The World According to Dr. El

Preventing burnout in long-term care

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

In my recent post, "Stuff I won't do for residents and why your staff shouldn't either," I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.

Employers find burnout reflected in high levels of absenteeism and tardiness, extended sick leave, and an increase in worker's compensation claims. Employees might notice symptoms such as stress-related medical conditions (for example, ulcers or headaches), reduced job satisfaction, feelings of depression, anxiety, cynicism, boredom, discouragement and loss of compassion.

One study found that burned out staff were more likely to be accepting of resident abuse (Shinan-Altman and Cohen, 2009). 

What is burnout?
In my research, I came across a number of definitions of burnout. Some definitions, like this early description by psychologist Herbert Freudenberger, focus on the role of the individual:

Burnout is “a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that has failed to produce the expected reward.” People most likely to burn out are those who are the most “dedicated and committed to their positions, have poor work boundaries and who have an over excessive need to give.”

Ouch.

Other explanations of burnout focus on the environment, such as this one by Pines and Aronson (1988): Burnout is “a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.”

It's probable that most burnout is due to a combination of a stressful work environment and an individual's difficulty balancing self-care with their commitment to their jobs.

Techniques to reduce burnout
The good news for management is that many of the causes of burnout can be addressed by the organization, whether they are due to the environment or rooted in the individual.

1. Training workers, including enhancing the initial orientation process and providing ongoing education programs that go beyond mandated courses, can address many factors that contribute to burnout. Studies suggest the following:

  • Orientation classes should provide clear job expectations and address ways to prioritize job tasks in order to reduce time pressures.
  • Managerial staff such as nurses and department heads would benefit from skills training to better help them supervise and manage their teams.
  • Team building efforts can improve relationships with coworkers and reduce professional isolation.
  • Training staff on how to manage aggressive behaviors reduces the stress of working with a verbally and physically aggressive population.

2. Scheduling issues are another area where management can make a significant impact on burnout through:

  • Consistent assignments
  • Higher staffing levels
  • Increased staff control over scheduling, particularly because many nursing assistants are single parents of young children who find it difficult to manage unexpected changes in their schedules.

3.Employee recognition programs can offer ways for organizations to reduce burnout by:

  • Reinforcing job expectations so employees are clear about what they need to do to perform their tasks well.
  • Providing a unified, structured way for supervisors to reward workers.
  • Creating a success experience in a situation where the rewards of good work are often subtle because residents generally decline rather than improve in health.

4. Increasing pay can reduce the financial stress of workers who have very low wages. Low pay is tied to turnover, particularly in areas where employees can get jobs at higher paying facilities or less stressful work (such as retail jobs) for the same salary. In addition, offering retirement plans and health benefits increases the job satisfaction of workers and the likelihood of an employee remaining with the organization.

5. Improving interview techniques so that new employees are a good fit for the job. Some research suggests that including residents in the hiring process can help identify quality candidates.

Individual factors can contribute to burnout as well, but again, facilities can help their employees manage these elements. For example:

6. Employee assistance programs provide limited sessions of psychotherapy plus referrals for additional assistance to address personal stressors such as grief and tension at home that may carry over into work.

  • Exercise programs offered through the job can encourage employees to make use of this essential stress reduction tool.
  • Health screenings encourage workers to address physical health problems that might impact their ability to adequately perform their duties.
  • Quit smoking programs offer workers a way to reduce expenses and improve health.
  • Career advancement opportunities such as providing a senior nursing assistant track allow workers the satisfaction of remaining with the organization while increasing their skills and salary.

The types of people Freudenberger identified as most likely to burn out — dedicated, caring workers who want to help others — are the kinds of people most likely to be drawn to long-term care. As employers, the challenge is to prevent them from “over-helping” and burning out so that they can have long, healthy careers within your organization.

Some helpful selected references:

Eleanor Feldman Barbera, PhD, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the author of The Savvy Resident's Guide, and an accomplished speaker and consultant with nearly 20 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.

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