I work in a residential home for adults with severe mental illness, and I came into work this morning to the news that my favorite resident passed away two weeks ago. Having just been CPR/AED certified a week ago, I was grateful this hadn’t happened when I was working, as I wouldn't have known exactly what to do. I accepted the news with a heavy feeling in my chest, a buzzing sensation hovering just over my skin that I was all too familiar with. I’d had it before, when I took part in psychological studies that used deception, and was then got debriefed. The feeling when your reality changes around you. The feeling when your reality had existed with someone in it and suddenly it doesn't. But because I know how to take care of myself, I sat at the desk, took the keys, and carried on with my shift.
Burnout is common in the healthcare workforce. It's been studied extensively, and been described as a phenomenon where healthcare workers become overworked and over invested, resulting in emotional exhaustion and dissatisfaction. It happens in any activity where you're heavily invested, particularly in activist circles. It can lead us to hate a job we once loved, get annoyed by little things, and possibly even take out our frustrations on our patients.
But how can we help keep ourselves from burning out, especially when we work such intense jobs?
The key to maintaining your healthy, professional work life is self care. You might already have self care techniques that you use for general stressors, things like bubble baths, journaling, or yoga. Self care is unique to every person, and it’s a long-term choice that we make every single day. There are many aspects of self care unique to healthcare providers that go beyond an act of kindness to oneself.
There are a lot of opinions surrounding how emotionally involved you can get with your patients -- what’s appropriate, what’s good for you, what’s good for them. Some people say that being invested is what causes burnout and you shouldn’t care about your patients personally, never get attached to them, and that it’s better to see them as symptoms than as people. The upside of this is that you won’t use up the emotional energy it would take to connect with your patients. But is this even possible? For a lot of mental health workers, we work with our patients long term. How do you spend weeks, months, sometimes even years with someone and never emotionally connect with them?
In my opinion, interacting and connecting emotionally with patients is mutually beneficial. I know that part of my own self care comes naturally, when a patient reaches a milestone. Today one of my residents -- a notoriously aggressive patient -- threw away his paper cup. He didn’t throw it at me. I expressed my pride and approval of his behavior and to my amazement, it held up throughout the day.
Patients can tell when you don’t care, and I say this as a person who has been a patient myself. And if we, whose job it is to keep them stable and healthy, don’t care then why should they? Communicating that you’re invested in their progress helps patients invest themselves, too.
But at the same time, you can’t be too invested. You can’t make every patient your number one priority every time. This leads to something known as compassion fatigue, coined when its abundance was noticed among people who work with PTSD patients.
Compassion fatigue is not burnout, but rather a possible phenomenon that may occur during the course of your work. Compassion fatigue is said to have three stages: compassion discomfort, compassion stress, and compassion fatigue. You can tell that you’re on the road to compassion fatigue when feelings of compassion are accompanied by stress, frustration, or other negative, taxing emotions. This is when you need to register it and decide what the best course of action would be for you.
Specific phenomena that are most prevalent in your field/clientele will vary. For instance, staff who work with victims of traumatic events are more at risk for experiencing secondary trauma. A kind of preemptive self care is to be aware of the risks associated with your work, and being sure to check in with yourself.
It’s all about boundaries, in the end. How invested you get with your patients depends on your comfort level, how predisposed you are to burning out, your daily energy levels, and the environment you’re working in.
Because I am aware of what burn out looks like for me, and have set appropriate boundaries with my residents, I was able to have a great shift. The other residents were in a good mood. I finished dinner, handed the keys to the person taking over for me, and got in my car.
This is where my boundaries come into place again -- this time, boundaries between me and my job, not my residents. I allow myself to think about what happened that day from the moment I get into the car until the third traffic light. About six minutes. After that I stop thinking about it, turn on the radio, roll down my windows, and focus on the sensations. There’s the whole concept of not taking work home with you, which is a good idea. Of course, you can’t ban yourself from having a single work-related thought whenever you’re in your home -- how would I remember to go to work? But I don’t let myself wallow, or obsess. Let thoughts go when they come, and redirect yourself gently to something else.
When you realize that you’re showing signs of burning out, you have a few decisions to make, short-term and long-term. Think about your level of investment in your patients -- are you devoting too much of your energy to your work? Is listening to stories of trauma all day becoming overwhelming? Would it be possible to de-escalate the intensity of your work while you recover? All of this is entirely dependent on you -- you are now your number one priority. Many mental health organizations are incredibly understanding about how the work affects their employees -- consider discussing your situation with your supervisor to find a solution that is beneficial to everyone.But that night, the night you come home knowing your work is starting to take its toll on you, that is the night for immediate self care. And what that looks like is unique to each person. Play music, scream into a pillow, talk to your own therapist. Today, I came home, lit a candle, made a healthy dinner, and watched Netflix with my partner. And I remind myself that life goes on.