My Burnout
There’s been a lot of talk about clinician mental health during the Great Pandemic. As a group, we’ve been stretched farther than ever thought, been forced to do even more with even less, endured PPE shortages, medication shortages, and the realization that a significant portion of the population who cheered for us and banged pot lids now look at us with scorn and disbelief.
Substance use is up among all populations, and I’d bet we’re no different. We probably haven’t totaled up or studied the loss of colleagues to a mental health crisis, suicide, or just plain walking away from the profession of caring for people at all levels. The impact on public health and our profession will without a doubt show itself in the coming years as we see people leave or not enter training.
So what exactly IS provider burnout? According to the American Psychological Association Dictionary of Psychology, burnout is defined as, “Physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others. It results from performing at a high level until stress and tension, especially from extreme and prolonged physical or mental exertion or an overburdening workload, take their toll.” It manifests itself in a lot of ways, but I’m going to talk about mine.
I got burned out.
I’ve been in EMS a long time. I was certified as an EMT back in 1994, and since then, I’ve held a license to practice at varying levels. My list of things I’ve never seen before has gotten progressively smaller; although it is still there. Of everything I’ve done in my adult life, I’ve enjoyed EMS the most, and it’s been good to me.
In early 2020, my colleagues at the shop I worked at were dealing with the dissolution of that department, our absorption into multiple other EMS departments, as well as this odd virus that seemed to be spreading quickly, although we were assured that there wasn’t a big issue, it would be mostly over by the summer.
We slogged through the multiple waves of COVID, using any protective equipment we could find or scrounge as we struggled to learn and understand the danger to our patients and ourselves. I watched friends get sick, and people that I worked with get very sick. Some died.
We kept moving.
As things progressed, I saw the change in people, even some I worked with, as they stopped believing in science and data, and made a strand of unthinking protein choose a political ideology.
I saw our shiny new MICU vehicles become like us. Scarred, scratched up, dented, and check engine lights on. Our brand new equipment bags became soiled and worn. There were a lot of reasons for this, and believe me when I say I understand how logistics and management in big corporate structures work, (or don’t). But there seems to be no remedy, just more signs, inspirational rocks, and “thank you for your service” pizza, etc.
The calls kept coming. We work in a tiered system, where paramedics should theoretically be reserved for the life threats and complex cases where we can truly help patients. Yet it seemed as though the calls we were going on were less acuity, and our cancel rate, which traditionally ran about 50% when things work; became 80-85%. We ran all day, chasing our tails and being reassigned to calls that were further and further away; lessening our chances of being available to help.
Worse, our moral injury would increase when during these “high volume” periods you would hear a BLS unit begin on the radio for any help with a sick person who needed an airway, or a pediatric near-drowning…and getting none. Or we would arrive on the scene only to be canceled by the EMTs.
15-20 times a day, we would head out in our vehicles in an emergency response. We would see maybe 2 patients. Multiple emergency responses, redirects, and “interfacility evaluations” where most of the time a staff nurse would look at us bewildered as we showed up, unaware that by answering a computer algorithm question asked by a non-clinical call taker, the transport of the sweet older woman who had abnormal labs led to a paramedic unit being sent.
There wasn’t a week that went by without some tweak to how we did things administratively. Another online form to fill out. Another check sheet. Another layer on the cake.
Our leadership meant well, but when things were brought to them, they would offer to “look into it” or “study it” and “get back to us”. That came to mean for the majority of us that the status quo would remain.
My partner, one of my closest friends and one of the best paramedics I knew, decided to leave for greener pastures. I couldn’t blame him, and I was thrilled that he found his calling and stability for his family. But it weighed on me, as every day I would have to adapt and find a flow with a different partner.
Some of them are great friends, and it was terrific to work with them and catch up on old times. Some were not.
More weight.
It became apparent in other ways.
I started to notice that I didn’t look forward to coming to work. I didn’t want to be there. I started feeling a sense of dread the night before, and as I got ready in the morning, I’d say to myself, “I just have to get to tonight.”
On my shift, if it didn’t directly involve patient care or a regulatory issue; I stopped caring. If the brass didn’t give me a place to wash the truck, that’s on them. Not my pigs, not my farm. Check sheets? Admin stuff? Didn’t care. I wasn’t the only one. In the brief breaks, we got; you could find me in the truck, napping or watching TikTok.
I was showing contempt for my job, much like Alan Alda playing Hawkeye Pierce in “MASH”, or Perry Cox in “Scrubs”. Great docs, but they gave absolutely zero you-know-whats about the organization they served in. And that was exactly who I was emulating. I became surprised by some of the wise-ass comments that came out of my mouth, but behind a mask and with smiling eyes; you’d be surprised what you get away with.
I didn’t care anymore. What were they going to do to me, assign me to a medic unit? Send me around the county chasing my tail for 12 hours again? I almost started to think getting written up for something would be fun, like what would it take for them to notice?
Even though I’m sure they noticed; it never got to that. And as I write this, I feel as though I’m pulling out of the trough of my burnout. How do you ask?
The first step in any problem is to admit there is one. While this is hard for institutions and sometimes leaders to do; as individuals, we can do it for ourselves. In my case, I looked at my feelings for what they were and recognized that something changed in me.
Next, I started to look at why I was feeling this way. In my case, it all stemmed from a feeling of being adrift in a system that has stopped giving a shit. The little things don’t matter anymore, and there’s no sign that they will come back soon. The stuff I didn’t care about? I felt that way because I had no reason to care about it.
So, what’s the solution? For me, I started to focus on the things I could affect and tried to stop worrying about things that were out of my control. Yes, my system is flawed as hell, and so is yours probably. But, for me what worked was making my world work the best way it could. I can’t change dispatch algorithms. I can’t change that my tech doesn’t work as well as it should. But I CAN work on the problem to find solutions I can live with.
Another thing I tried was to stop constantly bitching about the same stuff over and over. I found for me, it just grooved me into a state of constant irritation and annoyance. It’s OK to point out the absurdity of something to your partner or at shift change. But then, consciously tell yourself to put it away. Revisiting it doesn’t help. This didn’t work all the time for me; ask my partner.
If you’re the type of person that finds positives in engaging your leadership; do it. It doesn’t work for me, and after a stint in management myself, I have a lot of cynicism. I find for me it’s better to not.
Find the things that kindle your passion and keep plugging at them. For me, precepting new medics have been something as a way to see things through non-jaded eyes, and a way to reinforce your ethos to a new generation. I did, however, take a break for a couple of months during the worst of it. I wasn’t helping them as much as I could, and that’s not good.
Seek out your support structure, therapists, or both. Share your feelings, and you may be surprised to hear what you get back. It’s OK to tell a partner that you’re not feeling it today, but you’re going to give it your best. We all can’t just motor through this. I am extremely lucky to have a great partner, friends, and tour colleagues that reached out to me and truly cared about me as a clinician and person. I hope I can live up to that and pay it forward.
Finally, give yourself some grace. We need to recognize that COVID will recede, and we’re going to enter a new normal. We all will have the opportunity to live again without the cloud of the last three years hanging over us. This hasn’t been easy or fun for anyone, and it’s OK to not be OK. Sometimes your 80% is enough.
And so, I began the climb out of the hole of burnout. Am I out? Not yet. But I’m closer to the top than the bottom right now. And that’s OK for me.
