Burnout. Compassion fatigue. Chronic work stress. Vicarious trauma. Post Traumatic Stress Disorder (PTSD). Demoralization. Moral distress. Moral injury. Moral compromise.
These are all less stigmatizing terms than Adjustment Disorder with depression and/or anxiety.
2) Mental/emotional detachment from our jobs which have become less rewarding
3) Poorer work performance; “This isn’t me”.
4) Cynical, irritable & judgmental trending
5) Erosion of the soul in those of us with ideals and conviction
6) Low personal autonomy/agency with high job stress
7) *Not necessarily individual failure so much as social & occupational injustice begging political solutions
MORAL DISTRESS arises when we are prevented from doing what we believe to be the right thing. This may be caused by resource scarcity (not enough time), increased workload and interpersonal intrusion, having to enact someone else’s decision (which we disagree with, often in a setting of role confusion), disrespect, bullying, hardheartedness and lack of interdisciplinary team work/supervision.
RESILIENCE is a life force that promotes regeneration, renewal, and confronting adversity while still finding hope and purpose. It restores joy to our daily practice. Moral resilience seeks meaning in the midst of threats to integrity, or dissonance with our moral sensitivities and reasoning.
Responses may include partnering empowerment, adapting, re-prioritizing, a change of setting, communal whistle-blowing, “Walking our own talk; being true to ourselves.”
“It is one of the most beautiful compensations of this life that no one can sincerely try to help another without helping themselves.”
Ralph Waldo Emerson
Combat Burnout through Self-Care
1. Engage with others rather than isolate ourselves. Laughter and camaraderie improve mood.
“The people live in the shelter of each other.”Irish Proverb
2. Gather together to harness one voice. Present systemic concerns to a participatory leadership.
An elder once said, ”A bundle of sticks is not easily broken. I want you to live like this bundled together.”
“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it’s the only thing that ever has.”Margaret Mead
3. Seek support through a family physician, nurse practitioner, Crisis Lines, Workplace Programs, Mental Health Teams and Faith Communities. Screening tools exist for Burnout/Depression. The Good Men Project, Heads Up Guys.
4. Guard boundaries to preserve clear roles and safety for both us and our patients (colleagues, management).
5. Medication may be a life preserver.
6. Moderate Exercise- 30 mins. 5X week. Walk outdoors at breaks, to work, and to the shop. Take the stairs. Can you limit your sleeping and sitting to only 23 and 1/2 hours? Is this the single best thing we can do for our health?
7. Decrease screen time. Keep a journal. Reading (paper) novels increases compassion.
8. Listen to family, colleagues and friends’ concerns – especially use of substances. Authorize reciprocal check-in’s.
9. Consider splitting household tasks and childcare equally with a partner.
10. Improve Sleep Hygiene. Consider a sleep disorder clinic for adapting to shift work.
11. Be mindful of what your body deeply needs as nutrition and supplements. This can be a combination of bloodwork, meditation, and diet experiments.
12. Decrease intake of alcohol, stimulants and sugar.
13. Community centers offer crafts, TaiChi, dancing, choirs, sports, and hobbies.
14. Spirituality as a resource; soundscapes, devotions, meditation, prayers, attending services and doing acts of service, discussion groups and reading sacred texts. Seek sacred spaces where we may “sign in and sign out” on either side of work so as to more easily leave it behind.
15. Music as therapy. Sound baths, binaural beats/Solfeggio frequencies/brainwave entrainment.
16. Practice kind, positive self-talk. Be your own best friend.
Caveat: “If you’re in the coal mine and your canary dies, you don’t take deep breaths and do resiliency modules on line. You get out of the coal mine.” -Dr Pamela Wible