The other night when I was putting my son to bed, we read one of my favorite children's books, The Giving Tree by Shel Silverstein. If you haven't read it before, you should. Despite reading this story many times, I was struck by the visceral sadness of the tale. The Giving Tree is a children's story that starts off with a simple plot. A boy is climbing a tree (who is personified as a woman), and he happily swings from her branches, devouring her apples and enjoying all the comfort the tree provides. Readers follow the boy on his journey through adolescence, adulthood, and then as a tired elderly man. Throughout his life, the boy takes, and the tree gives. Whatever his needs are at each stage of his life, the tree is happy to provide a piece of herself to help. She gives her branches for shade, then her wood to help build a house. Finally, with her resources depleted, she dwindles to a stump. And even then, she manages to provide a place for the boy, who is now an elderly man, to sit.
I realized the tree's exhausted state is likely how many healthcare workers are feeling after this tumultuous year. While most everyone else was sheltering in place, healthcare workers were running into the unknown. Much of the world adjusted to a new routine of being inside their homes and with family 24/7. Healthcare workers opted to sleep in hotels, away from their families for indefinite amounts of time, to protect their families. While the rest of the world argues about social distancing, whether they should wear a mask, and the validity of basic science, healthcare workers charge forward caring for patients without judgment or question. Many healthcare workers look into the mirror after months and months of giving, and all they see is a tree stump. Yet they don't walk away; they continue to show up and care.
If you're a nurse or another healthcare worker, The Giving Tree is an all too familiar story. The depleted tree personifies the exhaustion and burnout most healthcare workers experience today or has experienced in the past. Burnout is not new, and publications date back to the 1980's regarding the effects of burnout. However, in the last few years, public awareness has increased. Burnout was deemed an official diagnosis by the World Health Organization a few years ago. As a nurse, I receive daily articles that reference burnout and company ads that offer a solution specifically to healthcare workers. But at the end of the day, the responsibility of executing the proposed solution to burnout falls back on the nurse or healthcare worker. "Here is something else for you to do to help you with your burnout." Burnout was identified as an issue decades ago, is only getting worse and with no resolution in sight. Despite the public's awareness, healthcare workers are still being asked to do more with less. The pandemic highlighted nurses and all healthcare workers' struggle with the mental and physical toll of the job. I don't want to talk about burnout or give you a litany of interventions for burnout. As we usher in 2021, let’s have a real conversation about healthcare worker burnout. As healthcare workers, let’s ask hard questions. Let’s stop pretending we know how to fix a problem that has plagued us for years. Let’s have a real conversation about burnout and discover basic questions every nurse and healthcare worker should be asking.
Burn-Out Is Not Our Problem to Solve
My personal problem with most of the resources designed to address burnout is that it creates more work for me. Now don’t get me wrong, I like learning about yoga and I actually believe things like exercise and diet have a positive effect on your mental health. But the reason I feel exhausted as a nurse is not because I don’t exercise or eat healthy. I have always adopted a healthy lifestyle even before I was a nurse. I’ve always been a runner and other than caffeine and the occasional sugary treat, my diet consists of mostly fruits and veggies. I do think that my healthy lifestyle allowed me to push myself physically and mentally as a nurse. The long hours, constant stress, and erratic schedule didn’t catch up with me for a decade. But I eventually burned out. And no amount of green smoothies or yoga could cure me. I found myself becoming overly cynical, I never felt like I was doing a good job or accomplishing something, and the sense of dread I felt driving into work was ominous. Yoga is good but it doesn’t solve physical and mental exhaustion. I love free coffee and other swag, but neither alleviates stress.
Burnout is the symptom of a larger disease: it’s the result of a process within institutions and the larger healthcare system overall. Healthcare workers experienced burnout long before this pandemic. The pandemic has only cast a light on an ugly truth most of us have been aware of for a long time. Some research cites creating resiliency and curing burnout is a responsibility shared between healthcare workers and their organization (Young et al.). I’ve personally become leary of anyone offering solutions who hasn’t asked for healthcare worker feedback or looked at the real problem. If burnout is not the healthcare worker’s problem alone to solve, who is responsible for solving it?
I propose it’s a problem for everyone to solve. Even if you aren't a healthcare worker or a stakeholder, at some point in your life you or someone who you love will be a patient. Do you want the nurse caring for your sick child to be a tree stump? Do you want the healthcare professional holding your loved ones hand who is dying of COVID to be a whole person who loves and connects with your family member on a personal level? Or do you want them to be someone depleted of their humanity and only sees your dying loved one as an object?
Here are real problems, I don’t have the answers. But I know we are too fragile to continue this way. I recently read about a mysterious illness in India that was sickening hundreds of people. I remember reading a similar article this time last year about another mysterious illness in Wuhan China. What was different this time as opposed to last year was the cold fear and nausea that I felt reading this article versus last year. Last year, I was clueless about the horror the world was about to experience due to COVID. While I knew our medical system was broken and that healthcare workers were being bet and stretched beyond capacity, I didn’t realize what a pandemic would do to our profession. I didn’t realize how vulnerable we are. Another mystery illness could destroy our healthcare system. The future is now. The what-ifs and maybes are reality. We can’t afford to hobble along anymore. We have to be willing to talk about the real issues and the first step is asking hard questions.
I know I can’t fix this today and I know I can’t fix this alone. I am setting the stage for a battle and I know my words will likely anger some people. To me, it’s a fight worth fighting. And maybe, by the time I retire, nurses and other healthcare professionals won’t suffer the way I’ve seen healthcare professionals suffer over the last decade. And maybe, unlike The Giving Tree, healthcare workers won’t give until they are depleted and they will be empowered to care for themselves the way they care for others. Join me this year in asking hard questions and exploring innovative solutions.