Presentation by Dr Justin Ross, PsyD, University of Colorado
At the 2023 Meeting of the Oncology Nursing Society Metro Denver Chapter (MDONS) Dr Justin Ross, PsyD, a licensed clinical psychologist and Director of the Workplace Well Being Program at The University of Colorado Health System, presented on the topic of clinician burnout in cancer care, and strategies to address this problem. He began by asking the group of healthcare provider attendees how many of them had experienced “burnout”, and nearly all participants in the room raised their hand. Dr Ross outlined the three fundamental components of burnout, including emotional exhaustion, depersonalization (loss of connection with other people), and a reduced satisfaction or sense of purpose with the work that we do. He noted a recent study suggesting that approximately 63% of physicians have experienced at least one of these symptoms over the past few years. Dr Ross noted that clinicians, in particular, often place a high value on “putting our head down and getting the job done” and are used to being the ones to “fix things” and help people, and as a result, they often internalize personal struggles without telling anyone.
Dr Ross explained the concept of “compassion fatigue” or a diminished capacity to empathize or feel compassion towards others, and again asked the room how many had experienced this, with a large number of participants also noting that they had. Dr Ross noted that compassion for others can become fatiguing in cases of hopelessness, where a situation we’re working on is not going to get better, with “no end in sight”. Another contributing factor is a sense of helplessness and loss of control, where “I can’t change this” or “I can’t make this better”. A third factor that contributes to compassion fatigue is a loss of compartmentalization, for example, moving from one distressing case to the next, or, as was frequent during the Covid pandemic, moving from a stressful day at the clinic to a stressful home environment/situation. In the face of these ongoing challenges, Dr Ross described what he calls “two types of tired”, with one being physical exhaustion that requires rest, time off, and space, and also a second, less recognized/appreciated type of tired that requires a sense of inner peace, peace of mind, and peace in spirit.
Dr Ross highlighted the concept that “opportunity is the starting point for well-being” noting that times of crisis can be the starting point for things like healthy eating, exercise, taking time during the day to stop and meditate, taking time for loved ones, and so on, although he highlighted some of the key impediments to well-being in the healthcare setting which can lead to burnout (Box 1).
Box 1. Impediments to Well-Being in the Healthcare Provider Setting
· Work stress and overload (“Not enough hours in the day”)
Lack of control (Lack of adequate resources, etc.)
· Insufficient rewards (Not feeling rewarded/recognized for the work we do)
· Community breakdown (e.g., Staffing shortages in healthcare)
· Absence of fairness (lack of equality)
Value conflicts (moral conflict and impact on decisions in patient care)
Managing Burnout: Practical Considerations
Dr Ross then guided the participants through a four-minute awareness exercise, noting that “you can’t change what you are not aware of”, and emphasized that a simple exercise can serve to increase your awareness and personal control over your situation. He encouraged the participants that, while none of the exercise was particularly challenging, what does require commitment is to give yourself the time, and to find the space during the day, to experience the positive feelings it can provide.
He outlined the three general skill sets that are needed to effectively prevent burnout (Box 2), making the analogy to a being in a burning building. Dr Ross emphasized that, while resiliency is a key component, it is time-limited: “I don’t expect you to become more flame-retardant” but instead to get out of the building as soon as possible. In addition, in the setting of healthcare “we are in burning buildings all the time” and as such, there is a need to make flexible adaptations in order to meet the demands of the job. From the perspective of healing, Dr Ross continued the analogy with, now that we are out of the burning building, checking in with ourselves to acknowledge what just happened: “am I injured?”, “what just happened”, etc. to realize the impact of the situation, and be willing to acknowledge that impact with ourselves and our colleagues. A third component he emphasized is that there needs to be an element of post-traumatic growth that arises from profoundly stressful situations, which can in turn lead to positive psychological changes for our lives.
Box 2. Skills for Preventing Burnout
· Ability to bounce back
Flexible adaptations to meet demand
· Moving through, not past
· Positive psychological changes
· Results of a struggle through highly challenging circumstances
Dr Ross then highlighted strategies to develop what he calls “real time resiliency,” or hardiness (Box 3). He notes that by developing these skills, healthcare providers can create a wedge between compassion fatigue and what he calls “compassion satisfaction” which can be an effective anti-burnout strategy to maintain the connection with your purpose and the sense of satisfaction that comes from the work that you do.
Box 3. Components of “Real Time Resiliency” or Hardiness
· Commit to “What must I do right now to get the job done?”
What does your patient need right now?
· Have the power to stop and take a moment for yourself.
· Take time to reconnect and understand how you are feeling.
· Create a challenge-based mind set for yourself.
· Recognize this is a growth-oriented opportunity.
· Embrace the challenge of your education, your skills, your abilities to deal with adversity.
In the final portion of his presentation, Dr Ross related some of the benefits of post-traumatic growth approach to managing burnout, which involves transforming adverse experiences and trauma into an opportunity for recovery, healing, and personal growth. To do this requires that we find new ways to take meaning from these adverse experiences to re-align them with our values, our purpose, and meaning for our lives. The steps for this process include education and understanding, psychological regulation, safe disclosure, narrative development, and service/purpose/meaning, and these concepts are described in Box 4. The benefits of such a post-traumatic growth approach, Dr Ross emphasized, are a greater awareness of our personal strengths. It can also serve to enrich our relationships, as often deeper emotional bonds are formed during times of stress, and it can also lead to an increased appreciation for our own lives, for example, increased appreciation for our own health and our ability to connect with our loved ones. Lastly, a focus on post traumatic growth can allow us to, instead of burning out, recognize new possibilities and opportunities for our life, and promote our spiritual development.
Box 4. Moving from Trauma, to Resiliency, to Growth
Education and Understanding
· Need to understand that none of this a sign that something is wrong with you, or that you lack resiliency, it is a sign that you are Human, and the work that you do as a healthcare provider is deeply impactful.
· We need to have skills and strategies available to us daily that allow us to regulate our psychology and calm ourselves in mind, body and spirit.
· We need to have people that we can talk to and understand these experiences as we go through them, not just minimize or dismiss them; need to have “people in the trenches with us” who can relate to the experience and its impact.
· We need to develop a narrative that enables us to understand how this experience fits into our lives as professionals and care providers.
Service, Purpose, and Meaning
· Need to recognize that the core of what matters most to use can change according to these experiences.
Speaker Disclosure Information: Dr Ross reported no disclosures for this presentation.