- by Lori Elliott

This is the first in a series. The second can be found here.

We have now surpassed the two-year mark of the pandemic and caregiver burnout is at an all-time high. In October 2021 the Ontario Covid-19 Science Advisory Table released a science brief called Burnout in Hospital-Based Healthcare Workers during Covid-19.

What is burnout? The World Health Organization classifies burnout as as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed." It can describe anyone whose health is suffering or whose outlook on life has become negative due to work stress. Signs of burnout include physical illness and emotional exhaustion; a loss of empathy, caring and compassion and a decreased sense of accomplishment. Burnout includes physical responses, such as changes in sleep patterns and gastrointestinal issues. It can also cause emotional responses, such as anger toward others or oneself and feeling unsafe or vulnerable. Mental responses may also occur, such as difficulty concentrating and behavioural responses, such as substance misuse, increased conflict with others and social withdrawal.

A key message in the Ontario Covid-19 Science Advisory Table brief is that burnout is an occupational hazard in health care, which harms the health care system, patients and healthcare workers. The research determined that the pandemic increased burnout rates to a level that threatened the functioning of the health care workforce. The brief also conveyed that burnout and other indicators of stress are expected to continue long after the pandemic ends. Though the brief focused on healthcare workers in hospitals, it identified similar challenges in other health care settings, such as long-term care, primary health care and public health settings.

The brief outlined that, in the spring of 2020, the prevalence of severe burnout was found to be between 30 and 40 per cent. By the spring of 2021, the study said that burnout rates in Canadian physicians, nurses, and other healthcare professionals were higher than 60 per cent. It is my guess that here, another year later, this rate has, again, drastically increased. I recently had the chance to speak with some Grey Bruce area emergency department staff and they said it seemed the rate of burnout has indeed increased, due to a lack of managerial support and insufficient staffing.

The Ontario Covid-19 Science Advisory Table study found that those professionals most at risk of burnout include nurses, intensive care unit and emergency department staff, recent graduates, and trainees. I would add all first responders, during the pandemic, to that list. The study found the rates of burnout were primarily driven by significant cycles of understaffing alongside difficult work conditions within the pandemic and concluded that sustained burnout will likely continue to contribute to staff retention challenges, due to health care workers leaving their professions. The brief indicated that "a vicious circle may be underway" where understaffing leads to increased burnout and an even weaker health care workforce.

The brief's intervention recommendations included organizational changes to ensure proper staffing, consistent evaluation of staff workloads, efforts to reduce overtime, reduction of staff deployment to areas where they lack training, and avoidance of long shifts. A supportive work culture, starting with effective leadership, was also recommended. The study found that organizational interventions had greater effects on reducing burnout than individual interventions.

Nonetheless, I will go on to outline some individual intervention suggestions as the brief also notes, "individual-level interventions include education and stress reduction techniques and should be complementary to organization-level interventions. Interventions that reduce burnout by even a small amount reduce adverse consequences."

The opposite of burnout is compassion satisfaction, which is feeling like it's a pleasure to help others through one's work, feeling positively about colleagues, and feeling able to contribute within one's work setting and/or toward the greater good of one's society. The first step away from compassion satisfaction isn't burnout, it's compassion fatigue. Compassion fatigue is emotional and physical fatigue that may take place when the person is unable to refuel and regenerate after helping those in despair.

You can think of it as first needing fuel in your own tank before you're able to take others for a ride. It's a natural consequence of consistently helping others without applying regular coping skills. Organizations may also benefit from awareness about compassion fatigue since studies show that compassion fatigue accounts for 54 per cent of all job-related absenteeism. There are various risk factors that can increase the likelihood of one experiencing compassion fatigue (aside from being a health care professional within a pandemic).

These risk factors include experience of major life losses, changes or other stressors, personal history of trauma, dual roles in the workplace, difficult personal history, over-exposure to trauma, being in an early stage in one's career, a lack of resources, a lack of self-regulation and general coping skills, and having little awareness of the traits of compassion fatigue and how it can become burnout.

Awareness of one's physical and emotional indicators is the first step toward implementing coping skills/individual interventions. A key indicator of compassion fatigue may be described as feeling like you have nothing left to give.

It's important to keep in mind that burnout is on the far end of a spectrum and that a person's status within this spectrum is constantly changing; at any point in time they will fall somewhere within the four stages of the spectrum: 1) compassion satisfaction 2) compassion satisfaction leading to compassion fatigue 3) compassion fatigue and 4) burnout. When the person consistently applies coping skills/individual interventions, the likelihood that they will fall within the compassion satisfaction stage increases.

Lori Elliott, M.S.W., R.S.W., has worked as a publicly funded mental health professional in the Grey-Bruce area since 2009and is currently a full-time psychotherapist in Grey-Bruce.