Selected Podcast
Overcoming Burnout: Finding Balance Between Doing and Being
Brooke Shepard, DNP shares tips on how to prevent burnout, and ways to overcome burnout.
Featured Speaker:
Brooke Shepard, APRN-NP
Brooke Shepard is a Doctor of Nursing Practice (DNP) and board certified Health and Wellness Nurse Coach (HWNC) who helps healthcare professionals overcome burnout. At Bryan, she works in the mental health emergency department and continues to work as needed as an electroconvulsive therapy (ECT) clinic staff nurse and is also preparing for an as needed sexual assault nurse examiner (SANE) role in Bryan Health’s emergency department. Transcription:
Overcoming Burnout: Finding Balance Between Doing and Being
Introduction: At Bryan health we care for patients, educate tomorrow's healthcare providers, motivate our community with fitness and health programs and collaborate to continually improve how we serve others. That's why we are proud to present another Bryan Health Podcast. Here's Melanie Cole.
Melanie Cole: Welcome to the Bryan Health Podcast. I'm Melanie Cole and today we're discussing preventing or even overcoming physician and healthcare provider burnout. Joining me is Brooke Shephard. She's a Doctor of Nursing Practice and Board Certified Health and Wellness Nurse Coach who helps healthcare professionals overcome burnout at Bryan Health. Brooke, I'm so glad to have you join us today. Healthcare workers are vital in our world, especially during these times. It's rewarding work, but it's hard work and sometimes even scary. Tell us a little bit about what burnout is and what have you seen as far as the prevalence of it. What are you seeing?
Brooke Shepard: So my review is more so on research and burnout with healthcare providers. I know there's other types of burnout out there, but a lot of my review has been specifically with healthcare providers. The National Academies of Sciences, Engineering and Medicine in October of 2019 actually released a report, a very large report talking about taking action against clinician burnout and they provided some guidelines. They had noted that there's 35 to 54% rate of clinician suffering from burnout and that was actually a pre COVID-19 statistic. So it could be likely much higher at this point in time right now. In healthcare there's often very dramatic and rapid changes with technology, regulation, policy and society and that impacts professionals in a capacity to be able to provide care. So I essentially like to call it what people are time compressed and stressed in healthcare.
It's kind of a discord between the demands we face as healthcare providers and the real or perceived inadequacy, I'm sorry, inadequacy of resources that we're equipped with to provide our professionally valued level of care and what they usually use is a Masslock burnout inventory to tell if people are burned out. There's different variations, but what we would usually use for medical personnel is a human services survey for medical personnel. And that's the most widely used tool for burnout is the Masslock burnout inventory. There's three dimensions of burnout, which is workplace exhaustion, cynicism and detachment from the job, and then a sense of professional in efficacy and lack of accomplishment.
Host: Well, thank you for that comprehensive answers. So as we're talking about the primary concerns of providers, and you just mentioned these three dimensions, tell us a little bit what that actually means for the listeners and those main drivers. How do you define what you just mentioned as far as, you know, work exhaustion, all of these things, I mean, even for nurses, they feel maybe their voices aren't heard. There's electronic records now, even before COVID, all of these things were contributing. Tell us what you meant by that.
Brooke Shepard: Right. So some of the signs of burnout, you can see on an individual, individual or organizational level. So with an individual, you might outwardly notice you're becoming inefficient, ineffective. You might have coworkers telling you, they're concerned that there's an imbalance of teamwork. And then there's also issues that you might be calling in more frequently and being absent from work. And then also the issue with presentism, which is showing up when you're not feeling physically or mentally well. Inwardly you may notice profound physical and emotional exhaustion and being prone to cynicism, which is being kind of a skeptic, pessimistic and sarcastic at times. And then on an organizational level you'll feel burned out. Or I'm sorry, burned out employees can have impaired attention and judgment and subsequent poor quality of patient care, which can lead to patients, staff complaints, workplace errors such as medication errors and falls. And then poor employee, physical, psychological and spiritual health with increased absences, sick calls and excessive turnover. So patient satisfaction scores and outcome indicators like readmission rates and employee engagement surveys and employee satisfaction are kind of good indications of those things. But it's also good that you do frequent rounding with employees and just touch base with them and check in on them and see how they're doing.
Host: Well, let's talk about some specific things and thank you for those red flags, but let's talk about some things that we can do to hopefully prevent burnout. What can healthcare providers do for themselves and who do they contact? They want to find joy in their practice again, and that seems to be very difficult right now.
Brooke Shepard: Right. So I found an overarching theme of burnout is this polarity imbalance of being and doing. So there's more pressure on the doing side of the scale. My process that I've been doing is rooted more with the internal nature of the Beamish, so to speak. And it's a seven step process. Almost all of my steps in the process are evidence based practices or to some degree have a level of evidence in support of the step. And the goal is to either overcome burnout and prevention of course is more ideal. So if you can actually do a lot of these practices before it gets to the point of burnout, that is ideal, but it also helps decrease burnout. So the first step is, I actually kind of termed them, there are seven different steps. The first one is begin within and that's a level of self reflection. And then the second one is be present, which is practicing mindfulness and then be still is the third step, which is sleep, meditation and delayed eating or intermittent fasting.
Step four is behaviors, which is a care plan development and identifying outcomes. And then step five is belief innovation and then step is become, which is kind of owning your overcome, navigating setbacks and failing forward. And then step seven is benefiting and celebrating and rewarding yourself. Each one has a different level of practices and takes various amounts of time. But all of them are very beneficial in developing a self care plan. And the first three I would really say, you know, begin within, be present and be still are the most foundational. I wouldn't, you know, try to plan to move on to any other types of the steps until you've accomplished that because a lot of the reflection in who you're being is very important into overcoming burnout and moving forward past it.
Host: So that's such a good point about being still and really being present, taking notice, sleep and rest, kind of go along with that. Can you provide some tips on being still and getting good sleep because in these stressful times, sometimes that's hard to come by,
Brooke Shepard: Right. Absolutely. So a good perspective is to try to retrain your brain to understand that your days actually start with your night's sleep before. So you want to ensure that you're getting enough sleep, our general, you know, recommendation is seven to nine hours. Everybody's a little bit different. But you actually want to ensure and schedule that time into your day and make sure that you're meeting that requirement that you need. You want to ensure that your sleep setting is conducive to sleep. So you want to reduce light exposure. You want to have it a cooler temperature and try to avoid any electronics about an hour before bed and then no caffeine at least eight hours prior to bed if possible. And then do something to kind of lighten your load and decompress the hour before bed. Sometimes watching the news or getting on social media isn't really conducive to that. So you'll want to do something that's a little more lighthearted. If you have persistent issues of sleep, you may want to try a natural over the counter sleep aids, such as melatonin. And if that isn't sufficient, it may be kind of an indication to seek help from your primary care provider. Meditation is a great Segway into a good night's sleep and then there's various forms of meditation that can be practiced independently or you can search for guided meditations online or use apps such as calm and Headspace, which also offer guided meditations and mindfulness practices.
Host: That's great advice and something that we really could all use at this time. And you mentioned rewarding yourself. Social distancing makes it a little difficult to celebrate progress. Do you have recommendations on how people should reward themselves during this bizarre time that we're in?
Brooke Shepard: Yes, actually I found a really interesting quote and I don't know who to attribute it to, but I found it really really neat. So it says if you can't go outside, then go inside. And that's kind of the perfect time to spend on reflection and then kind of deciding on really what you want for your life going forward in the future. Creating a special vision board of yourself or for yourself might be beneficial. You can do little things like diving into a good book giving yourself a manicure, pedicure at home if you're capable of doing that. You can purchase an online course you've been wanting to take. There's actually great online trainings for mindfulness based stress reduction and you can get CEs for doing it. You can spend 10 minutes outside in the sun, you can have a backyard picnic. There's a lot of simple things you can do, but when you do them, you want to spend, focus and have intention to fully appreciate it and yourself. And then also you can do some fun things like singing, dancing, coloring, give yourself permission to really just be playful and kind of be a kid again.
Host: That's great advice. As we wrap up, Brooke, give us your best advice on kind of summarize it all for us on health provider burnout, what you're seeing and really what are some steps they can take? Who can they reach out to? What is Bryan Health doing at this time to support their healthcare workers?
Brooke Shepard: Right. So the overarching thing is giving yourself some space just to be on the flip side of things at home, kind of eliminate some of the doing things. Of course we have things we have to do but just notice and take awareness to what you're being throughout those times. Just slow down. I mean, ultimately the time is always now. Of course we have things to look forward to and things we need to plan and schedule and have deadlines. But ultimately it's always going to be the moment of now. So essentially just kind of being mindful to that and then consciously creating the behaviors that you want and that you envision having for yourself. If you do have blind spots and issues with some of the thoughts and thinking behind some of your challenges, that's a good indication that you could work with somebody like a health coach, a counselor, a therapist, a mentor or other support persons. Even sometimes just discussing it with coworkers or some of your upper management, they're willing to at least listen and then provide some feedback of where you can go to get further support. And of course, at Bryan Health we have you know, for significant complications with anything like depression or PTSD. We have a lot of resources here for that. And in more severe cases, if people are contemplating suicide, of course we have our emergency mental health department where people can seek help and get an assessment to be evaluated and seek emergent treatment for that as well. Which is always very important that you reach out and get help.
Host: Great information and so important at this time, but really all the time, our healthcare workers are really on the front lines. And thank you so much Brooke, for coming on and sharing your expertise about this topic. That concludes this episode of Bryan Health Podcast. Please visit our website at bryanhealth.org for more information to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Bryan Health podcasts. Share this show on your social media with your friends and family because it's such an important topic and we can all learn from the experts at Bryan Health together. I'm Melanie Cole.
Overcoming Burnout: Finding Balance Between Doing and Being
Introduction: At Bryan health we care for patients, educate tomorrow's healthcare providers, motivate our community with fitness and health programs and collaborate to continually improve how we serve others. That's why we are proud to present another Bryan Health Podcast. Here's Melanie Cole.
Melanie Cole: Welcome to the Bryan Health Podcast. I'm Melanie Cole and today we're discussing preventing or even overcoming physician and healthcare provider burnout. Joining me is Brooke Shephard. She's a Doctor of Nursing Practice and Board Certified Health and Wellness Nurse Coach who helps healthcare professionals overcome burnout at Bryan Health. Brooke, I'm so glad to have you join us today. Healthcare workers are vital in our world, especially during these times. It's rewarding work, but it's hard work and sometimes even scary. Tell us a little bit about what burnout is and what have you seen as far as the prevalence of it. What are you seeing?
Brooke Shepard: So my review is more so on research and burnout with healthcare providers. I know there's other types of burnout out there, but a lot of my review has been specifically with healthcare providers. The National Academies of Sciences, Engineering and Medicine in October of 2019 actually released a report, a very large report talking about taking action against clinician burnout and they provided some guidelines. They had noted that there's 35 to 54% rate of clinician suffering from burnout and that was actually a pre COVID-19 statistic. So it could be likely much higher at this point in time right now. In healthcare there's often very dramatic and rapid changes with technology, regulation, policy and society and that impacts professionals in a capacity to be able to provide care. So I essentially like to call it what people are time compressed and stressed in healthcare.
It's kind of a discord between the demands we face as healthcare providers and the real or perceived inadequacy, I'm sorry, inadequacy of resources that we're equipped with to provide our professionally valued level of care and what they usually use is a Masslock burnout inventory to tell if people are burned out. There's different variations, but what we would usually use for medical personnel is a human services survey for medical personnel. And that's the most widely used tool for burnout is the Masslock burnout inventory. There's three dimensions of burnout, which is workplace exhaustion, cynicism and detachment from the job, and then a sense of professional in efficacy and lack of accomplishment.
Host: Well, thank you for that comprehensive answers. So as we're talking about the primary concerns of providers, and you just mentioned these three dimensions, tell us a little bit what that actually means for the listeners and those main drivers. How do you define what you just mentioned as far as, you know, work exhaustion, all of these things, I mean, even for nurses, they feel maybe their voices aren't heard. There's electronic records now, even before COVID, all of these things were contributing. Tell us what you meant by that.
Brooke Shepard: Right. So some of the signs of burnout, you can see on an individual, individual or organizational level. So with an individual, you might outwardly notice you're becoming inefficient, ineffective. You might have coworkers telling you, they're concerned that there's an imbalance of teamwork. And then there's also issues that you might be calling in more frequently and being absent from work. And then also the issue with presentism, which is showing up when you're not feeling physically or mentally well. Inwardly you may notice profound physical and emotional exhaustion and being prone to cynicism, which is being kind of a skeptic, pessimistic and sarcastic at times. And then on an organizational level you'll feel burned out. Or I'm sorry, burned out employees can have impaired attention and judgment and subsequent poor quality of patient care, which can lead to patients, staff complaints, workplace errors such as medication errors and falls. And then poor employee, physical, psychological and spiritual health with increased absences, sick calls and excessive turnover. So patient satisfaction scores and outcome indicators like readmission rates and employee engagement surveys and employee satisfaction are kind of good indications of those things. But it's also good that you do frequent rounding with employees and just touch base with them and check in on them and see how they're doing.
Host: Well, let's talk about some specific things and thank you for those red flags, but let's talk about some things that we can do to hopefully prevent burnout. What can healthcare providers do for themselves and who do they contact? They want to find joy in their practice again, and that seems to be very difficult right now.
Brooke Shepard: Right. So I found an overarching theme of burnout is this polarity imbalance of being and doing. So there's more pressure on the doing side of the scale. My process that I've been doing is rooted more with the internal nature of the Beamish, so to speak. And it's a seven step process. Almost all of my steps in the process are evidence based practices or to some degree have a level of evidence in support of the step. And the goal is to either overcome burnout and prevention of course is more ideal. So if you can actually do a lot of these practices before it gets to the point of burnout, that is ideal, but it also helps decrease burnout. So the first step is, I actually kind of termed them, there are seven different steps. The first one is begin within and that's a level of self reflection. And then the second one is be present, which is practicing mindfulness and then be still is the third step, which is sleep, meditation and delayed eating or intermittent fasting.
Step four is behaviors, which is a care plan development and identifying outcomes. And then step five is belief innovation and then step is become, which is kind of owning your overcome, navigating setbacks and failing forward. And then step seven is benefiting and celebrating and rewarding yourself. Each one has a different level of practices and takes various amounts of time. But all of them are very beneficial in developing a self care plan. And the first three I would really say, you know, begin within, be present and be still are the most foundational. I wouldn't, you know, try to plan to move on to any other types of the steps until you've accomplished that because a lot of the reflection in who you're being is very important into overcoming burnout and moving forward past it.
Host: So that's such a good point about being still and really being present, taking notice, sleep and rest, kind of go along with that. Can you provide some tips on being still and getting good sleep because in these stressful times, sometimes that's hard to come by,
Brooke Shepard: Right. Absolutely. So a good perspective is to try to retrain your brain to understand that your days actually start with your night's sleep before. So you want to ensure that you're getting enough sleep, our general, you know, recommendation is seven to nine hours. Everybody's a little bit different. But you actually want to ensure and schedule that time into your day and make sure that you're meeting that requirement that you need. You want to ensure that your sleep setting is conducive to sleep. So you want to reduce light exposure. You want to have it a cooler temperature and try to avoid any electronics about an hour before bed and then no caffeine at least eight hours prior to bed if possible. And then do something to kind of lighten your load and decompress the hour before bed. Sometimes watching the news or getting on social media isn't really conducive to that. So you'll want to do something that's a little more lighthearted. If you have persistent issues of sleep, you may want to try a natural over the counter sleep aids, such as melatonin. And if that isn't sufficient, it may be kind of an indication to seek help from your primary care provider. Meditation is a great Segway into a good night's sleep and then there's various forms of meditation that can be practiced independently or you can search for guided meditations online or use apps such as calm and Headspace, which also offer guided meditations and mindfulness practices.
Host: That's great advice and something that we really could all use at this time. And you mentioned rewarding yourself. Social distancing makes it a little difficult to celebrate progress. Do you have recommendations on how people should reward themselves during this bizarre time that we're in?
Brooke Shepard: Yes, actually I found a really interesting quote and I don't know who to attribute it to, but I found it really really neat. So it says if you can't go outside, then go inside. And that's kind of the perfect time to spend on reflection and then kind of deciding on really what you want for your life going forward in the future. Creating a special vision board of yourself or for yourself might be beneficial. You can do little things like diving into a good book giving yourself a manicure, pedicure at home if you're capable of doing that. You can purchase an online course you've been wanting to take. There's actually great online trainings for mindfulness based stress reduction and you can get CEs for doing it. You can spend 10 minutes outside in the sun, you can have a backyard picnic. There's a lot of simple things you can do, but when you do them, you want to spend, focus and have intention to fully appreciate it and yourself. And then also you can do some fun things like singing, dancing, coloring, give yourself permission to really just be playful and kind of be a kid again.
Host: That's great advice. As we wrap up, Brooke, give us your best advice on kind of summarize it all for us on health provider burnout, what you're seeing and really what are some steps they can take? Who can they reach out to? What is Bryan Health doing at this time to support their healthcare workers?
Brooke Shepard: Right. So the overarching thing is giving yourself some space just to be on the flip side of things at home, kind of eliminate some of the doing things. Of course we have things we have to do but just notice and take awareness to what you're being throughout those times. Just slow down. I mean, ultimately the time is always now. Of course we have things to look forward to and things we need to plan and schedule and have deadlines. But ultimately it's always going to be the moment of now. So essentially just kind of being mindful to that and then consciously creating the behaviors that you want and that you envision having for yourself. If you do have blind spots and issues with some of the thoughts and thinking behind some of your challenges, that's a good indication that you could work with somebody like a health coach, a counselor, a therapist, a mentor or other support persons. Even sometimes just discussing it with coworkers or some of your upper management, they're willing to at least listen and then provide some feedback of where you can go to get further support. And of course, at Bryan Health we have you know, for significant complications with anything like depression or PTSD. We have a lot of resources here for that. And in more severe cases, if people are contemplating suicide, of course we have our emergency mental health department where people can seek help and get an assessment to be evaluated and seek emergent treatment for that as well. Which is always very important that you reach out and get help.
Host: Great information and so important at this time, but really all the time, our healthcare workers are really on the front lines. And thank you so much Brooke, for coming on and sharing your expertise about this topic. That concludes this episode of Bryan Health Podcast. Please visit our website at bryanhealth.org for more information to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Bryan Health podcasts. Share this show on your social media with your friends and family because it's such an important topic and we can all learn from the experts at Bryan Health together. I'm Melanie Cole.