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BANNING BURNOUT, and beating the Blues Presenter: Hugh Irons RN., Master of Nursing (Community Health), MRCNA, Member Australian Counselling Association.

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Presentation on theme: "BANNING BURNOUT, and beating the Blues Presenter: Hugh Irons RN., Master of Nursing (Community Health), MRCNA, Member Australian Counselling Association."— Presentation transcript:

1 BANNING BURNOUT, and beating the Blues Presenter: Hugh Irons RN., Master of Nursing (Community Health), MRCNA, Member Australian Counselling Association : Training 14 th December 2010 Hugh Irons RN., December 2010

2 Distinguishing between stress and burnout Burnout is a form of chronic strain that develops over time in response to prolonged periods of high stress. (Dollard et al, (2003), Occupational stress in the service professions, Taylor & Francis, London) Hugh Irons RN., December 2010

3 Distinguishing between stress and burnout The state of burnout is qualitatively distinct to stress. Burnout may include some of the signs and symptoms of stress, but it also has its own features over and above stress reactions. Burnout is a long-term process characterised by “chronic malfunctioning” and negative and cynical attitudes towards clients and work in general. Hugh Irons RN., December 2010

4 Distinguishing between stress and burnout Whilst most people will experience periods of work stress, most people do not experience the more chronic and long-term condition of burnout. Three core dimensions of burnout have been identified: Hugh Irons RN., December 2010

5 Distinguishing between stress and burnout 1. Emotional exhaustion (feeling overextended and drained of emotional and physical resources) 2. Depersonalisation (negative, detached or cynical view of one s work) Hugh Irons RN., December 2010

6 Distinguishing between stress and burnout 3. Reduced personal accomplishment (low sense of achievement, feelings of incompetence, low sense of efficiency). While the symptoms of stress and burnout differ, the factors that contribute to stress, and in the longer term to burnout, are quite similar. Hugh Irons RN., December 2010

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8 BURNOUT May be mild, moderate or severe which at it’s most intense combines physical and mental exhaustion together with  Low morale  Feelings of insecurity  Workplace phobia  Overall pessimism  Defence mechanisms; denial, projection, anger  Reducing ability to cope with stressors  Gradual lack of concern for others, including colleagues. Hugh Irons RN., December 2010

9 OBSERVABLE BEHAVIOURAL WARNING SIGNS BLAMING OTHERS CRYING IRRITABILITY SHORT ATTENTION SPAN OVERACTIVITY NEGATIVE ATTITUDE SHORT TEMPER TAKING RISKS Hugh Irons RN., December 2010

10 EMOTIONAL WARNING SIGNS ANXIETY DEPRESSION FEAR FRUSTRATION GRIEF ISOLATION FEELINGS OF POWERLESSNESS FEELINGS OF WORTHLESSNESS Hugh Irons RN., December 2010

11 PHYSICAL WARNING SIGNS DIARRHOEA DRY MOUTH EATING DISORDER CLAMMY HANDS UPPER BACK PAIN STIFF NECK Hugh Irons RN., December 2010

12 And, from a Manager’s viewpoint Declining performance Increasing time at work / lack of leave requests Memory lapses Uncharacteristic mistakes and/or accidents Unwarranted criticism of others Lack of cooperation Declining enthusiasm Hugh Irons RN., December 2010

13 Preventing stress from becoming burnout Timely interventions are required. Burnout occurs when stressful working conditions are experienced over a prolonged period of time. Therefore, it is important to regularly monitor workers’ stress levels, and to take action to address stressors or stressful working conditions at the point when they begin to emerge. Hugh Irons RN., December 2010

14 An interesting finding “RN’s had a negative correlation between burnout and personal accomplishment….,indicating that as their lack of personal accomplishment increased, their burnout decreased. This linkage may have been based on detachment of the nurses or it may have indicated disengagement” ( Kennedy B R. “Stress and Burnout of Nursing Staff Working With Geriatric Clients in Long-Term Care” in Journal of Nursing Scholarship, 2005; 37:4, 381-382) Hugh Irons RN., December 2010

15 Important point If we are to prevent biopsychosocial dysfunction of nurses, and instead promote their physical and mental health ( i.e. a therapeautic workplace), the predominant factors contributing to nursing burnout should be crystal clear. But, they are numerous, part of a complex phenomenon. Hugh Irons RN., December 2010

16 For example: WORKLOAD AGE HARDINESS ACTIVELY COPING SOCIAL SUPPORT ROLE AMBIGUITY Hugh Irons RN., December 2010

17 The Cost of Complacency:: Decreased level of client care, low staff morale, increased sick leave, loss of productivity, increased workcover claims. Minimal Team Spirit. Reduction in Staff Loyalty. litigation Hugh Irons RN., December 2010

18 COST TO PERSONAL HEALTH Physical; e.g. sleeplessness, nausea, headaches, stomach and bowel problems, skin complaints, lethargy, hypertension. Psychological; e.g. Lost confidence and self-esteem, lost motivation, depression and suicide, anger and homicidal ideation, anxiety disorders, irritability. Social; disruption to family and friend ships Hugh Irons RN., December 2010

19 COST TO HEALTH SERVICES Victims may waste between 10% and 50% of work time. Increased sick Leave Increased staff turnover. Reduced efficiency and profitability, absenteeism, low morale, poor performance levels, increased training and recruitment costs. Hugh Irons RN., December 2010

20 REMEMBER: The absence of action (doing nothing) against workplace stressors does not ease the troubled waters, rather it may be seen as condoning the problem. Therefore, doing something is crucial So,consider the…. Hugh Irons RN., December 2010

21 Twenty Top Tips Hugh Irons RN., December 2010

22 Twenty self-help steps 1. ACKNOWLEDGE THE DAMAGE THAT CAN OCCUR 2. ACKNOWLEDGE Y O U 3. LET OFF STEAM APPROPRIATELY 4. STOP DENYING 5. AVOID ISOLATION Hugh Irons RN., December 2010

23 Twenty self-help steps 6. BE PREPARED TO CHANGE CIRCUMSTANCES IF NECESSARY 7. FIND PRESSURE BUBBLES AND BURST THEM 8. STOP OVERNURTURING OTHERS AND NURTURE YOURSELF 9. LEARN TO SAY NO 10. DELEGATE (at work and home) 11. REASSESS YOUR VALUES Hugh Irons RN., December 2010

24 Twenty self-help steps 12. PACE YORSELF 13. TAKE CARE #OF YOUR BODY AND MIND (It’s the only one you’ve got!) 14. MINIMISE WORRY AND 15 MAINTAIN A SENSE OF HUMOUR 16. TAKE ADVANTAGE OF DEBRIEFING 17. FULLY UNDERSTAND THE CONCEPT OF PROFESSIONALISM (more on this later) 18. UNDERSTAND THE CONCEPT OF “RATIONAL DETACHMENT” Hugh Irons RN., December 2010

25 Twenty self-help steps 19. Utilise assertiveness skills as oppo9sed to possible disrespect., 20.. Learn the Top Twenty Tips. And use’em. Hugh Irons RN., December 2010

26 What a staff member can do:: 1 As the health care staff shortage apparently continues, staff are working harder and burning out faster. For instance, too many battle- weary nurses are leaving the profession. Burnout creeps up on you. Look inside yourself for signs of unusual fatigue, insomnia, and general unhappiness in your practice. Hugh Irons RN., December 2010

27 What a staff member can do:: 2 Recognize how hard you work, how much you do, and how stressed you may be. Consider your colleagues too, especially those at the 2- or 3-year mark. They've worked so hard developing their nursing skills that they may not recognize how much pressure they're under. Even if they do, they probably haven't yet learned how to cope with the stress. Hugh Irons RN., December 2010

28 What a staff member can do:: 4 STOP DENYING. Listen to the wisdom of your body. Begin to freely admit the stresses and pressures which have manifested physically, mentally, and/or emotionally. Hugh Irons RN., December 2010

29 What a staff member can do:: 5 AVOID ISOLATION. Don't do everything alone! Develop or renew intimacies with friends and loved ones. Closeness not only brings new insights to stressors, but also fights agitation and depression. Hugh Irons RN., December 2010

30 What a staff member can do:: 6 CHANGE YOUR CIRCUMSTANCES? If your job, your relationship, a situation, or a person is dragging you under, try to alter your circumstance, or if necessary, leave. Hugh Irons RN., December 2010

31 What a staff member can do:: 7 DIMINISH INTENSITY IN YOUR LIFE. Pinpoint those areas or aspects which summon up the most concentrated intensity and work toward alleviating that pressure. Hugh Irons RN., December 2010

32 What a staff member can do:: 8 STOP OVERNURTURING. If you routinely take on other people's problems and responsibilities, learn to gracefully disengage. Try to get some nurturing for yourself. Pamper yourself !! Hugh Irons RN., December 2010

33 What a staff member can do:: 9 LEARN TO SAY"NO". You'll help diminish intensity by speaking up for yourself. This means refusing additional requests or demands on your time or emotions. Hugh Irons RN., December 2010

34 What a staff member can do:: 10 BEGIN TO BACK OFF AND DETACH. Learn to delegate, not only at work, but also at home and with friends. In this case, detachment means rescuing yourself for yourself. Hugh Irons RN., December 2010

35 What a staff member can do:: 11 REASSESS YOUR VALUES. Try to sort out the meaningful values from the temporary and fleeting, the essential from the nonessential. Hugh Irons RN., December 2010

36 What a staff member can do:: 12 LEARN TO PACE YOURSELF. Try to take life in moderation. You only have so much energy available. Hugh Irons RN., December 2010

37 What a staff member can do:: 13 TAKE CARE OF YOUR BODY AND MIND. Don't skip meals, abuse yourself with rigid diets, minimise sleep, or break the doctor appointm ents. Eat well, sleep well. Hugh Irons RN., December 2010

38 13 CONTINUED Thank yourself for doing a worthwhile and sometimes difficult job / task. Ensure that regular breaks are taken and use to relax. Learn relaxation methods. Try not to do too much. Take time to carry on with your favourite activities; walking, exercise, reading. Talk to the dog! Hugh Irons RN., December 2010

39 What a staff member can do:: 14 MINIMISE WORRY AND ANXIETY. Try to keep worrying to a minimum - it changes nothing after all. You'll see things more clearly if you spend less time worrying and more time taking care of your real needs. Pamper yourself again! Hugh Irons RN., December 2010

40 What a staff member can do:: 15 KEEP YOUR SENSE OF HUMORKEEP YOUR SENSE OF HUMOR. Bring happy moments into your life. Very few people suffer burnout when they're having fun!!! Hugh Irons RN., December 2010

41 What a staff member can do:: 16 Ensure you ‘debrief’ if necessary. Talk things through with a workmate or colleague Hugh Irons RN., December 2010

42 Fully understand the concept of Professionalism:: 17 More on this later. Hugh Irons RN., December 2010

43 Fully understand the concept of Rational Detachment:: 18 More on this later. Hugh Irons RN., December 2010

44 Fully understand the concept of Assertiveness:: 19 More on this later. Hugh Irons RN., December 2010

45 Use the Twenty Steps in your everyday practice. 20. Hugh Irons RN., December 2010

46 professionalism Exhibiting a courteous, conscientious, and generally businesslike manner in the workplace. But subject to:: Boundaries: Lines that are drawn to protect patients from being exploited by professionals who are more powerful Communication style and self awareness Hugh Irons RN., December 2010

47 WHY CARE ABOUT PROFESSIONALISM Network-Grievances often centre around professionalism Employee-Code of Ethics; builds confidence Employer-Prevents burnout and promotes mutual respect Patient is satisfied Hugh Irons RN., December 2010

48 The Pitfalls over self-disclosure-discussing personal problems Special treatment to a patient-bending the rules Patient giving staff special attention Selective communication “You and Me against the World” Name calling Threatening Discussing employer/employee issues (salary, staff errors, etc.) Hugh Irons RN., December 2010

49 ...and even more pitfalls... Moralizing Ordering Psychological diagnosing Gossip Flirtations Inappropriate dress Gifts Hugh Irons RN., December 2010

50 ...as it should be... Encouraging patient self-determination Providing informed consent Competence Not taking unfair advantage of any relationship Not having dual relationships Respecting privacy/confidentiality Explaining to staff our Codes of Ethics Empowering patients rather than creating dependency Hugh Irons RN., December 2010

51 Why is professionalism hard in health care settings the dialysis unit? Staff have baggage Difficulties at home Challenging situations at work Time constraints Not enough staff Multiple losses Patients have baggage Decreased ability to function independently Multiple losses Difficulties at home Hugh Irons RN., December 2010

52 Why is professionalism hard in health care settings Patients have baggage too! Decreased ability to function independently Multiple losses Difficulties at home Hugh Irons RN., December 2010

53 How do we stop “baggage” from affecting us? MAINTAIN BOUNDARIES!!! What is your purpose here? Why are you here? What is the goal? Whose needs are supposed to be met? HELPING RELATIONSHIPS ARE NOT RECIPROCAL!! PROFESSIONALS GET PAID! Hugh Irons RN., December 2010

54 How to Promote Professionalism in health care settings Be aware-if you deny power you are at risk of abusing it Be observant In-service over and over again Hugh Irons RN., December 2010

55 What if I am not sure whether I am being professional? Ask yourself these questions: Would this be allowed in another medical setting? How does this activity assist the patient in their care? Can this be documented in the medical record ? Are you willing to do this for all patients? Hugh Irons RN., December 2010

56 The concept of Rational Detachment ….. Rational Detachment ….. Rational detachment is the ability to stay in control of one’s own behaviour and not take ‘acting-out’ behaviour personally. Hugh Irons RN., December 2010

57 Rational Detachment Staff not able to control baggage, but can control how they react DO NOT internalize feelings DO NOT overreact This is OUR responsibility, not the clients’ Hugh Irons RN., December 2010

58 How do we rationally detach ? Know yourself What pushes your buttons? Don’t let someone find out for you. Recognize your limits What is your tolerance level? Anticipate and have a plan Positive outlets and coping skills Our response can either escalate or de- escalate the situation. Hugh Irons RN., December 2010

59 THE IMPORTANCE OF BEING ASSERTIVE Hugh Irons RN., December 2010

60 What is assertiveness? Assertiveness is the ability to ask questions, express opinions and criticise constructively As a way of having your voice heard. Assertiveness is a right and not a privilege. Hugh Irons RN., December 2010

61 BENEFITS OF BEING MORE ASSERTIVE This approach enables you to: Reveal to others the assistance you need to deliver high quality service Be the very best you can be in your role Have reasonable enquiries answered and needs met rapidly and effectively Ensure that you work competently and confidently Reduce your levels of stress to manageable and motivating levels Hugh Irons RN., December 2010

62 DISADVANTAGES OF BEING NON- ASSERTIVE NON - ASSERTIVE This approach will interfere with your ability to: To deliver a high standard of service and care Have your confusions clarified, information given and your reasonable workplace needs met Have reasonable enquiries answered and needs met rapidly and effectively Work competently and confidently Increase your levels of stress Hugh Irons RN., December 2010

63 Do you feel assertive?  Feeling confident;  Having self esteem;  Being myself;  Expressing myself;  Standing up for myself;  Feeling in control of my life;  Liking myself;  Respecting other and myself;  Making my own decisions;  Having the right to say yes and no for myself. Hugh Irons RN., December 2010

64 ASSERTIVENESS SKILLS Be Specific Decide what it is you want or feel and say so specifically or directly. This skill helps you to be clear about what exactly it is you want to say. Avoid unnecessary words and keep your statement simple and brief. Repetition (Broken record technique) This skill helps you to stay with your statement or request by using a calm repetition, over and over again. Using this technique, you can maintain a steady position without failing prey to manipulative comment, irrelevant logic or argumentative bait. Hugh Irons RN., December 2010

65 ASSERTIVENESS SKILLS  Fielding the response (fogging) In order to achieve a smooth verbal interaction and communicate effectively, you need to indicate that you have heard what the other person says, without getting 'hooked' by what they say. This skill allows you to acknowledge the response and still continue confidently with your statement or request instead of feeling defensive or aggressive. Hugh Irons RN., December 2010

66 ASSERTIVENESS SKILLS  Workable Compromise This is important to remember when there is a conflict between your needs and wishes and those of someone else. Assertiveness is not about winning so you need to negotiate from an equal position. This means finding a true compromise which takes both parties' needs into consideration. Compromising on a solution to a difficult situation need not compromise your self-respect. Hugh Irons RN., December 2010

67 BUT BEWARE OF BEING TOO ASSERTIVE Hugh Irons RN., December 2010

68 ENOUGH ABOUT THE WORKERS, WHAT ABOUT THE BOSSES! Hugh Irons RN., December 2010

69 Action Plan: employer. REMEMBER:: THE “BURNT OUT” NURSE BASICALLY WANTS TWO SIMPLE THINGS TO HAPPEN: 1) To stay in their job. 2) For the factors contributing to burnout to stop or at least be recognised and attempts made to reduce. Hugh Irons RN., December 2010

70 What Management should do Stress Audit Realistic expectations of the job Actively encourage all sorts of professional development Actively support career development Hugh Irons RN., December 2010

71 What Management should do Flexible working conditions Supervisors trained for recognising and minimising burnout Redesign the job itself? Positive recognition Active mentoring & Clinical Supervision Hugh Irons RN., December 2010

72 THE “S T R E S S A U D I T” The first stage in an intervention to alleviate stress or prevent burnout is a comprehensive assessment of stressors in the workplace as experienced by individuals or groups, and gauges the extent and nature of the difficulty. (Skinner N & Roche A M., 2005, Stress and Burnout, A Prevention Handbook…, National Centre for Education and Training on Addiction (NCETA), Adelaide, Flinders University.) Hugh Irons RN., December 2010

73 THE “S T R E S S A U D I T” But, to be unbiased, the responsibility should lie with an entity outside of the organisation. “A stress audit conducted by a Manager is not likely to deal with one of the most common workplace stressors – a poor Manager” (Jordan J et al., 2003, Beacons of excellence in stress prevention, Norwich (U K), Health & Safety Executive Hugh Irons RN., December 2010

74 So; IF WE PUT INTO PLACE ALL THE STRATEGIES DISCUSSED DURING THIS PRESENTATION, ARE WE LIKELY TO DEVELOP A WORKPLACE WHERE STAFF AT ALL LEVELS ARE ALWAYS SUPERB IN BEHAVIOUR AND WHERE STAFF BURNOUT NO LONGER EXISTS? SO, ALL WE CAN DO IS ACCOMPLISH THE BEST WE CAN, BUT BE PROACTIVE INSTEAD OF REACTIVE Hugh Irons RN., December 2010


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