“I was ready to throw in the towel last week. Is there a term or theory for giving your best to folks and just feeling drained because of the response you get? I guess what I’m trying to say is underappreciated…or not valued.”
These were text messages from a medical provider friend of mine. He spent nearly a decade putting himself through school followed by another decade of standing up his own practice and serving the community in which he grew up. However, in the past few years (particularly since the pandemic), he has experienced a noticeable increase in skepticism, distrust, and noncompliance from his patients. As a result, he has found himself feeling underappreciated, cynical, and emotionally exhausted. Said differently, he’s experiencing burnout.
My friend is not alone in his experience nor is it a recent phenomenon (although, it has most certainly been exacerbated given the plethora of effects from the pandemic). Researchers first focused their attention on burnout in the 1970s when human-services and care-giving occupations were thought to be at particular risk for burnout given the nature of their occupations. They defined burnout as consisting of three elements: emotional exhaustion, depersonalization (cynicism), and a decline in professional efficacy.
Emotional exhaustion refers to feeling worn out, depleted, fatigued, or debilitated. Those who experience emotional exhaustion may feel like they are “ready to throw in the towel” as my friend stated. In our own research with medical organizations, we have found emotional exhaustion, in particular, to be a significant predictor of attrition among providers. Depersonalization, or cynicism, is defined as having negative attitudes toward clients. Those who experience cynicism may view their clients/consumers/patients with contempt. They may start to generalize the notion that people are selfish, ignorant, and difficult. The third and final component of burnout is a perceived decline in professional efficacy. Those feeling inefficacious may feel unproductive, incapable, or that they are having trouble coping with their current circumstances. Taken together, if someone is experiencing psychological/physiological fatigue, an increasingly negative view of others, and a decreasing sense of personal accomplishment, then they are experiencing burnout.
While it is still true that health care providers are at a high risk for burnout, more recent research has highlighted problems with burnout in other industries such as customer service, technology, financial institutions, and law firms as well. As noted in Workplace Burnout (Part 1): Defining the Problem, burnout can be detrimental to both the individual and the organization. Fortunately, there are interventions at both levels that can mitigate and even prevent burnout. Starting at the individual level, the following are strategies people can take to protect themselves against burnout in the workplace:
Invest in the Big Three
Exercise, nutrition, and sleep are the cornerstones of health and happiness but are also protectors against the effects of burnout.
Exercise
Exercise has been shown to have a large effect on the reduction of perceived stress and burnout symptoms. One study of nearly 5,000 people found exercise to be just as effective as anti-depressant medications for reducing depressive symptoms (which include fatigue, feeling less efficacious, and often cynicism). Moreover, those who exercise regularly report more energy which directly combats the emotional exhaustion component of burnout.
Nutrition
Nutrition can also affect someone’s susceptibility to burnout. Researchers found that individuals who ate a plant-based diet experienced fewer negative emotions compared to those who ate fewer fruits and vegetables and more foods that were animal-based. This is thought to be due to the reduction of a proinflammatory compound called arachidonic acid found in animal products. Arachidonic acid is believed to cause inflammation of the brain which may contribute to negative emotional states. That means, the simple act of increasing one’s fruit and vegetable intake may help better protect them against burnout.
Sleep
Of the three, sleep is arguably the most important when it comes to its effects on psychological and physical health. In one study, researchers found “too little sleep” (i.e., less than 6 hours) to be the main risk factor for burnout development. Afterall, sleep deprivation, by itself, mimics the symptoms of burnout. Those who are sleep deprived are more likely to report fatigue and irritability regardless of their environment. Taken together, those who wish to prevent or reduce burnout should start by evaluating their current sleep practices.
Replenish Your Empathy
Empathy is crucial to being human. It is a social bridge that connects us with one another and its expression results in many positive outcomes in the professional world. For example, medical providers who accurately express empathy see greater improvements in their patients’ wellbeing. However, when someone experiences burnout, they start to question others’ motives and view people from a cynical lens. Their empathy for others begins to decay. Deliberately engaging in empathy-building strategies may help reverse the depersonalization that comes with feeling burned out. These strategies include cultivating curiosity about others, examining biases, deliberately engaging in acts of kindness, and setting healthy boundaries.
Cultivate Curiosity
Getting to know others on a deeper level can help you have a better understanding and appreciation for who they are. A great starting point is to practice active listening- that is, fully engaging in the conversation by seeking not just to hear the words of the other individual but to understand them. Ask open-ended questions (i.e., questions that don’t result in a one-word response; they usually start with “what” or “how”) and occasionally reflect or paraphrase what you hear the other person say. This will allow them to feel heard making the conversation a positive experience for them which only increases their positivity towards you. These positive social interactions are not only inherently enjoyable but, if experienced enough, may lead to an increase in positive feelings towards others (i.e., a decrease in cynicism).
Examine Your Biases
The fundamental attribution error refers to the tendency to attribute another person’s actions to their character while attributing our own actions to external situational factors. For example, if a doctor has an interaction with a patient who behaves rudely, that doctor may believe the patient is simply a rude person. If that doctor is short with another patient, she may attribute her lack of bedside manner to having a bad day (probably due to having to deal with rude patients). We have a tendency to hold others personally accountable for their behavior while cutting ourselves some slack. In actuality, most behaviors are situational. Most people don’t have ill-intentions and are just trying to navigate this world to the best of their ability. Keeping the fundamental attribution error in mind when interacting with others (clients and coworkers) may help to decrease the cynicism that often comes with this type of distorted thinking.
Engage in Acts of Kindness
Not only do acts of kindness increase one’s empathy, but they also result in a snowball effect of positive consequences. Those who engage in acts of kindness (i.e., putting others’ needs before our own) experience a reduction in stress and improvement in mood, self-esteem, and happiness. Moreover, as social creatures, we are programmed to reciprocate. In other words, we have an internal drive to repay others for “gifts.” An act of kindness for someone will, more often than not, result in a repayment of some sort usually in the form of a smile or expression of gratitude. This positive exchange, and others like it, will incrementally move the cynicism needle in the right direction.
Set Boundaries
While engaging in acts of kindness is good for building empathy, too much of a good thing can turn into a bad thing quickly. Giving too much of yourself can directly contribute to burnout. Leaving little room for personal time is almost certainly going to lead to feeling emotionally exhausted. Moreover, social reciprocation works both ways. When you give too much and get less in return, you may set the stage for resentment or cynicism. Boundaries are the solution. Boundaries make it possible for you to recharge by allowing you to prioritize your own well-being.
Never Worry Alone
We are social creatures. Despite what many tell themselves, we don’t do well alone, and certain jobs can be isolating. When people in those positions begin to feel burned out, they can feel alone in their experience. For those circumstances, peer consultation and social support are vital. In a study of over 1200 nurses, researchers found those who reported higher levels of social support also reported greater feelings of personal accomplishment and less cynicism. Social support can validate and normalize feelings of inefficacy and serve as an outlet to work through difficult workplace problems.
Burnout can have deleterious effects on the individual. However, those who take active steps towards wellness may be able to protect themselves from it. A strong foundation in health behaviors such as sleep, diet, and exercise may guard against emotional exhaustion, demonstrating compassion for others while maintaining appropriate boundaries may prevent cynicism, and maintaining a solid social support network can diminish any perceived threats to competence. If done right, individuals may develop a level of resilience that can face any workplace stressor and prevail.
While individual interventions are a worthwhile endeavor, they are only half the battle. We would argue that organizational interventions that change situational factors may yield a greater return on investment. Part 3 of this series will focus on what organizational leaders can do to prevent and mitigate burnout in their organizations.
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