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, and
- 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.
What is Burnout?
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, and
- Physical and emotional symptoms (fatigue, boredom, irritability, headaches, weight loss, etc) 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 highly significant.
Burnout is a significant cause of psychiatric morbidity and of loss of staff.
What also needs to be considered is compassion fatigue, which results from the relationships between clinicians and patients and their families.  This ongoing issue for those who work with the dying, with the constant need to form new relationships and then subsequent losses, can contribute to stress and to burnout.
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.