How (Hospice) Organizations Contribute to Burnout

I had some really amazing moments when I worked as a chaplain and bereavement coordinator in hospice. There were many times when I laughed, cried, was amazed, and was even left speechless with a smile on my face. There were also unfortunately times when I was left speechless while

shaking my head.

I had the honor of playing a pivotal role during huge moments in individuals' and families' lives. Holding peoples' hands as they transitioned. Praying with families just as or after their loved one took their last breath. Singing old hymns to someone who was no longer coherent but seeing the tears form under her eyelids and the smile come across her face while the family looked on. All precious moments.

There were moments, too, however, when I must honestly say that it felt like I was just checking tasks off of a list to get them done. It didn't have to be that way, but oftentimes it was. Much worse than what I was experiencing were the nurses who were understaffed and forced to take on-call shifts for weeks on end while management promised that "we would have someone hired soon" as the months passed.

These nurses developed compassion fatigue and were often robbed of the opportunity to see the patients and families for who they were. They only got to experience the rough parts of the family dynamics and hear the complaints about how to dress wounds and administer medications because there simply wasn't enough time to get to know them. Instead, the nurses were rushing off to another patient while fielding calls in between visits and ending their days sitting at home doing their documentation waiting for the phone to ring as they were on yet another on-call shift. This is no way to work, let alone live.

Studies show that 90% of burnout is caused by the organization's culture while only 10% by individual practices and habits. This tells us that organizations need to take a look at their practices so as to help keep their employees from burning out. This goes for hospice or any healthcare organization with their nurses or any corporation with their employees. Burnout IS avoidable.

We have explored the cost of burnout to the individual in previous posts and will explore further in future posts, but what about the cost to the organization?

Let's look at two scenarios: a burned out nurse who stays with the hospice team and a burned out nurse who quits.

I realize that I'm telling you things here that you already know. But sometimes we need that to awaken us to the obvious and move us to preventative action. If you have a burned out nurse in the field she is likely experiencing emotional difficulties. She may have to call off of work frequently because she is having difficulty coping. When she is in the field, her lack of ability to have compassion shows and patients, families, and facility staff notice. Your organization's reputation will suffer as a result. Referrals will decrease and business will decline. Your marketing director will be scrambling to undo the damage and your hospice director will start to feel the heat from corporate. Does any of this sound familiar? Ok, you get the picture.

What if the nurse quits? So now it's only been six months since you hired this nurse and he has already quit. We know that there's a shortage of nurses in general and, statistically speaking, most nurses who have worked in hospice will not return. So, the chances of finding a nurse with hospice experience is even less. Meanwhile, you have lost the money that you spent to train him and the cost of vacancy is beginning to accrue for each day the position is open. Every time someone walks out that door and someone else walks in, you have the hiring costs, vacancy costs, and the training costs all over again. These add up and it is MUCH cheaper - and might I add, much more humane - to create a healthy culture that will allow them to stay.

Typically organizations - let's focus on hospice as an example for now - tend to get stuck in the mindset that they have no choice but to do things the way they are. They don't have enough nurses, so they need to keep their on-call frequency higher. The truth is, though, there ARE other ways to do things. This is where coaching comes in. A good coach can help leaders to take a step back and see the other options that are right there in front of them. This is a practice of mindfulness - a type of awareness - that is aided by the coach asking powerful questions and helping the client to see the answers that they already had, but just weren't aware of.

Even if a person isn't actually called in, being on call takes its psychological toll. People who are on call typically do not get enough sleep as they are anxious that the phone will ring. This lack of rest is a huge contributor toward burnout. It's important that people are able to disconnect completely and not have to take any of their work home with them. On-call shifts are only one example of the job that can be adjusted to make the work experience healthier.

Hospice work is beautiful and meaningful work. It should remain that way. Because of the nature of what we do, it takes its toll. This is why it takes an extra dose of mindfulness and intentionality on the part of both the practitioner and the organization to avoid burnout. This can and should be done. All of the principles apply to any kind of organization with individuals who experience burnout. If you need someone to work with you in the process, I'd be happy to partner with you.

Brandyn Simmons

brandyn@brandynsimmons.com

www.brandynsimmons.com