Addressing staff burnout: a moral and ethical imperative

"Staff being in tears is now a regular feature of NHS life. We are all so tired and frustrated." Nurse, The Guardian (11th January) 
 

“I’m going home after every shift feeling guilty about the care that patients are getting. It’s heartbreaking.” Nurse, The Guardian (11th January)
 

“We want to give people the treatment they need and deserve, and we can’t. We can’t because we haven’t got the resources to do that now.” Junior doctor, The Guardian (14th January)
 

“Four patients in resus, all sick, all need to go to ITU. Only three beds available in ITU. Who doesn't get the bed? Sounds like a complicated ethics question, but this isn’t from a textbook, this is real life! #nhsmaths #nhspressure #nhscrisis #juniordoctor” Junior doctor, Twitter (15th January)  

These stories make painful reading, but they are also a siren call that politicians would do well to listen to. These are textbook descriptions of professional burnout.

And, as today’s report from the Health Select Committee suggests, some politicians are listening. The committee cites accounts from nurses afraid they will lose their registration due to the intense pressure they are under, and highlights the feeling from nurses that they are not recognised for their efforts, staying late, doing a lot on goodwill.

But recognising the problem is one thing. As the committee acknowledges, government must act to stop the alarming rate of attrition from nursing. And nursing is only part of the problem. So what do we know about burnout in the NHS and what needs to be done?

What causes burnout?

Burnout is caused by chronic stress in the work environment. Health care staff are particularly vulnerable because of their exposure to risk factors such as emotional interactions, long working hours and exhausting shift patterns, and a lack of control over the demands placed upon them.

The recent winter pressures have created the “perfect storm for burnout”. A situation made worse by the profound ‘moral distress’ staff experience when forced to work in a way that conflicts with their personal values – such moral distress is a major factor behind burnout.  

What impact does it have?

There is strong evidence that burnout has an adverse effect on quality of care, patient safety and patient satisfaction.   

• Staff experiencing burnout feel fatigued and unable to face the demands of their job, or able to make a meaningful contribution.
• Burnout reduces productivity and performance – in doctors, for instance, it is linked to higher rates of prescribing and ordering diagnostic tests.
• Staff disengage – high levels of burnout are linked to more staff leaving their job, or walking away from their profession altogether. The NHS is already seeing evidence of this, with rising numbers of staff leaving due to the pressure of work, and rising numbers of nurses and doctors either retiring early or leaving their profession.
• Burnout is also detrimental to staff wellbeing, and linked to higher levels of relationship breakdown and suicide.

What needs to be done?

The biggest overarching priority is to return the NHS to a position where funding keeps pace with the rising demands of a growing and ageing population.

But there are things that organisations can do today to mitigate the risks to patients and to ensure a healthy, productive and happy workforce. The Mayo Clinic has developed a wide range of organisational strategies to promote clinical staff engagement and reduce burnout. They argue that many of these interventions are relatively inexpensive and can have a large impact. They include:

1. Acknowledge and assess the problem. Regularly measure the wellbeing of staff and demonstrate that the organisation is trying to reduce burnout.
2. Harness the power of leadership. Develop and support clinical leaders. The Mayo Clinic found that a 1% increase in senior doctors’ leadership score brought a 3% reduction in how likely those reporting to them would be to suffer burnout.
3. Cultivate social connections and peer support. Invest in areas where staff can meet and relax. Sadly the NHS has a history of cutting precisely these areas.
4. Develop targeted interventions for specific clinical areas.
5. Align values and strengthen culture. Work to ensure shared values across the organisation, and use these for decision-making as well as recruitment.
6. Provide resources to promote personal resilience and self-care.
7. Flexible working patterns that support a better work-life balance. 

These actions are not a ‘nice to do’. There is a moral and ethical imperative to address staff burnout – something our political masters should wake up to.