Mental Fitness – A Solution to Burnout
by Liliane de Vries
Nurses and their leaders have been experiencing many symptoms of burnout for years, and although Covid is not the cause, it has certainly brought awareness to the outside world. The chaos of healthcare has left us all emotionally, physically and mentally depleted.
The World Health Organization (WHO) defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. WHO further defines the burnout by three dimensions:
- Feelings of energy depletion or exhaustion
- Increased mental distance from one’s job, or feelings of negativity/cynicism related to one’s job
- Reduced professional efficacy
Nurses and their leaders are tired of hearing themselves, and others around them, complaining of how unhappy they are at home and work, how exhausted they are, and how nobody cares. Their relationships are strained, their health is in severe distress, and they feel like they do not have the energy to get out of the spinning cycle they are in. The bottom line is that they feel unheard, unacknowledged, unseen and unloved – the very essence of humanity.
Before we can move on to solutions, we need to understand the root cause of burnout, which is ‘moral injury’. Moral injury results in deep psychological damage, and mental stress. It occurs when people are taking part in, or witnessing, actions that conflict with their core beliefs, and moral values, such as being asked to do more than humanly possible and sacrificing adequate care for patients. The result leads to the symptoms of burnout.
There are 3 things that need to be addressed, when dealing with burnout:
- Understanding the history of moral injury
- Addressing the burnout symptoms
- Taking responsibility for our mental fitness
Understanding the history of moral injury
As nurses, we have a natural ability to care for others. We often play that role in all areas of our life. My experience with nurses is that they too often put others before themselves. They go out of their way to give to their patients, their family, and their friends. They have habitually done this to the point that they are no longer even last on their list. By the time they get to themselves, they collapse into exhaustion. Historically, they have been saying YES to giving, and have forgotten to create boundaries for themselves. The resentment to saying YES, got stronger and stronger, but they were committed to doing the best they could at all times. That pattern caught up to them years ago and the more they said YES, the more they were asked to do. And the challenge got bigger and bigger until they wondered how the heck they got here.
So even though there were small things, at the beginning, that conflicted with their core beliefs of right and wrong, or their moral values, that this is no way to treat nurses or human beings, it progressively got to where we are today. Today, they are drowning in the inhumane demands of their profession. This is not to blame nurses, or their leaders, but to bring light to how we got here. When speaking to nurses, it is not uncommon to hear the fear that if they said NO or retaliated in any way, they were afraid to lose their job. Many voiced that they didn’t know how to do anything other than nursing. “What choice do I have?” It is only now, that the collective voices of nurses are coming together to say “Enough!”
Addressing the burnout symptoms
Burnout eventually impacts the quality of care and increases the risk of medical errors, absenteeism, and turnover. Nurses and leaders who have been working with me will often ask what they should be doing now. Should they leave their job? Should they leave their profession? And panic strikes as this adds just more stress and mental overwhelm. When someone is in true burnout, the only option is to STOP. This is NOT a time to make decisions. It may be time to go on medical leave and go back to the basics of getting proper hydration, nourishment, sleep, and breath. Saying NO to everything else is a must, if you don’t want to risk further health issues, or put your patients and colleagues in danger. You are here because of your commitments to your values and profession. There is no shame in this. It is time to accept what is, and heal from the inside out, while being gentle on yourself.
Taking responsibility for our mental fitness
Shirzad Chamine, author and founder of Positive Intelligence (PQ) clearly states, “Mental health is the absence of mental illness, whereas mental fitness is the presence of positive mental habits regardless of whether you have a mental illness or not. Mental health is a state of mind, while mental fitness is the strength of mind that allows individuals to handle the ups and downs of life with grace, ease, and confidence.”
Ideally, we are approaching our mental fitness as a preventive approach versus waiting to be in a state of poor mental health. Giving attention to the fitness of your body can look different for different people depending on your physical state. Some go to the gym to improve an already healthy body, while others my need a more gentle or targeted approach that might require physiotherapy. Whereas mental fitness can be done with a fully healthy mental state or even at times of burnout, where the individual may be negative, stressed, or emotionally depleted. It does not require strain on the brain. The PQ measure of an individual’s capacity to respond to stress, negativity, and adversity with a positive mindset will be different until the individual has practiced the art of focus on their senses through repetitive mental exercises over an average of 6-8 weeks. This does not negate the fact that anyone under moderate to severe burnout may require the support of a mental health professional.
Research suggests that PQ is associated with moral injury amongst healthcare professionals, including nurses. A study conducted by Wachter and colleagues (2022) found that nurses with high PQ were less likely to experience moral injury, as they were more likely to engage in moral courage, defined as taking a principled stand even in the face of adversity.
In conclusion, burnout is a serious problem that we can prevent by valuing each others core beliefs and moral values as human beings. I admit it is a challenge to be responsible for making harsh decisions based on what financial restraints we have had in healthcare, and I believe ‘we’ should have had these difficult conversations a long time ago. Individually we can prevent the burnout by defining and honouring our boundaries way before we lose objectivity. We must not dwell on our past behaviours and choices but learn from them. Prevention is key and addressing mental fitness as part of our daily choices is a must. Creating a positive work environment that values employee well-being and promotes emotional, physical, and mental health is everyone’s responsibility. What steps will you take today to prevent burnout and promote well-being in your workplace, and your home?
To find out more about Mental Fitness, the science behind it, and the methodology, please register for our free Mental Fitness webinar at https://aliveinhealthcare.com/mentalfitness/.