Keep the Flame Burning: How to Fuel the Fire as Caregivers
Avoid burnout and fatigue
By Alicia Backer, PTA
It’s probably safe to say that most of us chose this profession to help others. We have the opportunity every single day to have a direct and positive impact on our patient’s lives.
Our job allows us to spend a great deal of time with people where we are able to develop an authentic connection that considerably influences recovery and outcomes. With that relationship comes a high demand for empathy and compassion as our patients are usually coping with pain, impaired function, and/or declined quality of life. Over time, witnessing or being in the presence of those who have experienced traumatic events or are dealing with distress will have a negative impact on our ability to provide support and encouragement to others.
BURNOUT + SECONDARY TRAUMATIC STRESS = COMPASSION FATIGUE
Burnout and compassion fatigue are familiar to most of us. In recent years, burnout has been amongst the hottest topics in healthcare. The rising of perceived demands combined with the deficiency of perceived resources results in failure to meet expectations. This has caused a surge of frustration for many, if not most, healthcare professionals. Burnout has been consistently defined as a state of being mentally, physically, and emotionally exhausted, and is often conceptualized as resulting from chronic workplace stress. The moment a professional concludes that their workplace is causing these symptoms, they become victims of that workplace and the symptoms of burnout will start to take control of their lives.1 We all should be familiar with common signs and symptoms of burnout; fatigue, irritability, poor work performance, cynicism, relational difficulty, increased missed days of work, and withdrawal. Much of the research on burnout identifies “workplace factors” as the primary cause of these debilitating symptoms. If you were to ask any care provider if work is stressful the answer would likely be unanimous, “yes!”
Secondary traumatic stress, another component of compassion fatigue, is the emotional duress that occurs when we hear firsthand about other people’s traumatic experiences. In physical therapy, we are exposed to various levels of these stresses every single day. Some traumas may be more painstaking than others, but the result is the same, an accumulation of secondary traumas will slowly deplete your ability to empathize and provide genuine care for others. When we are frequently exposed to these small traumas the threshold of our autonomic response changes and we start to live in an elevated state of fight-or-flight. This is when things that shouldn’t cause worry will begin troubling us in ways we cannot easily recognize. We will eventually show signs of compassion fatigue as our capacity for combatting these weakens.
Unaddressed burnout and secondary traumatic stress will eventually lead to compassion fatigue which can be severely toxic to our professional and personal well-being. Compassion fatigue is defined as a state of physical, emotional, and psychological exhaustion from prolonged exposure of caring for others. Gentry and Dietz declare professional caregivers as modern-day superheroes who perform superhuman tasks to save the physical, emotional, and spiritual lives of people they hardly know.1 When you look at it that way there’s no wonder we are at a greater risk for compassion exhaustion. Gentry and Dietz also believe that compassion fatigue is not the inevitable consequence of working in a toxic environment, but instead a failure to develop the necessary “antibodies” of resilience needed to protect us from becoming infected.1 So how do we develop these antibodies?
RESILIENCE IN HEALTHCARE
Resilience is not a trait that you either have or don’t. Instead, it involves behaviors, thoughts, and actions that can be learned by all of us. Resilience is complex. Personality traits, life experiences, and your support system are major influencers on resilience practices. The complexity makes it hard to define. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress.2 It’s the ability to bounce back and grow in the event of adverse life experiences. Are we equipping ourselves and our teams with the skills to recover quickly from stressful events? Are we providing resources and support for our teams to combat burnout and compassion fatigue?
The level of resilience required for survival is at a much higher threshold than it was 20-30 years ago. Social media and its accessibility create a vector for information, whether good or bad, to reach a large audience in the blink of an eye. Life is also more demanding with overflowing schedules and higher expectations than it was years ago. Combine these with a job in healthcare and we have a recipe for disaster, burnout, and compassion fatigue. Our ability to deflect secondary stress, adapt, and grow must be that much greater.
Being a compassionate caregiver does not come without experiencing some pain. It’s natural and necessary for us to identify with the people we care for. However, there is a big difference between empathy and the deep suffering that drives so many caregivers out of the helping professions. Anyone working in healthcare knows that stress is inevitably part of the job description. Long hours, conveying bad news to patients and their families, and constant exposure to secondary trauma weigh heavily on us. It is critical that we foster a culture that encourages our employees to take care of themselves, but how?
BEST PRACTICES TO KEEP THE FLAME BURNING
Research on resilience training and how to contest symptoms of burnout and compassion fatigue has been around for years and has positively impacted many professions. Healthcare, however, has just recently jumped on the wagon and started using this information more proactively. Why? Because we’ve finally realized that it’s time to prioritize the health of ourselves and our colleagues so that we can continue to provide the highest quality of care for our patients and avoid the disastrous outcomes of unmanaged symptoms.
I began my journey as a physical therapy assistant in 2010. I was equipped, excited, and ready to serve others, or so I thought. In all my years of education and 12 years of practicing in various settings, I never received education or training on how to identify signs or survive the effects of burnout and compassion fatigue. I’ve worked for small and large companies, private practice to corporate hospital settings. None of which portrayed concern for my physical, mental, or emotional well-being as a caregiver. That’s wild! Until I recently started learning more about these topics, I hadn’t given my own situation much thought. Prior to working in healthcare, we have all experienced some level of hardship in our lives. Most of us have adapted and grown from these experiences but working in healthcare requires so much more tenacity. As healthcare providers and as educators, we need to do better. We need to prepare our students, our employees, and ourselves for overcoming adversity in healthcare, turning overwhelmed mindsets into productivity and purpose.
We have significant amounts of research on resilience training in healthcare. Formal programs help us gain the necessary physical, mental, and emotional skills to adapt, thrive, and grow in stressful situations. Improving resilience requires a shift in habits, beliefs, and behaviors so that we can maintain well-being, relationships, and work performance while functioning in stressful environments. Mindfulness, gratitude, and peer support are amongst the most popular addressed practices in literature and training.
Mindfulness is being fully present, aware of what you’re feeling, sensing, and thinking in the moment, without being overwhelmed or reactive in interpretation or judgment. It’s a way to self-regulate our response to a threatening stimulus and minimize activation of our sympathetic nervous system. This allows our bodies and mind to relax creating a better balance of parasympathetic and sympathetic activation.
Simple mindfulness practices include paying attention, living in the moment, accepting yourself, and breathing. The grind of life is fast and furious. Take time to slow down, find joy in simple pleasures, treat yourself well, and pause to take a breath. These can be practiced anywhere at any time and are easy to incorporate into our daily lives. Structured mindfulness practices, usually meditation exercises, require a bit more time and focus but are also highly instrumental in shifting mindset. Whichever you use, be consistent. Over time mindfulness practices will become effortless.
Gratitude improves our psychological health to help us overcome negative emotions. When we practice gratitude, we must pause for a moment to capture it. In that moment, the brain releases serotonin and oxytocin, neurotransmitters responsible for feelings of happiness and positive thoughts. Our brain is believed to be naturally conditioned to negatively biased input as we tend to be more alert to dangerous and threatening impulses. When we exercise gratitude, we are facilitating the necessary behavior changes to re-focus attention on the positive. People need a 3:1 positivity ratio meaning that for every negative statement we need to hear three positives.3 This is shown to increase resilience and happiness. Journaling, symbolic reminders (“gratitude rock”), expressing gratefulness to others, and random acts of kindness are just a few ways to practice appreciation. Creating a gratitude practice in your clinic is easy and can be a fun team-building activity to improve culture and morale and inspire vigor for taking care of others.
Philosopher and writer, Albert Schweitzer, was accurate when he said, “In everyone’s life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit.”1 Feelings of burnout and compassion fatigue commonly cause social isolation and loneliness. We are all affected by our workplace and creating a safety net of honest and caring feedback is essential for sharing our difficult, painful, and traumatic events at work. Establishing a network of peer support should be mandatory in your business.
Choose at least 2-3 people in your life that you trust to be a part of your support network. Talk directly with each person and ask them to hold you accountable to your personal and professional moral standards. Ask them to let you know when you’re acting in ways that are inconsistent with your beliefs and request opportunities to share specifics about your work experiences. During these encounters ask that they simply listen rather than trying to fix or solve your problems. The therapeutic value of just being able to relate your experience to another person is extensive. APTA Private Practice provides some excellent opportunities to facilitate and expand peer support. Conferences, peer-to-peer groups, and numerous committees are just a few examples. I encourage you to get involved and build a safety net that you’d feel safe jumping into.
BE PART OF THE SOLUTION
The strategies shared above are meant to provide guidance for your team, your students, and yourself. Because we are so focused on caring for others it’s important to remind each other that we also need to take some time to focus on ourselves. There is no “right” or “wrong” way to fuel your fire. Change the way you look at things and the things you look at change.1
When we foster our capacity for mindfulness, gratitude, and peer support, amazing things will happen. Think of it as a commitment to nurturing and reconnecting with ourselves and creating a culture to allow our team to thrive. Most importantly — we will become a powerful catalyst for change and growth in the greatest profession of healthcare. Let’s keep the fire burning.
1Gentry JE, Dietz JJ. Forward-Facing(r) Professional Resilience: Prevention and Resolution of Burnout, Toxic … Stress and Compassion Fatigue. OUTSKIRTS Press; 2020.
2Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. “Resilience Definitions, Theory, and Challenges: Interdisciplinary Perspectives.” EJPT. 2014;5(1):25338. doi:10.3402/ejpt.v5.25338
3Parker S. Smile & Move: A Reminder to Happily Serve. Give More Media, Inc.; 2008.
Alicia Backer, PTA, is owner and physical therapist assistant at North Born Physical Therapy in Thief River Falls, MN. She is a member of APTA Private Practice and the Impact Editorial Board and can be reached at firstname.lastname@example.org and on Twitter @AliciaBacker.