Self-Care is the Prescription
With the demand to perform in a stressful, and sometimes chaotic, environment for long hours at a time, physician and nurse burnout has become such a concern in recent years that several Memphis-area health institutions now offer solutions to increase the resilience of medical students, physicians and nurses in the classroom and the workplace.
From compassion fatigue rooms to meditation classes, local healthcare entities acknowledge the growing problems associated with burnout and are providing tools and implementing programs to assist medical professionals in achieving a healthy work/life balance.
"Many health professionals don't have a history of self care," said Kathy Gibbs, assistant vice chancellor of the office of student academic support services and inclusion at the University of Tennessee Health Science Center (UTHSC). "Life happens while students are here, and it will continue to happen when they become physicians. We want to help them develop healthy ways to cope and manage stress while maintaining a healthy work/life balance."
Medical Students and Physicians
According to a survey published this year by the American Medical Association, the Mayo Clinic and Stanford University School of Medicine, 43.9 percent of physicians exhibit at least one symptom of burnout. Burnout is defined as long-term unresolvable job stress, which leads to exhaustion, a lack of joyfulness, a reduced ability to show empathy toward patients, job dissatisfaction, a sense of failure and depression.
Another survey conducted this year by the National Academy of Medicine, which released its results last month, stated the percentage is much higher for medical students - almost 60 percent. The report from the survey stated that physicians are "more prone to burnout because of the workload, pressure and chaos they deal with each day."
"Doctors are under a lot of stress and make hard decisions every day," said Kimberlee Strome, wellness and yoga director for the Mind Body Wellness Center at UTHSC. "They are interacting with patients and their families and then must come home whole to their families. It's a demanding profession."
To assist in combating the national problem, the report suggested that medical and nursing schools should train students to deal with burnout.
According to Gibbs and Strome, UTHSC has developed many initiatives over the past year to tackle medical student and resident burnout.
Last September, UTHSC launched the #takecare program, an initiative designed to support the emotional health and well being of medical students by focusing on early intervention to help them successfully cope with the emotional, academic, social and physical demands of pursuing an advanced health science degree. UTHSC added counseling personnel, improved student access to mental health services and destigmatized mental health care by marrying it with academic support services and moving it out of a clinical setting.
According to Gibbs, whose department oversees the program, the purpose is for students to recognize that they must take time for self care. Besides offering counselors to students and residents, the university provides faculty panels from various colleges to discuss skills and techniques to better manage and handle the demands of medical school. Last December, UTHSC hosted a speaker to provide suicide prevention training to faculty, students and UTHSC staff.
"The rates of depression, anxiety and suicide are high for health professionals," Gibbs said. "They are 10 to 30 percent higher for medical students than the rest of the population. One physician commits suicide in the U.S. each day. It's extremely important to feel well-balanced. We have to communicate that they need to be cared for, so they can show caring for others. Counselors are trained to see how the student is doing emotionally. For instance, is the student using alcohol or drugs to calm down or sleep?"
UTHSC set up an online portal where faculty, staff and students can anonymously share concerns 24 hours a day. Additionally, the university provides educational specialists to assist medical students in developing good study habits.
"Students come to medical school academically strong, and some haven't had to spend a lot of time studying," Gibbs said. "They haven't developed good study habits, and when they enter medical school, it's like drinking out of a fire hose. There is more to learn and less time to learn. They start to question their abilities and whether or not they should be here. This environment is dysfunctional. It's tough and stressful, and the students must maneuver and learn to thrive in this environment to become successful health professionals. This initiative is designed to be preventive. We want students to feel comfortable to reach out if they are overwhelmed."
To assist students in managing overall wellness, UTHSC dedicated 3,214 square feet for its new Mind Body Wellness Center, which is under construction on the second floor inside the university's student-alumni center. The center will house a fully equipped studio for yoga, barre and pilates classes, a meditation studio and balcony study area. The student-alumni center also houses a kitchen, which will be used to demonstrate healthy cooking habits for students. All services will be free to students and faculty.
"We are giving medical students the tools to shut out the world for five or 10 minutes and calm their minds, which will give them a new perspective when they go back to their studies," said Strome, who is the director of the center and the wife of the executive dean of UTHSC's College of Medicine. "My hope is that this helps students long-term as they become physicians and must learn to be present for each patient. A simple mind body exercise can help sharpen concentration. I'm giving them tools they can do at work before they see a patient."
Wellness programming began in April for students with a 90-minute yoga hike at Shelby Farms Park, yoga classes at Health Sciences Park marketed through the Memphis Medical District Collaborative and a happiness workshop.
"As a wife of a physician, I understand how demanding this profession can be," Strome said. "This is a gift we are giving students."
The UTHSC Mind Body Wellness Center is scheduled to open in January.
It's not just physicians and medical students who are affected by burnout. Studies show there is statistical significance between nurse engagement and patients having better experiences. The National Nursing Engagement Report, which was completed by a national healthcare market research company, said 15.6 percent of nurses reported feelings of burnout. The percentage rose to 41 percent for nurses who are unengaged.
Earlier this year, Shelley Shellenbarger, director of cardiology services and the neurology telemetry unit at Saint Francis Hospital, Bartlett, was completing her final project for her master's degree in nursing. She looked at studies on nurse burnout and compassion fatigue.
"Nurse burnout and retention are national issues, and I wanted to see what we could do to reduce compassion fatigue," Shellenbarger said.
After much research, she discovered that nurses could benefit from a "serenity room," a quiet, calm environment where nurses could take a moment during a demanding shift. She saw benefits of a similar room for nurses at St. Jude Children's Research Hospital.
"Sometimes all nurses need is a few minutes to reflect or regroup during a long, 12-hour shift," Shellenbarger said. "The hospital was supportive of my idea. It's a little thing that makes a big impact. It benefits the quality of service at the hospital while being sensitive to the needs of the nurses and staff."
Shellenbarger presented her idea to Saint Francis Hospital leadership in February. One month later, the hospital created two compassion fatigue rooms for hospital staff. The rooms, which are on the second and third floors of Saint Francis Hospital, Bartlett, are painted pale blue. Essential oils, water bottles, snacks and a massage chair are available for employees to use. Shellenbarger says every hospital leader has key card access to the rooms and is trained to recognize someone who may be experiencing compassion fatigue during a shift. They can offer use of the room. Additionally, any hospital staff employee can request to visit the compassion fatigue room. The average break time is 15 minutes.
Other Mid-South hospitals, including Baptist Memorial Health Care and Methodist Le Bonheur Healthcare, offer employee assistance programs where employees and their families have access to professional counseling services. Methodist launched a Mindfulness Based Stress Reduction Program in 2015, which consists of a six-week mindfulness and meditation course for its employees. Offered five times a year, the course focuses on meditation techniques. According to Donna DiClementi, director of the employee assistance program for Methodist Le Bonheur Healthcare, the hospital system receives resilience feedback from an internal survey each year. Hospital officials say Methodist Le Bonheur's resilience score is "well above the national average benchmark."
According to Melissa Wilkes Donahue, director of concern employee assistance program for Baptist Memorial Health Care, Baptist is in the process of launching telehealth counseling for employees. All Baptist employees will be able to conference with a licensed counselor over their smart phone through a mobile app.
Regional One Health has a pastoral care department, which is made up of chaplains who can provide spiritual support to hospital employees in times of crisis. Lisa Schafer, executive vice president and chief nursing officer for Regional One Health, said pastoral care coordinates Code Lavender, which provides emotional and spiritual support, grief counseling and crisis debriefing when a team or nurse needs additional support.
"Members of pastoral care have carts of soft, treasured things like candy or something soft to hold, "Schafer said. "Because we are a level one trauma center, our nurses are constantly bombarded with tragic circumstances, one right after another. They may need a moment to recover in a debriefing room."
Schafer says the hospital provides a day course for nurses on de-escalating aggressive behavior in the hospital. As part of nurse orientation, nurses interact with actors in a simulation lab and learn how to handle aggressive behavior.
"We support our nurses and focus on gratitude, but we can do a lot more," Schafer said.
Methodist LeBonheur Healthcare
St. Jude Children's Research Hospital
University of Tennessee Health Science Center