Your resilience workshop can kindly fuck off

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This post has been submitted anonymously. It discusses burn-out and the overwhelming systemic problems being ignored while we are being told we just need to build resilience.

Yes, I’m bitter. I’m angry. I’m tired. I pretty much hate everything right now. Why? Well, I’m sitting here trying to recall the last time I had a shift with things running smoothly because staffing, resources, support, and all the other little things were, for the most part, there. My most recent shift was so horrible that it felt out of control and dangerous for my patient group because there was no one around to help when things went downhill for two of them simultaneously, remaining so for the last 4-5 hours I was there.

According to the DSM, WHO, and Twitter, I am experiencing burn-out. A pretty obvious conclusion I’ve reached myself a couple of times over the years. A large problem here, though, is that this word is reduced to buzzword status and the seriousness of it has been undermined by its cultural and actual definitions.

The World Health Organization’s definition of burn-out

Side note, according to this person, burn-out amongst doctors is “fashionable”.

I guess Germany has better working conditions.

The overwhelming truth from where I’m sitting is that burn-out is a thing that does exist, but it’s not thought of as the very serious problem it actually is. WHO says that burn-out is only intended to define workplace phenomenon, not applicable to experiences outside of work. Tell me, dear readers, when you leave work, does burn-out just stop being a problem for you? Does it no longer influence your moods, your conversations, relationships, your level of recreational activity, or usual life’s pleasures?

You see, in my non-scientific, purely anecdotal opinion, burn-out lives on a spectrum, from none to severe. On a scale of 1-10, you start taking that home with you around a 7-8. Suggesting this has nothing to do with outside-of-work stuff is asinine once you hit severe. The psychological lines between home and work blur as self-care happens less and less. Relationships turn upside down. Sleep stops. You end up being miserable.

A story of depression in healthcare. Or is it burn-out?

The experts will argue that burn-out isn’t its own diagnosis because it overlaps depression. Frankly, I think that’s absolute garbage. Experiencing both burn-out and depression at different and separate times in my life, depression and burn-out are equally as significant, distinct, and valid as one another. One has life triggers and requires life adjustments. The other has occupational triggers, remains for awhile at work only, then can cross a line that brings it home. It’s this occupational dread that has been filling me lately.

I’m pissed off. Frustrated. Mean. Dealing with intrusive thoughts of stress at work. I’m not depressed. I’m not anxious. I just thoroughly hate my job at the moment because of how seriously flawed healthcare is and how much harder it gets every day to do more with less. This hate and loathing is totally atypical of me. I usually feel tremendous passion and joy at what I do for a living. I wouldn’t trade it for the world. Even in my worst moments, when I consider leaving altogether, I know I’ll hate that I’ve left. So I stay, hoping for better shifts that lately seem not to come my way.

When we speak of burn-out in healthcare, there is a totally different experience altogether compared to other industries. Healthcare wasn’t my first occupation, and really, it wasn’t my second either. I’ve had jobs across different industries. Some very noteworthy things unique to healthcare need to be pointed out:

  • Healthcare workers are continuously in positions of vulnerability, in terms of patient safety, protecting the public, and protecting our own personal safety.
  • A known occupational hazards is vicarious trauma. Some people do okay witnessing the after effects of another person’s trauma. Others accumulate that trauma in themselves, which can produce PTSD symptoms.
  • Ironically, healthcare workers can be the harshest critics and judges when a worker discloses they are struggling coping with trauma and stress in the workplace. We face the possibility of termination or unlicensing if they admit to mental illness.
  • Of all industries, healthcare workers are the most likely to lose time from work because they’ve been assaulted on the job.
  • Healthcare workers depend on and collaborate with each other greatly in literal life or death issues, sometimes on a daily basis. Poor relationships, communication, or lack of trust between colleagues can have disastrous consequences.
  • We are under enormous stress because one mistake on the job can literally kill someone.
  • We can be held responsible for decisions made by other people (though management would never admit that), such as standing orders, protocols, subordinates’ decisions, policies, staffing, etc.
  • Speaking of staffing, (or, rather, short staffing of nurses), it can literally kill patients. So can too many admissions given to a nurse in one shift. The nurses and doctors charged with the care of these patients are held responsible for that, though they have no power to influence it.

This partial list hopefully illustrates a bit of what makes healthcare burn-out unique when compared to other industries. It’s the stress and enormous responsibility. We are faced with impossible demands with too few resources (that decrease more and more over time), mixed in with too many variables to count and account for adequately, and abuse from colleagues, superiors, and patients or their family members. I wont rattle on longer about this because anyone who has read this far probably works in healthcare and already knows all the other problems.

The issues we face are systemic. They range from simple to severe, from occasional to frequent. When we say we are burned-out, it means something entirely larger than we are just frustrated at work. It does extend outside of the job. It does affect personal relationships. It does affect self-care and interest in hobbies. Does that mean it is depression? No. Burn-out requires a different approach than treating depression.

So, about these Resilience Workshops you want to push on me and everyone else, let me tell you what Resilience Workshops imply to me:

  • I am flawed because clearly I can’t cope with some work problems
  • My employer is the abusive spouse who tells me that if I were just better and stronger, the abuse will stop
  • I should stop directing energy at fixing systemic issues because I am the one who needs to be fixed
  • I’m definitely not strong enough
  • I am broken, and that is my fault
  • It is not very reasonable that I feel something is wrong outside of myself
  • My anger is invalid
  • My frustration is an overreaction
  • Learning a couple of coping mechanisms will make this all better
  • The high rate of mental illness and suicide among healthcare workers is not worth looking at from a systems perspective or addressed with systems changes – just build resilience!
  • Burn-out is fashionable
  • We can simply Kumbaya this crap to make it all better
Might have to stick this on my Secret Santa list

Instead of spending this focus, energy, money, and time on developing programs based on us being too weak to hack it, consider developing programs that address the systemic issues instead. We need research. We need methods of improving this disaster we work in. Instead of teaching us to be strong, sit us down with senior leadership. Allow us to be honest without consequence.

Work toward something better. Develop solutions and implement them. Don’t tell me I need resilience when all you do is punch me in the metaphorical gut with one challenge after another, all these challenges being things that could be preventable if time & effort were committed. Frankly, your constant pushing of building resilience is offensive and only serves to build more anger. Perhaps it is to distract us from those things that keep going wrong, or the removal of resources but building of requirements put on us.

How about real effort toward real change? Improve the system instead of convincing the people working in it that they are the ones who are broken.

This post submitted to Silent No More Foundation with the request that the author remain anonymous. If you would like to share your thoughts on this, or other topics related to healthcare, workplace safety, mental health, and abuse of healthcare workers, email us at info@silentnomorefnd.com.