Where Does Burnout Come From?

This excerpt is adapted from Extinguish Burnout (SHRM, 2019) by Rob & Terri Bogue. It is the first in a three-part series on the effect of burnout at work.

Burnout is classically seen in three factors: exhaustion, cynicism, and lack of personal effectiveness. Of these three components, which are candidates to cause burnout? In other words, which came first: the proverbial chicken or the egg?

Originally published on SHRM.org. Read the full article here: https://www.shrm.org/ResourcesAndTools/hr-topics/employee-relations/Pages/Where-Does-Burnout-Come-From.aspx

Managing Demands and Preventing Burnout

Learning how to manage the multiple demands placed on you is an important part of managing your personal agency and guarding against burnout.  Managing demands is sometimes as easy as saying no – and sometimes it’s more complicated.

Burnout

In the first blog in our series, Thrive, Don’t Just Survive, we first defined burnout as the perception that you cannot change your environment and thus have no personal agency (your ability to get things done).  Burnout is frequently defined by exhaustion, cynicism, and inefficacy.  It’s what happens when we feel we have depleted our personal agency.  It’s when we feel like we don’t have any ability to make a change.  While our results, the support we receive, and our self-care fill up our personal agency, demands drain us.

The Valve on Demands

It’s commonly overlooked, but there is a valve on the demands that drain us.  We can say no, and we can manage our demands, so they don’t overly deplete our agency.  Often, we forget that, just because someone wants something from us, doesn’t mean that we must give it.

We don’t have to join the PTA, host the neighborhood watch meeting, agree to work overtime, or any of the other dozens of things that may ask for our assistance.  You can decline requests and save your ability to get things done for another situation or another cause to ensure you have enough reserves.

It gets harder when you need to say no at work to a peer, a manager, or someone on the team.  The reasons for saying no are different.  Some of the reasons for saying no are appropriate but have nothing to do with your need to manage personal agency.  When things are wrong or you can’t agree, then no is the right answer.  In business situations, after a polite no, it’s a good idea to start a dialogue about what is possible, whether your no is due to a disagreement or a need to maintain your agency.

When You Shouldn’t Say No

While it’s true that we can always manage our demands by saying no, there are times when this isn’t the right answer.  Sometimes the right answer is to persist, meet your commitments, and decide how to manage your demands in the longer term.  If there’s a crisis that your job requires you step into, it’s not a good time to say, “No, I don’t think I have the personal agency to support this.”  As healthcare providers, we are frequently required to act urgently for our patients, even if the condition isn’t life-threatening.  It’s incumbent on you to maintain reserves so that you can be ready for these circumstances.

The time to say no isn’t in a moment of crisis.  The time to say no is when you’re planning your activities, when you’re making the decision to pick up that extra shift, fulfill that extra committee role, or take on an extra project.  Once you’ve made the commitment to take care of a patient, you’re committed, whether you feel you have the capacity or not.

There are times when it feels like there is a gray area of what you can refuse and when you really cannot say no.  Where do you turn for help if you are unsure if you have the right to refuse?  Refer to your state’s Nurse Practice Act, your employer’s legal team and official policies, and Nursing Scope and Standards of Practice and Code of Ethics for Nurses.

Over Your Head

Just because you can’t say no in a moment of crisis doesn’t mean you shouldn’t ask for help – you absolutely should.  It is important to remember that asking for help is not a sign of weakness.  In truth, it is a sign of self-awareness and strength.  Whatever your capacity in a crisis is, the answer isn’t to stand alone or tough it out.  Instead, you should ask for support, so that you can share the load with others.  The more help that you can get from others, the less you have to carry.

Of course, you should equally be willing to support others when they call for help – even if they’re not good at calling for help.  Sometimes, supporting others means watching for situations where they may need help and proactively offering or providing support.

Learning how to manage the multiple demands placed on you is an important part of managing your personal agency and guarding against burnout.  Managing demands is sometimes as easy as saying no – and sometimes it’s more complicated.

Burnout

In the first blog in our series, Thrive, Don’t Just Survive, we first defined burnouts as the perception that you cannot change your environment and thus have not personal agency (your ability to get things done).  Burnout is frequently defined by exhaustion, cynicism, and inefficacy.  It’s what happens when we feel we have depleted our personal agency.  It’s when we feel like we don’t have any ability to make a change.  While our results, the support we receive, and our self-care fill up our personal agency, demands drain us.

The Valve on Demands

It’s commonly overlooked, but there is a valve on the demands that drain us.  We can say no, and we can manage our demands, so they don’t overly deplete our agency.  Often, we forget that, just because someone wants something from us, doesn’t mean that we must give it.

We don’t have to join the PTA, host the neighborhood watch meeting, agree to work overtime, or any of the other dozens of things that may ask for our assistance.  You can decline requests and save your ability to get things done for another situation or another cause to ensure you have enough reserves.

It gets harder when you need to say no at work to a peer, a manager, or someone on the team.  The reasons for saying no are different.  Some of the reasons for saying no are appropriate but have nothing to do with your need to manage personal agency.  When things are wrong or you can’t agree, then no is the right answer.  In business situations, after a polite no, it’s a good idea to start a dialogue about what is possible, whether your no is due to a disagreement or a need to maintain your agency.

When You Shouldn’t Say No

While it’s true that we can always manage our demands by saying no, there are times when this isn’t the right answer.  Sometimes the right answer is to persist, meet your commitments, and decide how to manage your demands in the longer term.  If there’s a crisis that your job requires that you step into, it’s not a good time to say, “No, I don’t think I have the personal agency to support this.”  As healthcare providers, we are frequently required to act urgently for our patients, even if the condition isn’t life-threatening.  It’s incumbent on you to maintain reserves so that you can be ready for these circumstances.

The time to say no isn’t in a moment of crisis.  The time to say no is when you’re planning your activities, when you’re making the decision to pick up that extra shift, fulfill that extra committee role, or take on an extra project.  Once you’ve made the commitment to take care of a patient, you’re committed, whether you feel you have the capacity or not.

There are times when it feels like there is a gray area of what you can refuse and when you really cannot say no.  Where do you turn for help If you are unsure if you have the right to refuse?  Refer to your state’s Nurse Practice Act, your employer’s legal team and official policies, and Nursing Scope and Standards of Practice and Code of Ethics for Nurses.

Over Your Head

Just because you can’t say no in a moment of crisis doesn’t mean you shouldn’t ask for help – you absolutely should.  It is important to remember that asking for help is not a sign of weakness.  In truth, it is a sign of self-awareness and strength.  Whatever your capacity in a crisis is, the answer isn’t to stand alone or tough it out.  Instead, you should ask for support, so that you can share the load with others.  The more help that you can get from others, the less you have to carry.

Of course, you should equally be willing to support others when they call for help – even if they’re not good at calling for help.  Sometimes, supporting others means watching for situations where they may need help and proactively offering or providing support.

The Impact of Trust on Burnout

Are you a trusting person?  The question isn’t whether you’re trustworthy but rather how easy do you find it to trust others.  The answer to this question may be the key to why you’re stuck in depression or why you’re relatively resilient to it.  The reason is all about your beliefs.

Trust is a Belief

Whenever you say you trust someone, you’re stating a belief.  Your trust, properly understood and tested, has limits and conditions.  When you say that you trust your accountant, you’re saying that you trust them to do your taxes.  When you say that you trust your babysitter, you’re saying you trust them to safely watch your child.  However, you likely wouldn’t let your accountant watch your child or your babysitter do your taxes.

Does your belief mean your accountant can’t make a mistake?  Of course not.  However, trusting your accountant is a simplification.  If you can’t trust your accountant, you’ll have to learn enough about your taxes to verify their work.  The desire to offload the responsibility for understanding the complicated tax code is why you hired an accountant in the first place.

Trust with Betrayal is Better

If you know that, at some point in your life, your trust will be unfounded, and someone will definitely betray your trust, should you still trust?  The answer is still yes.  The benefits that you get from appropriate trust outweigh the occasional betrayal.  The value of trusting others is that you don’t have to verify everything, which is time-consuming and exhausting.

Certainly, if you’ve recently been betrayed, it’s hard to accept that you should have trusted in the first place.  Surely the consequences of the betrayal mean that your net psychological gain-loss statement is negative.  It can be – and at the same time, overall, your trust has served you well.  Think of all the things that you didn’t have to verify.  How many meals at restaurants did you not have to prepare?  How many airplane flights ended successfully without you having to fly the plane?

As painful as a betrayal is – whether intentional or unintentional – it often doesn’t stand up against the weight of the verification and loneliness that becomes the only other option.  Betrayal is an important signal to improve whom you trust, for what, and for how long.  At the same time, it’s important to not sink into the belief that you’ll never trust again.

Trust That It Can Get Better

Burnout is only developed or sustained when there is a belief that things will not get better.  Burnout says that nothing you do matters, because you don’t have control or influence over the outcomes.  However, the alternative belief, that the current situation is temporary and things inevitably will get better, can immunize you from being infected by burnout.  The belief – the trust – that things will get better means whatever negative you’re enduring today, including a betrayal, is brief and temporary.

Trust Touches Everything

If you’re struggling to develop positive beliefs, you can start with beliefs that are easy.  You can believe in gravity, or that the sun will rise in the east tomorrow.  For most people, these are certainties that are easy to believe in.  From there, we move to the things that we inherently trust.  While this varies based on individual backgrounds, you may believe your parents will always love you, your friends will always accept you for who you are, or you’ll always “land on your feet.”  From there, it’s possible to extend trust, slowly and carefully, into areas where you’ve been betrayed, and into the space that it will get better, thereby using the power of trust to ward off burnout.

Avoiding Burnout by Rewiring for Happiness

It’s an unfortunate fact of life that evolution has shaped us to be more concerned with the negatives that happen to us than the positives.  If there’s a choice to worry about a lion hiding in the grass, the human who worried survived.  As a result, we’re predisposed to worry, be concerned about, and focus on the challenges we face instead of the opportunities.  However, as humans, we’re gifted with conscious awareness and a rational mind that can sometimes grab the reins of our historic perspectives and shift them a bit.

Happiness and Burnout

Burnout is caused by a feeling of inefficacy.  Those feelings flow more freely when you’re focused on the negative.  It’s easier to feel like you’re not making enough progress when you’re focused on the setbacks instead of the opportunities.  When you can refocus your attention on the things that make you happy and the things that are going well, you naturally feel as if you’re making more progress, you’re more effective, and life is better.

We tend to believe that we can compartmentalize our general mood and feelings into buckets and keep them from interfering with other areas of our lives.  However, research shows that our emotions in one area of our life bleed into other areas without our knowledge.  Stress reduces our creativity and our compassion for others – whether we’re aware of it or not.

Changing Happiness

Part of our happiness is defined by our genetics.  There’s a predisposition to a certain happiness level – sort of like setting a thermostat on the wall.  All things being equal, the heating and air conditioning will try to keep the temperatures set.  However, we can light a fire in the fireplace – which isn’t under the thermostat’s control.  While there are many ways to increase our happiness, two are particularly powerful: gratitude and savoring.

Gratitude

For most of us, meals are routine.  We enjoy a good meal, and we don’t give it a second thought.  Years after leaving home, children realize they took for granted what a great cook mom was.  We become accustomed to goodness and fail to realize how good things are now.  We can hold on to these things by making the conscious decision to catalog what we’re grateful for each day.

This might take the form of a gratitude journal, in which you write the things you’re grateful for each day.  The key point isn’t the writing.  The key point is to reflect on the day and recognize the good things.  It’s easy to succumb to our biology and focus on the negative, but by focusing on the positives, the things that we’re grateful for, we can shift our general mood and level of happiness.

When we recognize that more good things happen than bad, we lift ourselves out of the swamps of unhappiness.

Savoring

Recognizing the good things that are happening to us is a start, but unless you’re willing to dwell in them, they’ll still pass by too quickly.  That’s where savoring comes in.  Just like the idea of letting a forkful of a delicious meal sit on your tongue before chewing and swallowing, we can allow ourselves to experience the positive of the moment longer and more deeply before moving on.

Once you’ve built a habit of gratitude, you can apply it to your daily routine.  Instead of waiting until the end of the day, you can become more able to recognize good things when they happen – and savor those moment.  When someone holds a door for you, you can consider how the world is improving, how you’re a human worthy of respect and assistance.  Just lingering in these thoughts for a few moments is enough.

With these two simple techniques, you can develop your happiness, and ultimately help keep yourself out of burnout.

Self-Care or Self-Indulgence

Drawing the line between self-care and self-indulgence is a tricky proposition.  How much time should you spend recharging before returning to the battle to help others?  There is, it seems, no single right answer.  We know that we need to care for ourselves, yet when we’re doing that, we’re not sharing our concern with the rest of the world.

The problem is one of debt.  Not financial debt but a relational debt that we owe to ourselves.  We can continue to give and give, but eventually we’ll end up consuming our reserves, and we’ll start to borrow from our future in terms of our physical or mental well-being.  The debt service – the additional psychic cost – of being so depleted is debilitating.  Protecting ourselves from getting into this psychic debt should be and remains a priority.

The kind of thing that can keep us from psychic debt is an appropriate amount of self-care.  But what separates self-care from self-indulgence?  The short answer is the long-term impact.  Consider for a moment the idea of binge-watching your newest obsession with a television series.  It will likely be enjoyable and feel good for the moment, but, in most cases, it will bring no lasting joy, nor will it make you feel particularly refreshed.  As a result, it would fall under the category of self-indulgence.

It’s important to pause here and say that self-indulgence is necessary in appropriate amounts, just like food is necessary for our body – but it can be overdone, leading to obesity.  We need to accept that we can’t be “on” all the time.  We need to accept that there are times when self-indulgence is the right thing.  The key, however, is to not confuse the occasional self-indulgence with self-care.

Self-care leaves us with the residue of long-lasting benefits.  Each time we perform self-care, we develop a deeper understanding of ourselves or the world or the way we want to transform ourselves or the world.  Self-care makes the demands that we face in the future a bit lighter and strengthens our inner fortitude so that we can go out in the world and help others with bigger loads for longer.

Self-care might look like meditation, exercise, a contemplative walk in the woods, or a myriad of other things that build our long-term capacity to be ourselves, accept ourselves and our world, and, ultimately, sustain ourselves for longer.  Instead of a psychic debt, we build a psychic storehouse that’s stocked with the energy we need to persevere through long periods of intense load.

So, in the end, the difference between self-indulgence and self-care is simple: long-term impact.  The only complication is that sometimes that self-indulgence is self-care.  Sometimes you have to accept that the decision to allow yourself some self-indulgence is in itself developing a greater sense of acceptance and love for who you are and your need to be human – as long as the self-indulgence doesn’t go too far.

Burnout, Depression, or Both?

How can you tell if you’re just down, you’ve got depression, or you’re being consumed by burnout?  Sometimes, the official answers aren’t so useful.  Officially, depression is diagnosed based on the time and appropriateness of feeling down.  For instance, the loss of a loved one should cause someone to feel down – even for an extended time.  However, in general, the guidelines are a depressed persistent mood for longer than two weeks.

So how do you know if you’re suffering from depression directly, or if you’ve got burnout that’s leading to depression?  Being burned out increases the chances that you’ll develop depression, so perhaps burnout is the root cause of the malady of depression that you feel.

The real problem is what we call “depression” is such a broad category of things that it’s difficult to pinpoint a single cause.  From chemical imbalances to self-talk or self-image issues, depression can come from many sources.  Finding the root of depression keeps many counselors busy, and despite good work, counseling often seems to have limited ability to locate and eradicate the root cause.

One of the challenges is that we get so focused trying to find the source of the depression – the root cause – that we forget that many of the ways that are used to defend against and recover from burnout are the same techniques used for depression – regardless of the source.  We’re so worried about finding the cause, that we forget to focus on the cure.  Certainly, in some things, it’s essential to find the root cause, but in others there may not be any one root cause.  There may only be a set of causal factors that lead to the situation – none of which, if individually identified and resolved, solve the issue.

Whether you’re suffering from burnout, depression, or both, you may find that being more aware of the support you receive from others – and not discounting it – will lighten your burden.  Perhaps it’s learning to view the results you see from your efforts in a different light that will make things a bit brighter.  Maybe the challenge for you is learning how to set boundaries and develop decision-making criteria that will allow you to say no without feeling guilty.

Ultimately, the most powerful approach to dealing with burnout or depression is changing the way that you view yourself in terms of both your self-talk – the way you talk to yourself – and self-care – the way you take care of yourself.  If you can change the way that you talk to yourself to be more loving and more accepting of who you are, you’ll feel less internally-generated shame, and it will feel less like walking around in muck.  If you can learn effective self-care strategies, you can feel like you’re not indulging yourself, you’re rejuvenating yourself.

In the end, it may not matter whether you’re suffering from burnout, depression, or both.  It may be that your real goal is simply to find approaches that allow you to grow out of whatever pit that you’re in.

The Business Impact of Burnout

The World Health Organization (WHO) recently added new criteria for burnout as a part of its ICD 11 coding scheme.  This moves burnout forwards as a specific condition that can be diagnosed as an occupational phenomenon by health and mental health workers.  However, the impact to your business is more than just the fact that burnout can be formally diagnosed now.

What is Burnout?

Burnout was first discussed by Herbert Freudenberger in 1974.  Since then, the defining characteristics of exhaustion, cynicism, and inefficacy have held relatively stable – these are, in fact, the core of the WHO definition.  Though Freudenberger’s original work, and much of the subsequent work, targets burnout toward anything someone is passionate about, WHO defines burnout solely as an occupational phenomenon related to work.

Burnout has historically been assessed using variants of the Maslach Burnout Inventory (MBI).  More recently, the public domain Copenhagen Burnout Inventory (CBI) has become available for use to allow individuals to be assessed without the cost of the MBI.

What’s the Cost?

Because few organizations have assessed their employees for burnout with either the MBI or the CBI, it’s difficult to pin specific numbers to the impact of burnout.  However, we do know that there are several factors that are influenced by burnout.

Gallup reports that 85% of employees worldwide are not engaged or are actively disengaged in their job.  Employees can’t be engaged in the organization if they’re actively in burnout.  Organizations with the best engagement see turnover numbers that are 59% lower than those with low engagement scores (Gallup, Inc. 2017).  Further, we know from the Bureau of Labor Statistics that, across all industries, voluntary turnover was 24.6% in 2016, 25.7% in 2017, and 26.9% in 2018 (Bureau of Labor Statistics n.d.).  Josh Bersin estimates the cost of replacing an employee is somewhere between 1.5 to 2 times their annual salary (Bersin 2013).

Poor engagement costs your organization about 24% of your annual payroll, assuming 26.9% voluntary turnover, 1.5 times annual salary, and a 59% reduction in turnover.  (The cost rises to 32% if you use 2 times the salary.)

Gallup also reports that high engagement organizations have 21% higher profitability than their low-engagement peers.  In short, poor engagement – and thus burnout – hits the bottom line.

What Can Be Done?

Like any other aspect of your business, it’s possible to get control on the burnout problem and reign in the bottom-line costs – as well as the costs to the employees that you care about.  There are two ways you can support employees in their fight against burnout.

A Sense of Control

At the heart of burnout is a sense of hopelessness – that there’s nothing you can do to make things better.  Hopelessness is, at its heart, a lack of a feeling of control – or even influence – on the things happening around you.  The less influence you feel you have, the more hopeless you’re likely to feel.

Leaders can help the sense of influence by listening to employees, including their ideas and fears.  This doesn’t mean that you must utilize every idea provided or address every fear (if that were even possible).  Taking a small suggestion or simply listening at all can help restore a sense of influence and ward off helplessness.

Acknowledge Successes

After every success is the next challenge.  In business, we’re very accustomed to reorienting and getting ready for the next challenge.  However, in doing this, we sometimes don’t give our – or our employees’ – successes proper attention.  By spending a few minutes on acknowledging successes, we can restore a sense of agency with employees.  We can help them see that we are getting some wins.  It’s not all just a new hill to climb, there’s the one we’re standing on.

You don’t have to throw an elaborate party or even pause.  Simply acknowledging that the last win allows you to take on the next challenge is enough to break down helplessness and refocus everyone on the good work that is being done – even if you don’t win every fight.

Putting It Together

Burnout is a very serious issue for any organization that can cost up to a quarter of the annual payroll.  Helping employees avoid burnout isn’t impossible or even difficult.  A little bit of well-timed listening and a small amount of encouragement about the things that have already been accomplished can mean the difference between burnout and profitability.

References

Bersin, Josh. 2013. “Employee Retention Now a Big Issue: Why the Tide has Turned.” LinkedIn Pulse. August 16. Accessed June 11, 2019. https://www.linkedin.com/pulse/20130816200159-131079-employee-retention-now-a-big-issue-why-the-tide-has-turned/.

Bureau of Labor Statistics. n.d. Job Openings and Labor Turnover Survey. Accessed 06 11, 2019. https://www.bls.gov/jlt.

Gallup, Inc. 2017. “State of the Global Workplace.” Accessed 06 11, 2019. https://www.gallup.com/workplace/238079/state-global-workplace-2017.aspx.

Originally posted on Inside Indiana Business. You can read the full blog post here: http://www.insideindianabusiness.com/story/40741669/the-business-impact-of-burnout.

Burnout or Exhaustion

Many people fear that they have burnout.  Attached to burnout is a negative stigma that says you’re not good enough or strong enough.  As a result, people worry that they have burnout when they don’t.  While there’s nothing wrong with burnout, it’s not the same thing as simple exhaustion.  The problem comes from the fact that one of the indicators of burnout is exhaustion.  So, if you have exhaustion, how do you know that you don’t have burnout?

The answer is deceptively simple.  Do you still feel energized while feeling exhausted?  If so, you are just exhausted – not burnt out.  Here’s why.  If you still feel energized, you’re still pushing towards a goal.  That isn’t the behavior of someone who is burnt out.

Look at this another way.  If you could rest for an entire day, would you regain your zeal for your goal – or would you just trudge through the muck one more time to try to move a bit closer to the goal line?  In the first case, you’ve just reached the physical limits of your body.  In the second case, you’re most likely suffering from burnout.

Exhaustion is what happens when our physical and mental limitations are reached.  We find ourselves depleted of energy.  However, even after relatively short periods of rest, either from sleep or with a day of fewer activities, we bounce back like Tigger.  We find that our exhaustion was short-lived, and, with a brief recharge, we’re ready to go again.

A brief rest for someone with burnout seems to have no effect.  They don’t have the same desire that they once had.  The goals that seemed so important are suddenly a burden.  Instead of getting recharged, those with burnout often feel frustrated, afraid, and sometimes like they are failing.  Frustrated that they can’t regain their energy like they once did, and afraid that they’ll never be able to find their energy again.  They feel like they are somehow a failure, because they cannot make it all work like they want to.

If you want to know if you are simply exhausted, take the no-phone, no-internet test.  Plan a weekend where you’ve got no phone and no internet.  Plan to rest, relax, and, more importantly, disconnect from the rat race that most people call their lives.

Everyone can find a way to disconnect for a weekend.  There will be a way for the office to function without you.  You can bring the family with you if they’re more supportive than demanding.  Just put the brakes on your life and slow down.  If you end the weekend refreshed and chomping at the bit to get back to your world, it was a simple case of exhaustion.

If you end the weekend and feel more peace but no more energy, then burnout may have taken hold.  You’ll need to find ways to fill your personal agency by looking more closely for positive results, seeking the support of others, doing more self-care, and finding ways to limit both the demands that you place on yourself and those you accept from others.

While exhaustion is a symptom of burnout, not all exhaustion is burnout.

Don’t Give in to Burnout

Burnout is defined as feelings of exhaustion, cynicism, and inefficacy. What else could you feel if you know that, as soon as you hang up the phone, it will just ring again with the next customer? How can you avoid burnout when every day is an onslaught of the same thing?

Published on HDI. Read the rest of the article here: http://www.thinkhdi.com/library/supportworld/2019/dont-give-in-to-burnout.aspx