Right now, we’re hearing the word ‘burnout’ everywhere. There’s a healthcare crisis from the COVID-19 pandemic and healthcare workers are ‘burnt out’. Parents are ‘burnt out’ juggling home-schooling and work during lockdowns. John Kirwan is being interviewed about it and others are writing self-help books. The World Health Organisation (WHO) recently recognised burnout as a ‘workplace syndrome’. So what is workplace burnout, and what does it mean for us?
Ongoing stress is the cause of burnout
Burnout arises from stress. A stressful situation is any circumstance that you think might threaten your wellbeing and overtax you. Stress is subjective because it relies on you seeing the demands of a task or situation as exceeding your ability to cope. One person’s worst nightmare is someone else’s thrill…. cave diving, for example.
Stress may be a subjective experience but our response to it is real. In fact, right now there’s a global pandemic of stress. Like COVID-19 stress is contagious – we can transfer it to other people. Most of us know people who constantly say how busy they are – perhaps you’ve caught some of their stress in the process. Then there’s the boss, colleague or relative who’s dumping their ‘stuff’ on us. It also affects our respiratory system (just like COVID-19) making it hard to breathe. Why do people who are stressed sigh a lot? Because they forget to breath, and a sigh is our body’s way of forcing us to breath when stress or preoccupation make us hold our breath. That’s a physical sign of stress.
The effects of several stressors add up. In other words, our total stress is the sum of several minor or major stresses, and these can be from several sources, including home and work. Minor stressors are everyday things, such as traffic hassles, and major stresses can include the big stuff like divorce, bereavement and being made redundant.
Some stress is unavoidable and part of being human. Ask anyone with kids! However, when the stress is sustained and we think it exceeds our ability to cope, it triggers the stress response. If the stress response itself is sustained, the result can be burnout.
Who’s responsible for workplace stress – the organisation, the job or the individual?
Stress can come from the workplace. Organisational culture and climate play a part– for example, is bullying present in the workplace? Stress can also come from job factors such as unclear goals or unrealistic targets. Our personal life may also cause stress, such as the need to care for dependents. I won’t focus on personal factors outside the workplace, as employers have little control over those, other than to say that unpaid work can be a source of burnout too and family-friendly employment policies can help.
There are some individual factors that determine stress. We shouldn’t overemphasise these, as focusing on the employee, rather than the job and work environment, can increase the risk of burnout by putting the onus for stress management entirely onto employees. Leaders shouldn’t wash their hands of the responsibility to provide a safe working environment and healthy jobs. However:
Your best employees are most at risk of burnout
Someone who is at most at risk of burnout is likely to have the following three traits:
- Perfectionist; and
Sounds like the ideal employee for many roles, doesn’t it? This means that when an organisation loses someone to burnout, they’re probably losing their best. These are the people who will go the extra mile – but in doing so, run out of gas. An old Chinese proverb states ‘If not controlled, work will flow to the most competent until they submerge.’ When these people burn out, employers can be left with the ‘cruisers’, people less invested in their work, and those slick types who talk a good game but chronically under-deliver. So, it’s worthwhile getting across burnout.
Are you carrying a heavy allostatic load? You may end up burnt out.
The stress response is instantaneous and physical. Once we have recognised the stressor as a threat, we increase our heart rate and blood pressure. Our breathing becomes faster and more shallow. We release the hormone adrenaline. Our muscles become rigid. Our alertness increases. This is ‘fight or flight’ response (or, as understood more recently, ‘fight, flight, freeze or fawn’).
If the stress continues over hours, days and weeks another slower, bodily response takes over. This is the hypothalamic-pituitary-adrenal (HPA) axis. These three regions of the body (the hypothalamus, the pituitary gland and the adrenal glands) regulate the release of other stress hormones – especially cortisol. Cortisol raises our ability to respond to stress in the medium term, but elevated cortisol over the long term can cause problems, including lowering natural immunity to viruses and other nasties. We become more susceptible to colds, flu and yes, COVID-19, when we’re continually stressed.
When both our instant ‘fight or flight’ response, and our slower HPA axis are triggered, this is known as allostasis. Allostasis is designed to allow us to mobilise, respond and adapt effectively to threats and hopefully return to a more stable, balanced state where we cope effectively, or we eliminate the threats (when we’ve fled or flown!)
However, when we have a sustained allostatic load, and we can’t return to our earlier state, this leads to burnout.
Good stress vs. bad stress, and the physical changes that accompany burnout
Not all stress is bad, and some of it’s just unavoidable. Good stress is required for peak performance, and it’s called eustress. Eustress drives us to deliver at our best. As someone wrote in the HBR, “Anyone who’s clinched an important deal or had a good performance review, for example, enjoys the benefits of eustress, such as clear thinking, focus and creative insight.” We shouldn’t aim to eliminate stress from the workplace. It’s about ensuring that our experience of stress drives us to performance and not distress. When the source of stress is uncontrollable, unwelcome, and ongoing, that might result in distress, allostatic load and ultimately burnout.
Eustress results in great performance, be it sporting, artistic or otherwise, and to make it work for us we need a complex dance between stress and relaxation. As stress increases, we can respond by becoming more efficient – up to a point. After that point is reached, the dance is over, recovery is difficult, and performance drops off. We are in distress, not eustress. If we sustain distress for some time we have burnout.
In addition to the effects I’ve already mentioned, in burnout there are other changes. When we’ve reached burnout, observable brain changes occur. In burnout, sleep disturbances are common. Cholesterol increases, as does our body mass index (BMI). In burnout our bodies are awash with unwanted nervous tension and stress hormones such as cortisol (which may, paradoxically, plummet as well). It is difficult to concentrate. We are exhausted, unable to drag ourselves far. And we stop caring about work.
The result: exhaustion, cynicism and low productivity…
There are three stages to burnout, arising from ongoing allostatic load and an inability to return to normal:
- Exhaustion; followed by
- Cynicism; and, finally
- Decreased productivity. When we finally hit the wall, it’s hard to get things done.
There are ways of assessing burnout. If you think you may be burnt out it is important to see a GP, psychologist, counsellor or other professional. Luckily, all the physical and mental changes above are reversible.
Is burnout really a thing or are people just slacking?
Higher scores on burnout measures (which a psychologist may use) are associated with lower physical health and lower job satisfaction. Other outcomes include decreased performance, withdrawal, anger, increased likelihood of substance abuse and withdrawal from the organisation in one or more of the following forms: Disengagement; absenteeism and turnover.
Burnout is not a clinical diagnosis. It is not covered by ACC and is not included in diagnostic manuals of disease, mental or physical, although the WHO considers it an occupational syndrome. Some doctors and researchers consider other factors, such as depression, can explain burnout. However, most agree burnout is a distinct condition.
What is indisputable is that many of us experience ongoing workplace stress which leaves us exhausted, cynical, and struggling. Ironically, while doctors can’t formally diagnose burnout, they claim high levels of burnout themselves in their own profession. The New Zealand Association of Salaried Medical Specialists surveyed senior doctors. Fifty percent claimed to experiencing high levels of burnout. There may be scientific skepticism about whether burnout is really ‘a thing’, but many of us suffer from it.
There are clear differences between burnout and depression. Sufferers of burnout rarely develop suicidal thoughts (unlike those suffering from depression), and usually when the sources of stress are removed (for example, by leaving a job) the symptoms gradually disappear, and they make a full recovery. One person put the distinction like this: “With burnout I can still feel happiness and I’m not disinterested in life; I’m just so very, very tired” (this quote from a recent book on burnout by the Australian researchers Gordon Parker, Gabriella Tavella and Kerrie Eyers).
Burnout is real and, strangely, may come with benefits.
The silver lining of burnout
Burnout is an important self-preservation mechanism. The deep exhaustion people with burnout experience may prevent them from working themselves to death. In this way the symptoms of burnout are an important signal to wake up, chill out and make changes. Maybe this could lead to a fulfilling new job or career, or a change of pace. The Australian researchers state “Burnout is not just a state but a signal [for] the need for renewal.” The global pandemic of stress and burnout is telling us something about the need for change – not just as individuals but as a society.
Employers are liable
Here in Aotearoa New Zealand, employers have a legal responsibility to support the mental health of their employees, and this includes injury arising from prolonged stress. WorkSafe have already successfully prosecuted a South Canterbury employer, Michael Vining Contracting, fining them $325,000, for allowing an employee to become excessively fatigued to the point that the employee died. It is not a far jump from that case to see a prosecution for injury arising from prolonged stress, for example burnout. If you’re a leader, don’t make your workplace the test case.
Resources to deal with burnout
There are two types of resource that can prevent burnout:
- Workplace resources, such as the workplace climate, trust in employees and social support in the workplace, and
- Personal resources. Personal resources include the traits of self-efficacy, self- kindness, optimism, and mindfulness. Healthy habits such as exercise also help prevent burnout.
Workplace resources – lunchtime yoga and fruit bowls are not enough!It’s not sufficient to provide employees with personal tools to manage stress. Lunchtime yoga won’t remove employer responsibility if the stressor is ongoing and systematic. For example, if the stress is arising from the content of the job (e.g., customer service with little control, or understaffed caring) or the nature of the organisation (e.g., poor pay and recognition or lack of communication) then providing individual stress management tools can be futile and even counterproductive, increasing cynicism and piling further pressure on your people. Instead, you need to apply a risk management framework and treat it like any other workplace health and safety hazard. That may involve isolating and mitigating the sources of stress – such as hiring more staff to cover the workload. In these situations, an HR manager needs to be straight with their leadership team colleagues and directors, explaining the risks to them and the business and its legal obligations i.e., to provide safe working conditions. Healthy work has:
- A sense of personal control – the employee can decide how they do their work and in what order they do things;
- The ability to go offline, be away from work and recover (the dance of eustress and relaxation);
- Task variety and a good match of task to the employee;
- Quick resolution of relationship issues and conflict;
- Good, two way communication;
- A lack of hierarchy and respect for all, regardless of role;
- Fair reward and recognition for effort;
- Acknowledgement of the emotional cost of change and its effect on morale;
- Supportive leaders (it’s especially important for leaders to take ‘the hits’ and shelter their team members from external criticism); and
- Opportunities for progression and growth.
If employers can’t address these things, then providing personal stress management tools is not likely to prevent burnout.
Personal resources – mindfulness and self-compassion
Greater mindfulness is associated with a lower chance of burnout. This works possibly because when we’re mindful, we’re less reactive emotionally and behaviorally and can therefore cope better with stress. Including mindfulness training or meditation as part of health and safety or wellbeing in the workplace is reasonably cheap and easy for employers to put in place. We don’t need to rely on our employer to do this however– there are plenty of free or cheap mindfulness resources out there, such as the Headspace app.
Mindfulness works because it reduces negative feelings arising from stress, and because it takes the focus off the cause of the stress. However, it may make us less likely to move on to a job where there is a better workplace climate and social support, so there may be a downside to it. It’s great if our employer offers mindfulness training, but are they neglecting structural change to address the source of the stress?
Self-compassion (the ability to treat ourselves with kindness) has been shown to protect against burnout in New Zealand nurses. Interestingly, self-compassion also moderates dysfunctional perfectionism. Remember that those of us with perfectionist streaks are more prone to burnout. It’s possible that by being kinder to ourselves, we make take the pressure to be perfect off ourselves and allow ourselves the odd mistake or missed deadline without beating ourselves up too much – and in doing so, protect ourselves from burnout.
Healthy habits help
Healthy habits help modify the stress response and build resilience to burnout. This includes ensuring we have regular exercise, good nutrition and sleep hygiene, maintain social connections, have recreation and find meaning in life.
Burnout and COVID-19
Working from home has highlighted additional sources of stress. In addition to the stress from the pandemic itself, COVID-19 has changed our jobs and workplaces. Stresses include balancing work and family demands in the home workplace; the inability to go offline; endless online meetings, uncertainty and confusion about how to work; isolation from workplace social support etc. How do we timebox (i.e., put clear boundaries around tasks and diary slots), and maintain good relations with our colleagues when we can’t be with them? These are big challenges for all of us since 2020. On the other hand, there may be benefits from remote working, such as increased flexibility for exercise, so it’s not all bad. Whether these changes in working patterns increase or decrease our chances of experiencing burnout, will depend on our own makeup, as well as how our employer manages them.
Covering staff absences due to COVID-19 may increases stress for remaining employees by spreading the same or more work across fewer workers.
From the employer’s perspective…
Managers and CEOs need to cultivate the skill of spotting burnout. By the time someone comes to their manager (if they ever do), saying they are burnt out, they probably already have their resignation letter in hand, and that’s only the ones who are honest. Most employees who leave with burnout will give other reasons. After all, they probably want a good reference and to put all the stress behind them. If you’re committed to being a good employer, you need to ensure work conditions are decent. This includes:
- Fair pay and conditions
- Providing employees with the resources to do their jobs without undue interference and develop their competence (autonomy and growth)
- Health and wellbeing programmes, including an employee assistance programme (EAP)
- Zero tolerance for bullying and harassment
Creating a safe organisational culture is also important. The best organisational culture is one of caring but not over-controlling.
What do you do if, as a manager, you suspect burnout? It’s not up to you to diagnose burnout. But you can ask questions about how an employee is feeling. If someone reports specific work stressors, focus on how you can help. If your organisation has an EAP there may be resources available to the employee through that channel. Recognise that burnout usually requires time off to turn around, and this is likely to be for longer than the burnt out person estimates they need – think weeks or months, not days. The structural change you need to put in place before the planned return to work is also important.
From the employee’s perspective…..
Is your employer likely to be supportive? If so, you may consider approaching your manager to discuss stressful aspects of your work or personal life that you feel the organisation can support you to manage. If your employer is unlikely to be supportive, you have two other options:
- You can focus on coping strategies to manage your stress, such as mindfulness, exercise, sleep, contacting your EAP provider, taking an extended break from work if you can, or medication (under supervision from your GP). You employer may already have support for some of these things in place (such as an EAP, or a subsidised gym membership); and/or
- You can change your workplace or job, retire, or undertake some other life change. This might involve taking burnout as an opportunity to reset your compass and follow your dreams.
Lastly, recall that people with perfectionist tendencies are at higher risk of burnout. If burnout is a recurring theme in your personal or working life, and if perfectionism is part of your makeup, it may pay for you to do some work to address these tendencies. A psychologist or counsellor may be able to help.
Stress is a pandemic. Stress is unavoidable and some of it is useful to help us perform, but when its ongoing, and we can’t manage it, or use it to mobilise our resources and overcome the stressor, we are carrying a heavy burden – an allostatic load. Then, we may flip into burnout -a state of exhaustion, cynicism, and low productivity. Once in burnout, we need a long recovery time. Some valued employees are prone to burnout because of their own internal high standards. Employers have a legal liability to keep employees safe. Employers need to structure work and organisations in a way that provides a healthy working environment. For employees, mobilising the resources of mindfulness and self-compassion may help to manage stress; burnout may also be an opportunity to reflect not only on our job or career choice, but also on whether our high standards are serving us. Burnout is an important message to us, our employers and our society on the need for change.
About Shaun Bowler
Shaun is a registered psychologist, chartered organisational psychologist and wellness practitioner. He uses evidence-based approaches to workplace wellbeing and organisational performance and works with organisations and individuals. With a background in sustainability management Shaun advocates hauora, or wellness, in the widest possible sense; ‘Ko au te whenua, te whenua ko au’. Shaun has a strong interest in the body-mind connection. He is a registered exercise professional (REPS) and certified ‘Exercise As Medicine’ trainer. He also teaches and practices yoga and mindfulness. Shaun is a support provider in the Ignite platform, and users of the Ignite platform can book individual sessions with him.