BANNING BURNOUT, and beating the Blues

1. BANNING BURNOUT, and beating the Blues Presenter:Hugh Irons RN., Master of Nursing (Community Health), MRCNA, Member Australian Counselling Association: Training 14th December 2010 Hugh Irons RN., December 2010

2. 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

3. 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

4. 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

5. 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

6. 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

7. Hugh Irons RN., December 2010

8. 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

9. OBSERVABLE BEHAVIOURAL WARNING SIGNS • BLAMING OTHERS • CRYING • IRRITABILITY • SHORT ATTENTION SPAN • OVERACTIVITY • NEGATIVE ATTITUDE • SHORT TEMPER • TAKING RISKS Hugh Irons RN., December 2010

10. EMOTIONAL WARNING SIGNS • ANXIETY • DEPRESSION • FEAR • FRUSTRATION • GRIEF • ISOLATION • FEELINGS OF POWERLESSNESS • FEELINGS OF WORTHLESSNESS Hugh Irons RN., December 2010

11. PHYSICAL WARNING SIGNS • DIARRHOEA • DRY MOUTH • EATING DISORDER • CLAMMY HANDS • UPPER BACK PAIN • STIFF NECK Hugh Irons RN., December 2010

12. 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

13. 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

14. 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

15. 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

16. For example: • WORKLOAD • AGE • HARDINESS • ACTIVELY COPING • SOCIAL SUPPORT • ROLE AMBIGUITY Hugh Irons RN., December 2010

17. 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

18. 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

19. 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

20. 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

21. Twenty Top Tips Hugh Irons RN., December 2010

22. 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

23. 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

24. 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

25. 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

26. 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 battle-weary 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Fully understand the concept of Professionalism:: 17 • More on this later. Hugh Irons RN., December 2010

43. Fully understand the concept of Rational Detachment:: 18 • More on this later. Hugh Irons RN., December 2010

44. Fully understand the concept of Assertiveness:: 19 • More on this later. Hugh Irons RN., December 2010

45. Use the Twenty Steps in your everyday practice. 20. Hugh Irons RN., December 2010

46. 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

47. 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

48. 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

49. ...and even more pitfalls... • Moralizing • Ordering • Psychological diagnosing • Gossip • Flirtations • Inappropriate dress • Gifts Hugh Irons RN., December 2010

50. ...as it should be... • 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