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Burnout
BURNOUT
Burnout has come to be an alarming problem in all facets of society. People in the helping professions seem to be inordinately affected. The pressures to achieve as well as the desire to do everything well makes one especially vulnerable to burnout, Webster dictionary defines burnout as “. to fail, wear out or become exhausted by making excessive demands on energy, strength and resources.“l Burnout can occur irrespective of age, sex, and occupation. Therefore, nurse-midwives are not immune to this entity. According to Seuntjins, “between 35 to 60 percent of hospital personnel leave the work force every year.“2 According to Buechler,3 the primary reasons consistently stated by nurses for leaving are lack of job satisfaction and not feeling adequately appreciated by patients and doctors, typical symptoms of burnout. Burnout destroys the motivating spirit and enthusiasm that brought the person into the helping profession in the first place. To leave or drop out completely from one’s profession only makes the person feel unfulfilled, defeated, and left with a sense of failure. Why do people have burnout? There is no specific answer to this question. It seems the causes of bumout are many; and often it is a combination of factors that contribute to the susceptibility to burnout. As nurse-midwives, we are in a peopleoriented service profession. We are
Journal of Nurse-Midwifery
?? Vol.
expected to provide quality maternity care to mothers and babies. The amount of nurturing, commitment, and physical and emotional energy nurse-midwives expend to deliver quality care often is at the expense of their own emotional and physical well-being. Could it be that on the unconscious level so many of us have a deep desire to prove to the world that we can do it all? This intense drive to achieve, to excel, and to change the maternity care delivery system will sooner or later become a compulsion when it is done in an injudicious manner. This obsession may ultimately prove to be unhealthy and injurious to our bodies and spirits as well as to the very survival of our profession. Where does this compulsion come from? Some feel obsessive behavior is self-imposed. Yet, this very quality may be what first led nurse-midwives into territories and institutions where maternity care once was the sole domain of the physicians. The tendency among certified nursemidwives (CNMs) to overextend themselves professionally may simply be a manifestation of their perpetual strivings to legitimize themselves and their profession by doing more and driving harder. It is no small task to initiate and maintain a nurse-midwifery practice in today’s consumer-oriented milieu where obstetric practice is still ultraconservative. The need to be accepted as equal partners within a maternity
31, No. 3, May/June
Copyright 0 1986 by the American College of Nurse-Midwives
1986
care team where obstetricians automatically assume the leading role has been a frustrating one for assertive nurse-midwives. This is only compounded by their very humanness which requires that they feel loved, appreciated, respected, and recognized. When the approval, acceptance, and equality are not forthcoming, they become frustrated, angered, and feel a sense of powerlessness. To further attempt to live up to the image of an ideal nursemidwife under these circumstances will only direct the person onto a path of burnout. Can burnout among CNMs be prevented? What intervention strategies are helpful? There are already too few nurse-midwives in this country. Can we afford to have further attrition and dropout due to burnout? Those nurse-midwives whose pnmay role is caring for high-risk populations are themselves high-risk candidates for burnout. Many of the institutions in which they serve have inadequate personnel and resources that create daily frustrations for the dedicated health care provider. There are also external and internal forces that control the course and operation of the institution over which nurse-midwives have no control. Nurse-midwives who lack the knowledge of the underlying sociopolitical structure within their workplace and who commit themselves to the betterment of maternity care soon feel overwhelmed and victim-
119 0091-2X32/86/$03.50
ized when they ty to enact change. Many nurse-midwives do not possess either the power or the position that enables them to make certain necessary changes. As clinicians, we are often too absorbed in patient care activities and are too politically naive to be effective change agents. Comparable pay for jobs of comparable worth hardly applies to nurse-midwives when many of our colleagues are still earning a salary comparable to that of the nursing supervisors. Some of the usual challenges of our worth are “How can you compare a nurse-midwife with a physician?” “Nurse-midwifery care should be cost effective.” It seems that the real issue is not whether one can compare a physician with a nurse-midwife, but whether the methods used to compare them are unbiased. Compensation should be based on the quality of performance rendered by the qualified provider and not solely on one’s credentials on paper. Health care agencies need to consider a different reward system for their workers. Rewards do not necessarily have to be in the form of money, although it is an important and necessary consideration for quality of living. Rewards could include compensation for time off, sabbatical leave as well as monetary reimbursement, and time for professional development. Herbert Freudenberg&r4 defines burnout as a wearing down and wearing out of energy. “It is exhaustion born of excessive demands which may be self-imposed or externally imposed. It is a feeling state which is accompanied by an overload of stress and which eventually impacts on one’s motivation, attitudes and behavior.” For burnout management and prevention, one must first recognize the symptoms of burnout. To intervene and break the burnout cycle, one needs the support of colleagues, friends, families, and whoever else is important in one’s life. When we are dealing with the frustrations of our
120
work conditions and work place, many of the intervention strategies will have to take place during off hours. These have to do with building and maintaining a satisfying personal, social, and family life. If the job does not provide one with fulfillment and challenge, then the job can not be a person’s sole source of satisfaction. To reevaluate one’s career goals by either changing jobs or changing occupations will have to be seriously considered. According to some sociologists, no matter how much the institutional environment is modified, some of the causes of bumout are still unavoidable. For example, in many public institutions it is beyond the power of the management to do away with client’s resistance to change, the shortage of funds for human services, the tendency of people to engage in political and power gain, and the disappointment and frustration of the providers not being able to exert their influence on people to make the needed changes. Perhaps, the nurse-midwifery education program will need to introduce their students to the reality that, although nurse-midwifery is a helping profession, the professionals do not have to be loved or appreciated by all. The idea that nursemidwives are superwomen who are competent as well as born leaders in their chosen profession is a figment of the imagination. Nurse-midwives are human beings, who are not omnipotent. They need to learn and acquire good leadership skills through training and experience. It is essential that we know what we can do and what we cannot do. This, however, does not mean that we should not become actively involved in working with and through people to make changes. It is our responsibility to facilitate change; whether or not people will change, however, is their decision as well as their ultimate responsibility. We have to learn to focus on successes rather than mistakes and failures. To dwell on past
problems unnecessarily consumes one’s energy and time without constructive gain. Learning to manage pressure and stress in a positive manner is crucial to the prevention of burnout. The above suggestions seem to be so basic and self-evident that often they are easier said than done. The ACNM must also assume partial responsibility for the prevention of burnout among its members. To those nurse-midwives who have contributed tirelessly and unselfishly toward the advancement of our profession, public recognition is long overdue. Some new mechanism, in addition to the annual presentation of the Hattie Hemschemeyer Award, needs to be established to show appreciation to the many CNMs who for years have labored with distinctions as scholars, teachers, and clinicians. And what of the many who have maintained a lower profile while continuously serving the College? We cannot allow any of these valuable members of our profession to fall victim to the burnout phenomenon. To feel needed and appreciated is a very basic need. Surely, the College is in a position to recognize and reward professional and organizational achievement and dedication. In the final analysis, this may be the key to counteracting the speed of burnout.
Lily
Hsia, CNM,
MS, CPNP
REFERENCES 1. Webster’s third new international dictionary.
Springfield,
MA, G and
C
Mertian Co., 1966, p 300. 2. Becker, HS: Notes on the concept of commitment. Am J Sociology 60:3240, 1960 3. Buechler, Donna K: Help for the burnout nurse. Nurs Outlook 33:4: 18185, 1985. 4. Freudenberger, Women’s burnout. day and Company,
Journal of Nurse-Midwifery
?? Vol.
HJ, North, G: New York: DoubleInc., 1985, p 9-10.
31, No. 3, May/June
1986
Burnout has come to be an alarming problem in all facets of society. People in the helping professions seem to be inordinately affected. The pressures to achieve as well as the desire to do everything well makes one especially vulnerable to burnout, Webster dictionary defines burnout as “. to fail, wear out or become exhausted by making excessive demands on energy, strength and resources.“l Burnout can occur irrespective of age, sex, and occupation. Therefore, nurse-midwives are not immune to this entity. According to Seuntjins, “between 35 to 60 percent of hospital personnel leave the work force every year.“2 According to Buechler,3 the primary reasons consistently stated by nurses for leaving are lack of job satisfaction and not feeling adequately appreciated by patients and doctors, typical symptoms of burnout. Burnout destroys the motivating spirit and enthusiasm that brought the person into the helping profession in the first place. To leave or drop out completely from one’s profession only makes the person feel unfulfilled, defeated, and left with a sense of failure. Why do people have burnout? There is no specific answer to this question. It seems the causes of bumout are many; and often it is a combination of factors that contribute to the susceptibility to burnout. As nurse-midwives, we are in a peopleoriented service profession. We are
Journal of Nurse-Midwifery
?? Vol.
expected to provide quality maternity care to mothers and babies. The amount of nurturing, commitment, and physical and emotional energy nurse-midwives expend to deliver quality care often is at the expense of their own emotional and physical well-being. Could it be that on the unconscious level so many of us have a deep desire to prove to the world that we can do it all? This intense drive to achieve, to excel, and to change the maternity care delivery system will sooner or later become a compulsion when it is done in an injudicious manner. This obsession may ultimately prove to be unhealthy and injurious to our bodies and spirits as well as to the very survival of our profession. Where does this compulsion come from? Some feel obsessive behavior is self-imposed. Yet, this very quality may be what first led nurse-midwives into territories and institutions where maternity care once was the sole domain of the physicians. The tendency among certified nursemidwives (CNMs) to overextend themselves professionally may simply be a manifestation of their perpetual strivings to legitimize themselves and their profession by doing more and driving harder. It is no small task to initiate and maintain a nurse-midwifery practice in today’s consumer-oriented milieu where obstetric practice is still ultraconservative. The need to be accepted as equal partners within a maternity
31, No. 3, May/June
Copyright 0 1986 by the American College of Nurse-Midwives
1986
care team where obstetricians automatically assume the leading role has been a frustrating one for assertive nurse-midwives. This is only compounded by their very humanness which requires that they feel loved, appreciated, respected, and recognized. When the approval, acceptance, and equality are not forthcoming, they become frustrated, angered, and feel a sense of powerlessness. To further attempt to live up to the image of an ideal nursemidwife under these circumstances will only direct the person onto a path of burnout. Can burnout among CNMs be prevented? What intervention strategies are helpful? There are already too few nurse-midwives in this country. Can we afford to have further attrition and dropout due to burnout? Those nurse-midwives whose pnmay role is caring for high-risk populations are themselves high-risk candidates for burnout. Many of the institutions in which they serve have inadequate personnel and resources that create daily frustrations for the dedicated health care provider. There are also external and internal forces that control the course and operation of the institution over which nurse-midwives have no control. Nurse-midwives who lack the knowledge of the underlying sociopolitical structure within their workplace and who commit themselves to the betterment of maternity care soon feel overwhelmed and victim-
119 0091-2X32/86/$03.50
ized when they ty to enact change. Many nurse-midwives do not possess either the power or the position that enables them to make certain necessary changes. As clinicians, we are often too absorbed in patient care activities and are too politically naive to be effective change agents. Comparable pay for jobs of comparable worth hardly applies to nurse-midwives when many of our colleagues are still earning a salary comparable to that of the nursing supervisors. Some of the usual challenges of our worth are “How can you compare a nurse-midwife with a physician?” “Nurse-midwifery care should be cost effective.” It seems that the real issue is not whether one can compare a physician with a nurse-midwife, but whether the methods used to compare them are unbiased. Compensation should be based on the quality of performance rendered by the qualified provider and not solely on one’s credentials on paper. Health care agencies need to consider a different reward system for their workers. Rewards do not necessarily have to be in the form of money, although it is an important and necessary consideration for quality of living. Rewards could include compensation for time off, sabbatical leave as well as monetary reimbursement, and time for professional development. Herbert Freudenberg&r4 defines burnout as a wearing down and wearing out of energy. “It is exhaustion born of excessive demands which may be self-imposed or externally imposed. It is a feeling state which is accompanied by an overload of stress and which eventually impacts on one’s motivation, attitudes and behavior.” For burnout management and prevention, one must first recognize the symptoms of burnout. To intervene and break the burnout cycle, one needs the support of colleagues, friends, families, and whoever else is important in one’s life. When we are dealing with the frustrations of our
120
work conditions and work place, many of the intervention strategies will have to take place during off hours. These have to do with building and maintaining a satisfying personal, social, and family life. If the job does not provide one with fulfillment and challenge, then the job can not be a person’s sole source of satisfaction. To reevaluate one’s career goals by either changing jobs or changing occupations will have to be seriously considered. According to some sociologists, no matter how much the institutional environment is modified, some of the causes of bumout are still unavoidable. For example, in many public institutions it is beyond the power of the management to do away with client’s resistance to change, the shortage of funds for human services, the tendency of people to engage in political and power gain, and the disappointment and frustration of the providers not being able to exert their influence on people to make the needed changes. Perhaps, the nurse-midwifery education program will need to introduce their students to the reality that, although nurse-midwifery is a helping profession, the professionals do not have to be loved or appreciated by all. The idea that nursemidwives are superwomen who are competent as well as born leaders in their chosen profession is a figment of the imagination. Nurse-midwives are human beings, who are not omnipotent. They need to learn and acquire good leadership skills through training and experience. It is essential that we know what we can do and what we cannot do. This, however, does not mean that we should not become actively involved in working with and through people to make changes. It is our responsibility to facilitate change; whether or not people will change, however, is their decision as well as their ultimate responsibility. We have to learn to focus on successes rather than mistakes and failures. To dwell on past
problems unnecessarily consumes one’s energy and time without constructive gain. Learning to manage pressure and stress in a positive manner is crucial to the prevention of burnout. The above suggestions seem to be so basic and self-evident that often they are easier said than done. The ACNM must also assume partial responsibility for the prevention of burnout among its members. To those nurse-midwives who have contributed tirelessly and unselfishly toward the advancement of our profession, public recognition is long overdue. Some new mechanism, in addition to the annual presentation of the Hattie Hemschemeyer Award, needs to be established to show appreciation to the many CNMs who for years have labored with distinctions as scholars, teachers, and clinicians. And what of the many who have maintained a lower profile while continuously serving the College? We cannot allow any of these valuable members of our profession to fall victim to the burnout phenomenon. To feel needed and appreciated is a very basic need. Surely, the College is in a position to recognize and reward professional and organizational achievement and dedication. In the final analysis, this may be the key to counteracting the speed of burnout.
Lily
Hsia, CNM,
MS, CPNP
REFERENCES 1. Webster’s third new international dictionary.
Springfield,
MA, G and
C
Mertian Co., 1966, p 300. 2. Becker, HS: Notes on the concept of commitment. Am J Sociology 60:3240, 1960 3. Buechler, Donna K: Help for the burnout nurse. Nurs Outlook 33:4: 18185, 1985. 4. Freudenberger, Women’s burnout. day and Company,
Journal of Nurse-Midwifery
?? Vol.
HJ, North, G: New York: DoubleInc., 1985, p 9-10.
31, No. 3, May/June
1986