Losing staff to burnout? Recognize the symptoms

Fatigue, sloppiness, complaints signal burnout

"I’m tired of the paperwork. I don’t enjoy seeing so many patients in one day. I’m not satisfied with my work. I just feel burned out."

Burnout is a hard state of mind to define, but many times it is one reason that good employees leave, says John Henry Pfifferling, PhD, director of the Center for Well-Being in Durham, NC. "Although there are no studies or data that correlate job burnout with retention, there are many anecdotal examples," he says.

A home health manager can improve retention of good employees by understanding the factors that increase job stress that leads to burnout, and by recognizing the symptoms of burnout early on, so the manager and employee have a chance to address the problem before the employee decides to leave.

Prevent burnout before it strikes your staff

Obviously, the best time to address staff burnout is to prevent it in the first place, says Pfifferling. While there is no guaranteed method of preventing burnout, organizations that experience low burnout among employees have similar characteristics, he says.

Organizations that communicate honestly with employees, offer specific, timely feedback on employee input, and address the issues that can create stress and exhaustion are the organizations with lowest burnout, says Pfifferling. "It’s also important to address excess workloads and personal issues that add to job stress," he adds.

Because home health employees deal with emotional issues such as the illnesses or deaths of their patients as well as illnesses or deaths in their personal lives, it’s important to put a process in place to help people through tough times, says Mary Dyck, RN, BSN, MHA, director of home care services for Riverways Home Care Services of Ozarks Medical Center in Westplains, MO. "When an employee has an illness or crisis in their personal life, it can create extra work and tension for other employees if you don’t have a program that plans for the unexpected," she explains.

Dyck’s agency has set up a care team network that goes into action when any employee has a crisis in his or her personal life. The network is designed to help employees with meals, personal errands, transportation to the doctor or clinic for treatments, housework, or anything they need to help them get through the crisis. "Other employees appreciate the network because it gives them a way to help that is meaningful but doesn’t overwhelm them," she explains.

Dealing with personal crises

By having a process that helps the employee deal with his or her crisis and helps co-workers deal with the uncertainty of an ill or absent employee, everyone benefits, Dyck says. "We’ve found that this program has retained our good employees because it clearly demonstrates that we look at each of our employees as family members and we don’t want them to feel left out or burdened," she says.

Burnout is a process that differs from person to person but there are typical symptoms that can help a manager identify an employee who is approaching burnout, Pfifferling says. "All of these symptoms can be symptoms of any number of problems, but if a manager notices a pattern or trend in behavior that includes these symptoms, he or she should explore the cause with the employee," he suggests.

The symptoms include:

Fatigue and health complaints

"The employee complains of aches, gastrointestinal problems, tiredness, and is also more irritable than usual," Pfifferling says. Sometimes, the employees blame their mood on their inability to fall asleep or stay asleep, he adds.

Depersonalization of clients

The patient is no longer "Pat" but "that old lady," says Pfifferling. "It’s important for managers to listen to the words used by the employee," he says. An employee who is burning out will refer to patients as the diabetic or the heart patient, or even as the third patient seen on Tuesday, Pfifferling explains. Relationships with patients no longer are personal, just part of the job, he adds.

Negativity, cynicism, bitterness

A highly stressed employee notices only the bad, points out Pfifferling. For example, rather than viewing the use of a laptop for charting as helpful, the employee sees it as yet another thing to learn. The employee always expects the worst and focuses on what has gone wrong in the past, he adds.

• Lack of creativity

"An employee who feels burned out is not motivated to find a new way to provide care or engage a patient in conversation," Pfifferling continues. The employee will do the job, but because of his or her fatigue and lack of interest in the job, there won’t be any extra effort made, he adds.

• Talk about quitting work

While we all experience days that make us wish for another job, the burned out employee actually tells co-workers, patients, or friends that he or she wants to find another job, Pfifferling says. The employee may not be looking actively for something else, but talking about it may be a tactic to convince him- or herself that it is the right thing to do, he adds. A manager also will notice an increase in tardiness, inattention to details, and sloppiness, he says.

Talking with employees who are exhibiting potential symptoms of burnout is important, Pfifferling says. "A burned out individual is contagious. That person’s tardiness, criticism, or sloppy work affects all other workers, increasing their stress and their risk of burnout."

The first step is to know what you are going to do when you identify an employee who seems to be burning out, Pfifferling suggests. "Talk with the employee privately or if a manager has a supervisor who knows the employee better, have the supervisor talk with the person," he says. Keep the conversation nonthreatening and express concern. If the employee makes a statement such as "I don’t feel like I fit in anymore," ask what can be done to make it a better fit, he suggests.

As you evaluate your staff and yourself for signs of burnout, remember that health-related caregivers are very susceptible to the emotional depletion that can contribute to burnout, says Pfifferling. Giving people a chance to get together at inservices or social settings to talk about what they like is important. "Don’t forget to talk about the energizers in your jobs, the things that make the job more special than other types of jobs, and don’t forget to give people a chance to talk with each other about the good things about home care."

[Editor’s note: A burnout risk appraisal can be viewed at the Center for Professional Well-Being web site. Go to www.cpwb.org and click on News, then click on Burnout Survey at the top of the page.]

For more information on combating burnout, contact:

John Henry Pfifferling PhD, Director, Center for Professional Well-Being, 21 W. Colony Place, #250, Durham, NC 27705. Telephone: (919) 489-9167. Fax: (919) 419-0011. Web site: www.cpwb.org.

Mary Dyck RN, BSN, MHA, Director, Riverways Home Care Services of Ozarks Medical Center, 114 E. Main, Westplains, MO 65775. Telephone: (417) 256-3133. Fax: (417) 256-5961. E-mail: riverways@ozarksmedicalcenter.com.