Burnout – finding the silver lining

By , RDH

As we sat around our dental hygiene study group a few years ago, I could tell that Mary was not herself. Tears filled her eyes and all six of her fellow hygienists asked her what was wrong.

"I'm done!" she said.

"Done with what?" we all questioned.

"Done with hygiene!"

We all sat quietly, and I'm sure our faces could have said it all. Our mouths were wide open and all eyes were on her. Mary was an amazing hygienist, working for 12 years at a public health facility. What did she mean she was done?

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As we let her talk and we all shared, we soon found out that Mary was experiencing burnout. What Mary didn't realize the day she came to the study group was that many of us experience burnout in some form or another. Instead of discussing forensic odontology that day, we actually studied burnout in its truest sense.

To understand burnout is to know the facts. What we do know from a defining standpoint is that it is described as exhaustion of physical or emotional strength or motivation, usually as a result of prolonged stress or frustration.1 I think we could all agree that we have been frustrated in life with our jobs, our children, etc. However, true burnout has a spectrum, stages associated with it (just like Elisabeth Kubler-Ross's grief staging),2 and a continuum with behavioral and physical attachments. Burnout is a big deal, and is so prevalent that there are inpatient clinics in Sweden and Switzerland to help cope with the problem.

Burnout is a widely studied area and researchers and psychologists are tackling the issue on every front. The most studied measurement of burnout in professional literature is the Maslach Burnout Inventory. Christina Maslach, professor of psychology at the University of California, Berkeley, and her colleague Susan Jackson first identified burnout in the 1970s, and they developed a measure that weighs the effects of emotional exhaustion and reduced sense of personal accomplishment. This indicator has become the standard tool for measuring burnout in research. The Maslach Burnout Inventory uses a three-dimensional description of exhaustion, cynicism, and inefficacy. Some researchers and practitioners have argued for an "exhaustion only" model that views that symptom as the hallmark of burnout.

Maslach and her colleague Michael Leiter defined the antithesis of burnout as engagement. Engagement is characterized by energy, involvement, and efficacy, the opposites of exhaustion, cynicism, and inefficacy.

Many theories of burnout include negative outcomes, including measures of job function (performance, output, etc.), health-related outcomes (increases in stress hormones, coronary heart disease, circulatory issues), and mental health problems (depression). It is important to note that those suffering from burnout have a host of illnesses. They can suffer from an inability to perform certain functions, describe themselves as detached, have feelings of isolation, have decreased motivation, become irritable, find themselves discouraged, and even have thoughts of suicide.

It has been found that patients with chronic burnout have specific cognitive impairments that should be emphasized in the evaluation of symptoms and treatment regimes. Significant reductions in nonverbal memory and auditory and visual attention were found for the patient group.3 Burnout is a generic term applied to the masses. So what does it look like in a clinical sense? For Mary, burnout sounded like "I'm done!"

Burnout on the lower spectrum can be a persistent state of joylessness, or a place where you have hit a wall. Are you simply tired and worn out, or are you at the end of the spectrum where you may have a mental breakdown? The interesting thing about burnout is that whether you're on the low end of the spectrum or at the escalated end, you are in a state of burnout.

Ever hear of the frog that is boiled ever so slowly? It isn't aware it's in trouble until the pot is hot! I can just hear some of you now. "No, that's not me," or "I can just pull myself up by my bootstraps." Trust me, I know you. We hygienists power through, but why? It's who we are. Researchers who study burnout look at individual groups as a whole. The dental hygienist fits into a specific demographic. The caring, helping, and service industries have the highest rate for burnout.4 Not only do we help people and constantly serve others, we are oral-health specialists who constantly try to find the balance between disease management and health maintenance.

This is a place where the scales can tip between health and destruction, and we as hygienists are trying to achieve our own mental homeostasis, and trying to find balance between fulfillment/engagement and burnout. The scales can tip very quickly if we're not careful.

I'm sure many of you could add your own bullet points to the list of facts about burnout in the related sidebar. As one lady in our group said, "I've fallen out of love with my career." Did that mean she was figuratively divorcing it? No! Did it call into question her ability, means, or manner in which she performed as a hygienist? Absolutely not! It meant she needed to take a serious look at her life, circumstances, and career.

As Christina Maslach pointed out in her burnout research, the antithesis of burnout is engagement. So how do we do that if we don't have the energy, motivation, or will to move forward? First of all we need to give ourselves a break. We need to think about the following:

A. Regroup – In business, if the direction of the company is not where it should be, the board of directors or the powers-that-be will sit down and have a meeting of the minds. We may need to do that mentally and emotionally from time to time. Start writing or journaling what it is that is causing the burnout, and if it's possible, enlist those around you to help evaluate and hold you accountable to the progress you're making.

B. Take on something new outside of dental hygiene that will inspire you -- Take a college course. Enroll in an art class. As hard as it may be, try not to have hygiene define you and don't let your circumstances box you in.

C. Start or join your local component dental hygiene group -- ADHA has excellent networking opportunities, and information can be accessed through adha.org.5 My component group has been a catalyst for both personal and professional growth, for which I am so thankful.

D. As tough as it may be, financial or otherwise, consider taking a step back from hygiene -- One lady in our hygiene group had a short-term illness and took a few months away from dental hygiene, and it was the best decision she ever made. She said that it was very difficult on her pocketbook, but she came back refreshed and renewed and had a new sense of purpose in her life. Sometimes we can't put a price on our health, mental or otherwise.

Dr. Dina Glouberman's book, The Joy of Burnout, How the End of the World Can Be a New Beginning,6 is by far the best book I've ever read on the subject. She discusses the beautiful silver lining that comes with burnout, that we really have the power to not only embrace it but we have the instinct to change it.

She states in her book, "We are bound to think that we have done something wrong, or that something is wrong with us, or that the world has treated us badly. Yet if we did but know it, burnout is so powerfully transformative that it appears to be a signal not of failure, but of a challenge to create a new life. In fact, burnout is probably one of the best things to ever happen to us."

My colleague, Mary, created a new life. When she said, "I'm done," she meant it. After four surgeries on her hands, she embraced a new way of life. She didn't choose this path, but it chose her. Mary has never been happier. She has transformed her life, and her silver lining is this -- embracing her memories as a hygienist and stepping into retirement. 

Clinical burnout and its prescriptive behavioral attachments

  1. Burnout – The powers-that-be expect you to do many things during a one-hour hygiene appointment, and they keep adding things to the list because of changes in technology. Patient care then becomes secondary to technology. Prescriptive behavior -- Frustration
  2. Burnout – The bureaucracy in an office, the power structure, or lack of power structure, can either be an agent for micromanagement or can allow for a leadership vacuum. In either case you feel powerless to change your circumstances. Prescriptive behavior -- Anger
  3. Burnout – The physical demands and toll on your body can cause harm in spite of correct ergonomics, and this situation is not a respecter of age. Some 22-year-olds burn out as much as some 50-year-olds. Prescriptive behavior -- Depression
  4. Burnout – The simple fact is that we as hygienists are a caring and compassionate group of people. We are usually type A personalities that give and give. Our nature, personality, and the reason we chose dental hygiene careers can be the catalyst for burnout. Prescriptive behavior -- Cynicism
  5. Burnout – The job itself. This is simply doing the same thing over and over and not being challenged. Prescriptive behavior -- Isolation
  6. Burnout – The fact that dental hygiene is predominantly women-centric, balance between work and family can cause burnout. Burnout can come from outside forces. Prescriptive behavior -- Detachment
  7. Burnout -- The transient society we live in causes us to move, change jobs, etc. Burnout can also ironically be caused by the transient economy we live in. We can become burnt out looking for dental hygiene jobs, whether we have been in the field for a long time or are a new grad. Prescriptive behavior -- Skepticism

Suzanne Hubbard, RDH, works for a private practice in Boulder, Colo.

References

1 Burnout: definition – Webster's Dictionary http://www.merriam-webster.com
2 Stages of Grief – On Death and Dying. 1969. Quality of Life, Elisabeth Kubler-Ross.
3 The Maslach Burnout Inventory (3rd ed.). 2004. Palo Alto, CA: Consulting Psychologists Press.
4 Battling Burnout in Healthcare, Health Professionals Are at High Risk, Megan Malugani. 2006. career advice – monster.com.
5 adha.org, membership – www.adha.org.
6 Glouberman, Dina. The Joy of Burnout, How the End of the World Can Be a New Beginning. Inner Ocean Publishing. 2003.

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