This month’s newsletter is going to be a little different. I’d like to introduce you to my dear friend Crystal Pompos, who I talked about a little in last month’s Q-Wave.
Crystal is a nurse. She’s been an RN for 18 years and she has an MBA and MSN in health care management. At the Moffitt Cancer Center, she’s kind of like Morgan Freeman from Shawshank Redemption. She just makes stuff happen, you know? I’ve learned more about Crystal’s passion as I’ve gotten to know her. Crystal’s passion is not only nursing, but the toll medicine takes on practitioners and how we get burnt out. What is burnout? How do you put into words what burnout is?
Crystal: I believe burnout is an insidious process. It’s not like you just wake up one day and you’re burnt out.
Burnout comes from multiple directions and stressors, specifically our occupational stressors. It can appear with symptoms of fatigue, severe fatigue that results in exhaustion. We have bad feelings about our job and our workloads. These cynicisms can even make us question whether we’re really even competent to do our job anymore.
Burnout can really take a hit on us emotionally and mentally and physically.
I have studied burnout over the years. At the beginning of my career, I was a trauma ICU nurse. Trauma nurses in the ICU struggle with PTSD and burnout quite significantly, along with any emergency medicine or ICU practitioner.
That’s when I first became interested in the topic. How can I prevent this from happening in my career? This question led me to start my business, RN Rainmaker. I initially thought I would just focus on burnout in nurses, but other health care providers have reached out to me.
I realize that burnout is such a significant concern in the health care field, and we have a hard time speaking up about it or asking for help for it.
John: This has become a big enough deal that burnout will be named an occupational phenomenon in the ICD-11 beginning in January 2022. So, burnout is going to be a diagnosable psychological disease?
John: I see two problems here. First, let’s have one conversation with leaders, gatekeepers, people who hire. Let’s just spend a few minutes talking about corporate responsibility, especially with this upcoming diagnosis. What advice do you have as a nurse manager specializing in burnout prevention? What’s your role and how do you engage with your staff?
Crystal: In my role as a nurse manager, I’ve been over several programs and currently have approximately 125 employees at Moffitt Cancer Center. We have tough jobs too.
It’s not just in the ICU or emergency medicine. When you’re in oncology care or transplant, you see a lot of things. You’re with patients for a lot of emotional experiences. Leaders need to have a pulse on what’s going on. Not just clinically, but emotionally and psychologically within the unit.
It’s not just about the care that’s given to the patient or how your practitioners are feeling that day during their shift, but what’s going on in their personal life? Do you know your employees? Do you know what’s going on in their world? Our personal lives run parallel to our professional lives, and sometimes they intersect and impact one another. We think that we should be able to keep them separate. They’re not separate. We live, eat, and breathe our work. We bring our home stuff to work with us.
I always say, “We all carry backpacks.” Some people’s backpacks are much heavier than others. Some unpack it in front of people and some keep it really balled up inside. I think keeping that pulse means getting to know your employees on a personal level. Really talk to your employees; ask them “How are the kids doing? How was vacation?” Care about them.
John: When I look back at my 22 years as an emergency medicine PA, I remember the bosses for whom I was just a resource. I also know the bosses who cared for me and really nurtured me. They wanted to see my potential. I’ll never forget them.
If you’re reading this right now, I want you to think about your boss now and your bosses in the past. Think about the bosses who really empowered and nurtured, and those who just didn’t care. You know who I’m talking about. They’re the ones who they have their own agenda.
Crystal: Because the World Health Organization is classifying burnout as an occupational diagnosis, it is an organization’s fundamental responsibility to make sure that their employees avoid or come out of burnout. I think this classification means addressing burnout on a much deeper scale than we do now.
It’s not just an employee assistance program and access to counseling. It’s screening, prevention, and really getting people help. We need to break the stigma of getting that help.
I believe the missing component in many programs is routine screening of employees, especially direct care providers. I think that screening needs to be on an ongoing basis and available at any time. When someone’s feeling burnt out, they don’t need to wait for the next survey to come along. They’re able to go online and take a survey to see if they’re burned out. Then, they’re quickly directed to counseling that can actually help intervene.
John: As a business owner and employer, it took me time to realize how essential support is. I love my employees and I care for them so deeply, but as a younger entrepreneur, I didn’t see the importance of burnout prevention.
Let’s talk about the personal side of things. There’s clearly a corporate responsibility, no question. There’s an educational component that, quite frankly, I wasn’t even aware of until a couple of years ago. It was my experience working in emergency medicine, that when you have a bad case, you suck it up. I had one, just one, case that was really bad and I had to go to a debriefing. But I want you to understand that this is very real.
Crystal, when someone experiencing burnout calls you, and they’re really at their wits’ end, how do they think? How do they think about their job? How do they think about their life? What are some things that you’ve heard?
Crystal: They didn’t expect it. They didn’t see it coming. They’re heartbroken that they’re in this place. They may not admit it at first, but they’re heartbroken. It eventually comes out. They didn’t go to school for this. I hear that a lot. “I didn’t go into medicine for this.”
I hear hopelessness sometimes. Through coaching, I dive into very fundamental topics with each client. We get so caught up in our heavy, heavy workloads. Patient acuities are higher than ever because our population is aging. We’re working with fewer staff because baby boomers are retiring and we’re not filling those spots.
John: If you’re reading this and thinking it doesn’t resonate with you, that’s great. But it doesn’t mean it will always be this way. If some of the things Crystal’s talking about start creeping into your life, you better pause. It’s kind of like a decompensating COPD, right? You want to BiPAP them early so they don’t crash. You really want to get on top of this. Burnout could manifest itself in you, a coworker, a spouse or a child.
Crystal: Self-awareness is huge. This may not be happening to you right now, but we’re all susceptible. It can happen to any of us at any time. There are certain things we should turn into well-ingrained habits so we can’t make excuses for letting them slip away.
Energy is composed of four components: physical, mental, emotional and spiritual. The physical component is central, but they’re all essential. When you’re missing one of them, you start feeling the burn.
John: It’s like the wheels on a wagon. When one wheel falls off, the wagon doesn’t roll so smoothly.
Crystal: No, it’s kerplunk, kerplunk. The energy is comprised.
The physical energy is exercise. Routinely working off stress and keeping our bodies in condition to respond – especially when you’re in emergency medicine. We have an adrenaline rush mimicking the fight or flight response. Our cortisol levels rise. It’s essential that we exercise and keep our bodies fit. The fuel that we feed our bodies is also really important. It’s easy to grab comfort food whenever we’ve had a rough shift.
Next is our mental intelligence. Are we getting our degrees, getting into our jobs, and just not flourishing mentally? We should be lifelong learners, and not just be in medicine. It could be learning emotional intelligence, reading books, exploring the world or learning about different cultures.
Then we get to the emotional component of energy. If we’re not sleeping well because we’re worried about the patient we left or some charting that we did or didn’t do, what are the consequences? That can create emotional stress. A lack of sleep will impact our emotions.
Our emotions are also greatly impacted by our thoughts. What thoughts do you allow yourself to have? We can have good stories or ugly stories. If we allow those ugly stories to creep in, we can tell ourselves stories about our practice that aren’t really factual. We tell ourselves that we’re not competent or we can’t handle this work. In fact, it could just be your workload.
Our thoughts control our emotions, and therefore control our words and actions.
John: I started telling stories about my patients. All of a sudden, I’m making up things in my head that really break the fiduciary relationship. I think it was worse for me when I would tell stories about patients abusing or manipulating the system. That was very toxic for me.
Crystal: How often did you tell the stories to someone else, who then internalized that ugly story? Instead of finding some way to connect with the patient to get to the heart of what’s wrong, you’re all thinking about this ugly story.
Spiritual energy is the last component. Spiritual energy does not necessarily have to connect with religion, but it can. For me, it does. I have a strong faith and I rely on that faith to spiritually renew me and to add to the energy level that I maintain.
However, spirituality is just the belief in something higher, the belief that we have a purpose here and that there is a greater good. You can experience that in many different ways, through prayer, just going for a walk in nature among the trees. Finding what feeds your soul is really important.
What I find in my clients experiencing full burnout is that all four of those components are missing. They forgot to take care of themselves along the way because they were too tired after a long shift. The workload was really heavy and, eventually, their fatigue turns into exhaustion. You get to burnout. You stop caring.
You just don’t know how to climb out of it once you’re there. It’s our responsibility to show up every day in a healthy way. It’s also our responsibility to take care of ourselves so that we can endure the stressors of medicine.
John: There was a pre-hospital care book I read with an introduction that said something like, “Our patients didn’t pick us. We chose to care for them.” They just got sick and came into the emergency room. Anyone working in medicine has a responsibility to be optimal. When you go to work tired, fatigued, emotionally exhausted, bitter, sarcastic, or flippant, you go in with an unhealthy emotional barometer. You have to remember that we’re choosing to take care of patients, but they didn’t choose us.
A physician once said to me, “Remember your essay.” What did he mean? He went on, “Before you got into any kind of professional school, you had to write an essay.” I wrote about altruism, about service. How can I help others? How can I get the skill set, the education, to be of deep service to others?
When you wrote your essay, you made a contract with the universe. If you’re reading this, there’s a very good chance you are questioning that contract. You are questioning the reason why you practice medicine.
Crystal: Absolutely. Our original “why” gets lost and we forget why we’re showing up. I ask my clients, “Why did you go into medicine? Why did you become a PA? Why did you become a nurse? What was your purpose? What did you want to do? How is that different from now?” Getting back to that why is essential in healing and moving forward. It can really elevate you to live your best life again.
John: Let’s talk about what to do if this conversation is really resonating with you as you read it. You’re thinking, “I feel like I could be on very thin ice here and if the ice gets a little thinner, I’m going to break. Something’s going to break.” What are two or three things that you would advise them to do?
Crystal: First and foremost, I would seek help through counseling or coaching. I find that both together works best. I think finding a reason to continue on is important. You can’t throw in the chips. Love yourself enough to do something about it.
We as health care providers are the ones people look to for help. We’re very reluctant to ask for help. Have that courage to step forward and say, “I need help.” I want you to also have the courage to approach your peer you think could be in burnout and have that conversation.
Reach out to me at email@example.com so we can have a conversation about whether coaching would be a good fit for you. Let’s develop a personalized plan. If you don’t reach out to me, I just implore you to reach out to someone.
I go through all the components of burnout with my clients to try to identify some low-lying fruit. Some small wins will help you feel better about the process. Sometimes just that first step really starts reigniting that flame in you. As you take baby steps towards your goals, you’ll see results more rapidly.
To listen to John’s entire conversation with Crystal, visit the Talk EM podcast!