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Burnout in the lab: symptoms, stages, strategies.

Burnout in the lab: Symptoms, stages, strategies

Burnout is a common buzzword with little understood implications. Managers apply it promiscuously to all manner of staff problems, including constant lateness, excessive absences, abrasive or negative behavior, and careless work. These problems may or may not be manifestations of burnout. Often they are not, and the manager who trots out the buzzword is trying--subconsciously --to escape responsibility for counseling or disciplining a poor performer.

In effect, the employee is being written off. "You're burned out, maybe you need a change' is a way of prodding someone to look for a new job.

What is burnout, and how did it come to mean so many other things?

It is my contention that we need a better definition of burnout in order to separate it from other types of problems and deal with it more effectively. Perhaps Edelwich supplied the best definition thus far: "a progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of their work conditions.'

Freudenberger, a psychoanalyst, introduced the term in 1974 to describe a staff disorder in alternative care facilities.2 Since then, a number of authors have used burnout to explain the decline in enthusiasm experienced by health care professionals in various jobs. The concept grew popular in the late 1970s and early 1980s as many articles and even some management textbooks expounded on it.3-5

Confusion crept into the writings and spread. Individuals with specific complaints were misclassified as victims of this new malaise. Many anecdotal accounts-- about overworked mental health staffs, underpaid substance abuse counselors, nurses soured on patient care, unappreciated laboratorians, and private practitioners tired of demanding workloads-- became case histories of burnout.

Clinical laboratorians who complain of burnout, or observe it in others, cite a conglomeration of symptoms and conditions. The symptoms include apathy, fatigue, low morale, decreased interest in work, reduced productivity, tardiness, absenteeism, anger, resentment, headaches, backaches, muscle tension, frequent upper respiratory illness, and depression.

Conditions listed as evidence of burnout include role conflict, resistance to change, and the feeling of isolation that laboratorians have from other health care professionals. These conditions require some elaboration.

Role conflict afflicts technologists who no longer have the same sense of purpose on the job because of changes in assignments, procedures, and instrumentation brought on by financial pressures. They don't receive a good explanation for the changes, and that's what really bothers them.

For example, the laboratory may have long used a chemistry analyzer that needed no operator attention beyond loading, thus freeing a technologist for more challenging duties. Now a semiautomated instrument is brought in as a replacement. It does the same testing for less than one-third the cost--but it requires more attention from the technologist. If the employee doesn't know about these savings and why they are so essential, the switch in instruments will seem capricious. Then symptoms like anger and resentment may set in.

Resistence to change is a related problem. Like role conflict, it surfaces when management does not confide in employees about its intentions. To overcome resistance, management should also seek input on forthcoming changes from all levels of the organization.

The other burnout condition we have mentioned, the feeling of isolation from other health care professionals, is an old situation that continues to plague laboratorians. It need not. There are many opportunities, from hospital committee work to allied health seminars and workshops, to get to know colleagues in other disciplines and to learn that they share similar concerns.

We have touched on some possible causes of burnout as it is perceived by employees. Besides the changing direction of the profession and lack of recognition, troubled laboratory staff members cite inadequate pay, excessive hours, too much paperwork (more befitting clerks than scientists), and fear of making a mistake, particularly in the blood bank. They also note a feeling that their careers are at a dead end. They see few opportunities to advance; only a select number will be called to the supervisory level.

Researchers have defined four stages that characterize the degree or extent of burnout: enthusiasm, stagnation, frustration, and apathy.6 A burned out employee does not necessarily go through all four of these stages.

At the enthusiastic stage, health care workers overidentify with their clients and carry out their jobs to an excessive degree, often at an inefficient expenditure of their own energy. Enthusiasm can also carry employees past the bounds of the job, as when a technologist notifies a clinician directly about an abnormal bone marrow or applies for a promotion beyond his or her capabilties.

Then there is the seemingly opposite stage, stagnation. Here the employee is stuck for a long time in a very routine assignment, such as plating cultures or processing stool cultures. The job offers no challenge and eventually productivity slackens.

When work becomes frustrating to an employee, he or she may become irritable and ask, "Why me?' Or the employee may withdraw from the job, assuming an attitude of apathy as a defense against frustration.

Other researchers have come up with different rites of passage in burnout. For example, Pines and Kafry focus on fatigue at work. They identify three stages: physical fatigue and feeling drained; psychological fatigue with alienation from clients and work; and spiritual fatigue, which involves self-doubt.7

Tanner mentions that burnout victims experience intellectual boredom and a shortened attention span. When this happens, employees change career objectives because they perceive a loss of skills and strength in their present jobs.8

From the plethora of characterizations of burnout, it becomes obvious that descriptions of human behavior are difficult to categorize and quantify. Most important is the fact that different people have varying degrees of tolerance for workplace situations. What may cause one laboratorian to become stressed and/or burned out may not stimulate a similar response in others. Unlike practitioners in the basic sciences, behavioral scientists don't have reliable measuring devices.

It thus becomes important for managers who must judge performance to have a workable definition of burnout to use along with their own intuition and observational skills. Again, a good starting point might be Edelwich's definition: "a progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of their work conditions.'

A sustained sense of mission and purpose is essential in health care because the stakes are high. But professional detachment is also needed. When one identifies too emotionally with patients, the job becomes much more stressful.

We can, of course, prevent burnout from occurring in the first place. The following strategies are recommended:

1. Demonstrate and encourage recognition for all staff.

2. Elicit ideas and involve staff in participative management.

3. During performance evaluations, assist staff to develop more realistic personal goals.

4. Develop and use mechanisms for feedback, in both directions, between supervisors and employees.

5. Provide continuing education that includes workshops on coping strategies, stress reduction, time management techniques, etc.

6. Encourage open-door counseling for those staff members experiencing stress. Let them walk in and air their concerns.

7. Demonstrate a caring attitude. Respond promptly to an employee who exhibits unusual behavior on the job. Use one-on-one meetings with the employee to get to the root of the problem.

8. Insist on competent leadership if you are an administrator. Management has a responsibility for staff concerns and for selecting the right personnel for supervisory positions. Create a managerial climate that encourages acceptance and provides training and development programs for current and future supervisory staff. Emphasize the people skills that are necessary for supervisors, such as communication, motivation, and leadership.

In conclusion, there is a clear need for a better definition of burnout and objective, measurable criteria. Until they are developed, management's best bet is to employ preventive strategies.

1. Edelwich, J., and Brodsky, A. "Burnout: Stages of Disillusionment in the Helping Professions.' New York, Human Sciences Press, 1980.

2. Freudenberger, J.J. The staff burnout syndrome in alternative institutions. Journal of Social Issues 30: 1959-1965, 1974.

3. Greenberg, J.S. "Comprehensive Stress Management.' Dubuque, Iowa, William C. Brown, 1983.

4. Allen, R.J. "Human Stress: Its Nature and Control.' Minneapolis, Burgess Publishing, 1983.

5. Girdano, D., and Everly, G.S. "Controlling Stress and Tension: A Holistic Approach.' Englewood Cliffs, N.J., Prentice-Hall, 1979.

6. Lammert, M. A group experience to combat burnout and learn group process skills. Journal of Nursing Education 20: 41-46, 1981.

7. Pines, A., and Kafry, D. Occupation tedium in the social services. Social Work pp. 499-507, November 1978.

8. Tanner, A. Middle management stress: Recognizing and treating burnout victims. Human Facilities Management pp. 12-22, January 1983.

Photo: "Burnout is a progressive loss of idealism, energy, and purpose experienced by workers in the helping professions.'

Photo: "What may cause one laboratorian to become stressed and burned out may not stimulate a similar response in others.'
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Author:Martin, Bettina G.
Publication:Medical Laboratory Observer
Date:Mar 1, 1986
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