Communication and Leadership Are Key in Preventing Healthcare Burnout

Healthcare is a profession filled with hope and healing but also comes with long hours and sometimes loss. By dedicating their careers to caring for others, doctors, nurses and other clinicians may find their own wellness takes a back seat.

Proactively addressing burnout and helping healthcare professionals achieve wellness is a core component of a thriving healthcare workforce in the future.

LHA Trust Funds had the opportunity to discuss this issue with physicians, nurse leaders and healthcare administrators. Our burnout and wellness series this month shares those insights as well as perspectives from industry experts and intervention strategies.

Burnout: What’s To Blame?

The pandemic undoubtedly exacerbated the potential for burnout, but the pressures and challenges of practicing modern medicine were increasing long before 2020. Dr. Vincent Culotta, Jr., retired OB/GYN physician and LSBME executive director, noted that the evolving practice setting, changing reimbursements, and adapting to EHR documentation have all been factors contributing to the prevalence of burnout among physicians.

“The degree to which the profession now allows [physicians] to act in the manner that they thought was the reason they got into it, is the degree to which they find themselves in the face of burnout. So for example, if you want it to be an autonomous entrepreneurial physician, and you find that you can't do that anymore because of insurance company regulations and things like that, then that certainly can contribute to burnout, sadness, and job dissatisfaction,” Culotta says.

Dr. Benita Chatmon, Assistant Dean for Clinical Nursing Education with LSU Health New Orleans, says that staffing levels, lack of delegation, and patient acuity are often contributing factors to burnout among nurses.

Impacts of Burnout

The impacts of burnout are far-reaching and ignoring its prevalence can be detrimental not only to the wellbeing of clinicians but also patient care. Chatmon observed that quality of care and critical thinking may be affected when a clinician is experiencing the exhaustion, frustration, and emotional withdrawal that come with burnout.

Chatmon also noted that nurse attrition is a concerning trend related to burnout that, while amplified by the pandemic, has been increasing in recent years. Nurses are leaving the field earlier and at a higher rate than previous generations. As nurses retire, this compounds nursing shortages. Fewer veteran nurses also mean a deficit in the critical role that these nurses play in mentoring new nurses.

On the physician side, Culotta stated that, in his LSBME role, he sees disciplinary concerns that may correlate to burnout.

“We deal with complaints about care. Some of those complaints are related to things that are manifesting burnout such as substance abuse and things like that,” Culotta says.

The LSBME is currently studying physician deaths related to disciplinary actions. This is of interest, Culotta says, because physicians have a two-fold increase in the number of suicides over the average population. The research is being conducted with an eye toward helping support physicians through what can be an anxiety-provoking process.

Address the Stigma with Better Communication

While the need to address burnout and mental wellness in healthcare workers has come to the forefront nationally, especially in the last year, many clinicians see a tendency for physicians and clinical staff to avoid reaching out for help when they are struggling.

“Often when nurses notice that they feel this way, they push through and move on,” said Chatmon says. “But we need to be intentional about self-care – when you feel stress, take a break.”

But the lingering stigma around burnout still presents barriers to clinicians seeking help.

“They're afraid that if they admit to burnout, they will either be terminated or ostracized. And I think people don't really understand that we all need help,” Culotta says. “I was very fortunate. Two tough times in my life, I had a very good friend who's a psychologist, who was also a personal friend, and he worked with me and helped me.”

Healthcare Organizations Can Drive Change

With the rise in employed physicians, hospitals and healthcare facility administrators can be instrumental in recognizing early signs of potential burnout, such as noticing that documentation is slipping or a physician is having difficulty with interpersonal relationships. Those are important clues that should signal an intervention.

But the key to success with these processes for physicians is offering resources through a non-punitive, peer-to-peer approach.

“For example, you take a longtime excellent physician who suddenly decompensates and throws a computer on the floor and storms off the floor. What do we do with that? Well there’s something else we got to do and that is, hey we need to talk – let’s find out what’s bothering you,” Culotta says. “Hospitals need to set this up in such a way that is non-disciplinary […] what these people need is much less discipline than they need support and help.”

Another key to preventing burnout is knowledge. Often, clinicians are unaware of the resources available to them.

Culotta stated that the Physician Health Program, available through the Healthcare Professionals’ Foundation of Louisiana (HPFL), is a resource that physicians can contact directly. They can receive a free, confidential consultation and, if needed, be directed to the appropriate treatment.

From the nursing perspective, Chatmon suggests that hospitals and healthcare facilities can shift to being more conscientious is by increasing communication between leadership and frontline staff. A few examples Chatmon provided include having in-services to openly discuss burnout, debriefing after trauma, and discussing how to recognize when someone is having a mental health challenge and what to do to help.

Both Dr. Culotta and Dr. Chatmon echoed the importance of de-stigmatizing burnout from the top down by increasing access to support and encouraging physicians and nurses to reach out.

“I think the key is, right now, administrators tend to look at physicians as healthcare providers that are interchangeable – you’re a problem physician, we don't want to spend any money on you, we're just going to get rid of you and hire somebody else,” said Dr. Culotta. “I think physicians feel that way, a lot of times, especially in these large mega groups […] the key is ultimately whether the physicians feel the worth by the recognition that if they are sick, we want to help them.”