Opinion | Sunday, 6th May 2018

NHS staff are burning out – here’s how to make it stop

People working in caring professions are not superhuman, says Dr Sarah Parry

Originally published on The Conversation

by Dr Sarah Parry, Clinical Psychologist and Senior Lecturer in Clinical and Counselling Psychology at Manchester Metropolitan University

Stories about the mounting struggles of NHS staff are becoming routine. Newspapers and newsfeeds tell of how increasing pressures are taking their toll on nurses, GPs, psychological therapists and more. There is a growing awareness of the emotional impact of working in frontline services and the gender inequalities and biases being enshrined in new contracts, most recently for junior doctors.

Professional bodies have been advocating for change, petitions have been signed. People working in caring professions are often deeply passionate about their work but are not superhuman and cannot be expected to manage the unrealistic pressures many currently face, especially with such limited support.

The central theme to the stories we hear is often burnout: a concept unique in many ways to people working in professions that support others. Burnout specifically involves feelings of emotional exhaustion, disconnection and a lowered sense of personal success.

The wider picture

The continued austerity agenda has left many people and families struggling to cope, including many underpaid health and social care practitioners. This is particularly the case for professions that typically receive less financial reimbursement for their work and workforces largely represented by women, such as nursing.

We know that socioeconomic factors, specifically financial uncertainty, and organisational stressors, such as rapid privatisation are likely to exacerbate burnout. The withdrawal of certain training bursaries also leaves many underpaid practitioners bearing the burden of additional financial debt. All of these factors naturally impact the emotional well-being of those working in care services.

But many healthcare practitioners who experience anxiety worry about the stigma they may face if they speak out – both for experiencing emotional difficulties in the first place and for doing so while being in their caring practitioner role. As my colleague Hannah Wilson, who is a clinical psychologist working for the NHS, demonstrated, stigma around mental health is still prevalent in the workplace. This is a real barrier for healthcare practitioners to seeking help.

When I spoke with Hannah recently, she explained that “some clinical psychologists worry that experiencing mental health difficulties is seen to have a negative impact on their professional competency”. Understandably, it seems as though many practitioners struggle to openly discuss their experience of severe emotional distress, despite recognising past personal experiences of distress can enhance empathetic connection when supporting others.

Hannah added that “mental health difficulties are thought to occur on a continuum, which we all lie on regardless of our qualification or profession”. So of course, health practitioners are just as likely to experience mental health difficulties as anyone else – perhaps even more so considering the nature of our work.

Key issues

People working in emotionally demanding jobs, in which an “off-day” isn’t usually an option, need to emotionally process negative situations and information. When practitioners are unable to do so, there is a direct link to instances of burnout.

Therefore, the absence of psychological support in staff meetings and supervision compound the impact of work-based stress and exacerbate the experience of burnout. Research suggests that workplace support protects people from emotional burnout. Government strategists need to recognise that it is not appropriate to expect NHS staff to simply become even more resilient without organisational support – it is neither moral nor effective.

A change in working culture is essential if the well-being of those working in care services is to be truly addressed. Growing awareness around the importance of emotional well-being in one’s job role has led to a number of new recommendations collated in a forthcoming report from the British Psychological Society. The report aims to offer guidance around developing psychologically healthy places of work.

What can be done?

In the meantime, what can we do to look after each other and ourselves? I recently explored how people in health and social care professions can protect themselves from compassion fatigue and burnout in challenging working environments. The following four steps were found to be key:

• A sense of purpose and of belonging is essential. Developing compassionate relationships with patients and colleagues really helps. But precious time with people is too often compromised due to large caseloads and a target driven culture. This needs to change.

• A safe and supportive space with colleagues or a supervisor for reflectively processing distressing events and information at work is key in protecting practitioners from burnout. Supervision therefore needs to include compassionate connection and a genuine care for a practitioner’s well-being, rather than being only a case management review.

• Feeling valued and wanted is incredibly important for staff, especially during times of difficulty. Sadly, for many NHS workers in front line services, pay and workload demands undermine their sense of being valued and amplify a “never enough” narrative.

• Self-kindness and acceptance are indispensable. Caring professionals are not superhuman and can only work with the means at their disposal.

Going forwards, everyone has a role to play, whether that is as an ally for someone who needs compassionate support, signing a petition supporting greater fairness and equality or lobbying for greater social justice for staff who offer their care. The current socioeconomic crisis has led to increased demand for health and social care services in the UK, especially for mental health services. We therefore need to ensure society and government support those who offer care to remain in their professions without compromising their own well-being by promoting social justice and social change.

Join Dr Parry and people from across the health and social care sector for the one-day Practitioner Wellbeing and Self-Care Conference (14 June) to explore how we can better address the emotional needs of health and social care practitioners. Book now.