In October 2019, The National Academy of Medicine released the widely anticipated report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Wellbeing, a culmination of the research conducted by The Action Collaborative on Clinician Well-being and Resilience since 2017. Their findings indicate that more than half of all clinicians, most prevalently nurses and physicians throughout the United States, experience symptoms of burnout, depression, and suicide; now widely recognized as a public health epidemic that is having adverse effects on the quality and safety of healthcare.
Burnout is manifested by symptoms of emotional exhaustion, feelings of ineffectiveness, cynicism, no longer finding work as meaningful, and a tendency to view patients, students, and colleagues as objects rather than human beings. Burnout leads to lower job satisfaction, increased rates of alcohol, drug abuse, and suicide, in addition to higher rates of medical errors and decreased patient satisfaction. And although nurses and clinicians desire to provide the highest quality of patient care, they often fall into neglect of their own self-care, leading to increased physical and mental health problems. The NAM report identified there are multiple causes of burnout in clinicians, including both personal and workplace system factors. Personal factors include not engaging in good self-care and healthy lifestyle behaviors such as exercise, healthy eating, adequate sleep and not paying attention to daily stress-reducing activities. Workplace factors can include poor staffing, long shifts, inadequate leadership support, challenges with EMRs, less time with patients, and pressure to increase patient caseloads. Toxic and negative work environments, relationships, and lack of connection and trust with co-workers are shown to all lead to cynicism and burnout. (Melnyk, 2019 American Journal of Managed Care)
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As a nurse and clinician, what measures can you personally engage in to build your resilience against stress and burnout, fuel your best self, and increase your personal and professional well-being?
Let’s explore “best self” - Martin Seligman, the founder of Positive Psychology, identifies three areas of human functioning:
- “Flourishing” describes people who maintain an “optimal level of functioning”, aka “your best authentic self”, showing characteristics of goodness, generativity, growth, joy, hope, and resilience
- “Languishing” describes those who are showing up day to day, watching the clock at work, and collecting their paycheck but ultimately feel like something is missing in their lives.
- At the far end is “Dysfunction” leading to depression, anxiety, and loneliness.
He found five factors shown to be essential for achieving authentic happiness, optimal functioning, and well-being known as PERMA: Positive Emotions, Engagement, Relationships, Meaningfulness, and Accomplishments (Seligman 2011). Ryan Niemiec, PsyD, of the Via Institute, has recently revised to add a sixth domain – PERMA-H – reflecting on health and wellbeing. (Niemiec 2019)
Individuals who are “flourishing” (aka best self) are passionate about pursuing goals, know and honor their core values, are able to engage in meaningful relationships, are able to proactively respond to challenges by using their strengths versus reacting negatively, are able to maintain their energy reserves and build resilience versus burning out and leave a legacy by empowering themselves and others to make a meaningful difference.
Thomas Muha, Ph.D., developed an evidence-based program specifically designed to increase clinician well-being helping one to increase resilience to stress and burn-out, and if in a state of burn-out, steps to rise above and learn how to flourish in your personal and professional lives. The PROPEL program has been shown to have proven efficacy and sustainability for raising nurses' and clinicians’ engagement, retention, quality patient outcomes, and overall satisfaction both for the clinicians and the patients. PROPEL is an acronym for six steps guiding you to learn how to elevate your level of satisfaction and success. (Muha, 2018) Major themes of the PROPEL Principles:
- Passion is the source of your inspiration and motivation. Enhancing your passion for doing excellent work empowers you to perform at the highest level. There are two types of Passion:
Harmonious passion occurs when you choose to engage in an activity on your own accord and you are in harmony with your core values and all areas of your life – you are your best self. People who have harmonious passion can inspire others and remain resilient.
Obsessive passion occurs when a task is done solely for the motivation of an external reward or recognition. The obsession with perfectionism and attaining your personal goal leads to overcontrolling your own and others’ behaviors which leads to conflicts, negative emotions, and frustration.
Several studies have shown that nurses and clinicians who demonstrate obsessive passion have decreased life satisfaction and burn-out whereas harmonious passion protects the nurse from burn-out, detachment, and irritability.
Identification of your core values is the first step to realizing your passion(s) and recognizing what is important to you. Then visualizing what it would look like if you achieved that outcome. Becoming clear of your values guides and empowers you to make decisions and life choices that will fuel your inner passion and provide you with a level of sustained inspiration and motivation.
- Positive psychology studies show that individuals who have the highest levels of success in life also have a large circle of friends, coworkers, and others who provide abundant support. They are far more likely than the average person to be satisfied in their Relationships at work, in their families, and in their social activities which fosters well-being.
Research has shown that when an individual is able to maintain a 3:1 positive-to-negative ratio with their thoughts they are more able to actively engage in courageous communication without negativity, defensiveness, anger, and hostility. They ask questions of each other and can understand what is going on in each other’s world which brings forth empathy with challenges and enthusiasm for their successes.
- Optimism and Pessimism are both learned ways of thinking:
Pessimistic thinking comes from having a fixed mindset and leads one to suffering and burn-out whereas Optimistic thinking leads to a growth mindset and hope.
When you experience a setback a fixed mindset presents problems because the story you tell yourself focuses on not having what it takes to reach the next level. Your pessimistic explanation will likely focus on your weaknesses, leaving you feeling too discouraged to continue to even try to make an effort. A fixed mindset automatically assumes you’re not good enough and leads you to conclude it’s best to just give up.
A growth mindset, however, assumes: “I can change. We can improve.” In addition to having better mental health, optimists perform better in their personal and professional lives. People who practice optimistic thinking when facing challenges have been shown to be healthier physically and live longer than pessimists!
- Choosing to be Proactive when facing challenges is the opposite of being reactive. People who are most successful at achieving their goals proactively play to their strengths – consciously deploying their best attributes in order to perform at their best. Proactively playing to your strengths empowers you to remain optimistic and resilient when facing challenges. Inner Character Strengths align with your values which align with your actions. Developing your inner strengths promotes personal well-being and is intrinsically motivating. Visit the VIA Institute website to take a free Character Strength Assessment: https://www.viacharacter.org/
People who use their strengths at work are six times more likely to be engaged in their jobs and have lower turnover, higher productivity, and greater patient satisfaction. (Sorenson, S. 2014)
Studies have shown that if you practice using your strengths for just 11 minutes a day, you will become a more Proactive person – and can respond to challenges with your best qualities: www.michellemcquaid.com/strengths-habit/
- Just like batteries, we are not all like the Energizer Bunny – especially healthcare providers caring for the sick, injured, or dying. It is imperative that to ward off stress and burn-out, healthcare providers need to have adequate physical, emotional, and mental Energy.
Recent research has shown that not everyone suffers adverse effects from stressful situations. In The Upside of Stress, Kelly McGonigal points out that “the most common effects of stress include strengths, growth and resilience”. With the proper mindset, stress can create positive changes: a sense of personal growth, increased appreciation for life, spiritual growth, enhanced social connections and relationships with others, and identifying new possibilities and life directions. How can you change your mindset? Every time you become aware of feeling stress, reframe your thinking to “I have energy available for dealing with this situation.” (McGonigal 2015)
Neuroscience research studies have shown that embracing a healthy diet, exercise, mindfulness, meditation, expressing gratitude and EFT tapping can all help to measurably decrease stress, increase your resilience and enhance your emotional and physical wellbeing.
- Leaving a Legacy; empowering yourself and others to bring purpose and meaning to the workplace and bringing out the best in each other, brings us the highest level of life satisfaction and optimal functioning; aka flourishing.
Try using the PROPEL Principles to give yourself an optimal growth mindset: Envision outcomes that honor and align with your values and ignite your passion, nurture and engage in positive relationships that provide support, embrace optimistic thinking that enables solutions, and deliberately practice using your strengths to remain proactive in your responses to workplace challenges. These practices will enable you to be your best self and you will flourish in your personal and professional lives! (Muha 2018)
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