Burnout in Orthotics and Prosthetics
Joseph Wanchik, C.O., O.T.R. *
A review of the literature on the phenomena of burnout indicates it is one of the major concerns of the 1980's. This syndrome is especially prevalent in professions categorized as caregivers. We, in orthotics and prosthetics, are closely identified with this category and are probably more vulnerable to succumb to burnout than the population at large. As caregivers, we have the responsibility to deliver quality orthotic and prosthetic service to our patients. This can only be accomplished if we maintain our own emotional and physical well-being. A careful look into our work environments will find individuals, perhaps ourselves, who are struggling to maintain this state of wellness. We are cognizant of the many pressures exerted on our profession today, which are more complex than they were a matter of years ago. It is necessary that we update our coping mechanisms to deal with this new stress, or surely we will face the possibility of burning out and losing the dedication most of us have to our profession.
Herbert Freudenberger, a clinical psychologist, coined the term burnout in 1972, and has written two books and authored several articles concerning this subject. He indicates that burnout is wearing out, exhaustion, or failure resulting from excessive demands made on energy, strength, or resources. It can be defined as a reaction to job-related stress that varies in nature with the intensity and duration of the stress itself. It may manifest itself with workers becoming emotionally detached from their job and may ultimately lead them to leave their jobs altogether. Burnout may develop within a worker via a process so gradual that he/she is unaware it is happening and may even refuse to believe anything is wrong.
Individuals with symptoms of burnout will display feelings of excessive or constant physical, emotional, intellectual, and spiritual exhaustion. Their lowered resistance to physical illness may lead to hypertension, ulcers, sleeplessness, headaches, gastrointestinal upset, frequent colds or flu, or musculoskeletal aches and pains. New evidence is mounting that vulnerability to infectious disease and even cancer may be affected by how people react to stress. Researchers are finding that high levels of stress frequently precede illness.
Emotional depletion can lead to depression or anger, excessive drinking, smoking, or drug abuse, and the loss of ability to enjoy friends, family, or leisure time. Intellectual functioning can be hampered by an inability to prioritize tasks, the blocking out of new information, going by the book, and avoidance of responsibility. Social and interpersonal functions become impaired, which can lead to a collapse of personal relationships with colleagues at work and elsewhere. This, in turn, becomes a major stressor and increases vulnerability to stress. An attempt to avoid co-workers or pass stress onto them increases stress for everyone, including the individual burning out. We have all experienced how difficult it is to enjoy work where there has been a breakdown in communication with fellow employees or supervisors.
Persons suffering from some stage of burnout become less efficient at work and accomplish less even though greater effort may be exerted. They tend to become increasingly inflexible and show behavior that confirms their increased dissatisfaction and pessimism about their job. They may voice concern about their ability to continue working in their present position for a prolonged period of time.
A professional experiencing burnout lacks sympathy and respect for his patients and may develop a cynical and dehumanized perception of them. He may label patients, refer to them in a derogatory manner, or tend to distance himself from any emotional involvement with them. Other symptoms include a feeling of unhappi-ness with oneself or a tendency to leave a series of jobs in a short period of time in the absence of evidence that one is moving vertically in one's career.
Burnout is a very complex phenomena and the unrelieved problems that lead to it can be caused by a combination of stresses, including those experienced at work. Family problems, faulty ways of relieving stress, and environmental demands over which we have little control are a few of these. Environmental demands could include such events as inflation, rises in taxes and energy costs, loss of a job or moving to a new job, city, or neighborhood, or natural disasters such as fire, flood, earthquakes, or tornados. Our family lives can bring us great amounts of comfort but can also bring the most intense forms of stress. The death of a spouse or close relative, a severe illness, marriage, pregnancy, and gaining a new family member can all produce a great deal of stress.
Often, stressful events occur in our lives over which we have no control, and one must cope with this series of events without choice. There are, however, occasions when the number of stressful events can be controlled. Therefore, it is wise to space them to prevent overload at any given time. Stress does not simply result from a particular negative event; rather it results from a complex interaction between events and a variety of psychological factors, such as a person's expectations and experience, and the presence or absence of a network of caring friends.
Each individual has some inherent ability to cope with stress, but what may be stressful for one person may merely present a challenge to another. We need to realize that stress is not necessarily bad. Some stress is positive and necessary to energize us to do our activities of daily living. There are some people who suffer from stress underload, which can just as easily lead to depression and boredom.
People in helping professions, such as orthotics and prosthetics, tend to suffer from stress overload. It saddens us deeply when we hear a fellow professional has broken down emotionally or physically, or has even taken his own life. If we looked closer into the situation, we would possibly find the person subjected himself to prolonged periods of unrelieved stress and never bothered to develop coping skills that would lead to a more balanced life. Everyone around him may have noticed that negative changes in his life, but were powerless to do anything about it. There are persons who find it very difficult to admit they Cannot handle a situation, invest more energy into the problem, and merely intensify the stress.
The first steps in preventing burnout are to recognize its existence, be aware of personal feelings, and remain open to input received from co-workers, supervisors, friends, and family. These individuals are often the ones who first recognize the burnout symptoms and may be able to help in providing a support system. Many times a relative or friend will mention that we are looking tired or worn out, or that there is a need to slow down or take better care of ourselves.
Most authors agree that burnout usually occurs in stages. Jerry Edelwich and Archie Brodsky note four stages: Stage one (enthusiasm) is characterized by high hopes, high energy, and unrealistic expections. Stage two (stagnation) occurs when the job ceases to be a central force in an indivudal's life. Stage three (frustration) occurs when the individual questions his/her work effectiveness and the value of the job itself. Stage four (apathy) becomes the natural defense mechanism against frustration when workers find themselves in an unsatisfying job they cannot change or leave.
Robert L. Veninga in his book, The Work Stress Connection, describes the states as the honeymoon, fuel shortage, chronic symptoms, crisis, and hitting the wall.
Burnout from an industry's or organization's point-of-view can be very costly. Absenteeism, depression, low morale, and impaired decision-making can effect the quality and quantity of work produced. Constant turnover of staff due to burnout can greatly impact on a facility's ability to provide professional services in an uninterrupted and timely fashion.
Another concern for an employer is that in many states, physically and emotionally burned out individuals or their surviving family members can sue stress-inducing employers. The basic legal argument is that the place of employment did not provide a safe and healthy workplace, and as a result, the employee was hurt and deserves compensation. Other states claim that both the damage and the cause can be strictly emotional. Authors on this subject estimate that at any given time, five to 15 percent of employees are at some end stage of the burnout process and two to three times as many are somewhat in the process of burning out and are therefore at risk. Others have proposed the controversial idea that entire organizations may burn out as they make adjustments in their procedures and practices to accommodate the needs of increasing numbers of burned out employees.
Orthotics/prosthetics laboratories are particularly vulnerable, since at no time in history have they been subjected to the type of stresses experienced today. There is the demand to keep up with the explosion of medical and technical knowledge to insure quality and up-to-date treatment, while at the same time deal with insurance companies, unions, employers, and government agencies who are unwilling to pay the full charge for patient services. This, compiled with increased competition from all areas and shortage of trained professional staff, leads to a great deal of stress.
There are several actions we can take to minimize burnout in our own profession. First, we must present realistic job expectations to our student orthotists/prosthetists and those just entering the field in order to help them understand the nature of the stresses involved in our profession. Perhaps a few lectures on this topic noting mature ways of coping with stress would help to cushion the shock of reality when these individuals eventually encounter particularly difficult job situations.
In the long run, it is the responsibility of each individual to recognize the signs of burnout and develop a strategy for dealing with his/her unique situation. Occasionally, being unable to cope does not mean we are failures; it simply means we are human. We spend so much of our day caring for others, why not reserve a little time for caring for each other, especially fellow professionals and staff who are in need of our support. An atmosphere of genuine caring and support for each other in our workplace would do much to reduce stress.
Why is it that many individuals in our profession seem fulfilled, pleased with their accomplishments, and continue to maintain positive relationships with their patients and fellow professionals for many years, while others feel the need to leave the profession after a short period of involvement? The answer, of course, is very complex; however, studies have shown that those individuals who successfully cope with occupational stress have three important characteristics. First, they are problem-solvers. They have a "we can solve this" type of mentality. Rather than endless hours of complaining, they convince themselves that a problem can be managed. They use logic, analytical thought, and data based decision-making along with imagery, positive visualizations, and creative brainstorming to solve complex issues. They believe that tough times never last, but tough people do. They believe it is impossible to fail totally if you dare try to do something worthwhile. The very fact that they take positive action to resolve an issue markedly lowers the stress of the situation. Second, they keep their work expectations in line with reality. They determine what is reasonable to accomplish in a day's work, make sure major objectives are met, but also set aside time for interruptions and unexpected crises. Persons who have their daily work life governed by interruptions seem to have a high level of job dissatisfaction. Third, those who cope successfully are able to resolve conflict situations. They are able to discern which of the conflicts at work are worth their involvement. Persons in late stages of burnout seem to be involved in all kinds of conflict situations and have arguments with their boss, their colleagues, and even their patients.
A person who is successful in dealing with burnout seeks to reduce stress in all areas of his life. He becomes more conscious of how his body feels and reacts to stress. He listens to what his body tells him in terms of needing more rest, relaxation, or increased physical activity. He no longer blames everyone else for the stress he feels. He looks into himself to see whether his perceptions of a situation are helping to create the stress. He is realistic about his goals in life and does not force himself to try to reach the impossible. He is conscious of the need to change gears from work to rewarding and pleasant physical activities, hobbies, sports, family, or friend relationships. He is willing to discuss his problems with a friend, relative, minister, priest, or counselor to help release pent-up emotions.
We all have a choice of taking a negative or positive view of stressful events in our life. Those who are prone to burnout tend to take a negative view and tell themselves such things as "I've had it," "I give up," "What's the use of trying, it won't work," etc. With this attitude one becomes cynical, apathetic, uncaring, and unproductive. On the other hand, one can use the positive approach and say to himself, "I'm not going to give up—to give up will only hurt myself and other people," "I've handled challenges in the past and I can and will be able to handle this," "I'll work constructively on this one step at a time," "When the going gets tough, I get going." This kind of positive thinking will lead to liking yourself, having a pleasant disposition, and being productive and creative.
Those of us who are managers can introduce some organizational interventions which may help relieve job stress. Particularly, management that allows employees to help make decisions regarding their work environment, job assignments, and work schedules can help them feel they have some control of their work situation.
A manager should look at issues such as:
- Is there an up-to-date accruate job description that has been discussed with the employee so that job expectations are clearly defined?
- Does this employee have sufficient training for the job assigned him?
- Does the employee have time for educational pursuits to update his/her professional or technical knowledge?
- Is his/her workload reasonable and salary competitive?
- Is there an opportunity for career advancement?
- Has sufficient space been provided for the employee to do his work effectively and are the physical surroundings as pleasant as possible?
- Is there a systematic method for using employee input to influence organizational policy?
- Can the supervisor recognize negative effects of stress on the employee so that some action can be taken to reduce it? This may include a less stressful job assignment, a few days off, or the need for the employee to take a vacation.
We must realize that the manner in which we as managers behave may have much influence on whether our employees burn out. Employees treated with respect, support, and dignity will be more productive than those employees who have a boss they dislike or despise. A good manager will learn to communicate effectively with his employees and be an active listener. He should learn to accept honest criticism from his subordinates and be willing to make changes that will benefit all in the work environment. An employee who is suffering from some stage of burnout needs our support, concern, trust, and acceptance if it is our intent to help him. On the other hand, an employee who has made an incorrect career choice, dislikes his work intensely, or is incapable of performing satisfactorily, should be counseled to leave the profession as job difficulties will inevitably ensue.
How close are any of us to burnout? That is a question each of us must answer for ourselves. We must take an honest and close look at our values, perceptions, expectations, communication skills, and the manner in which we treat our fellow human beings. We should feel good about ourselves and realize that we have needs for rest, relaxation, recreation, and physical exercise. We need to know who we are spiritually and develop our inner strength. We have to realize that the maintenance of a positive attitude and good emotional and physical health is really our own responsibility. Every effort should be made to maintain that state of health and well-being so that we can be more effective in treating the patients to whom we are dedicated.
The future of the orthotics/prosthetics profession lies in our ability to cope with stresses that we encounter today. This is particularly important since our greatest recruitment efforts for the profession lie in the example each of us sets in our daily practice. Those who wish to imitate us will be those who have a positive experience with us, perhaps even a patient who has been treated with dignity and respect. Many of us were former patients who were impressed by those who cared for us. Therefore, it behooves all of us to take a closer look at ourselves. We must understand our own needs and feelings in order to make those changes that will lead to good emotional, physical, and spiritual health. Only then can we carry on with the business of helping others.
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