Expectations vs. Reality
“The work environment often doesn’t match the intrinsic drive that led them to become a healthcare professional.”
– Dr. Carol Clayton, Relias Chief Translational Neuroscientist and practicing clinician
Healthcare professionals burn out – physicians, clinicians and direct care staff alike. As health care is increasingly run more like a traditional business, there can be a disconnect for the care provider who was initially drawn to healthcare as a caring profession. This often creates a divide between how they thought they might spend their day versus the reality of how their time is actually spent. Of course, time is spent providing direct care, but there are also administrative burdens like record keeping and other tasks that must be done make the system tick. This can lead to burnout for those currently in caring professions, and it can serve as a deterrent to those who are interested in entering the healthcare profession.
Consider for example the experience of treating individuals with substance use disorders (SUDs) and opioid use disorders (OUDs). Given the nature of these disorders, there can be significant illness complexity in this population, making it difficult to help them get better. It also poses significant and overwhelming challenges for the providers who care for and serve them.
“In the time it took for me to be good at my job, most of the people I worked with had already turned over and gone elsewhere.”
– Don Spiers, Relias Product Manager, and former direct care professional working with individuals with disabilities.
For direct care professionals who don’t have years of post-secondary education or extensive training to prepare them for their positions, the burnout happens swiftly and leads to problematic turnover in every aspect of healthcare. Don shared his experience with me in working as a direct support professional in college.
“Prior to my first day working with people with intellectual and/or developmental disabilities (IDDs) as a direct support professional, I was very enthusiastic and wanted to help. I wanted to document our progress well, I wanted to do good and I wanted to help the care planner use my info to create better plans, but I had little direction or training on what that looked like.
I read a care plan for an individual I would be working with. It listed his hobbies, interests, diagnoses, but included little info on what to expect based on the diagnoses. I was immediately introduced to the consumer, or the person I would be working with. I hadn’t worked with someone with cerebral palsy before and had to document things. The care plan asked that I document behavior based on the number of verbal prompts it took to assist the consumer I worked with.
I needed to concisely document things like how many verbal prompts it took to complete the task at hand: Did they complete the goal at all; did they complete the goal with x number of verbal prompts; or, did they not complete the goal at all. I was urged to take notes and record things, and the goal was to get him better at skills like putting the silverware away or doing a chore. I was provided no training or specificity on how it should be done. I used my judgement all the time, wondering, for example, “Does it count as a verbal prompt to tell them to put the big spoons/little spoons together?”
In the beginning, I didn’t feel like I was qualified to teach that individual, and I wasn’t taught strategies to help them make progress on their individual goals. I remember us going over “I” statements, but that didn’t help me explain the difference between a small spoon and a big spoon, much less why it was important that those spoons go their rightful place in the drawer. I was stuck Googling for info. You are asked to be nimble and adaptive and learn on your own for $10 an hour. I was a rarity in that I stayed for more than four years, but I saw new faces every two weeks. The retention rate was likely less than 25 percent. I don’t blame the agency; they were doing the best they could with the funding they had.”
Financial and Administrative Hurdles and Regulation
Treating OUDs has a lot of rules and regulatory boundaries related to evidence-based practices, specifically, for example, medication-assisted treatment, which is well documented to often be the best course of treatment for persons with dependency. However, the certification to be a MAT provider and meet the administrative requirements in terms of documentation, number of patients per provider and some of the onerousness of setting up the system itself, can drag down the provider who wants to engage in evidence-based practice and set up their systems to do so. It takes a lot of persistence, and you have to jump through some hoops.
And as we learned from Don’s experience as a direct support professional, administrative duties and documentation can be as overwhelming and unclear as they are crucial.
From a financial perspective, the rates don’t always stretch far enough to pay for service supporting a whole-person approach. Those working in the SUD field know that dependency doesn’t exist in isolation. For people who are substance dependent, they often are experiencing pain, have psychiatric overlay, are using other substances or have other chronic health conditions that haven’t been properly treated. And for those providing direct care and support services, funding is often at risk and is rarely allows for surplus. The ability to take a whole-person approach, in terms of funding and being able to support yourself as a professional, a caregiver or as a business, is more challenging because sometimes the revenue doesn’t match the cost.
Tips to Avoid Burnout
1) Doctor’s Orders: Self-Care and Team Work
Sharing with others is key to reducing the burdens of stress that lead to provider burnout – especially when you are working with a difficult population. Creating a system or organization where other peers join with you as a care team can be critical, and it reduces stress since single providers are not shouldering the entire burden.
The adage “care for the caregiver” rings true but is so often not given priority by those in caring professions. As with anyone who experiences stress – stress management and protecting your health is crucial for the provider and the best inoculation against burnout. Making time for self-care must be a priority.
2) Coping Mechanisms for Job-Specific Stress
While being dedicated to individuals for the long haul has its benefits and rewards, consider that some kind of variety or rotation offers relief from predictability that can benefit the caregiver as well as the patient or consumer. Take Don’s experience in working with individuals with IDDs – their improvement and progress may be slow and can include unpredictable regression, and dealing with that is just part of the job. But if you keep unwavering consistency with the consumer/caregiver, that slow progress coupled with unpredictable regression causes stress, likely for all involved. With no coping mechanism taught and in place, burnout is a surety. Perhaps a team approach and a rotation that introduces some novelty would go a long way to heading off that stress and burnout?
3) Employee Assistance Programs
An often under-utilized tool is the Employee Assistance Program (EAP). These employer-sponsored programs offer resources for caregivers ranging from debt reduction programs to mental and behavioral health counseling. The EAP can help retain the individual who is stressed or burning out, and the onus is on the employer to strongly encourage that their staff take advantage of the EAP benefits. Imagine that things are going just fine, and unexpectedly a client dies – and those caring for the individual get no counseling and no coping resources. An EAP offers someone to talk to, and Don’s opinion was that this would be the place to invest if an organization must choose one thing to offer. Employers should promote these services with great regularity and offer providers an easy way to discuss their stress with a qualified professional. Organizations should go beyond simply offering the services but also encourage providers and caregivers to take full advantage by incentivizing usage.
How Can Relias Help?
From a Relias standpoint, people who are competent and confident in their knowledge base have less burnout. Making sure that you are operating at the top of your profession, and making sure that you are strengthening and maintaining your skills to keep confidence in what you are doing, has been proven by research to help clinicians who are dealing with stress on the job.
Providers should read, learn and stay abreast of trends, and latest research and information, to maintain their confidence.
Listen to a podcast that dives deeper into the factors that contribute to provider burnout when treating opioid use disorder and tips for providers to cope.