Book Review-Reversing Burnout: How to Immediately Engage Top Talent and Grow!

It’s surprising how many books there are on burnout. It seems like every day I get introduced to someone else who has a book either directly on burnout or with a subtitle including the word burnout. When a friend introduced me to Peter Atherton, I hadn’t heard of his book, Reversing Burnout: How to Immediately Engage Top Talent and Grow! However, I’m glad that I did learn about the book, both because of its ability to share Peter’s story as well as the insights it can offer folks who are struggling.

Stress

Like many of his peers, Atherton connects burnout to stress. While I disagree with this framing, I understand the perspective, because stress does, in an indirect way, contribute to burnout. When Terri and I did the research for Extinguish Burnout, we discovered that the key was that feeling of inefficacy, what Martin Seligman and Steve Maier would have called “learned helplessness” decades ago and more recently recognize is the lack of learned control. (See The Hope Circuit for more.) For us, it’s about whether our expectations of ourselves and our perceived results are aligned when we are triggered into evaluating them. When they’re not aligned, we feel like we’re ineffective, we have no control, and burnout sets in with its exhaustion and cynicism.

Stress is a contributor in that it triggers a set of reactions that are like a payday loan. The person feels like they need their entire capacity to fight today’s fight and the result is shutting down the immune response, digestion, and anything else the body feels it can defer to another time. The problem is that restarting these processes and getting them back into homeostasis takes more energy than just leaving them running. The result is less long-term efficacy for a bit of short-term efficacy. Living in a constant state of stress has been linked to numerous health issues, but its role on burnout is simply the reduced overall efficacy. (See Why Zebras Don’t Get Ulcers for much more on the impacts of stress.)

Overloaded Becomes Overwhelmed

At some level, the kind of biological stress that triggers the literal stress response in humans isn’t the kind of stress that Atherton is speaking about. Instead, he’s talking about the kind of gap between expectations and results. When you’re unable to answer all your emails, address every customer concern, take care of all the employees, etc., you feel the weight of the gap between your expectations that you can do it all and the reality that you can’t. The perception that we should be able to do it all keeps us in a perpetual state of being overloaded. Instead of prioritizing or delegating, we continue to believe that we can do it all, even when we can’t.

We all get overloaded at times. It’s a part of the normal ebb and flow of life. It’s not the idea that we’re overloaded that’s interesting, it’s the idea of what we do when we’re overloaded that’s interesting. Atherton’s point is that when we remain overloaded, we become overwhelmed – which leads to the inefficacy that we believe is at the core of burnout.

The solution, we believe, to managing the fact that you are overloaded is to ground yourself in reality. It’s unreasonable to believe that you’ll always be able to keep up. It’s unreasonable to believe that you’ll handle every complaint. You can resolve the problem of being overloaded by letting go of things you don’t need to do – or simply can’t do. You recognize these things by connecting yourself with what is reasonable for a human to be capable of.

Detachment and Disengagement

Atherton spends some time connecting burnout to disengagement and explaining what he calls the “burnout-disengagement cycle.” Here, too, the underlying message seems to harken back to learned helplessness. Of course, disengagement, like burnout, is bad, but one of the things that can prevent burnout, detachment, is strangely close to disengagement linguistically, and because of that they seem to be often confused.

Disengagement is giving up or shutting down. Detachment is accepting the limitations you have in controlling outcomes. While we have influence over the outcomes, the reality is we’re rarely in true control. There are always external circumstances that can interfere with our ability to do something. (See Resilient for more on detachment.)

The truth is that our world is probabilistic. We like to think A leads to B, but, in reality, A only leads to B in 90% of the cases. In this situation, it’s denying reality to say that anything we could do could truly cause an outcome we desire. (See The Halo Effect for more on the probabilistic nature of life.)

The best place to land is concerned for the outcomes, committed to our own behaviors, and, in the end, letting go of the poor outcomes we couldn’t prevent. We continue to care for the hurting, while not blaming or shaming ourselves because we couldn’t prevent it. (See our video post Kin-to-Kid Connection: Understanding Shame and Guilt for a video on shame and guilt, Dare to Lead for a collection of Brené Brown’s work on shame and guilt, or my review of I Thought It Was Just Me (But It Isn’t) for a shame map.)

Shifting From “Me” To “We”

At the beginning of our careers (and our lives), we’re naturally concerned with “me.” We’re looking for the best job for us. We’re focused on us. Gradually, as we mature, we broaden our scope from “me” to “we,” initially defining “we” as our significant other and expanding it gradually as children are born. However, at some point, we make an even bigger leap from “me” to “we” when we expand our considerations beyond our immediate or extended family and instead focus our interests on our ultra-extended family in the form of the entire human race. Perhaps, you may say, that most folks never get to a concern for the entire human race. However, this is the path we’re on. (See The Evolution of Cooperation for more on the thinking about why this is true.)

Many of us built careers around some technical skill, and some of us became successful because of it. That success reduced the degree of challenge in our career, and our success plus the passage of time makes it possible for us to see that we can do more for our world than just deliver the technical skills. We get restless and want to do something more. Decades ago, it would have been called a midlife crisis, and it would have led to a divorce and remarriage – and a sports car. However, today it can mean finding a path to help others.

Fear of the Same or Fear of Missing Out

We’re afraid that nothing will ever change. We’re afraid that what we have today is all there is. Fear rules our lives. On the one hand, we’re afraid we’ll be stuck or we’re missing out on something. Our friends’ Facebooks are littered with vacations, parties, and accolades. We wonder why we can’t have what they have.

We forget that, from their point of view, our feeds on Facebook are glamorous too. We post our trips to conferences and the customer success stories. We don’t post the red-eye back from Seattle leading directly into preparation for the wedding of a child and the pain caused by a lack of sleep. No one wants to hear that, it’s not happy. So, we don’t post it, and they see only the trips and the weddings. They see the highlight reel we post, not reality.

We see the same thing from them, just the highlight reel. All good, no bad. The result is we feel like they’re doing things that are better than or more interesting than we’re doing, but the truth may be very different.

Making the transition from a successful career to one of uncertainty for the good of “we” at great personal risk to “me” isn’t for the faint of heart. It’s challenging on nearly every level – but it can be equally rewarding.

Golden Handcuffs are Still Handcuffs

Too many people become trapped in their success. They are being paid “too much.” They enjoy the symphony tickets, the new cars, and the mansion they call home. The result is the fear of letting it all go to respond to the calling of our heart and help others can speak too loudly, and we can turn away from that calling we all have to help our fellow men and women.

The good news is that golden handcuffs often create a margin – the ability to work on your own projects. That margin is fertile ground for rediscovery and regrowth that may imbibe us with the courage to conquer those fears. Maybe you’ve got enough margin to consider Reversing Burnout and finding your new mission.

Book Review-Burnout to Breakthrough: Motivating Employees with Leadership Tools That Work

Everyone has a backstory. You do. I do. Every author I meet does. Everyone I read has some sort of a backstory that has led them to where they are today. That’s certainly true of Ina Catrinescu. She relates part of her childhood from the former Soviet Union in Burnout to Breakthrough: Motivating Employees with Leadership Tools That Work. She has a unique perspective on the “chains” that bind us. Having moved from the socialist world to the capitalist world, she’s seen firsthand how both worlds have the capacity to demoralize and demotivate people. One was enslaved to an immutable dogma, and the other is tethered to a rat race.

Overwork

Around my house, the family is quite fond of saying that, if anything can be done, I’ll overdo it. I believe in excellence and have been known to take on some crazy projects. (Like the solar powered mini-barn.) However, I’ve got absolutely nothing on the Japanese, who created a whole word that means “overwork to death:” karōshi. It’s more than a high suicide rate. It’s literally being so encompassed in their work that they’ll keel over at their desks. They’ll work until they simply can’t work any longer.

Not to be outdone, the former Soviet Union taught kids songs that basically translated to, “Your only purpose in life is to work your fingers to the bone, and you better do so thoroughly because the whole country is watching!” While this may not rise to the death toll of karōshi, it’s still a powerful push towards overwork.

In America, we’re subject to our own factors. Our protestant work ethic has us believing that we need to work not to live but rather work to achieve. Achievement, for many, is measured in the cars you drive, the neighborhood you’re in, and the clothes you wear. We work so we can get more things that prove to others that we’re working. As more people work and can afford these things, we must find ways to differentiate ourselves and demonstrate that we work hard.

Productivity has improved 97.5% since 1960, but that hasn’t meant that we work fewer hours. In truth, we’re working as many or more hours today than we ever have. Greater productivity isn’t reducing the number of hours we’re working.

Minimum Income

Communism was a grand experiment. At least in the case of the Soviet Union, it didn’t work out. Another experiment was done in Canada that did work out – until it was stopped. What would happen if you offered people money every month with no strings attached? Would the recipients become lazy and do-nothing, or would they use the money to get back up on their feet? The experiment in Dauphin, Manitoba, Canada did just that. Money was provided to low-income residents with no strings attached. They could continue to receive it for as long as they needed it.

The results seemed positive even though the program was stopped. It seemed like the results were better health, but as of now, the program hasn’t been tried on a broader scale.

Prosperity not Profit

Most organizations measure their results with a balance sheet. It’s net income that matters. However, much like gross domestic product doesn’t capture the full picture of the good we’re doing, profit isn’t the full measure of the organization. (See The Hope Circuit for Gross Domestic Happiness.) Red Goldfish explains how looking at the good you do in the world may be good for your bottom line. Reinventing Organizations focuses on how increasing the level of consciousness in the organization can be an important part of bringing more joy to the individual, the organization, and the world.

More people are trying to figure out how to run their lives with the new bottom line. Instead of it being all about money, it’s about impact. While not everyone is trying to find a way to make the world better, more people are considering it. Given that the roots of burnout exist in the world of caring professions, in which professionals try to “change the world,” it’s no surprise that this idealism, while beneficial to the world, can cause challenges to the psyche of the individual.

Finding Meaning

Finding your “why” is a challenging – and evolving – thing for everyone. (See Simon Sinek’s Start with Why for more.) Despite the challenge, without a sense of purpose, you’re likely to find yourself adrift without a clear sense of what you expect to get done and what you need to be focused on.

Privilege of the Platform

Years ago at an NSA annual event, I heard a comment that has stuck with me. “The privilege of the platform” resonated, because, despite the fact that so many people fear public speaking, it’s still an honor to be asked to share what you know with so many people. The platform isn’t a right, an obligation, a duty, or a task to be done. It’s a privilege. Similarly, management can be seen as a burden or a great opportunity. Robert Greenleaf in Servant Leadership speaks about how leaders serve those that they lead.

When we speak about burnout, we find that we speak about the difference between “having to” and “getting to” do something. It’s obviously a mindset shift, but it’s one that makes a big difference.

Values are not Virtues

Everyone has values. Whether we can articulate them or not, everyone has values that they hold. However, not all these values are virtues. Just because you value something doesn’t make it virtuous. It seems that too many people believe their values are universal values that everyone holds rather than recognizing that we each have our own values and motivators. (See The Righteous Mind and Who Am I? for different ways of learning what values we hold and what motivates us.)

We must accept the reality that others hold different values than we do.

What About Burnout?

There is a lot of good information in Burnout to Breakthrough, but, in the end, I found that I struggled to find the tie-in to burnout. While you may get a lot of good information, I’m not sure how it will help you avoid or prevent burnout.

Book Review-The Burnout Solution: 12 weeks to a calmer you

The recognition that burnout is more than a “job thing” and can impact any area of your life was one of the reasons why the book The Burnout Solution: 12 weeks to a calmer you was interesting. As with most burnout books I’ve read, there’s a lot to agree with – and enough to disagree with.

The Role of Stress

Many people – particularly those who have been led astray by some of the academic literature – like to say that burnout is caused by stress. The problem is that’s an oversimplification of what’s really going on. To understand, we must understand the basics of stress, how we appraise stressors, and, ultimately, the root cause of burnout.

When it comes to stress, I always start with Why Zebras Don’t get Ulcers. I start there because it’s the most complete coverage of stress that I’ve found. It took me three blog posts to do a review of it because the information was that powerful. The short version of stress is that it’s a “payday” loan. It’s a high interest loan against the future, so that you can survive today. When we feel stressed, our body makes choices that work for the short term at the expense of our long-term productivity, energy, and efficacy. One of the things in Why Zebras Don’t Get Ulcers that contradicts The Burnout Solution is that the impact of stress is a reduction in immune system response – not an increase. Research consistently shows that the introduction of steroids (including the cortisol released during stress) makes people more susceptible to infection, not less.

The tricky part about stress is that it’s almost always generated internally. Certainly, there are objective stressors in the environment, but they don’t convert to stress unless our appraisal of the stressor is that we’ll be overly harmed or overwhelmed by it. (See Emotion and Adaptation for more on how we appraise our emotions – including fear, which causes stress.) When we believe that we have all the resources and support necessary to overcome the stressor without any real risk, a stressor doesn’t convert to a stress. Thus, stress is something we generate internally.

The root of burnout is our belief that we can’t be effective. If we can’t manage our stressors, we can’t make progress towards our goals, and we’ll perceive ourselves to be in burnout. Secondarily, the impact of stress is short-term gain at the expense of long-term efficacy, which further deepens the perception that you’re not effective. At some level, stress is coincident with burnout, because the belief that you can’t navigate or overcome the stressors exists in both. However, at another level, stress is just a sidekick, not a cause.

Self-Imposed Demands

When Terri and I talk about the bathtub model in Extinguish Burnout, we explain that demands have a valve, and we can control the degree to which we accept them – even the degree to which we generate them ourselves. It’s one thing to learn to say no to others. It’s another thing to say no to the “shoulds” and “aughts” that happen inside your head.

More than anything, understanding how we view our demands and learning to change our perspective can allow us to hold onto our personal agency.

Impatience is a Reaction, Patience is a Response

When it comes to finding more calm, learning to respond and not react is important. We’re wired with two systems (to use Kahneman’s language from Thinking, Fast and Slow). The first system is quick and instinctual but often devoid of consideration of the long-term consequences of actions. The second system is more contemplative and is a response instead of a reaction.

When we tune our ability to change our appraisal of events, and we can consider them in a larger context, we’re able to be calmer – and, in the perspective of The Burnout Solution, we’re able to prevent burnout. I believe finding calm is an important goal. I even believe that reducing stress will reduce the degree of burnout you’re feeling, but I’m not convinced that solving stress alone will do it. However, read The Burnout Solution and make your own decision.

Book Review-Burnout: The Secret to Unlocking the Stress Cycle

People now casually mention that a friend of theirs is reading a book on burnout. Because I’ve read so many of the classic and contemporary books on the topic, I have begun to ask which one, believing that I may have read it. When I asked that question recently, the answer was Burnout: The Secret to Unlocking the Stress Cycle. Having not read it, I picked it up and began a journey.

Discrimination

Discrimination can be a good thing when it’s separating different aspects of something. When it’s used to separate people, it’s a bad thing. We speak of a class of people, and we minimize or dehumanize them. Burnout is direct in its admission that it’s designed to be read by women. That doesn’t slow me down a beat. Much of Brené Brown’s work is designed for women as well. However, it gives me pause when a marginalized group decides to take a position of victimhood against their perceived oppression. (See Boundaries, Beyond Boundaries, Daring Greatly, and Change or Die for more on victimhood.)

Burnout gave me this pause. I felt like, at times, the authors were more interested in pointing out the evils of the patriarchy than they were in fixing it or trying to elevate women’s concerns in a way that helps unravel patriarchy. From my point of view, you can elevate women without tearing down men. You can address the topic without trying to turn the tables.

The master caution I have for Burnout as a book is that some people may encounter it, excuse their burnout as something that someone else caused, and therefore not try to resolve it. The simple truth of the situation is that, no matter who caused you to be in burnout, you’re responsible for getting yourself out of it. You can’t expect others to do the work of healing, you have to do that yourself.

Sticky Emotions

We process our emotions. We work through them. Emotions are beyond our control but not beyond our influence. We can stuff them. We can ignore them – to a point. We have some influence on how and the degree to which our emotions surface. Burnout explains that one of the challenges that causes burnout is emotions end up getting stuck. They end up not being processed. The Zeigarnik effect kicks in, and the emotion becomes more powerful. (See The Science of Trust and Emotional Appraisal Theory + Zeigarnik Effect => Anxiety for more on the Zeigarnik effect.)

I’ve been in the “splash zone” near a family where emotions are suppressed. Emotions for that family are simply not ok. They’re not supposed to have emotions good or bad and the impacts are tragic. We’re not designed to operate by denying our emotions and in addition to a lack of happiness, the design of the family system led to mental illness.

If you suppress emotions and prevent them from reaching their conclusion, they’ll rise to the surface, like lava suddenly erupting, into behaviors that no one likes.

Human Giver Syndrome

Burnout describes “human giver syndrome” as a malady driven by the belief that someone can’t be a human being, because they’ve got to be a giver. Their needs aren’t as important. They’re supposed to become subservient to others. This is a subtle message that exists in the way that girls used to be raised. Their goal was to get their “Mrs.” Degree. It didn’t matter what they got the degree in. The point was that, with a college degree, they were more likely to find a husband.

There’s a healthy desire to help others. There’s also an unhealthy degeneration of oneself as being unworthy of love simply because you’re you. We’re all worthy of love and respect because we’re members of the human race, not because of what we do. (See The Road Less Traveled and The Gift of Failure for more on performance-based love.)

Stress

Like many authors, the Nagoskis perceive stress as a cause to burnout rather than a contributing factor. Unlike other authors, they recognize that stress is what we make of it. Our appraisal of a stressor allows us to decide whether it will become stress or not. (See Emotion and Adaptation for more)

Their view is that stress is only bad when we’re no longer able to process it. I’d argue that stressors are only bad when we’re no longer able to address them. The key being that a stressor doesn’t have to become a stress. When we’re in stress, I believe that we’re doing long-term damage to our body. The trick is to become focused and motivated without crossing over into stress and the associated chemical cocktail that comes with it. (See Why Zebras Don’t Get Ulcers.)

The Monitor

There is a switch that trips. It’s called “the monitor.” It’s the moment between your goals being attainable – but difficult – to unobtainable. It’s the moment, more than any other, that burnout happens. It’s the moment where we lose our sense of learned control and fall into learned helplessness. (See The Hope Circuit for more.) More than anything else, it’s this switch tripping that causes us to fall into burnout. The trick is there’s no way on the outside to see that the switch is about to trip.

That’s why when we talk to folks about burnout, we encourage them to keep their personal agency bathtub full. The more you recognize and believe your capacity to get things done, the less likely it is that the switch will trip.

Growth of What You Don’t Know

I remember a warm, early fall day in Bay City, Michigan when my favorite teacher drew a small circle and a large circle on the board. He explained that our knowledge is like a circle. Our awareness of what we don’t know is the edge of the circle – the circumference – and our knowledge is the area. When we don’t know much, he continued, we don’t believe that there is much that we don’t know. As we learn more, we realize there is much more that we don’t know.

This is problematic as we go through life, because we’re bound to learn more even if we’re not trying. The result of this is that we become more aware of the things that we don’t know. It can be discouraging to start in any area of our lives thinking that we just need to learn a little, and the more we learn, the more we feel like there is to learn.

I’ve been reading a book each week for years now. Every single week, there’s a book review posted that chronicles what I’ve been reading and learning. The problem is that, when I first started, I picked a few books that I should read. I’d carefully highlight references to other books so I’d know what to read next. Today, I have dozens of books on my iPad and hundreds in my wish list. As I’ve learned more, I’ve discovered there’s more for me to learn.

This is sometimes discouraging. There is no end. It seems like I’m falling further behind. I must counter this with the awareness of what I have learned and knowing there are still things that are learnable. I have to fight the natural tendency to see the “slippage” in terms of how much there is to learn as moving backwards, when it’s really moving forward with more awareness. It’s a form of positive reappraisal that’s critical if I want to avoid burnout.

Save Yourself, Save a Marriage

Embedded in the discussion of burnout was a strange but important remark. It was that, to save the marriage, a friend needed to save herself. There’s a tendency to blame other people for our situation – fundamental attribution error. (See Thinking, Fast and Slow for more.) While discussing the challenges of their friend, it was clear that the friend had to escape burnout and get right with herself if she was to save her marriage.

She wasn’t a victim of her partner. (See Boundaries, Beyond Boundaries, Daring Greatly, and Change or Die for more on victimhood.) Her responses were fueling the sick cycles that were making things work. (As were her partner’s.) Gottman is known for his work on identifying couples who are going to ultimately divorce. In his book, The Science of Trust, he explains how our responses are sliding door moments, where we can either do something to build the relationship, or we can withdraw from it. I believe that, for any of us to have a good relationship, we must first learn How to Be an Adult in Relationships.

Maintaining the Gap

Visionaries and dreamers create a world in their mind where the imperfections of today are already gone. At some level, they live in this dream world. The challenge for them, and all of us, is the gap between that vision and current reality. It’s easy for “the monitor” to make the future vision unobtainable, but we’ve got to guard against it. It would be easy to descend our vision to today’s current state, but to do so would mean giving up on our desire to make things better.

In our quest to prevent burnout, we’d lose the very drive that we’re hoping to protect by avoiding burnout. We’ve got to find a way to maintain the gap between that perfect possible future and the reality of today.

Prove Your Character

In Star Trek, there’s a test for new captains. It’s an unwinnable test called the Kobayashi Maru. The point of the test isn’t to beat it. The point of the test is to show your character while losing. (That is, unless you’re James T. Kirk.) The truth is that we will run into unwinnable situations. We’ll accidentally stumble into places where, no matter how much grit we have, we’re not going to be successful. (See Grit for more on grit.) The trick in these situations isn’t to win, the trick is to lose with character.

It’s easy to say that you should persist. However, the question is for how long. Our energy is an exhaustible but renewable resource. If we can’t succeed at something, how do we become ok and move on to the next thing that we might be successful at? There aren’t any clean answers to these questions, but learning to walk through them with your head held high may just be the way to avoid Burnout.

Book Review-Nurse Burnout: Overcoming Stress in Nursing

It’s easy to get distracted and miss the key point. It’s harder to look through noisy data and imperfect experience to see the hidden signal behind the noise. When you look at stress, it seems like it’s the cause of burnout. It’s an easy target. After all, most people experience stress in conjunction with burnout. However, the question always is which came first – and why should someone focus on one versus the other. Nurse Burnout: Overcoming Stress in Nursing follows a line of thinking that stress is causal to nurse burnout, but we don’t think that’s the case. Let me explain why.

Stress as Friction

It’s important to point out that Nurse Burnout is well researched and pulls in ideas and suggestions from numerous parties. However, many of these parties have failed to understand that stress is fundamentally friction in the system. The problems existed before the stress became apparent, and the stress just mucked up the works enough to cause the whole thing to break down.

Burnout is defined by exhaustion, cynicism, and inefficacy. Stress isn’t the source of these feelings; rather, it’s a coincident outcome. Consider, for a moment, someone who has a strong belief in their ability and a need to make a difference in the world (e.g. a nurse). When they begin to feel as if they’re ineffective, they believe they’re unable to accomplish their expectations, and they develop stress.

Stress, as Why Zebras Don’t Get Ulcers aptly points out, is a payday loan. It’s necessary for short-term threats at times when long term processes wouldn’t get a chance to run if things aren’t successful. However, the cost of focusing all resources on short-term problems – and therefore aborting long-term but important things like digestion and immune system response – is very high. Much like a payday loan, you get what you need in the moment, but the cost is very high.

A stressed person, then, consumes more resources than a non-stressed person would, and the result is less energy (more exhaustion) and greater feelings of inefficacy, further reinforcing stress. This is a classic runaway feedback loop. (See Thinking in Systems for more.)

One could argue that the stress might not come from work and may not be related to their performance of their role. However, once the process kicks off – no matter what the origin – the feedback loop starts to build, much like the feedback that’s sometimes heard from a PA system. Once it starts, the only solution is to turn things off to break the cycle.

Stress is like friction. Instead of getting out 100% of what we put into our efforts, we get a little bit less. The overall drain on our bodies and psyches by maintaining the focus on the short term reduces our overall capacity and makes those feelings of inefficacy worse. Eventually, the forces that conspired to create the first bit of feeling ineffective overtake someone, and they’re stuck, no longer able to put in enough energy to break the inertia.

Causes of Stress

Externally-triggered stress can be just as damaging as internal stress. There are the standard work stressors, as explained in Amy Edmondson’s book, The Fearless Organization, but nursing has its own special drivers for stress as well. The stakes are high – lives literally hang in the balance. The situations are ambiguous – you may believe you know the right answer, but there are always confounding factors.

The healthcare system contributes to the stress as well, between a nursing shortage and the drive for profitability, leading nurses to take on more patients with higher acuity than feels comfortable. A nurse isn’t alone in this situation. Their peers are taking on too much as well. Even physicians are feeling the pressure – and they’re venting some of that pressure onto the nurses.

More challenging for many nurses is the reality that there are times when it’s appropriate to temporarily minimize or ignore their own needs in the care and service of another. The challenge is how long is temporary, and to what degree should self-care needs be minimized. There are no answers to these questions, as nurses who are struggling to find the balance between taking care of the patients and taking care of themselves can attest.

It’s easy to say, “Put your own mask on first before helping others.” At the same time, it’s difficult to know when you’re supposed to do that or finish taking care of the code before taking a trip to the bathroom or getting lunch. These are always difficult choices and ones that nurses face every day.

Fatigue

Everyone gets tired. Everyone feels exhausted at times. The challenge is determining whether that fatigue is the result of a need for a simple break – or something more. If it’s simple fatigue, a vacation, long weekend, or even an evening of peace may relieve the feeling. Even accomplished athletes often need to take a slower pace for a while to regain their strength.

However, fatigue – or exhaustion – as a part of burnout is different. It doesn’t recover with a simple period of rest; it takes something more. It takes believing you can make a difference. Henry Ford said, “Whether you think you can, or you think you can’t – you’re right.” That’s the fundamental truth about how our beliefs limit us. People mostly speak of this in terms of Carol Dweck’s work in Mindset as having a growth mindset rather than a fixed mindset. However, the power goes well beyond that.

Edmund Jacobson first discovered – in the 1930s – that simply visualizing exercises increased muscle strength. Pause and think about that for a moment. It wasn’t the actual effort of lifting heavy things that made a difference, it was merely thinking about lifting heavy things. I’m not suggesting that couch potatoes should be encouraged, I’m saying our beliefs are much more powerful than we’d like to admit. (See The Rise of Superman for more on Jacobson’s work.)

Learned Helplessness and Learned Control

In the late 1960s, Martin Seligman and his colleagues, including Steve Maier, began researching what they ultimately would call “learned helplessness.” It’s the tendency for animals, dogs in their case, to learn that they couldn’t do anything about a situation. Instead of attempting to escape a mild shock, they’d sit down and take it. This continued, even when they were later presented with an opportunity to escape the shocks.

The animals had learned that they couldn’t succeed, so they gave up and stopped trying. Decades later, with the help of new technology, Steve Maier discovered that he and Seligman had it backwards all those years ago. What really happened is the animals learned they had control and used that to mitigate their fear. (See The Hope Circuit for more.)

The implications of this on our ability to recover from burnout – or, more specifically, for us to recharge and overcome our exhaustion – is profound. If we believe that we’re unable to feel refreshed or escape burnout, we won’t. It’s the same kind of wall that Roger Banister crashed through.

Four-Minute Mile

For nearly a decade, runners had been running a mile in just over four minutes. It was believed physically impossible for a man to run a mile within four minutes. He’d die, people believed, as if there were some cosmic relationship between the arbitrary length of a mile and the arbitrary measurement of time in four minutes. However, no one could cross the four-minute mark until 1954, when Roger Bannister did it. His record only lasted for two months. Once the invisible four-minute mile barrier had been breached, others were free to do it as well.

For some, getting past the fatigue is a four-minute mile. It may not be a conscious decision or a choice, but the invisible barrier exists nonetheless. They’re prevented from recovering, because they believe it’s not possible, or at least not possible for them.

Alcoholics Anonymous

There’s a fair amount of controversy about what does and doesn’t work in addiction recovery. Some claim that Alcoholics Anonymous (AA) isn’t effective, though there are no firm statistics, because of the nature of the group’s design. (See How and Why 12-Step Groups Work for more on the basic structure.) What we do know is that AA gives alcoholics hope. They see other people who claim to have been in the same place they’re in – and they’ve recovered and are leading a productive life.

It builds a community of people who are committed to the same thing. (See Start with Why for the power of shared purpose.) The community supports you and therefore helps you not only to know that you can do it but that you don’t have to do it alone. (This also reduces stress.)

Types of Stress

Waddill-Goad refers to Richard Lazarus’ work to describe stress from a positive (eustress), neutral, or negative (distress) perspective. Lazarus’ later work Emotion and Adaptation explains that emotions are a larger category than stress, and stress is primarily a function of the individual’s appraisal of the situation.

Because of the appraisal component, I’d separate stress from motivation. Stressors are motivation. Stress is the result of an appraisal of the stressor (or just the environment) and its impact on our capacity to meet our goals. At the most basic level, our goal is survival, but this is often extended by modern humans to include keeping our homes and therefore being able to pay the mortgage.

Waddill-Goad explains that stressors are evaluated from the perspective of adequate/inadequate resources for our goals of surviving the stressor, the belief in our accuracy of assessing the stressor, and our belief in the controllability of the stressor. Ultimately, these three assessments boil down to whether we’ll be able to compensate or cope with the stressor.

Creating a Supportive Culture

Just like AA can help alcoholics learn that it’s possible to lead productive and happy lives, it’s important that someone be a leader in the organization and create a culture of supportive sharing. There is a great deal of confusion about leadership, as it’s often assumed that management is equivalent to leadership – though Rost takes a whole book in Leadership for the Twenty-First Century to explain why these two are different and what he believes leadership entails. The net effect of which is that leadership can be done from any position.

If you’re willing to be a servant (see Servant Leadership) and focus on the important things (see Heroic Leadership), it’s possible to transform even hostile environments into more caring ones.

Agree to Disagree

There are a few places where there are disagreements that don’t seem to be solved easily by trying to connect missing dots. For instance, this quote: “The opposite of trust is fear.” Having spent a great deal of time researching trust, I can say that trust is not the opposite of fear. (See Trust=>Vulnerability=>Intimacy, Revisited for more.) The opposite of fear is safety – and it’s a perception.

The problem, I believe, is that the mistake was made that trust is the absence of fear. That’s no truer than it is to say that courage is the absence of fear. Courage is moving forward in the presence of fear. (See A Fearless Heart for more about courage) Trust is the decision to believe that someone will behave in the way you expect, knowing there’s a risk that they’ll betray that trust by behaving differently than you’d expect. Trust is a gift that you give the other person in vulnerability, so that you can become more intimate.

In the model of trust to vulnerability, there is safety. You must feel relatively safe to be able to be vulnerable. This is the rub – it’s not that trust is the opposite of fear, it’s the safety that you must feel to trust more and become more vulnerable.

Similarly, there’s the statement, “Respect is a noun, which means it is a thing. It’s a feeling or an emotion. Respect is how a nurse feels about others and how others feel about him or her.” The problem isn’t that respect is a noun. The problem is that respect isn’t a feeling. Respect is a decision. It’s a decision to behave in a way that recognizes the other person’s value, either intrinsically as another member of the human race or because of their unique value to the team or situation. I can respect a person and not feel good about them.

Quality Care

While we care about the mental health of nurses, there’s a secondary concern for the patients in helping nurses overcome burnout. Nurses and physicians who are burned out do not provide as good of care as those who are not burned out. Ultimately, everyone is better when there are better patient outcomes. That’s why there is sometimes confusion when nurses resist what the research says is a best practice.

Nurse reports about the care of a patient during transition used to be done between the two nurses. In most institutions now, it’s being done in the patient room in front of the patient. The research says that this is best for the patient – but, sometimes, it’s still not done. If it’s better for the patients, why would nurses resist?

First, they can’t see that it’s better for the patient in any meaningful way. They may – or may not – believe the research, but it’s not tangible and palpable. Second, if report is done in front of a patient, they may ask questions, thereby slowing down the process. The nurse can only leave when they’ve given report on all of their patients. It’s also embarrassing to have a patient correct the nurse, as may happen when the report is done in front of the patient. While these aren’t substantial, they are pressure that keeps the status quo in some organizations and prevents a transition to doing report – or rounding – with the patient.

Another insidious problem with creating the right culture is that, the more you focus on patient safety, the less likely it is people will want to report a safety issue. It is hard to accept is errors happen. We don’t have to like them (and we shouldn’t). We don’t have to encourage them (and we shouldn’t.) However, because they’re reality, we must accept them. No one wants to admit their errors. (See Mistakes Were Made (But Not By Me) for more.) The one belief that seems to have some ability to help is the understanding that mistakes happen, and it’s what you do about them that really matters.

Mental Models in Nursing

The key difference to managing stress is in the appraisal. If you believe you have the resources – or the support you need – to be successful stressors, will not impact you much. The way you view the stressors can eliminate the potential for them to convert into stress.

Every nurse’s environment is different. It’s true that a nurse isn’t a nurse. Acute care, emergency room, critical care, ambulatory, palliative, oncology, long-term etc., are all different. They require a different mix of skills and perspectives to allow the nurse to survive the environment without burning out. The more that we can learn about the burnout, the more likely we are to eliminate Nurse Burnout.

Book Review-Ignite: Beat Burnout and Rekindle your Inner Fire

Imagine, for the moment, that you felt like India was the edge of the world. You had fought your way to what you felt like was the edge of civilization over eight grueling years – only to see more land before you than you could see the end of. Your expectations of going home and seeing your family again are dashed in a moment, and you confront the reality that you don’t know when your quest will end. This is one of the stories from Ignite: Beat Burnout and Rekindle your Inner Fire. It’s the story of Alexander the Great and his devoted army losing their hope and ultimately facing burnout at what was supposed to be the end of the world.

Missing the Point

Ignite focuses on the eight years of hardships. It proposes that, even though the army was fiercely loyal to their king, they had nothing left to give. However, I’m not convinced. In Extinguish Burnout, we point out that it’s the gap between expectations and reality that can create burnout. Things snap because the anticipated break or accomplishment doesn’t come when it’s expected.

While it’s true that the army had accomplished a great deal during its time and sustained heavy losses as they carved their way through the continent, that’s not the real problem. The real problem is they lost their way. Not they couldn’t read their compass, but they thought their leader – and they themselves – knew the truth about the end of the world. When it wasn’t there, their belief that they could reach it was dashed not by another army but by the expanse of land that still remained in front of them.

Burnout Bleeds

An important point that Ignite makes is that burnout in one area of your life will bleed into other areas. You’ll be affected in your work if you are burned out at home. And vice versa: when your work life is a train wreck, you’ll want to come home and “kick the dog.” Of course, that doesn’t help anyone, but the desire to take your frustrations out elsewhere are understandable.

The bathtub model that we use in Extinguish Burnout is filled with results, support, and self-care. What we don’t say is that you have different bathtubs for different areas of your life. When you’re feeling good at home, you’ll be more assertive at work and vice versa. You don’t have one bathtub of personal agency. You’ve got several connected bathtubs that cross-feed one another.

Inner Fire

Everyone with drive has a “fire in their belly.” This drive keeps us going, and it’s the thing we lose when we encounter burnout. Instead of being willing to take on any challenge, we stop at the first sign of difficulty. It isn’t worth it, we’ll think. That’s when we know that burnout has taken hold.

Your inner fire is your passion. It’s what sustains you when there are barriers in your way. It’s the drive that allows you to look past the lack of results in your new business for six months, a year, or however long it takes, because you know it’s right. In Jim Collins’ words, it’s the Stockdale Paradox. (See Good to Great for more.)

Passion, Purpose, and Action

Ignite makes the point that passion needs both purpose and action. Purpose as a focusing force that keeps us moving in a direction, and action to get something done. I’m not convinced that either Drive or The Psychology of Hope would view sustaining passion this way. Start with Why would certainly recommend purpose as an ignitor for passion, but it gets muddier as we look to the way that action is defined.

The book is a more story-based and novel-like, but it’s not necessarily a clear path from burnout to reigniting your fire. Of course, you can take an action: read Ignite and see if it can rekindle your inner fire.

Book Review-Breaking Out of Burnout: Overcoming Mid-Career Burnout and Coming Back Stronger

Sometimes you climb a mountain, and you realize it was the wrong mountain. That’s the sentiment you get when you’ve spoken to people who have reached the pinnacle of a career and then realized it wasn’t the career they wanted. It wasn’t right for them. It didn’t fit. Rex Baker is a former journalist who now runs a mission, and in Breaking Out of Burnout: Overcoming Mid-Career Burnout and Coming Back Stronger, he shares some of his experience and a lot of his perspective on burnout and how to break free.

The Truly Important

It’s important to note that Baker’s redirection allowed him to focus on how he wanted to leave the world rather than how he wanted to live in the world. Mid-career, or, more commonly, mid-life, crises have people reevaluating what they thought was important and making course corrections with their lives. It’s more than buying the sports car to try to regain some youthful vigor. It’s more than scuttling the life they have for something different. A mid-career reevaluation brings you face-to-face with the reality that wherever you planned to go – if you had a plan – isn’t where you ended up. Bob Pozen in Extreme Productivity admits that, while he had many plans, his path rarely followed them.

Sometimes the dream job – whether that’s in front of a camera or as the leader of a company – isn’t the right job for you long term. Somewhere along the way, we get distracted by something that seems desirable, and we lose track of what we long for most in our lives. When I started my career, I couldn’t have told you that I’d be working on burnout. I was enamored by the technology and figuring it out. However, my goal today isn’t to figure out technology (the challenge is gone in that). The goal today is to help people live better lives. Technology isn’t the problem. The problem is that we’ve not supported people into learning how to be happy and fulfilled.

Great Expectations

Generation X, as we’re called, had great expectations. We were raised to believe that we could do anything. We didn’t get participation awards and we expected that if we worked hard, we’d get rewarded with success. (See America’s Generations for more.) Most of us will have to accept that our lofty ambitions for ourselves didn’t end up happening. News flash for you, I’m not an astronaut.

Having great expectations can be a powerful driver that propels us forward into being more than we could be without any drive. I remember a single word that a teacher said about me while I was within earshot. “Potential,” she said. I remember that it was the best thing she could have said – and the thing I resented most for many years. If she had said I was great, then I could coast. If she had said that I didn’t have potential, I could coast. However, to say that I had potential set me up to strive and try to reach that potential. (She was a kung-fu master of Mindset before the thing existed.) She set up in me an expectation that I could do great things.

While great expectations are powerful forces for good, they leave us vulnerable to burnout. When we can’t connect our perception of reality to those great expectations, the rubber band pulling us forward can snap. That’s what burnout is: our expectations and results being so far out of alignment that we can’t sustain the gap any longer.

With today’s children expecting to do better than their parents, they’re set up for an expectation that will be difficult to meet – especially since their parents are the Gen Xers, and they were very productive. The other problem is that we set expectations that the world will reward you for just showing up. Participation awards, ribbons, and trophies taught our children that they deserve to be rewarded for gracing us with their presence rather than doing the hard work it takes to get the job done. We’ve set them up for the problem.

Master Caution

In twin engine airplanes – and larger – there’s generally a panel that illuminates cautions and warnings. Each caution and warning has a specific indication calling out a function of the aircraft that isn’t working as intended. Any time that any caution comes, on the master caution light comes on as well. It’s a bit redundant to ensure you can always see when there’s a problem, and it’s a way of focusing attention to something that may become a critical problem soon.

Baker views burnout as our emotional system’s master caution – or worse, master warning. It indicates that there’s something wrong. It may not be something that we fully understand yet, but it’s something that we need to pay attention to. It’s important, and if we don’t pay attention, we may crash and end up in burnout.

Burnout may be, as The Joy of Burnout also indicates, a way for us to wake up and pay attention to the things that are not right.

Short Term vs. Long Term

Baker posits that burnout can be either short-term or long-term. That is, we can experience episodes or periods of burnout driven temporarily by circumstances or long-term burnout that we can’t seem to shake. I think he may be articulating the difference between a momentary loss of hope, where we’re shaken so completely that our coping mechanisms take some time to catch up, and a loss of hope that we’re going to need help with or changes to recover from.

Short-term burnout simply needs relief of the pressures that are causing it. By simply giving enough space for our coping mechanisms to catch up, the burnout will eventually fade. That’s why some folks will recommend some time off work, a special event of self-care, or some other momentary solution that will seem like magic to help the person recover.

However, when I’m speaking of burnout, I mostly speak of the kind of feelings of inefficacy that loom over a person for weeks, months, or years. I’m talking about an exhaustion that doesn’t go away after a long weekend or even a week’s vacation. Something has done serious damage to the hope that things can get better – and that’s a problem to be solved. (See The Psychology of Hope for more about how hope works.)

Who is Responsible for Burnout?

Baker explains that he doesn’t agree that you can blame other people – or your job – for being burned out. The idea is that an individual must take responsibility for themselves. I agree with Baker that individuals need to be responsible for addressing their burnout but for slightly different reasons. Here’s the thing. If you break a bone, it doesn’t matter whose fault it is. The person whose bone is broken is ultimately responsible for healing. It’s that simple. Fault and blame just don’t matter. What matters is finding a path to health.

Much is made of a bad fit between an employee and an organization. That bad fit, they say, is why we have burnout. I’m closer aligned to Baker’s thinking that the problem isn’t fit – it’s expectations and the ability to feel like those expectations are being met.

Starting the Healing

If you’re in burnout, the key is to understand what you can do differently to change your results. Baker quotes Charlie Jones as saying, “You will be the same person in five years as you are today except for the people you meet and the books you read.” One might expect, given that I’ve read a book every single week for years now, that I’d recommend reading. Sure. However, how do you change the people that you meet? That requires getting out of your comfort zone and doing something different.

With burnout, it’s not that you need to make one connection to solve the problem. It’s more likely that you need to find people who you can connect with and who can shine a light on the results that you are getting and perhaps make your expectations a bit more reasonable. (By the way, loneness is a key challenge. Look at Loneliness for more – and try to increase your connections.)

Do the Work

As I mentioned in my review of Seeing David in the Stone, James McDonald says that many people wanted his success, but few people wanted to do the work. The thing is that whatever you want in life you must work for. It takes courage to get back on the horse. It makes winners to do it faster. (See Peak for more about becoming the best at something.)

If you’re interested in Breaking Out of Burnout, maybe it’s time to do the work of reading the book.

Book Review-The Joy of Burnout: How the End of the World Can Be a New Beginning

I’ve heard burnout called a lot of things. Never once have I heard someone say that it was a joyful experience. However, Dina Glouberman’s book, The Joy of Burnout: How the End of the World Can Be a New Beginning, seeks to turn the thinking about burnout around and make it a gift instead of a burden.

The characteristics of burnout are exhaustion, cynicism, and inefficacy. That’s not exactly the recipe for joy. However, Glouberman’s point isn’t that burnout itself is joy but rather that it can be a wakeup call that leads you to greater joy. While I wasn’t sold on the idea, I took the journey to see where Glouberman was leading.

Messages from Beyond

A long time ago, I heard that someone was seeking to use the word “signal” instead of “pain.” They felt like pain had developed a negative connotation. (You think?) Their reasoning was that pain was just a signal. It’s a signal that what we’re doing is causing damage. Athletes know it as a signal of muscles breaking down. When partnered with rest, it leaves our muscles stronger than they used to be. Instead of pain being bad, the idea was to think about it as a signal for us to interpret and use. That’s a fine sentiment until you’re in intense pain.

In essence, Glouberman’s message is that. Burnout is a signal. So, the question is, what’s it telling you? Her assertion is that you’re not doing what you should be doing. You’re not leveraging your unique talents in the way that was intended (by the universe, higher power, or God – whichever you choose). Said differently, our soul has a desire for our lives, and we’re not living it. As a result, our soul withdraws its energy from our lives.

Coherence

A little less mystical explanation has to do with the coherence of our thoughts, emotions, and energy. Coherence is the idea that everything is consistent or aligned. When our thoughts, feelings, and actions are aligned, there’s no wasted energy. To make this make more sense, let’s look at a practical example.

Consider the light output by a regular bulb – even an LED version. It creates the light we need to see. At roughly 20 watts, an LED version doesn’t consume much energy by historical standards – however, the same amount of power applied to a laser – which is just coherent light – can cut through metal.

The inner conflict in our world is like friction. It converts the motion we have towards our objectives and converts it to heat, robbing our efforts. The more we can eliminate the friction in our worlds, the further we can get. In the case of burnout, Glouberman says that the inner conflict is the gap between what our soul wants for us and what our mind propels us towards. If we can get our heart, soul, and mind in alignment, then there will be less friction – and less of a tendency to enter burnout.

Choices, Expectations, and Commitment

Glouberman explains that we’ve got more choices and opportunities than our parents did. We have more doors open to us. We expect that we’ll do greater things than our parents were able to accomplish. At the same time, our choices have made us less prone to commitment to anything. This shift in dynamics has an important role to play in burnout.

I agree, but it’s important to separate two factors. First, and most directly, high expectations create the opportunity for a huge gap between our expectations and reality. I believe the awareness of this gap causes burnout, like a rubber band breaking after being stretched too far. (There’s plenty more about this idea on the Extinguish Burnout site.) Second, our lack of commitment robs us of the opportunity to become truly great at anything, there by keeping us from having an area of our lives to be proud of.

Our choices and lack of commitment does have an impact on our susceptibility to burnout, but it comes back through our expectations. We grew up with the Norman Rockwell view of the past. We’ve idealized the world of our parents and their parents, when communities banded together against the wilderness to conquer the frontier or to maintain the sanctity of the city. The bonds that were forged in these fires were strong and would never dissolve under the weight of a move, job change, or change of the times.

The problem with this view is that it’s not an honest reflection of reality. On average, our parents did have deeper connections than we have. (See Bowling Alone, Our Kids, and Alone Together for more on this topic.) However, just because our parents had greater community connections doesn’t mean that they had substantially more confidants. According to research cited in Loneliness, the number of confidants fell from an average of three to none in the 19 years between 1985 to 2004.

Our view of the past has us longing for the connections that our parents seemed to have. We want the confidants and the community. While we need to maintain people with whom we can confide in, the days of banding together as a community may regrettably be behind us as a society. When we expect this – but can’t get it – we necessarily see the gap between our expectations and our results.

Illusions and Delusions

One of the largest problems that we have as humans is our belief that we understand. As Incognito explains, we don’t understand the world, we perceive it – and our brain is willing to lie to us to make the perception be consistent. Thus, everything we think we know is an illusion. We have the illusion that we knew how things were just as truly as we believe we know how things are. We delude ourselves into believing that was can go back to places that never existed, because we’ve so distorted our perceptions of the past.

You see, our memory isn’t a tape recorder, it’s a set of fragments that are reconstructed. Every time we reconstruct them, we change them slightly. Every time we recall our childhood fondly, it becomes a little bit better. (See Mistakes Were Made (But Not By Me) for more on the malleability of our memory.)

Sometimes, we learn lessons through our delusions that aren’t real. We believe that we’ll only be loved if we’re good. (See The Road Less Traveled and The Four Loves for more on performance based love.) We learn that under the sink is dangerous. For me, I was taught that under the sink was bad, because that’s where my mom kept the cleaning chemicals. I can remember that, until quite recently, I didn’t like going under the sink, because it was somehow bad. It often takes a great deal of work to free ourselves from the things that we learned in our childhood – even if what we learned wasn’t right.

Loving Ourselves Differently

If we were different, we could love ourselves. When you say it that way, it sounds funny. I’d like myself if I weren’t myself is a common undertone that permeates some of our lives. In our striving to become better, we forget that we’re good – and enough today. Burnout, from Glouberman’s perspective, is in part caused by our lack of acceptance of ourselves for who we are.

Certainly, the lack of acceptance of who we are is draining to anyone. Resolving this discrepancy will free up more energy and personal power to fight burnout and accomplish our life’s desires.

Detachment – Waiting without Hope

Sometimes, the language we use obscures as great idea. Such is the case when Glouberman explains that we should wait without hope. As I read carefully, I began to realize that she wasn’t focused on the need for a lack of hope – which would be bad. (See The Psychology of Hope for more on hope.) Instead, the intent was to convey a lack of attachment to the outcomes. That is, we can become so attached to the outcomes that, when things don’t happen exactly as we had planned (or hoped), we become dejected and burned out. Instead of being attached to the outcomes, we should be detached and accepting of whatever comes to minimize the risk for burnout. (See Resilient for more on detachment.)

To find The Joy of Burnout may be too much to ask, but to learn how to consider the growth from burnout as joy is something that we can aspire to.

Book Review-The Burn Book: 8 Key Strategies to Recognize and Extinguish Teacher Burnout

I’m not a teacher in the traditional sense. Sure, I’m an educator. I stand in front of classes and teach, but not in the way that Colleen Schmit means “teacher” in The Burn Book: 8 Key Strategies to Recognize and Extinguish Teacher Burnout. As a former kindergarten teacher, she means teacher in the kindergarten-through-12th-grade sense. Still, I wanted to get a sense for how teachers experienced burnout, so I started reading.

Independent Book Publishing and Speaking

First, it’s important to note that several of the books I’ve published have been self-published. I even laid out the math of self-publishing in my post Self-Publishing with Lulu.com. It talks about the finances to get a book done and what you get back from it once it’s published. I also explained that self-publishing wasn’t for the publishing revenue.

There’s a well-known reality in speaking circles that a book makes you more credible and more valuable. There are numerous services that exist to help speakers publish books to create more credibility. From extensive editing services and flat-out ghost writing to services like Lulu.com, they are designed to get someone listed easily.

This is important, because The Burn Book feels very much like a book that was designed to increase Schmit’s credibility as a speaker. She speaks once in the book about needing to teach occasionally to maintain “street cred.” She also discusses her work doing professional development workshops for teachers. While I don’t fault the desire to get credibility, I’m sometimes frustrated when I’m looking for a well-researched and well-thought-out book on a topic. The Amazon listing for the paperback version of the book says 120 pages – but the Kindle version reports 59. In any case, the book is short.

Work Wife

Schmit recommends that teachers get a work wife (her preferred term) or a work husband. The intent isn’t something adulterous. Rather, she advocates a close relationship with a peer and mentor who can help you become a better teacher. My problem with this is that a friend of mine was deeply – and appropriately – offended when her former boss called her a “work wife” in front of the team.

Certainly, having others who can help you up when you’re feeling down and provide a path forward when your waypower is lacking can be helpful. However, I’m not sure everyone’s spouse would appreciate the recommendation. (See The Psychology of Hope for willpower and waypower.)

Blame, Shame, Guilt, and Sarcasm

Schmit appropriately recommends that teachers avoid blame, shame, guilt, and sarcasm in their classes. I’ve written several times about shame and guilt. Having said that, shame is bad, and guilt can be, but isn’t necessarily, good. (See I Thought It Was Just Me (But It Isn’t) for more on shame and guilt.) I think the key here is to respect your students and try to help, not harm, them.

What About Burnout?

Honestly, I missed the connection to burnout. There was the occasional reference thrown in – but, all in all, it felt like this was a book about how to be a good teacher that got wrapped in a thin veneer of language that seemed “hot” to make it interesting.

If you’re a teacher and want to know how to be better, then by all means, pick up The Burn Book. If you’re looking for an understanding of research on burnout or different perspectives on burnout, there are better options.

Book Review-Compassion Fatigue and Burnout in Nursing

I’m not a nurse, but I’m married to one. My daughter is also a nurse. If nursing could rub off onto someone, I’d be covered in it. That’s one of the reasons why I was so curious about what Compassion Fatigue and Burnout in Nursing had to offer to help me understand.

When Terri (my wife) was working in a pediatric intensive care unit, there were days I knew she would come home to go directly to our room, and I knew I needed to just hold her and let her weep. The things she saw were horrific. How she was able to face it day after day was beyond me. While I can’t say I understand compassion fatigue directly, I can understand some of the burden that is borne by healthcare workers trying to ease the world’s suffering.

I also understand burnout and largely see it as an overarching container that includes compassion fatigue as well as other specific types of burnout. While this view isn’t uniformly held, it’s one that many people agree with.

Compassion Fatigue

Compassion fatigue is the experience that workers sometimes get while caring for others who have experienced trauma. It happens in nursing and other workers who have care at the center of their lives. It’s sometimes called “secondary trauma,” because it’s the trauma suffered by people caring for those who experienced the trauma directly. However, care must be exercised to not minimize the trauma or dismiss it because it’s not primary.

Our egos are amazing things. They allow us to ignore the very real and present fact that we’re all vulnerable. We’re not nearly as powerful as we’d like to believe. Our psyches couldn’t cope with the idea that, at any moment, an asteroid could come raining down and destroy our lives as we know it. (See Change or Die for more along this line.) When you witness the harm that happens to others – particularly when that harm comes at the hand of other human beings – it forces you to confront your own vulnerability and recognize that there are many intentionally and unintentionally cruel people on the planet. The only way to blunt out these feelings is to stop caring about others. You can still care for their physical needs but disconnect emotionally to protect yourself. This is the heart of compassion fatigue.

Burnout

Burnout, on the other hand, is a result of the gap between our expectations and our results. When we expect that we can do much and then see results that are not much, we’ll eventually experience this as burnout. Another way to think about burnout is as the exhaustion of our personal agency. (See Extinguish Burnout for more about these and other aspects of burnout)

For most caring professionals, the expectation is that they can prevent, alleviate, or heal the trauma that others experience. When the patients keep coming, it takes great strength to maintain the belief that you’re making a difference. When the traumatized doesn’t seem to be getting immediately better, the caregiver is faced not only with their own vulnerability but also the understanding that their expectation of their capacity to help others was likely very over blown.

Compassion fatigue is viewed as an acute event associated with the care of others, and burnout is more frequently viewed as a chronic condition that doesn’t have a precipitating event. However, burnout is often triggered by an event that causes someone to question the gap between their expectations and their results. In this context, it makes sense that compassion fatigue is a form of, and triggering factor for, a broader condition of burnout.

The Unseen Impact

Combatting burnout often means recognizing the impact we have that might otherwise be ignored or overlooked. The patients who get better don’t come back, so the only observations are that patients don’t get better. We begin to believe that what we see is all there is. (See Thinking, Fast and Slow for more on this.) The most prevalent image in our minds is the image of the person who didn’t recover and is back again.

Combatting compassion fatigue is a bit different. Our natural tendency will be for our ego’s defenses to attempt to “right the ship” and make us feel as if we’re more powerful than we are. However, this takes time, and when you’re bombarded by pain and suffering, it may not be possible for our egos and our faith in humanity to get a foothold. For that, we need to create space by focusing on the beauty, joy, and compassion in the world.

It’s easier said than done. But the more we can find comfort in the fact that most people are decent human beings, and few people face the kinds of trauma that caregivers witness every day, a sense of balance and normalcy can be regained.

Care and Compassionate Care

It’s entirely possible to do one’s role as a nurse and not care. The technicalities of the role can be learned and executed, like a robot making their millionth widget. However, that’s not the role of nurses – or any caregiver. The technical aspects of care are necessary but not sufficient to be a good nurse. Good nurses have a genuine concern for those in their care. They don’t become overly involved with the patient’s (and the family’s) needs, but they do adapt their way of working to maximize the things that are important to the patient and the family.

Without losing their own identity, they place themselves in the position of the patient and respond from a place of compassion – the same place that drew them to the career in the first place. Compassion is empathy – understanding another’s situation – and the desire to alleviate suffering. (See more about compassion in Sympathy, Empathy, Compassion, and Altruism.) When a caregiver suffers from compassion fatigue, they no longer have the strength to connect with someone – to understand them – and protect themselves from becoming overwhelmed with their circumstance.

As a result, the best care that nurses offer, the kind of care they all became nurses to give, cannot be done while experiencing compassion fatigue. Organizations are well served to identify and support nurses in resolving their compassion fatigue for better nurse retention and patient outcomes.

Moral Distress

If you want to find something that will steal the motivation and personal agency for someone, put them into a situation of moral distress. Moral distress is knowing the right thing but feeling as if you can’t do it. There are times when this moral distress is real, times when it is perceived, and, unfortunately, times when there should be moral distress but is not.

Shortly after the second World War, the world was asking how it was possible that so many German soldiers were able to assist with the mass extermination of Jews. Milgram devised an experiment where a test subject thought they were shocking another test subject –even when the shocks were presumed lethal. Milgram showed that many people could be coerced into these acts. (See Moral Disengagement and The Lucifer Effect for more on this set of experiments.)

For those cases where a nurse feels moral distress because of a difference in point of view, perspective, or diagnosis, the pain they feel is real. The organization (and the nurse) are missing an opportunity to understand the problem more fully so that the moral distress can be alleviated. In medicine, there’s rarely one right answer. The truth is that most patients are complex, and there are a variety of risk factors that the team navigates to try to return the patient to health. When the whole team – including the nurse – can openly discuss the challenges and agree upon a plan, the moral distress of some situations can be addressed.

There are, however, some cases of moral distress that are real. A surgeon won’t scrub up when walking into the operating room or picks up an instrument after it’s been dropped to the floor and continues to use it. Providers ignore nurses’ pleas for more pain medications or a different course of treatment for patients who are suffering. In some cases, nurses don’t feel as if they’ve got the opportunity to safely communicate their concerns, and that is their moral distress. (See The Fearless Organization for more about creating a culture of safety.) In other cases, even after a nurse voices the concern, they’re ignored or minimized. These are organizational challenges that eventually need addressed, or they’ll rip the organization apart.

Emotional Violence

Compassion Fatigue and Burnout in Nursing contains more than a few semi-related nuggets of information, including the revelation that emotional violence is still violence. While this may seem obvious, our world treats our words differently than our actions. “Sticks and stones may break my bones, but words will never hurt me” just isn’t true. Most of our hurts in the modern world come from words and the emotions they stir inside of us. While there’s a law against striking someone else, there’s nothing protecting us from a tongue lashing.

Emotional violence, or the words we say to each other and the non-verbal ways we communicate our disapproval with another person, are a form of violence that is all too often ignored. They’re the kinds of senseless attacks that we see around us and do nothing about. Left unchecked, they’re also one of the ways that we encourage Compassion Fatigue and Burnout in Nursing.