Tag: burnout

Hitting the wall

On 15 May 2022

You’re not prepared for it. You’ve seen it in others, recognised the signs, and hoped it would never happen to you.
And then, WHAM!

Lethargy. Insomnia. Anxiety. Physical illness. Complete mental, physical and emotional exhaustion.

I should have seen it coming. I didn’t.

Some of the signs had been there for months. Feeling disillusioned about my job, and finding it hard to concentrate. Little snippets of irritability and impatience poking through during the day. A sense of never being able to get on top of the workload, and not being able to see the good outcomes – never feeling like the job is done properly and of being completely overloaded and overwhelmed. Frustration and anger with management. An overall lack of job satisfaction.

Burnout in nursing is not a new concept, and it is not just having a bad day. It is continuous work related stress that can have a cumulative, unwanted effect. Workforce studies have identified burnout as a nursing ‘outome’; with high workload, low staffing levels, long shifts and low control all associated factors.¹ Nursing stands out as one of the most at risk professions, due to the different circumstances in professional practice causing physcial and emotional exhaustion.²

Other risk factors for burnout include a lack of control or an inability to influence decisions that affect your job, a lack of resources needed to do your work, and extremes of activity (read: chaos). Some personality traits can make you more vulnerable and increase the risk of burnout – perfectionism, over commitment, idealism and self-criticism.

Many blame the pandemic for the increase in health workforce burnout, but if we are honest, the truth is that many of us were at risk prior to the start of the pandemic.

Health services have been stretched to capacity for decades. Unfilled shifts and roster shortfalls. Nurses working long hours and unpaid overtime. Phone calls to staff on days off, begging them to do extra shifts. Bed block and caring for patients on trolleys in corridors. And in aged care, no staff:resident ratios, and an ever increasing workload and patient complexity.

In my own palliative care service, the workload has increased three-fold in the last two years. We are averaging 15-20 referrals and 5-10 deaths each week. In January, February and March, we had more than one death each day. The emotional burden of this work really takes it’s toll.

For the last two years I’ve pushed through – working in COVID outbreaks in aged care facilities, using telehealth much of the time to increase efficiency, and attending an unbelievable amount of meetings. I’ve tried to support the people working with me, at times to my own detriment. Palliative care by telehealth is not my idea of clinical excellence. My job satisfaction has suffered. My health has suffered.

In a week when multiple members of the team were diagnosed with COVID19, I trudged on. It was good to get out of the office and do face to face consults, but by the end of that week I was at the end of my tether.

I hit the wall.

Something had to give, and I realised that if I wasn’t careful, it would mean long term damage. It took a strong lecture from one of my team mates to really bring the message home. It was time to stop, recover and take stock.

After a visit to my GP and some reflection on how I was feeling, I set out to get myself back on track. Daily exercise, eating well and plenty of rest. Lots of reading, some meditation, listening to podcasts, and crochet. I bought storage boxes and sorted some cupboards – regaining a sense of control over my personal space at home. I completed some administrative tasks that have been piling up for months.

After two weeks I feel rested, but not fully recovered. I’m ready to go back to work, but I’ve made some decisions. It’s time to be very clear that our team cannot continue to work without adequate staff and resources. It’s time to step back from some of the committees and meetings. It’s time to put some boundaries in place to protect myself from real burnout which may lead to walking away from a job that I really do love.

Burnout CAN be managed, and you can learn strategies to prevent it from happening. Paying attention and taking control over your own health is just the first step. Information about preventing and managing burnout can be found at https://www.nmsupport.org.au/. Please don’t wait until it’s too late.

References

Dall’Ora, C., Ball, J., Reinius, M. et al. Burnout in nursing: a theoretical review. Hum Resour Health 18, 41 (2020). https://doi.org/10.1186/s12960-020-00469-9
de Oliveira, S. M., de Alcantara Sousa, L. V., Vieira Gadelha, M., & do Nascimento, V. B. (2019). Prevention Actions of Burnout Syndrome in Nurses: An Integrating Literature Review. Clinical practice and epidemiology in mental health : CP & EMH, 15, 64–73. https://doi.org/10.2174/1745017901915010064
https://www.nmsupport.org.au

Flight of the butterflies

By Unravelled

On 8 October 2021

In Reflections

The first time I saw a butterfly on a door, I had no idea what it meant.

It was not until many years later that I would learn that butterflies are universal symbol in palliative care, and that a butterfly on the door meant that the person inside the room was dying.

The symbolism of butterflies is based on metamorphasis and the process of transformation through the life stages. From the egg comes a caterpillar, the caterpillar becomes a chrysalis, and in the last stage of rebirth the butterfly emerges and flies away ‘reborn’.

Each of these stages signify life, death and resurrection – concepts familiar to christians but which in fact have meaning in many cultures and religions.

In Michoacán, Mexico, the annual migration and return of Monarch butterflies coincides with the celebration of The Day of the Dead (Día de los Muertos) on 2nd November. The Mazahuas indigenous community believe that the butterflies are the souls of their ancestors coming home for their annual visit.

Aristotle gave the butterfly the name psyche, meaning “breathe, breath of life, soul”. Greek people believe that when someone dies, their spirit leaves the body in the form of a butterfly.

The Aztecs believed that the happy dead in the form of beautiful butterflies would visit their relatives to assure them that all was well.

Elizabeth Kubler-Ross, the swiss born psychiatrist who is well known for her theory of the stages of grief, gave the example of a cocoon and butterfly as an analogy for the body and soul.

“Death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher state of consciousness where you continue to perceive, to understand, to laugh, and to be able to grow.”
Elizabeth kubler-ross

The concept of the death of a loved one is painful and brings with it feelings of grief, loss and finality. Even for those who work in palliative care, death does not always sit comfortably.

We sometimes struggle – not only with bearing witness to suffering, but with finding meaning in the work that we do and ways of coping with our thoughts and feelings. The situations we find ourselves in day in, day out, can lead to vicarious trauma, compassion fatigue and burnout.

Dr Naheed Dosani spoke at the OCEANIC palliative care conference this year about his work providing palliative care to the homeless in Canada. When a homeless person dies, his team shares the experience of grieving in a group by forming a healing circle and using the ‘4Rs’ to remember, reflect, recover and plan to reinvest.

A week later, I heard renal supportive care rural nurses from Broken Hill talking about a wall of butterflies in their office, symbolising the people that their team had cared for who had died.

Both of these resonated deeply for me. I wondered if combining the two concepts could provide a way of helping our team to cope with the sometimes overwhelming nature of our work, and to honour the people we have the privilege of caring for.

We have a large whiteboard in the office, which we use to keep track of patients who are receiving end of life care, and schedule visits or reviews. We now have a number of butterflies fluttering across the whiteboard towards the window. Each represents a person who has died in the past month under the care of the PEACE team.

On the last day of each month, our team will come together in a ‘grief circle’, with the butterflies in the centre. We will take time out of our busy schedules to pause, to remember the person, their story and their family.

We will reflect on their death, share our experiences and what we have learned from them. We will take a deep breath, recover, and prepare to reinvest and continue our work.

Butterfly photo @GettyImages