Takeaway
As with other traumas, burnout, viewed as an opportunity for personal and professional development, offers a way to expand ourselves as wholehearted healers.
Lifelong Learning in Clinical Excellence | October 18, 2022 | 7 min read
By David Kopacz, MD, University of Washington, Lucinda Houghton, PhD
As healthcare workers concerned about clinician wellness, we’ve found that there’s a dualistic narrative around burnout and resilience: that burnout is “bad,” and resilience is “good.” This narrative implies that if we were more resilient (did more self-care in our personal time) we wouldn’t burnout. However, this view uses a judgmental, shame-based narrative that can lead to personal and professional feelings of failure, disappointment, humiliation, and unworthiness. We’ve both been in the throes of burnout, found our ways out, and sometimes, we find ourselves venturing back there. Admitting these truths has been taboo in healthcare. We’ve both struggled with the “should” culture this type of lens presents: feeling we “should” just work harder, we “should” not feel burnout, we “should” be more resilient. We challenge the shame-based narrative as research has shown that healthcare workers can be both resilient and burned out! We offer the concept of post-burnout growth.
Post-burnout growth comes from a synergistic interaction of burnout and resilience as inter-related, interconnected concepts. This helps us move from a dualistic shame-based lens to a holistic growth-based lens to view our lives and work. Post-burnout growth doesn’t replace burnout and resilience, instead situating them in a synergistic dynamic like a yin yang relationship. Instead of opposites, burnout and resilience are viewed as two interlocking components of the growth process. The resilience in post-burnout growth isn’t resistant or immune to suffering, but rather is able to use it to grow in compassion and self-compassion.
Dina Glouberman wrote about the growth potential of burnout in her book, “The Joy of Burnout: How the End of the World can be a New Beginning.” Post-burnout growth is similar to Glouberman’s perspective, as well as being consistent with the process of initiation, transformational learning, and Joseph Campbell’s hero’s and heroine’s journey model. These models provide a narrative in which suffering, disorientation, and the dark night of the soul can be steps in a process of growth and transformational learning. In this way, burnout can be a gift, a tremendous opportunity for growth even while it causes suffering. Post-burnout growth is analogous to posttraumatic growth, in that suffering can lead to transformative growth and wisdom. Posttraumatic growth doesn’t glorify trauma in recognizing that it can lead to growth. Similarly, post-burnout growth isn’t a glorification of burnout. Suffering is a fact of life. As healers we move toward suffering with the intention of alleviating it.
We can approach burnout, rather than trying to avoid it through wishful resilience. True resilience includes the capacity to suffer and periodically go through burnout. There’s no way to avoid suffering in working with other’s suffering. Post-burnout growth shows us that there is a beautiful choice, a beautiful opportunity that lives in this space of burnout. Within burnout is a potential energy that can us expand our previous level of resilience. In this sense, resilience is not about bouncing back to who we were, but expanding as wholehearted healers. We can use the fragments of our hearts and even our souls to rebuild a higher order of resilience. Becoming a healer is a process of burning out, reigniting, and rebuilding ourselves to become even more capable of working with suffering—our own and our patients.
There’s a Buddhist story that illustrates post-burnout growth. Once upon a time there was a buddha named Chenrezig who was moved by all the suffering in the world and made the vow, “May I alleviate all suffering or burst into a thousand pieces.” After working tirelessly for many years, Chenrezig steps back and sees that suffering is endless and boundless. In despair and shame at having broken the healer’s vow, Chenrezig bursts into a thousand pieces. However, another Buddha, the Buddha of Compassion collected all these pieces and told Chenrezig, “To heal is a noble vow, but the work of healing is never done, and one must feel suffering in order to reach it—therefore I will put you back together, but now with a thousand eyes to better see suffering and a thousand arms to better touch suffering. Go back to your work as a healer, but do not think that because there is suffering, or even if you suffer, that you are failing in your task.” In this way, the Buddha of Compassion is acting as a ritual elder, a mentor of compassion, providing a kind of peer support that teaches “There is a goodness that can be found in the suffering you are experiencing now which can become your strength.” Perhaps the role of the modern Chief Wellness Officer is not to prevent burnout, but to provide mentorship and advocacy for institutional changes that support the growth of the wholehearted healer.
The story of Chenrezig teaches us that is ok, maybe even expected to burst into a thousand pieces when working with suffering. Post-burnout growth brings to light the possibility of positive, compassionate growth allowing for enriched personal and professional fulfillment and thriving. Perhaps part of the epidemic of burnout is an industry-wide inattention to, and lack of prioritization of, caring and compassion for clinicians. Maybe part of the problem is that we have over-emphasized technical, protocolized approaches to suffering and we have forgotten that suffering requires our full, engaged humanity—for our patients and for ourselves. We call on the healthcare industry to recognize the inevitable suffering that comes from working with others’ pain as well as the potential opportunity to grow in compassion, caring and empathy. Healthcare organizations can anticipate and proactively create the structures needed to honor and support our experiences in recognition that we may periodically fragment into a thousand pieces. We talk about life-long learning and have annual requirements for Continuing Medical Education (CME) to ensure we are best prepared to heal our patients suffering. We propose healthcare organizations also support Continuing Healer Education (CHE). CHE presents an opportunity for healthcare organizations to care for their clinicians through the time, space, knowledge, education, and tools needed to heal and grow from the inevitable wounds of suffering.
In summary, we offer:
1. Post-Burnout Growth as an opportunity to rise from the ashes of burnout and experience the positive transformation of growth as a healed healer and a thriving human.
2. Use suffering to develop a deeper understanding of self, increased capacity for compassion and connection, and a sense of gratitude for life.
3. Help create a responsible growth-based culture of healing for both clinicians and patients in your organization.
Individual practices
1. Cultivate the courage to walk through the discomfort of burnout and start the growth process.
2. Focus on connection: to your inner self, to your purpose, to your family, friends, colleagues, and to your patients.
3. Care for yourself, remembering “the kindest, most responsible action we can take for others, is to take great care of ourselves.”
4. Practice self-compassion becoming a best friend to yourself—supportive, gentle, and loving.
5. Engage in reflective practices: journaling, mindful movement, creative work/play, breathing and meditation, allowing you to metabolize any residual suffering.
6. Develop practices for cultivating joy and bliss for yourself and for your patients―life is full of suffering, but that’s only half the equation: you can find the most beautiful and inspiring moments even in the darkest places.
Institutional practices
1. Eliminate policies and protocols that cause moral injury and burnout.
2. Eliminate obstacles to clinician caring for clients.
3. Commit to built-in organizational practices, time, resources, and leader behaviors that make clinician wellbeing a top priority.
4. Anticipate clinical work may lead to burnout and equip staff now!
5. Develop institutional supportive resources tailored to the care of healers.
6. Build in paid time for well-being activities.
7. Many institutions offer Continuing Education for professional development―we suggest giving an equivalent time to developing as a healer with Continuing Healer Education (CHE), encouraging clinicians to return reinvigorated and rejuvenated, bringing new energy into the institution and promoting retention.
8. CHE could promote community building, peer support, mentoring, wellness learning networks, wellbeing certification learning, etc.
9. Establish a Second Victim Response Team for clinicians in crisis or who experience traumatic events while at work.
10. Provide high quality, confidential, and non-punitive mental health and substance use care.
11. Utilize human-centered design—create policies, procedures, and protocols that enhance the humanity of those working in the system and those receiving care.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.