There is extensive literature about the prevalence of stress in the healthcare workforce. A number of significant risk factors have been identified:

• Conflict and interpersonal issues in the workplace
• Workload and / or lack of control over the work environment, lack of balance between home and work life
• Unresolved losses, unrecognised mental health issues
• Personality and coping style
• Mismatch between motivations and expectations, and the actual reality of day-to-day work
• Problems with identifying boundaries and setting limits on expectations – either those of patients or colleagues, or the clinician’s own expectations of him or herself.

The Therapeutic Guidelines – Palliative Care has a useful chapter on self-care. It summarises the balance between protective factors and vulnerabilities which suggests the risk for burnout in a given clinician.

Burnout is a syndrome of emotional exhaustion, depersonalisation, and reduced accomplishment which occurs in health workers and others who work in human services. Burnout occurs when the stressors exceed the person’s ability to cope. It is frequently assessed using the Maslach Burnout Inventory, which has been well validated and is widely used in research.

Some markers of burnout are:

• Negative or cynical attitudes about patients and their needs
• Negative attitudes to work, the workplace, and / or colleagues
• Pervasive feelings of dissatisfaction and unhappiness related to work
• Physical and emotional symptoms (fatigue, boredom, irritability, headaches, weight loss, and so on) which can be associated with absenteeism.

The impact of burnout on the healthcare worker, on the quality of the care they can provide, on their workplace and colleagues, and on their family and friends, are potentially very significant. 

Burnout is a significant cause of psychiatric morbidity and of loss of staff.

Resilience is the capacity to adapt under stress, and the ability to thrive and find satisfaction from producing good outcomes in difficult situations. The resilient palliative care provider is able to monitor their own levels of distress and identify and deal with potential problems in their practice. There is an evolving literature on resilience and how to promote the qualities that also support professional survival and growth.

Resources

• End of Life / Palliative Education Resource Centre (EPERC) Fast Facts
  • Health Professional burnout Part 1
  • Health Professional burnout Part 2
  • Health Professional burnout Part 3
  • Health Professional burnout Part 4

Related CareSearch pages

GP Pages
Self care for clinicians

Free Full Text Article

Penson RT, Dignan FL, Canellos GP, Picard CL, Lynch TJ Jr. Burnout: caring for the caregivers. Oncologist. 2000;5(5):425-34.

References

• Chilvers R. Implementing a clinical supervision programme for nurses in a hospice setting. Int J Palliat Nurs. 2010 Jan;15(12):615-9.
• Perry B. Why exemplary oncology nurses seem to avoid compassion fatigue. Can Oncol Nurs J. 2008 Spring;18(2):87-99.
• White K, Wilkes L, Cooper K, Barbato M. The impact of unrelieved patient suffering on palliative care nurses. Int J Palliat Nurs. 2004 Sep;10(9):438-44.
• Newton J, Waters V. Community palliative care clinical nurse specialists' descriptions of stress in their work. Int J Palliat Nurs. 2001 Nov;7(11):531-40.
• Wakefield A. Nurses' responses to death and dying: a need for relentless self-care. Int J Palliat Nurs. 2000 May;6(5):245-51.
   

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Last updated 21 October 2011*