Santa Barbara, California

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Santa Barbara, California ?
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Burnout in the ICU

• Deanna Purvis, VMD, DipACVECC
• California Animal Referral Emergency Hospital
• Santa Barbara, CA

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Life in the ICU
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BURNOUT

• The popular term used to characterize the loss of
  physical, emotional and mental energy.
• If ignored or denied, the consequences can be
  serious not only for you, but for your family,
  employer, co-workers and patients.

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Definition

• Generally, burnout is a progressive phenomenon
  signaled by subtle changes in mood. People who
  are on the verge of burnout take a long time
  regaining their energy and positive attitude
  about work. This cumulative process can lead to
  emotional exhaustion and withdrawal.

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Etiology

• Burnout is a problem born of good intentions
  because it happens when people try to reach
  unrealistic goals and end up depleting their
  energy and losing touch with themselves and
  others.

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Why Burnout in the ICU?

• Intensive Care is Intense!
• No easy patients
• The only thing certain is change
• Constant adrenaline drain
• Long Hours
• No end to the work, it doesnt stop coming.
• We experience the grieving process when we lose a
  patient.
• Unrealistic Goals
• We fail if our patient dies.
• We want clients to be happy/content sometimes
  they cant be.

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Why Burnout in the ICU
We Love These Little Guys ?
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The Symptoms

• Symptoms are as varied as the sufferers some
  are angry, some blaming, some quiet, some turn to
  mood-altering substances. Still others may
  experience a range of physical symptoms,
  including chronic illness, high blood pressure
  and frequent headaches.

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Burnout is NOT the goal

• If you win the rat race
  youre still a
  rat!
• (De-stigmatize Burnout As A GOAL!)

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The Symptoms

• Youre relieved at no-shows cancellations
• Work has become a chore
• You feel exhausted emotionally physically
• You are easily frustrated with your co-workers
  and patients
• You no longer laugh or have fun at work
• You have NOTHING left to give
• You cannot possibly take on one more patient or
  task (you ruminate about overwork)
• You have become negative and cynical

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The Symptoms

• Failures and disappointments take on a life of
  their own
• Isolation and loneliness become themes
• Compassionate support and assistance is not
  sought
• You become chronically late
• You are psychologically absent
• You take care of everybody but yourself
• Somatic symptoms arise (sleepiness, digestive
  problems, headaches, etc.)
• Your sleep is disturbed

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Burnout is NOT the goal

• Do not do this work if you are friendless

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Risk Factors

• You dont know how to say no to demands on your
  time and energy you are overloaded!
• You assume added responsibility when you are
  already working at capacity
• You lack control in your position
• You regularly suppress your emotions
• You DONT discuss your problems or feelings
• You routinely criticize yourself
• You feel pulled in many directions and are trying
  to do everything equally well without setting
  priorities

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Assessment

• It takes you a LONG TIME to restore your energy
  (e.g. it takes a week rather than a weekend away
  from the workplace to restore your energy)
• You used to wake in the morning looking forward
  to your day Now you dont
• And... at the end of your day only recollecting
  negative parts of your day is a serious sign.
  (The IRONY is that you were previously
  enthusiastic and brimming with ideas)
• SO evaluate your priorities. Think about
  different areas of your life (family, career,
  hobbies, religion, etc). Divide up your life by
  drawing two pies 1) how your life is actually
  sliced and 2) how youd like your life to be
  sliced. DO it!

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Assessment

• Try to remember when it was that you began
  feeling so tired and unable to relax
• Were you always under such pressure to succeed?
• When did this one area of your life become
  disproportionately important?
• At what point did you lose your sense of humor
  and the personal side of your relationships with
  friends and co-workers?
• Are you identifying so closely with your
  responsibilities that youve come to believe that
  if something fails that you have failed?
• Are you too tired to enjoy a good book, a movie,
  a relationship, sexual intimacy, a walk in the
  woods?

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Burnout is NOT the goal

• Find ways to nurture
• your soul or this work will deplete you

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Good Stress Vs. Bad Stress

• GOOD STRESS a balance of arousal relaxation
  that helps you concentrate, focus achieve what
  you want
• BAD STRESS constant stress and constant arousal
  that may lead to high blood pressure,
  cardiovascular disease and worse
• REMEMBER EMOTIONS are INFORMATION

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The Diagnosis

• Remember the onset is slow ...
• First Degree Burnout
• Exhaustion and fatigue set in ...
• May be nothing more than negativity about the
  workplace
• Second Degree Burnout
• A sense of alienation, cynicism, impatience,
  negativism and feelings of detachment to the
  point that the individual begins to resent work
  and people associated with work
• Fatigue is ever present
• The burning out individual becomes uncaring. The
  first care behavior to leave is self-care.

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The Diagnosis

• Third Degree Burnout
• Can be so bad that the veterinary technician has
  no interest in ever going back to work in the
  field
• You constantly think of quitting or changing
  fields

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Burnout As A Grief Process

• KUBLER-ROSS
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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Costs to the Individual

• Emotional exhaustion
• Detachment from patients, colleagues, friends and
  loved-ones
• Overwhelming feelings and loss of interest
• Creativity, individuality and excitement are
  stifled boredom sets in

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Costs to the Organization

• Poor Performance
• Lowered Productivity
• Absenteeism
• Attrition
• Burnout
• Increased insurance claims
• On-site Accidents
• Decreased Employee Morale

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Costs to the Organization

• Indifference to the organization
• Decreased civility
• Increased backbiting
• Free-floating conversations about blame
• Limited feedback to supervisors
• Decreased creativity
• Poor delivery of services (especially people
  services)

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Burnout Proofing for Individuals

• Ask for different work - one of the biggest
  reasons for job burnout is not living up to your
  full potential
• LEARN something new (life and work become dull
  when you stop learning)
• DO something new (it doesnt have to be work
  related)

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Burnout Proofing for Individuals

• Become more active in your field (remember why
  you became a technician in the first place)
  find ways to rekindle this passion
• Restructure your job (teach, provide direct
  service, offer pro bono work, take on more or
  less administrative tasks)
• Heed the advice eat right, get sufficient rest
  and exercise routinely.

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Burnout Proofingfor Individuals

• Find ways to divide your time and energy between
  professional and personal interests
• When you are on the verge of burnout, take
  concrete action to minimize or alleviate the
  source of stress
• Technicians who are least susceptible to burnout
  have high-self esteem and an ability to laugh at
  themselves. Attack the problem head-on

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Burnout Proofingfor Individuals

• ALL of this is nice but not realistic - then
  assess the source of your burnout You have at
  least three choices 1) change the source of
  your stress, 2) confront the source of your
  stress, 3) adopt a positive attitude (you can
  change how you perceive stress)
• You can change departments, change employers,
  change fields
• Keep your sense of humor. You cant be burned
  out and having fun simultaneously

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Burnout is NOT the goal

• You are a sponge for grief and rage.
  Wring yourself out
  regularly.

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Burnout Proofing for Employers

• Open communication in the workplace is a key
  element to a healthy and supportive work
  environment
• Look at provider satisfaction with an attitude
  that if someone is complaining its not that
  theyre a complainer, but that something needs to
  be fixed
• Let employees participate in decision making
  where possible scheduling, developing policies
  procedures, and help them protect protected
  time

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Burnout Proofing for Employers

• Encourage your employees catch them doing a
  good job and reward them. Managers should also
  make an effort to recognize which employees have
  difficulty managing stress
• Offer stress management and wellness classes.
  Offer discounts to on-site gyms.
• Make efforts to create more productive, caring
  and clearly defined work situations to improve
  technicians skills reduce stress

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Burnout Proofingfor Employers

• Highlight staff efforts and contributions in
  staff meetings
• Let technicians know verbally and/or in writing
  that his/her work is appreciated (e.g. memos or
  notes placed on completed paperwork)
• Give awards, certificates, or other commendations
  for specific accomplishments and contributions

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Burnout Proofingfor Employers

• Promote staff or encourage them to apply for
  promotions
• Allow and encourage staff to attend specialized
  training programs and conferences
• Hold staff retreats
• Employee self-worth is inversely related to
  burnout

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Treatment Plan

• THE BASICS
• Rest! (The good technician has slept well)
• Eat Healthy!
• Exercise Regularly!
• Establish Some Long and Short-term goals that are
  REALISTIC. Write them down. Do it TODAY!

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Treatment Plan

• Renew friendships with other people. Talk to
  them about your feelings. Dont keep your
  frustrations and anger bottled up. When you
  discuss frustrations try to find solutions.
• Analyze how you spend your time (remember the
  pie).
• Incorporate time management techniques into your
  life.
• Rather than trying to be great in all areas,
  target one area for improvement over the course
  of a year.

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Treatment Plan (Continued)

• Develop REALISTIC expectations about your work.
  Reduce the scope and intensity of the emotional
  relationship you have with patients by learning
  to see them in a more objective light.
• Remind yourself of the severity of your patients
  challenges and realize that lack of patient
  progress does not necessarily indicate
  shortcomings on the technicians part.

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Treatment Plan (Continued

• If you are working hard each day for your
  patients, students, employer, etc, pat yourself
  on the back and recognize that you cannot do it
  all.
• Make distinctions between your job and your
  personal life. When you leave the hospital, do
  the mental work necessary to leave thoughts of
  your patients in the work environment. Leave
  WORK at WORK

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Treatment Plan (Continued)

• Learn to say NO when youre asked to do more than
  you can handle.
• Learn to delegate responsibility to others. You
  are NOT indispensable.
• Set your priorities daily, or at a minimum,
  weekly deal with problems in order of importance

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Treatment Plan (Continued)

• Find the sense of humor youve probably lost.
  When is the last time you had a good belly laugh?
  Learn to laugh at yourself and the situation.
• MOST OF ALL, get in touch with yourself, your
  values and what you want out of life. Learn to
  recognize when you are driving yourself too hard
  and when you are depleting your inner resources.
  Set yourself up to SUCCEED!

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Be happy while youre living, for youre a
long time dead.
Scottish Proverb

• SATISFACTION is the GOAL

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Write Down Your Frustrations

• Mental as well as physical relief is important
  during stressful times. Journaling not only
  gives you the opportunity to vent your anger and
  frustrations but can also help you solve your
  problems.

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Put Yourself First

• Veterinary Technicians are constantly putting
  their patients needs above their own and are
  prone to compassion burnout. We have a well of
  compassion and theres only so much we can give
  before drawing on our own personal needs. The
  only antidote realizing that taking care of
  ourselves is not selfish and means we will have
  more energy for others.

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Maintain Good Boundaries

• OFF CALL ...
• means ...
• OFF CALL !!!
• You gave at the office
• (Dont take your work home with you)

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Praise Others

• BE A TEAM PLAYER
• Acknowledge Assist the Works of Others
• (Whens the last time that you gave a compliment
  to a co-worker?)

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Start A BRAG File

• Start a file full of items that show the
  positive impact of your work. Save thank you
  cards and other pick-me-ups like good performance
  reviews. Many technicians forget the good
  theyve done. When youre feeling down, pull out
  your BRAG file and remember the impact youve
  made.

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Dig Deeper

• Attack the underlying causes and workplace
  issues. Too often, people try to find the quick
  fix for stress. The only way many people can
  combat long-term stress or burnout is by changing
  their lifestyles or improving their working
  situations.

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How Close to Burnout Are You?

• The Best Defense is to have a personal plan of
  action. What is yours?
• Do you set good boundaries?
• What will you do today, this week, this year to
  renew yourself?
• What is your time frame for reassessment? (Dont
  wait for your next New Years Resolution!)

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Psychological Tasks to Prevent Professional
Burnout

• Establishing and maintaining a strong sense of
  self-esteem.
• Maintain a good social support system.
• Laugh (or youll die crying!)
• Acknowledge your priorities and build your life
  around them.
• Like diet exercise quality of life is a
  process that takes considerable time and effort.
• Life and work become dull when you stop learning.
  So dont.

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Therapeutic Contract

• SO how will you and I know when weve reached
  our goal?
• You restore your energy quickly
• You again look forward to your day
• And... at the end of your day you reflect on
  accomplishments
• Your pie reflects the life you want to live.

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The technicians Mantra

• Above all else To thine
  own self Be true
• William
  Shakespeare

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Resources

• Center for Professional Well-Being
• Colony West Professional Park
• 21 W. Colony Place, Suite 150
• Durham, NC 27705
• [phone]
• Theres a fun little burnout quiz at
  www.queendom.com

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Patient Death

• Denial We refuse to believe what has happened.
• Anger We can blame others, blame ourselves,
  blame the veterinarian.
• Bargaining Can be with ourselves, or with God.
  We try to make a deal to have our loved one back.
• Depression Listless, tired, guilty. Feeling
  like there is no purpose to life anymore.
• Acceptance You realize life has to go on. You
  regain energy and goals for the future.

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How to Deal with Loss of a Pet

• It is normal to have feelings of intense grief
  over the loss of a pet if you considered that pet
  a beloved friend, companion or family member.
• Besides sorrow most everyone goes through the
  stages of grief (in varying order and intensity.
• Be honest about your feelings. You ave the right
  to feel pain and grief.

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C.A.R.E. Hospital Santa Barbara, CA