Preventing Personal Burnout

This article was published in the Dutch journal for lymphedema therapists Oedeminus, 10(3): 20-21, September 2007, and includes material from Dr. McMahon’s presentation “Challenges for the Lymphedema Therapist” given at the National Lymphedema Network’s 7th International Conference For Healthcare Professionals held in Nashville, Tennessee, USA.

What Is Burnout?

Burnout is when negative emotions outweigh positive emotions.

All of us experience some negative emotions in our daily work lives. We may feel frustrated, discouraged, anxious, bored, angry, guilty, blaming, like a failure, or similar feelings.

Such feelings are normal. The problem arises when they become more frequent, more intense, and/or more enduring than positive emotions such as satisfaction, confidence, excitement, pride, joy, absorption, pleasure, gratitude and so on.

What Makes You Vulnerable to Burnout?

Three aspects of being a healthcare professional treating lymphedema may put you at risk for burnout:

1. The condition itself. Lymphedema is a chronic condition without a cure. As such, it requires lifelong changes in patient self-care and intermittent professional care. For the lymphedema therapist, treatment can be repetitive and success achieved can be compromised by factors outside your control.
2. Patients’ emotions. Your patients may come to you feeling stressed and needing emotional support. They may feel hopeless, overwhelmed, and discouraged.  They may feel self-conscious and ugly; fearful and anxious; or mistrusting and angry.
3. Your own emotional reactions. It is very normal to have negative feelings in response to your patients’ negative emotions – or in response to less-than-perfect successes. This is particularly true if, like many healthcare professionals, you are idealistic, demanding the best of yourself, and emotionally sensitive to your patients. You may find yourself feeling self-critical or guilty; helpless or hopeless; frustrated or angry.

Preventing Burnout

The key to preventing burnout is to increase positive emotions and decrease negative emotions. Here are nine practical suggestions for achieving this goal.

Suggestion 1: Prioritize Your Efforts

As you set out to reduce the negatives in your life, identify actions that will have the biggest impact for you. Ask yourself “What would ease my stress the most?” For example, you might delegate specific tasks you find particularly onerous. What stresses you may not be stressful for someone else. Reach out for help. Actively problem-solve.

Similarly, to increase the positives in your life, ask “What would increase my sense of satisfaction the most?” Let the answer guide your actions. One good place to begin is by deliberately praising yourself inwardly every day and deliberately looking for things to praise in your patients and coworkers and expressing this to them openly.

Suggestion 2: Separate What You Control from What You Don’t

Do not take on responsibility for what is outside your control. You can only feel responsible for those things that you directly control. You are responsible for your words and your actions. You are not responsible for having spontaneous emotional reactions or thoughts – only what you choose to do in response to them. You are not responsible for others’ actions.

Suggestion 3: When Faced with Challenging Patient Behavior, Assume There is a Reason for it, No Matter how Unhelpful the Behavior is

Step back and be honestly curious. Ask your patients what is going on with them. Work until you can see the situation from their side. You don’t have to agree - just understand.

Think about the many, many factors that may be influencing your patients: their genetics, the physiology of their bodies, their past experiences, their inborn personalities, their knowledge, their assumptions, their resources, and their stage of change. They are probably, like most of us, doing the best they can at the moment given these factors.

Suggestion 4: Offer Hope

People change. Treatments improve. When your patients are noncompliant or treatments are unsuccessful, remind yourself and your patients that no one knows the future. Emphasize that change may occur in the future. Hope is powerful and opens a door for the future.

Suggestion 5: Decrease Unrealistic Expectations

Do not be unrealistically demanding of yourself, your patients, the condition, or other people. Acknowledge and accept the reality of this point in time. Do what you can. Accept what you can’t. Work on what’s doable now.

Suggestion 6: Redefine Success

The specific treatment interventions you use vary for different patients at different times. Similarly, your definition of success may need to vary to fit the present circumstances.

Sometimes you carry out treatment, patients fully implement your recommendations, and lymphedema symptoms reduce to a degree that pleases everyone. Sometimes, however, success may be that partial improvement occurs. And at other times, you may need to define success as supporting patients’ efforts to problem-solve and encouraging progress through the stages of change until they are ready to act.

In other cases, success is that you are able to offer information and refer patients to sources of support or that you monitor and measure. Perhaps, you may need to redefine success as using good communication skills and working to understand your patients; conveying respect, empathy, and concern while providing a listening ear and a caring heart; offering encouragement, support, and hope.

Remember, patients in the earliest stages of change are unready to take action. At these stages, moving directly to treatment recommendations may be counterproductive. Success may be tailoring what you do to their stage of change and assisting them to progress toward readiness to change in the future.

Of course, you use your best knowledge and skill to achieve the best result. But in the absence of perfection, you need to notice, emphasize, and celebrate the partial successes. Partial success is not the same as total failure.

Suggestion 7: Put Things in Perspective

Look at the big picture. One of the best ways I know to do this is to ask the “three ways” questions. It is important to ask these two questions in this order. First, list three (or more) ways the situation could be better, more ideal, closer to what you wish. Then, list three (or more) ways the situation could be much, much worse than it is.

Suggestion 8: Keep a Balance

Keep a balance between ideal versus partial achievements. Your goal is to work toward ideal outcomes, while noticing and emphasizing progress and positive steps – however small. Take credit for what you (and your patients or coworkers) are doing well now.

Balance your work life and non-work life. One way to counterbalance work stress is creating a richly satisfying personal life outside work. Sources of satisfaction may include involvement with family and friends, religious or philosophical beliefs, and/or intellectual, cultural, or physical activities. Find activities that absorb you, that use your skills and strengths, and that link you with something larger than yourself.

Keep a balance between you and your patients. Do not take all the responsibility for your patients’ success and emotional responses on your shoulders. Your job is to do your part. You can’t do the patient’s part.

Suggestion 9: Practice Helpful Self-Talk

When you notice negative feelings, write down two or three true statements that can change your emotional response. Here are some examples:

• “This is not under my control. What I can choose is my attitude and response.”
• “I am being given an opportunity to grow in understanding, in maturity and wisdom, in calm and balance.”
• “Even if this patient is currently not ready or able to implement ideal treatment, I can at least offer understanding, information, help, encouragement, and hope.”
• “If it is hard for me to deal with this person, imagine how much harder it must be to be that person.”
• “This busy day is an opportunity to help many people”

Summary

Deliberately notice and savor the rewards of your work and your daily life. Recall the underlying values and ideals that led you into this profession. Balance your positive and negative emotions to prevent burnout. By caring for yourself, you are able to continue to care for others.