The World According to Dr. El

Stuff I won't do for residents and why your staff shouldn't either: preventing burnout in LTC

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

In my last post, I wrote about some of the many things I do for residents as a long-term care psychologist. The astute reader will note that most of the tasks were accomplished during work hours and within the facility. There's a reason for that.

When I first started out as a shrink, I worked at the Manhattan Psychiatric Center, a setting similar to many nursing homes in that residents didn't have access to stores and other amenities. “Next time you're in the supermarket, will you get me some of that lotion I like?” “Can you buy me a new watch battery?”

The small requests were never-ending and because they were so small, I felt I couldn't refuse.

And then there were the tasks I volunteered for because I could see the need and I was, you know, a nice person.

The breaking point came after I offered to darn a sweater with a small hole in the front. It was only after I got the sweater home that I discovered the large holes in the back. During the hours of mending — I didn't want to go back on my word — I realized I had to set some limits on these “extras” or I'd quickly burn myself out on my chosen career.

Establishing limits

Knowing I was in this for the long haul, I created a personal “no errands” policy. The exceptions are endeavors that connect residents to their loved ones, such as obtaining and mailing out holiday cards. (And, I admit, I relish Internet searches for estranged family members.) On the occasions where I'm tempted to do something really special, I soul-search and sometimes consult with an advisor to determine if it's something I'd do for any of my residents or if I'm going too far for one particular person. It's important to be fair, especially in the “small-town” LTC environment.

Potential for burnout

My personal policy has been essential for me to stay focused on my psychology work, but I worry for your staff. I see these kind people running errands on their off-hours and taking care of your residents above and beyond their job description. It's very nice for the residents and for the facility, but there's a risk that they're being too nice to others at the expense of themselves.

Burnout is expensive for them and for you too, in terms of tardiness, absenteeism and the need to train new staff when employees are too overburdened to continue their work. Stressed workers are more prone to injury, a common cause of absenteeism in long-term care. Absenteeism is costly in terms of patient satisfaction as well, with higher rates of nurse absenteeism associated with decreases in patient satisfaction (Moret, et al. 2012).

How to prevent burnout

Here are some ways to reduce “over helping” in your facility:

·      Teach staff how to avoid burnout by providing training on how to politely and effectively set limits. Help them distinguish between what's comfortably helpful and what's setting themselves up for stress, overwork and resentment.

·      Use your employee recognition programs to emphasize reasonable helping, recognizing workers who are able to help within the context of their jobs and not those who are spending large amounts of personal time on resident tasks.

·      Seek volunteers to handle resident needs that fall between job descriptions, such as mending clothes, replacing watch bands and batteries, and taking individuals out for some sunshine.

·      Create options for residents so they don't have to rely on staff assistance. Shopping, for example, can be accomplished through an on-campus store, regular resident trips to an off-campus market, assistance to shop online, and by linking resident bank accounts to a debit card so residents can make their own purchases.

Every year around the holidays, I still make mental lists of what I'd buy each of “my” residents if I could. But then I check with the “home office” (i.e.; the personal guidelines I established early on) and remember that if I hadn't set these limits, I would have burned out long ago. My present is my continued presence.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an accomplished speaker and consultant with over 17 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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