work competently and confidently
• Increase your levels of stress
Hugh Irons RN., December 2010
Do you feel assertive?
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Feeling confident;
Having self esteem;
Being myself;
Expressing myself;
Standing up for myself;
Feeling in control of my life;
Liking myself;
Respecting other and myself;
Making my own decisions;
Having the right to say yes and no for myself.
Hugh Irons RN., December 2010
ASSERTIVENESS SKILLS
• Be Specific
Decide what it is you want or feel and say so
specifically or directly. This skill helps you to be
clear about what exactly it is you want to say. Avoid
unnecessary words and keep your statement simple
and brief.
•
Repetition (Broken record technique)
This skill helps you to stay with your statement or
request by using a calm repetition, over and over
again. Using this technique, you can maintain a
steady position without failing prey to manipulative
comment, irrelevant logic or argumentative bait.
Hugh Irons RN., December 2010
ASSERTIVENESS SKILLS
 Fielding the response (fogging)
In order to achieve a smooth verbal
interaction and communicate effectively,
you need to indicate that you have heard
what the other person says, without
getting 'hooked' by what they say. This
skill allows you to acknowledge the
response and still continue confidently
with your statement or request instead of
feeling defensive or aggressive.
Hugh Irons RN., December 2010
ASSERTIVENESS SKILLS
 Workable Compromise
This is important to remember when there
is a conflict between your needs and
wishes and those of someone else.
Assertiveness is not about winning so you
need to negotiate from an equal position.
This means finding a true compromise
which takes both parties' needs into
consideration. Compromising on a
solution to a difficult situation need not
compromise your self-respect.
Hugh Irons RN., December 2010
BUT BEWARE OF BEING TOO
ASSERTIVE
Hugh Irons RN., December 2010
ENOUGH ABOUT
THE WORKERS,
WHAT ABOUT
THE BOSSES!
Hugh Irons RN., December 2010
Action Plan: employer.
• REMEMBER:: THE “BURNT OUT” NURSE
BASICALLY WANTS TWO SIMPLE THINGS
TO HAPPEN:
• 1) To stay in their job.
• 2) For the factors contributing to burnout
to stop or at least be recognised and
attempts made to reduce.
Hugh Irons RN., December 2010
What Management should do
• Stress Audit
• Realistic expectations of the
job
• Actively encourage all sorts of
professional development
• Actively support career
development
Hugh Irons RN., December 2010
What Management should do
• Flexible working
conditions
• Supervisors trained for
recognising and
minimising burnout
• Redesign the job itself?
• Positive recognition
• Active mentoring &
Clinical Supervision
Hugh Irons RN., December 2010
THE “S T R E S S A U D I T”
• The first stage in an
intervention to alleviate stress
or prevent burnout is a
comprehensive assessment of
stressors in the workplace as
experienced by individuals or
groups, and gauges the extent
and nature of the difficulty.
(Skinner N & Roche A M., 2005, Stress and Burnout, A Prevention
Handbook…, National Centre for Education and Training on
Addiction (NCETA), Adelaide, Flinders University.)
Hugh Irons RN., December 2010
THE “S T R E S S A U D I T”
• But, to be unbiased, the
responsibility should lie with an
entity outside of the organisation.
“A stress audit conducted by a
Manager is not likely to deal with
one of the most common
workplace stressors – a poor
Manager” (Jordan J et al., 2003, Beacons of excellence in
stress prevention, Norwich (U K), Health & Safety Executive
Hugh Irons RN., December 2010
So;
• IF WE PUT INTO PLACE ALL THE STRATEGIES DISCUSSED DURING
THIS PRESENTATION, ARE WE LIKELY TO DEVELOP A
WORKPLACE WHERE STAFF AT ALL LEVELS ARE ALWAYS
SUPERB IN BEHAVIOUR AND WHERE STAFF BURNOUT NO
LONGER EXISTS?
• SO, ALL WE CAN DO IS ACCOMPLISH THE BEST WE
CAN, BUT BE PROACTIVE INSTEAD OF REACTIVE
Hugh Irons RN., December 2010