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Understanding Burnout: Individual, Organizational, and System Factors

Burnout is an occupation syndrome defined by the World Health Organization (WHO) as including feelings of exhaustion, increased distance from one’s job, and reduced professional efficacy. Increasingly, burnout in health care workers is understood as resulting from organizational and systems-level influence, such as third-party reimbursements and administrative loads.1 In the military, providers must also complete many administrative tasks in addition to the emotional labor of providing direct services to service members. Workload and work setting are the most commonly cited factors that contribute to burnout2, which reinforces the idea that personal behavior and self-care are not sufficient to prevent or reduce burnout. One meta-analysis found that behavioral health providers working on an installation had higher rates of burnout than behavioral health providers working with military clients in other settings, which further suggested that workplace specific factors play an important role in burnout.3 Besides the term “burnout,” other emergent useful terms include “moral injury” to describe the possible effects associated with needing to prioritize institutional or administrative demands over direct patient care.4-5 Stress-management like exercising, making boundaries with others and work, and seeking professional help when needed can be impactful. However, sustainable burnout prevention and response will include addressing stressful circumstances at their source and examining institutional processes that might contribute to burnout.

Compassion fatigue, also called the “cost for caring,” refers to physical and mental exhaustion and emotional withdrawal that is sometimes experienced by those who care for individuals in distress.

In addition to working or caregiving in an environment where people are experiencing significant emotional or physical pain, such as patients with PTSD, risk factors for compassion fatigue include:

  • Inadequate self-care
  • High empathy
  • Gender (women are at higher risk)
  • Personal history of trauma
  • Lack of supportive social network
  • Early career status

The signs and symptoms of compassion fatigue are similar to those of burnout and can include:

  • Reduced empathy
  • Intrusive imagery or dissociation
  • Increased use of drugs and alcohol
  • Difficulty sleeping
  • Impaired decision-making
  • Headaches
  • Hypersensitivity to emotional material
  • Increased irritability, anger, or anxiety
  • Emotional and/or physical exhaustion
  • Symptoms of depression
  • Strained relationships

Self-care Strategies

Practicing self-care can help to lessen the effects of workplace stressors and potentially protect against burnout and compassion fatigue. The ability to recover from stressful experiences is a skill that can be learned and cultivated and by implementing effective self-care strategies, providers can alleviate burnout and compassion fatigue. Self-care practices should be tailored to each individual’s needs and preferences. Providers can implement strategies focused on one or more of the following areas: physical wellness, supportive relationships, work-life balance, emotional boundaries, and professional support. Some beneficial practices to address burnout and compassion fatigue include:

Focus on Physical Wellness

  • Eat a balanced and nutritious diet
  • Engage in relaxation (meditation, listening to music, etc.)
  • Exercise regularly
  • Avoid alcohol and drugs
  • Establish restful sleeping habits
  • Practice mindfulness and self-awareness

Maintain and Cultivate Supportive Relationships

  • Invest in relationships outside of work
  • Nurture social support networks
  • Cultivate strong working relationships with co-workers

Establish Work-life Balance

  • Make time for leisure activities
  • Keep work at work
  • Take a break/vacation

Set Emotional Boundaries

  • Establish protective/firm emotional boundaries
  • Remain compassionate without taking on patients’ pain
  • Honor your emotional needs

Seek Professional Support

The following resources can support leaders and providers in addressing compassion fatigue and burnout.

  • Mindfulness Coach
    This mobile app provides a gradual, self-guided training program designed to help you understand and adopt a simple mindfulness practice.
  • Provider Resilience Mobile App
    This mobile app gives health care providers tools to manage burnout, compassion fatigue, and secondary traumatic stress, keeping them productive and emotionally healthy as they help others.
  • The Professional Quality of Life Scale
    The ProQOL is a self-assessment tool developed to measure the positive and negative impact of working with traumatic stress survivors. Sub-scales include compassion satisfaction, burnout and compassion fatigue.

References

  1. Ballenger-Browning, K. K., Schmitz, K. J., Rothacker, J. A., Hammer, P. S., Webb-Murphy, J. A., & Johnson, D. C. (2011). Predictors of burnout among military mental health providers. Military Medicine, 176(3), 253-260.
  2. McCormack, H. M., MacIntyre, T. E., O'Shea, D., Herring, M. P., & Campbell, M. J. (2018). The prevalence and cause (s) of burnout among applied psychologists: A systematic review. Frontiers in psychology, 9, 1897.
  3. Stearns, S., Shoji, K., & Benight, C. C. (2018). Burnout among US military behavioral health providers. The Journal of Nervous and Mental Disease, 206(6), 398-409.
  4. Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare professionals: a scoping review and discussion. Nursing Ethics, 28(5), 590-602.
  5. Sriharan, A., Ratnapalan, S., Tricco, A. C., Lupea, D., Ayala, A. P., Pang, H., & Lee, D. D. (2020). Occupational stress, burnout, and depression in women in healthcare during COVID-19 pandemic: rapid scoping review. Frontiers in Global Women's Health.

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Last Updated: August 11, 2023
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