Don’t Put it On Us: Burnout & The Gaslighting of Healthcare Workers

The Burnout Messaging

Burnout has been a theme we have been seeing in healthcare lately, which was likely intensified and brought to public attention due to the pandemic. There were even entire podcast shows and countless continuing education courses and in services on the subject.

And we are often lead to believe (from healthcare practitioners on social media, continuing education, even research studies) that it is something that we should deal with ourselves. To “take care of ourselves better”. I mean, look at this research article’s title: “Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care”.[1]Posluns, K., & Gall, T. L. (2020). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International Journal for the Advancement of Counselling, 42(1), … Reference List I don’t disagree with many of these points, but that is not the only reason nor is it the primary reason I would argue why healthcare workers are burning out.

Will all the work-life balance, self-care, social support, spirituality-seeking, or whatever is recommended that “we do” going to prevent burnout? Or is there another culprit leading us to doubt ourselves and wonder why we are no longer fit to do this line of work? Are we being gaslighted and misled to believe that there is something we are not doing, when in fact, there are more systemic factors?

A Pandemic Thing? American Healthcare Thing? Great Resignation Thing?

I mentioned the pandemic. So yes, this is kind of obvious – this systemic issue that has led to a strain on our healthcare resources for frontline workers. But that’s not the entire story. We also haven’t been able to hire and retain more healthcare workers in other settings as well, from nurses, doctors, to therapists. And in terms of bedside staff shortages, why do we keep hearing of just as many if not more administrative staff on duty at the same time. Shouldn’t they hit the floors and be healthcare heroes themselves and do bedside care instead of sitting in an office or working remotely from home to ease this pandemic burden? Well, they can’t. Most of them don’t know how (nor are they willing).

And burnout is nothing new, it’s just been intensified due to the pandemic. Low wages, lack of benefits, overtime, scheduling requirements, no relief staff, penalties, write-ups, missed-lunches, inaccurate payrolling, micromanagement, surveillance, lack of resources, lack of support, lack of training, lack of kudos and appreciation…the list goes on and on. Healthcare workers, not just in the United States with its privatization of healthcare, but also Canada seems to be having a difficult time keeping their nurses from burning out – and they have a public healthcare system (a politically underfunded one apparently).

I’m left to wonder how is it that in two different first-world countries, with two different healthcare systems (public and private) that both are having burnout rates probably much higher than historically? It can’t all be due to due the pandemic and aging baby boomers and such. How is it that we spend so much our GDP here in the US on healthcare, yet we have quite crappy outcomes for life expectancy and quality of life? Where’s all this money going?

Burnout. Are we all just not taking care of ourselves? Or is the system (both public and private) not taking care of us? We were asked to be healthcare heroes to make our sacrifices for the greater good of the public in the pandemic. No wonder we are burning out.

Culprits of Burnout

  1. Lobbying & politics
  2. Underfunding in healthcare
  3. Convoluted insurance
  4. Lack of trust in healthcare providers
  5. Lack of transparency for the public about healthcare costs (goes with #s 2&3)
  6. Low wages for ancillary and support staff, e.g., CNAs, EMTs, janitorial – all except the CEOs and upper management
  7. Inefficient systems and processes
  8. Nurses going to jail
  9. Unnecessary expenses, e.g., overpaid management and administration
  10. Leadership (a distracting term that is being used interchangeably these days by management) styles and culture

Burnout Gaslighting of Healthcare Workers

Why did I use the term gaslighting?

Because we are not all crazy. We aren’t as incompetent as you make it seem. Yes, we are human and make errors, but it’s not like every second we are screwing up. We don’t need to keep improving ourselves when the system or what you implement needs to be improved and more realistic in the first place before it comes out as a company memo or e-mail.

Why are we spending our own free time checking our timecards for known-errors? What are you spending all this money on that makes these errors even happen in the first place? We literally have cars learning to drive ourselves, yet we can’t get payroll right. It’s not that complicated. Yes, this is a very specific and extreme example, but a very real expectation that is going on. Now that’s crazy! Inefficient systems? Maybe there’s malicious intent? This is what led me to think of gaslighting.

So the question is, who is doing this gaslighting? Is it some evil CEO or politician? Economics and the nature of business?

In the context of the workplace, authoritarian controlling measures employed by management such as surveillance, performance evaluations, strict deadlines, non-informative feedback and non-constructive criticism, without any positive and caring support should be regarded as occupational stressors, which have the potential to diminish feelings of autonomy, competence and relatedness. Such diminution may result in erosion of intrinsic motivation with a consequent negative impact on professional performance and job satisfaction with an increased risk of burnout. On the contrary, empowering professionals to make autonomous judgements and decisions and to be responsible and accountable for their choices, and using positive, informative, constructive and sympathetic feedback, promote a sense of autonomy, competence and relatedness. In turn, satisfying the psychological needs of autonomy, competence and relatedness will strengthen intrinsic motivation, and consequently improve professional performance and personal well-being, and ultimately may decrease burnout risk.[2]Khammissa, R. A., Nemutandani, S., Shangase, S. L., Feller, G., Lemmer, J., & Feller, L. (2022). The burnout construct with reference to healthcare providers: A narrative review. SAGE Open … Reference List – this points the finger at management? The culture? Who started this in the first place?!

And especially when us healthcare workers are spreading this message of self-care, etc., then we are part of the problem and it is our own that is gaslighting us and not portraying the entire picture. Yes, burnout is a complicated subject with many variables, but all of the “take a day off to take care of ourselves” in the world is not going to prevent someone from burning out. And neither are higher salaries. We need to look at this phenomenon, look at the culture of how healthcare workers are treated and change it to minimize burnout.

Surviving the Burn

Either that or we have a time machine or the ability to freeze time to do more with less. Or what’s, unfortunately, happening to a lot of healthcare workers – just burnout, from gaslighting.

In case you are wondering. No, I personally am not burning out (not even close). But it does pain me to see my friends, colleagues, and some very compassionate and smart people burn out and think something is wrong with themselves – you all are perfectly fine!

References

References
1 Posluns, K., & Gall, T. L. (2020). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International Journal for the Advancement of Counselling, 42(1), 1-20.
2 Khammissa, R. A., Nemutandani, S., Shangase, S. L., Feller, G., Lemmer, J., & Feller, L. (2022). The burnout construct with reference to healthcare providers: A narrative review. SAGE Open Medicine, 10, 20503121221083080.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.