I watched Insight (SBS, Tuesdays) and it broke my heart. It was an episode dedicated to “burnout” in the medical professions and consisted of an all-female panel of 2 doctors and 1 nurse.
It broke my heart because there are so many others experiencing the same despair that drove me to breaking point a decade ago.
It broke my heart because the correct terminology was not used anywhere within this program. An outdated term was instead used, which is not specific to the helping professions. Compassion Fatigue (and some trauma-related injuries such as Vicarious Trauma) have been in use since the 1990s and reflect the important research that has been conducted in these areas. Why not use these terms?
It broke my heart because every interviewee reported similar experiences, reflecting the already known (and preventable) causes of CF:
- Impossibly high caseloads and lengthy works hours (especially shift work)
- Caseloads consisting solely of highly traumatised clients/patients
- Workplace culture where employees are reluctant to disclose [to CF or other workplace-related distress] or seek treatment, fearing that doing so will negatively impact their career
- Workplace culture where quality supervision and/or regular formal debriefing is not regularly provided.
In addition to the above factors, the program reminded me of two personality traits prevalent in helping professionals with CF:
- Those who are high achievers with perfectionistic tendencies
- Those with low assertiveness skills
Being a high achiever is not, in itself, a risk. Indeed, only those with superior intellect, dedication and academic ability are admitted to specialist university programs. And rightly so. There is nothing wrong with being driven to achieve, but concern arises when a high-achieving perfectionist drives themselves to the point of self-flagellation. These people are likely to spend an inordinate amount of time questioning themselves, thinking and feeling:
“I should be able to fix/do/complete this!”
“I shouldn’t feel this way!”
“I’m a terrible [insert professional title]!”
How can the workplace culture be adapted to address the risks facing high achievers?
Actions speak louder than words. Employers must provide regular opportunities for their employees to speak up about workplace worries. They also need to recognise that employees may need to be asked “are you ok?” many times or in many different ways before they feel sufficiently safe to speak up.
Demonstrate that those who speak up will have their concerns taken seriously. If you, as a supervisor, believe your employees should learn how to “stand the heat or get out of the kitchen” you are contributing to the problem. Just because you had to deal with unreasonably high workloads when you were new to the profession, does not mean you are required to serve your employees with the same.
Recognise that high achievers are probably more focus on outcomes rather than the process. They need active encouragement to practise physical, social and emotional self-care. Be a role model and talk openly about how you practise these things.
Go out of your way to ensure high achievers leave on time, take lunch breaks, attend de-briefings and get enough sleep. Do not take advantage of their high-achieving status by giving them additional work.
The second personality factor – low assertiveness skills – can be an issue for everybody but is especially common amongst young women. With women being over-represented within many areas of the helping profession (especially nursing, education, social work and counselling), it is time we recognised the gendered risks to these professionals.
With girls being traditionally taught to help and nurture others, it isn’t surprising that women feel guilty when asserting their workplace rights, torn between their responsibility to themselves and their responsibility to their clients/patients.
Neither is it surprising that these same women are reporting that they feel ill-equipped to:
- refuse unreasonable and/or unpaid overtime
- refuse unreasonable workloads
- ask their boss for a pay rise
- ask for time off
As mentioned, those who are young are most likely to demonstrate low assertiveness (Maslach, 2003. P99-100) A graduate with a four year university degree can enter a frontline helping role from twenty two years of age. Due to high turnover rates, there are almost always vacancies available for frontline roles. And yes, they are attractive to young people and other energy-filled souls eager to make a difference.
A common symptom of CF is apathy, impatience, or even disgust, towards clients/patients. It is equally common for professionals to feel horrified and ashamed of these same feelings. This is compounded by the shame they’re probably feeling at not being able to meet their own impossibly high expectations. Someone who is overwhelmed with shame is unlikely to seek help.
How can the workplace culture be adapted to address the risks facing those with low-assertiveness skills?
Promote quality assertiveness skills and model that “using your words” leads to positive outcomes. Encourage employees to insist on receiving the regular supervision and/or debriefing they are entitled to receive.
Educate employers about how to listen first and act second. Train supervisors regularly – do not assume that because they’re good at their job they know how to provide excellent supervision and/or debriefing.
Don’t assume your employees have plenty of people they can talk to about workplace-related stress and worry. Some helping professionals feel desperately lonely, even when they’re surrounded by other helping professionals all day long. Perhaps they’re the only specialist in a multidisciplinary team. Perhaps they work in a big, busy hospital surrounded by hundreds of people who are all too time-poor to stop and chat.
Educate employers about CF and trauma-related injuries. You can’t expect to be a safe and reliable sounding-board for your employees if your understanding of these illnesses are inadequate. You can’t expect to provide thorough or compassionate counsel if you believe the many outdated myths surrounding these illnesses. Please remember CF and trauma-related injuries:
- ARE NOT the victim’s fault
- DO NOT only affect the oldest/longest-standing employees
- DO NOT mean you are weak, lazy, incompetent or an otherwise “bad” worker
- DO NOT have to be career-ending, especially if treated early
- ARE NOT illnesses that must be “put up with” or seen as “part of the job”
Our helping professionals are vital to our society and it is in our interests – all of our interests – to keep them safe from CF. Whether you are an employer, employee or consumer of helping services, there is an important role you can play.
References: Maslach, Christina. (2003). “Burnout”. Malor Books: Massachusetts, USA