Finish Mental Health Awareness Month with More Knowledge & Supports

 

“Researchers estimate burnout costing up to $190 billion in health care costs annually, not to mention the expense of disengaged employees (34% of their salary) and the expensive/predictable turnover that happens as a result.” (Haskett, 2020)

Burnout is a concept that emerged in the mid 1970s, and in the healthcare environment, it can lead to serious mental and physical health issues among workers, negatively impact patient care and safety, as well as staff retention. Healthcare settings include a variety of risk factors for workers such as lack of control, high workload, long hours, emotional demands associated with patient care, and insufficient organizational support.

Burnout is characterized by three key dimensions (ICD-11, 2022):

• Exhaustion: Physical and emotional energy depletion
• Detachment or Cynicism: Mental distance or negativity toward one’s work
• Reduced Efficacy: Diminished sense of professional achievement

Perspective Is Important

Some stress is good for us. It encourages us to grow, learn, and change. Stress (WHO, 2023) is a state of worry or mental tension. It is a natural human response that prompts us to address challenges or threats.

Stressors will always be there…work, money, kids, all the things. Internal stressors may be present as well (such as trauma history, self-criticism, unhelpful habits). Environmental stressors, those that are sensory or relational, may also have an impact.

Nagoski (2019) reminds us:

• Stressors do not automatically lead to stress; they do not have to be removed in order to feel better.
• Removal of stressors does not mean that stress in the body is gone.

When the nervous system senses a challenge or threat, an automatic and unconscious response unfolds. There is an increase in cortisol and adrenaline, and a resulting action that falls into one of four categories – fight, flight, freeze, or fawn. Keep in mind that the same nervous system response happens when there is actual physical or emotional challenge/threat or merely perceived.

This Autonomic Nervous System (ANS) response is necessary for survival, but it is designed to be temporary. When we get stuck, when the response becomes chronic, there is a negative impact on multiple body systems including the cardiovascular, digestive, and endocrine systems.

“The way we respond to stress…makes a big difference to our overall well-being.” (WHO, 2023)

There are a variety of evidence-based supports and strategies associated with preventing and mitigating burnout, from personal / individual approaches to societal / policy efforts, and everything in between. Let’s take a look…

It Starts with You, Me, Us!

Building our own personal awareness and emotional intelligence is the foundation. Emotional Intelligence (EI) is a protective factor against burnout (Kant & Shanker, 2021; Cao, et.al., 2022; Sanchez-Gomez & Breso, 2020). When we have a better understanding of our unique, individual interoceptive experiences, we can make better choices for health, comfort and regulation.

Interoception, the eighth sense,

“can be defined as the sense that allows us to answer the question, ‘How do I feel?’ in any given moment.” (Mahler, 2015).

Interoception includes two types of ‘emotions’:

• • Affective / Feeling Emotions: enjoyment, distress, anger, etc.
  • Body / Homeostatic Emotions: hunger, pain, temperature, etc.

The more we experiment with and practice the process of noticing, connecting and regulating, the more skilled we become.

It’s all about the idea of cultivating curiosity. As humans, we are habit-seeking, habit-forming creatures. Some of those habits are helpful, meaningful, and effective. Others are not. We often useunhelpful or ineffective habits / patterns / scripts to cope in the moment because they are familiar. What if we practiced pausing, paying attention, getting curious, in the moment? Might we be better able to respond rather than react?

In addition to personal awareness, emotional intelligence, interoceptive ability, and curiosity, there are many regular proactive and responsive practices that support us in being healthy and well (Grady, 2020). Consider the following examples:

These strategies require intentional choice, planning, deliberate performance and positive habit development…easier said than done, perhaps, though also maybe why they are called “practices”.

So. the ANS mechanism kicks in, we know it is beneficial as a temporary response, but how do we recover, how do we get back to baseline so it doesn’t become a chronic state? That emotional energy in the body needs to be processed, so our bodies can guide us correctly moving forward. Over activation or prolonged activation may result in body signals that tell us we are not safe when we actually are. Remember the ANS responds the same way whether the challenge / threat is actual or perceived. Nagoski (2019) suggests 7 stress cycle completion practices.

Relational, Organizational, and Societal Supports

The more in touch we are with all of the above, the more instrumental we can be within other contexts such as relational support efforts, as well as organizational and societal strategies.

Burnout has a social dimension, in part due to emotional contagion – the tendency to absorb the emotions of those around us (Jun & Kelly Costa, 2020). Social connection is essential for wellbeing. Here are a few evidence-based ways to foster human connection, shown to help prevent and mitigate burnout: peer support groups, storytelling, and expressive / reflective writing groups.

Yes, there are many things we can do personally and relationally. Also, organizations and policy makers have an important role.

Efforts focused on designing efficient, optimal work environments help to empower individuals and reduce the amount and intensity of stressors experienced at work. Jun & Kelly Costa (2020) and AACIN (2019) note these areas of priority: ensure appropriate staffing, manage job demands, increase job control, promote shared decision-making, strengthen teams, recognize contributions in a meaningful way, and lead authentically.

Policy makers are also taking notice and there have been multiple initiatives in recent years (AHA, 2022; OSG, 2022; NIOSH, 2024; NAM, 2019). Here are the main takeaways: align roles and responsibilities; foster supportive workplace cultures; evaluated and reduce administrative burden; strengthen public health systems; enhance professional wellbeing; prioritize health, safety, and wellbeing; and promote connection and community.

If you need support, here are some recommendations:

• • National Suicide Prevention Lifeline (U.S.): 988

  • Crisis Text Line: Text HOME to 741741

  • Employee Assistance Programs (EAPs)

  • Headspace for Healthcare App (offers free access to healthcare workers)

  • Calm, Moodfit, or Talkspace Apps

References

• American Association of Critical Care Nurses, Healthy work environments. 2019; https://www.aacn.org/nursingexcellence/healthy-work-environments?tab=Patient%20Care.
• American Heart Association (2022). Well-being Works Better Scorecard™. Retrieved from: https://www.wellbeingworksbetter.org/en/scorecard.
• Coo, C., Salas, R., & Carmona-Halty, M. (2022). Emotional intelligence and romantic relationship satisfaction: A systematic review and meta-analysis. Personality and Individual Differences, 196, 111713. https://doi.org/10.1016/j.paid.2022.111713
• Grady, A. (2020). Mind over moment: Harness the power of resilience. Independently Published.
• Haskett, M. (2020, November 13). The pitfalls and potential of being feeling creatures who think. Indianapolis Business Journal. https://www.ibj.com/articles/mandy-haskett-the-pitfalls-and-potential-of-being-feeling-creatures-who-think
• International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021.
• Jun, J., & Kelly Costa, D. K. (2020). Is It Me or You? A Team Approach to Mitigate Burnout in Critical Care. Critical care nursing clinics of North America, 32(3), 395–406.
• Kant, R., & Shanker, A. (2021). Relationship between emotional intelligence and burnout: An empirical investigation of teacher educators. International Journal of Evaluation and Research in Education, 10(3), 966–973.
• National Academy of Medicine (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Retrieved from: https://nam.edu/wp-content/uploads/2019/10/CR-report-highlights-brief-final.pdf
• Nagoski, E., author. (2019). Burnout : the secret to unlocking the stress cycle. New York: Ballantine Books.
• NIOSH [2024]. Impact Wellbeing™ Guide: Taking action to improve healthcare worker wellbeing. Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication 2024-109, (Revised 07/24).
• Office of the U.S. Surgeon General. (2022). Addressing health worker burnout: The U.S. Surgeon General’s advisory on building a thriving health workforce. U.S. Department of Health and Human Services. https://www.hhs.gov/surgeongeneral/reports-and-publications/health-worker-burnout/index.html
• Sanchez-Gomez, M. & Breso, E. (2020). In Pursuit of Work Performance: Testing the Contribution of Emotional Intelligence and Burnout. Int. J. Environ. Res. Public Health 2020, 17(15), 5373.
• World Health Organization. “Stress.” WHO, https://www.who.int/news-room/questions-and-answers/item/stress. Accessed 14 March. 2025.