The Secret to Achieving Joy and Avoiding Burnout at Work!

Evelyn Clingerman, PhD, RN, CNE, FNAPExecutive Director, The Bonnie Wesorick Center for Health Care Transformation

Kirkhof College of NursingGrand Valley State University

clingere@gvsu.edu

Disclosures

I have no conflicts of interest or relevant financial support to disclose.

Evelyn Clingerman, PhD

Objectives: After attending this session, you will be able to maintain momentum in your transformation experience by:1. Identifying signs and effects of burnout in individuals and

organizations,

2. Identifying three strategies to use to achieve joy in work, and

3. Identifying three strategies to avoid burnout in work.

What is Burnout?

A three dimensional syndrome that involves:1. emotional exhaustion,2. cynical treatment and

negative thoughts towards patients and the healthcare team (depersonalization); and

3. a low sense of personal accomplishment.

• (Maslach & Jackson, 1981)

Prevalence of Burnout at Work

Clinician burnout, stress, depression, compassion fatigue & emotional exhaustion levels are a national epidemic (National Academy of Medicine, 2017).

1 Davidson et al. (2018)2 Kishore, Dandurand, Mathew, & Rothenberger, 2016

Burnout Prevalence• increased 9% physicians

(2011-14)• For RNs ranged

33-44%(2002-11)1

• 400 physicians die by suicide annually

• No national suicide data for nurses.2

• In the last 30 days, 14% of nurses report falling asleep while driving

Nurses and Health

BMI Sleep Nutrition StressNurses 28 7.0 13% 60%Average American 26.6 7.8 hours 23% 29%

Body Mass Index: BMIs in the 25-29.9 range are classified as “overweight”.Sleep: Number of hours of sleep in a 24-hour period.Nutrition: % eating recommended servings of five fruits and vegetables daily.Quality of Life: % reporting high levels of stress.

American Nurses Association, 2018, Analysis of the Healthy Nurse Survey.

Impact of Burnout

Personal: Physical health; Emotional

health: Exhaustion: Sadness, Depression

Suicidal IdeationProfessional: Turnover

Lack of EngagementDepersonalized care,

Substance abuse, poor quality relationships

• Poor working relationships and social interactions

• Low quality scores• Increased turnover

rates(physicians & Nurses)

• Workplace violence• Employee

Assistance• Dismissal Rate

Clinic

• Provider becomes less vigilant with

patients• Greater medication

• Lower Patient Satisfaction

• Poor clinical outcomes

(infections, safety)

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Factors Affecting Clinician Well-Being (NAM, 2018)

EXTERNAL Factors

Society & Culture• Societal

Expectations• Culture of Safety• Patient

expectations• Social

Determinants

Rules & Regs• Accreditation• Licensure• Certification• Policies • Reimbursement

type• HR • Compensation

Organizational• Bureaucracy • Power• Workload &

Time pressure• Scope of Prt• Mission Values

profit emphasis

• Data collection• Harassment• Inclusion

LearningPracticeEnvironment• Autonomy• Collaborative?• Health IT

interop EHRs• Mentoring• Team structure• Workplace

Safety

Health Care Responsibilities• Admin Resp• Clinical Resp• Career

Development• Patient

population• Specialty

Issues• Teach

Research ?

Individual Factors

Personal• $ Stressors• Family dynamics• Flexible to change• Purpose, Meaning

in work; values? • Personality• Work Life Balance• Social Isolation

Skills & Abilities• Competency

clinical & tech• Communication• Coping • Delegation• Empathy• Resilience• Teamwork skills

What Are We Doing About Burnout?

Bodenheimer & Sinsky (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annuals of Family Medicine, 12(6): 573-6

Where are we on the river? Upstream Parable

Restoring and Finding Joy in Practice

(Perlo et al., 2017)

“Management’s aim should be to create a system in which everybody may take joy in his or her work.”

W. Edwards Deming

Why Focus on JOY?

Institute for Healthcare Improvement (IHI) Model

• Dialogue Sessions: Listen & Learn (skilled facilitators)

• Prioritize Concerns• Identify your champion?

Involve the clinicians: What matters to you?

• Ensure all voices are heard; huddles

What are the pebbles in your

shoes? (barriers)

• Pause for joyful moments, bright spots

Commit to Shared Goal: JOY in Work

• Best Evidence• Knowledge Hub• IHI

Use best methods &

measures for aim.

National Academy of Medicine’s Action Collaborative• Join the Collaborative and Stay Informed• Take advantage of the “Knowledge Hub”

https://nam.edu/clinicianwellbeing/• Causes• Effects• Solutions• Conceptual Model

• Join the Listserve

Improve

Improve baseline understanding of challenges to clinician well-being

Raise

Raise the visibility of clinician stress and burnout

Advance

Advance evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver.

https://nam.edu/ClinicianWell-Being

Return to Joy in Work: Individual Level• Encourage Healthy Behaviors• Encourage Connections with

Family, Friends, & Co-workers• Set Aside Compliment Time or

Compliment Wall; Gratitude Time• Have Debrief Time• Take mandatory breaks• Off duty means off duty• Avoid email when off duty

To Achieve Sustainable Transformation: What We Measure gets our Attention• Identify metrics: What gets

measured gets our attention.• Why? Quantify shortcomings &

follow improvements; • Measure What? Varies by level:

• Patient AND Provider Satisfaction Safety & error Data

• Turnover/Retention Rates• Work-Life Balance for all• Hassles Inventory; Safety Inventory• Maslach Stress Inventory

• Measure When or Frequency (stay vigilant) hand on the pulse; track over time

• How to measure? • Scorecards • Keep it on the table at meetings/discuss

findings• Real time feedback • Podcasts

• How to Intervene: • Engage HCPs in solutions• Best Evidence (NAM; IHI frameworks)• No single answer: Both AND approach

Vaccinate HCPs for Exposure to Stressors (Nedrowet al., 2013)

• Burnout is linked to four values: service, excellence, curative competence & compassion but excess is unhealthy

• Training: mindfulness, self-compassion, gratitude, reframing

• Relax, Restore, Recharge and Wellness Events; Social gatherings, especially for newbies

• Use of Support Services & consider redistributing or sharing tasks• Pleasing Environment• Education: mindfulness, sleep, resilience

Organizational Interventions to Advance Joy (Barnett, 2017)

• Peer Support Networks and Resilience Networks• Address personal emotions (+ emotional first aid)• Build healthy stress management behaviors

• Organizational Re-design + Infrastructure• Huddles• Flexibility & Control with Hours• Well-being Days (Cleveland Clinic)• Protected time to attend Mindfulness

• Creative Arts• Visual, Written, and Music

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as it is to be able to walk through

water without getting wet.Rachel Naomi Remen