8 STEPS Navigating Burnout for Busy Providers
8 STEPS Navigating Burnout for Busy Providers
Dima Arbach, MD
After this year, it doesn’t come as a surprise to anyone that bad things happen. What’s
less obvious is how we can cope with this reality and thrive. Life can often feel
exhausting and hard to maneuver, especially for busy providers who may feel as though
their jobs never end during these challenging times.
Most healthcare providers are busy trying to help patients while maintaining their family
and social lives during the continuously challenging reality of the pandemic. In addition
to all of these duties to others, self-care is more essential now than ever. And it so often
falls by the wayside.
SAFE HOPE is a simple acronym to help you organize your thoughts and resources.
This acronym outlines a sequence of eight steps that can reduce your energy drain and
improve your ability to respond to changing circumstances.
Before you use SAFE HOPE for the first time, I’d like you to ask yourself one question:
Am I okay?
We must take care of ourselves before we can take care of others, and I want you to
consider whether your own mental and physical health is something you may benefit
from addressing using the SAFE HOPE method.
Take a moment to really answer that question. Feel what your body is telling you. Write
down what you notice if you like.
Next, let’s practice the SAFE HOPE steps together:
• S: See and seek
• A: Accept and allow
• F: Find and fact check
• E: Expectations management
• H: Help and support
• O: Organize and plan
• P: Persist
• E: Examine
SEE AND SEEK:
To begin to accept a situation and thrive, we must first stop, look and see the circumstances for what they are. We must take a moment to step back and evaluate what is truly happening.
Every so often, our days glide by fast and we don’t recognize what’s taking place and how it is happening. We simply accept each small change as it comes without noticing that many small changes have added up to a massive transformation.
So take a moment to stop to see if you are stressed. Do you have any of the signs of burnout listed below?
• Feeling withdrawn
• Having decreased empathy
• Guilt and self-doubt about your actions
All of these are signs that your situation may have changed in ways you haven’t fully become aware of and addressed. Needless to say, none of these are good signs. But once we recognize what the situation is, we can take steps to address it.
If you drag yourself to work each day and leave bitter and unsatisfied, then it is time to stop and look at what’s happening. If you feel that you are not appreciated and your work does not make a difference, then it is time to stop and look.
Also part of “See” is “Seek” - the process of seeking out the factors which have changed, or which are contributing to making the situation less than ideal.
Seek the details that are adding difficulties in your life and note them. Some examples may include a difficult colleague, an inconvenient schedule, children staying home from school, and many other factors that can contribute to burnout.
We as providers appreciate how insight and identification of variables play a huge part in addressing any problem in the clinical setting. But the same is true in all aspects of our daily and professional lives.
So throw away those hazy eyeglasses and inspect the problem with an unflinching gaze. It may be scary to admit how many things aren’t quite right, but this is the first step to fixing them.
You may wish to Seek help with evaluating and understanding the situation from others. You may wish to ask loved ones and trusted resources what they notice about the situation and how it may have changed over time.
Many times, those who know us best realize our distress and can help us recognize the problem, or at least make it more visible.
Ask your coworker if she has noticed any changes in your temperament or behavior. Ask your partner if they feel you have been more irritable or angry.
It’s normal to be apprehensive of what you may learn, but keep in mind that if other people have noticed these changes, there have probably also been substantial changes to your own health and happiness.
Now that we know what the situation is, we can...
ACCEPT AND ALLOW
Now that you know where you are, allow yourself to be not perfect, and to be not well. Accept that things may not be going your way.
Many of us may have trouble doing this, because we may feel that it is our responsibility to be perfect, healthy, or in control. However, the truth is that we are human. Nobody is perfect, and nobody is in control all the time. We must extend the same compassion to ourselves that we would extend to our patients, our partner, and others.
Denying that you are in burnout will not make it better. In fact, it may make the situation worse. Refusing to experience and make space for your emotions will only add fuel to the fire.
Allow yourself to feel tired. Allow yourself to feel stressed. Allow yourself to need a break from it all!
We are all human, and we need to connect with these basic human feelings and needs. Accepting that reality is happening does not mean we are giving up. In fact, accepting reality - warts and all - is the first step to creating true change.
Now that you have allowed yourself to dwell in the truth about your experience, it is time to...
It’s time to fact-check your understanding of the situation and note all the participating elements. This may be a time to gather data from more sources, to ensure that the next steps you take really will move you in the direction you want to go.
As part of this, classify what you can control from what you cannot control.
There will be many factors in any given situation, such as the COVID-19 pandemic, that we cannot control. This may feel stressful, or make us feel that the situation can’t be improved. But the truth is, the reason you want to separate the factors you can control from those that you can’t control is that once you have done this, you can stop wasting attention, time, and energy worrying about things you simply cannot change.
Admitting what you cannot control is a massively liberating step that frees you up to put your attention toward optimizing the things you can control.
Some factors are just unchangeable reality and we need to work with them as they are. The regulations of your workplace, the weather, the distance you commute, your family, your neighbors are all factors you may not be able to control on demand.
But you may be able to control what you eat, when you sleep, whether you take the elevator or the stairs, what working conditions you ask for and seek out, how you conduct your pandemic protection rouine, and many other details that make a difference to your peace of mind and the quality of your day-to-day life.
For example, as a resident I couldn’t control the call schedule. But I could control what I listened to during my commute to work (a happy song or a helpful audio book vs. depressing news or stressful phone calls). That simple switch could drastically change the tone of my morning, and the rest of my day.
Now that we have identified all the things we can control in a situation and how we can use them to improve our lives, it is time to begin...
Expectation management becomes key when you are overwhelmed with responsibilities and time limitations.
For example, at the beginning of the pandemic when all kids stayed home from school, the expectations for allowed screen time had to be managed. More tolerance for increased screen time was a way to keep our sanity while the drastic changes to our lives.
Many situations require that we lower the expectations from absolutely ideal to “good enough” or “that’s okay.” Doing everything “well enough” may be better than doing one thing perfectly while everything else falls by the wayside, or pushing yourself and others to achieve superhuman standards of perfection.
Saying “no” can come in handy here. If you are a busy healthcare provider and also have other responsibilities in life, as all of us do, then saying “no” to volunteering for an extra shift when you have only one afternoon to spend with your family is wise.
It is not selfish. It is necessary.
Once we have settled on balanced expectations for the major areas in our lives, it is time to ask for...
Asking for help and reaching for support is essential when trying to improve your emotional wellness.
Let’s face it, life can be too demanding to handle alone. Trying to handle life alone can also be a lot less satisfying.
Don’t shy away from reaching out to friends, family, and even colleagues to ask for help and support in making the changes you’ve realized are necessary. Delegate work or organize your interpersonal resources for mutual benefit whenever possible.
While I was in training, a friend of mine and I took care of each other’s children during call duty. This was a huge help for both of us, and our kids had friends to play with a few days of the week even when Mommy was busy.
Once you’ve reached out for support and assistance and you know what interpersonal resources you have, it’s time to...
ORGANIZE AND PLAN
Organize and plan your schedule and your resources. Aim for specific daily or weekly goals. These can be very small. You might be amazed by the cumulative effect of a month of one or two very small changes.
Dissect your day-to-day schedule and look for opportunities to rest or spend quality time with family, pets, or friends, or with self-care. Be intentional about how this time is spent. Spending 30 mins scrolling through frustrating news articles and stressful social media messages probably does not count as very effective self-care. The power of each minute is not to be underestimated!
Try to take short, intentional breaks during the day, even if it is 5 minutes each. You will appreciate the accumulated benefit over time.
Think about your tasks. What is important? What is not? What is urgent? What is not.
Once you have a schedule and a plan lined up, it is time to...
Change is not easy. Yet every healthcare provider appreciates how compliance affects the success of any treatment plan. Something as small as remembering to take a pill each day - or not - can have devastating or transformative effects.
Consider your plan as a prescription. Make it realistic and manageable - and then stick to it.
What are the side effects of your new plan-prescription? Discomfort with unfamiliar changes? Saying “no” to some tasks and favors? Making some mistakes along the way?
What are the benefits? Reducing stress level and improving your appreciation of life far outweigh the risks of most such plans.
Keep your eyes on the prize: the benefits of your plan. Accept the side effects as a necessary cost of getting better.
Every day you follow your plan, you will find things getting a bit easier.
Now that you have a plan in place and you’ve made the decision to persist, it’s time to...
As time goes on, examine your plan. Are you feeling better? Is what you are doing working?
Ask trusted people about the changes they notice in you. Look for measurable results such as improved mood, finances, or hours of sleep. You may wish to begin keeping a bullet journal, including daily recordings of your mood and important health or well-being measurements and events. This can assist you in verifying how well your plan is working. Knowing how well your plan is working gives you the motivation to stick to it, and can show you how to make it even better in the future.
Adjust your plan as needed. You may wish to schedule regular “check in” points with yourself to determine if your plan needs an adjustment or an upgrade. Just remember: you may wish to space these further than a week apart to give yourself time to see how the current plan is working before you change it again. In the business world, plans are often evaluated and adjusted every three months, or quarterly.
This process is not easy, but it is doable! And it can transform your life. I have seen many healthcare providers change their lives by following these simple steps and believing in themselves.
So believe in yourself and carry on. These times are stressful, but when we take time to see the situation for what it is, accept it and allow it to be, we will soon find ourselves inspired to ask for help and make a plan to make things better.
Dima Arbach, MD is an Assistant Professor of Psychiatry. Board-certified in psychiatry and Obesity medicine. Partner and founder at Avicenna Behavioral Health where she practices body-mind approach to wellness and thriving at https://www.avicennabh.com/.