By Serena Agusto-Cox | News & Views

According to the American Psychological Association’s 2021 survey, 79% of workers experienced work-related stress the prior month. Healthcare workers, teachers and first responders are among the professionals who are considered the most at risk for burnout. Cardiac and pulmonary rehabilitation (CR/PR) professionals also experience chronic job stress, which can lead to burnout.

At the 38^th Annual Meeting of AACVPR, Megan M. Hays, PhD, ABPP, FAACVPR, from University of Alabama at Birmingham, along with Carly M. Goldstein, PhD, FAACVPR, and Sharon Y. Lee, PhD, both from Brown University, offered tips CR and PR professionals can use to decrease burnout in their teams and for themselves.

Identifying the Problem

Burnout is a work-related psychological response to chronic job stress, and it can manifest due to a combination of factors. During the “Help the Helpers” session, alongside Dr. Goldstein and Dr. Lee, Dr. Hays explained that emotional exhaustion, cynicism and depersonalization need to be consistently experienced over long periods in order for an employee to be classified as burned out. Compassion fatigue is also a contributor to burnout because of the cumulative effect of constant exposure to suffering that can deplete healthcare professionals’ energy and empathy, which Dr. Lee said is known as “the cost of caring.”

CR and PR professionals can properly identify burnout through a series of questions developed by the Mayo Clinic.

How to Recognize the Signs of Burnout:

• Have you become cynical or critical at work?
• Do you drag yourself to work and have trouble getting started?
• Have you become irritable or impatient with co-workers, customers or clients?
• Do you lack the energy to be consistently productive?
• Do you find it hard to concentrate?
• Do you lack satisfaction from your achievements?
• Do you feel disillusioned about your job?
• Are you using food, drugs or alcohol to feel better or to simply not feel?
• Have your sleep habits changed?
• Are you troubled by unexplained physical complaints (e.g., headaches, stomach or bowel problems)?

Individual team members and leaders who foster a culture of open communication and create a psychologically safe environment will have an easier time spotting burnout and preventing it, according to Dr. Hays. Identifying and addressing burnout can help employers reduce turnover, cut recruitment and training costs, lead to higher patient satisfaction, reduce errors and improve staff performance. CR and PR professionals who tackle burnout can reduce workplace stress, increase their own compassion and empathy, create a greater connection with the purpose of the work and improve their own physical and mental health. “Everyone wins,” said Dr. Hays, reminding all CR and PR professionals that they are resilient.

Practical Tips for Staff Cohesion

Workplace tension is another big contributor to burnout, according to Dr. Goldstein, which can be addressed by the adoption of interpersonal effectiveness strategies. She outlined three communications strategies, with easy-to-remember acronyms. GIVE encourages team members in difficult conversations to be Gentle, Act interested, Validate feelings, and speak in an Easy manner., Similarly, FAST guides them to be Fair, offer no Apologies, Stick to values, and be Truthful. DEAR MAN, on the other hand, is a little more detailed in that one team member must Describe a situation that needs to be addressed; Express their feelings and opinions about it; Assert themselves and ask for the solutions they want; Reinforce the negatives and positives of the situation; be Mindful of the goals; Appear effective, confident and competent; and Negotiate by focusing on what solutions will provide the best results.

Dr. Goldstein said that each strategy is designed to help colleagues communicate and validate their emotions, while addressing areas of concern and finding effective solutions that promote staff cohesion and better patient outcomes. “These methods improve collegial relationships, foster healthy behaviors for CR and PR staff and encourage connection with personal and professional values through work,” she added. Each of these strategies can be used to roleplay scenarios and conversations before they occur, training staff in how to handle high-stress situations in advance, as well as build trust among team members.

Improving Personal Fulfillment to Reduce Burnout

On the individual level, CR and PR staff need to take stock of their own relationships, spirituality, personal growth, health, leisure, education and work to determine what values they would like to focus on to reduce feelings of burnout. Dr. Goldstein explained that to increase a sense of fulfillment and satisfaction, CR and PR professionals should prioritize one to two values to work on and establish small, achievable goals to meet those value improvements. For example, they may want to live a more active life, and to do that, they could establish a goal of working out three times per week for one hour each.

According to Dr. Goldstein, focusing on what individuals can control in their own lives and creating a more balanced life can improve their relationships at home and work. Other tips included seeing a therapist, making doctor’s appointments for lingering health issues, tidying sleeping areas and spontaneously reaching out to friends or family to generate additional social support.

Resiliency Training to Reduce Burnout

Dr. Lee added that to promote resilience and personal growth, CR and PR professionals should reflect on their average workday to assess how well they are at carving out their own quiet time for tasks, how often they connect with colleagues and whether they take regular lunch breaks, among other considerations.

Steps for Building Resiliency

1. Conduct a self-assessment for self-care and burnout/distress.
2. Choose 1-2 resiliency factors to focus on (e.g., meaning/purpose in life; sense of coherence; positive emotions; hardiness; self-esteem; active coping; self-efficacy; optimism; social support; cognitive flexibility; or spirituality).
3. Choose activities that can improve these factors slowly over time.

Dr. Lee pointed out that staff can use these assessments to review their own strengths and weaknesses; focus on pleasant activities or engage in mindfulness activities; talk about the meaning/purpose of their lives with other colleagues outside of work; reflect on life challenges and identify personal resources; and create action plans for imagined stressful situations. Additionally, introspection can also identify which previously used strategies were successful in difficult situations.

Dr. Hays, Dr. Goldstein and Dr. Lee agree that many of the resiliency strategies focus on curbing burnout at the individual level; however, as each member engages with them, team and cultural changes occur, improving team communication and cohesion. Team leaders and mentors should also model vulnerability, examining their own stressors and learning how to prevent burnout. When each individual of a team engages in these communication strategies, the team culture will shift and become more respectful and valuable.

"Helping the Helpers” originally presented at the 38^th AACVPR Annual Meeting; register for the On-Demand Pass to access this recording and many others.