More than 62% of hospice and palliative care clinicians have suffered from burnout, research indicates. As hospices contend with widespread staff shortages across all disciplines, staff burnout threatens to increase turnover and cause some staff to leave the industry altogether.
Factors leading to burnout included emotional exhaustion, working longer hours, being younger than 50-years-old, and working weekends. Staff working in smaller organizations were at higher risk, according to the study.
Burnout has an extremely detrimental effect on staff both personally and professionally. An employee suffering from burnout can experience fatigue, depression, social withdrawal, insomnia, increased vulnerability to illness, and increased risk of substance abuse, heart disease, type 2 diabetes, interpersonal conflict and suicide, according to Mayo Clinic.
An employee experiencing burnout is also more likely to make mistakes and less likely to realize that an error has occurred. This can endanger patients and staff and have a negative impact on the quality of care the organization provides.
“Burnout is essentially a flight or fight response to an external threat. That’s why staff withdraw or act out. I would liken it to trying to do your taxes while a tiger is chasing you,” said Arif Kamal, MD, associate professor of Medicine and Business Administration at Duke University and co-author of the burnout study. “There is evidence across the nursing and medical literature that burnout is associated with more mistakes, specifically in paying attention to detail.”
Another significant driver of burnout is the nature of the work itself, frequent exposure to others who are suffering and eventually dying.
The prevalence of burnout can contribute to serious staff shortages the industry is facing.
Currently the United States has 13.35 hospice and palliative care specialists for every 100,000 adults 65 and older. An April 2018 study estimated that by 2040 the patient population will need 10,640 to 24,000 specialists; supply is expected to range between 8,100 and 19,000.
Hospice and palliative care providers are already seeing shortages in other disciplines, including chaplains, nurses, and social workers. As far back as 2008, the U.S. Centers for Medicare & Medicaid Service (CMS) began allowing hospice providers to use contracted nursing staff because not enough nurses were available to fill permanent positions.
In 2015 only 44% of hospital palliative care programs met national staffing standards set by The Joint Commission. The shortages are exacerbated when considering the current rapid expansion of community-based palliative care, such as in outpatient and home-based settings.
“There is turnover not only in the sense of moving to a different employer but also in terms of people leaving the field altogether. Research has found that burnout is the second leading reason for people leaving the field other than normal retirement,” Kamal said. “Organization turnover is one thing, but if we have a high level of field turnover we have an inadequate workforce to cover the people who need our services.”
The relationship between burnout and turnover is reciprocal. Just as burnout contributes to staff shortages, staff shortages contribute to burnout.
“If you are trying to do a certain job with 75 percent of the personnel that you ordinarily would like to have, you are either going to be running at many times normal during that time, or you are going to be cutting corners to make it work. Both of those can contribute to burn out,” said Timothy E. Quill MD, professor of Medicine, Psychiatry, Medical Humanities and Nursing at the University of Rochester School of Medicine.
Hospices can adopt strategies to respond to or prevent staff burnout, often through resources they already have available. That begins with recognition that burnout is not a sign of personal or moral failure.
“There needs to be a call for action,” Kamal said. “Large hospice providers and national organizations need to get behind this because the discipline-wide, customizable solutions we need are probably something we already know how to do. We just have to figure out how to scalably implement them.”
Some hospices organize staff support groups in which clinicians meet to discuss their experiences and provide mutual emotional support. Others implement wellness programs that include mindfulness meditation, yoga, nutrition information and other aspects of health and self-care.
A hospice team can also benefit from having some objective metrics for hours and scheduling and workload to ensure that staff know that the process is equitable
The multidisciplinary team model of hospice care itself can help provide an additional layer of support
“Multidisciplinary teams are often protective against burn out because staff can support one another through challenging cases and divide up the workload,” Quill told Hospice News. “Many hospice programs have people within the team that others can confide in. Creating a high-functioning multidisciplinary team is a sophisticated process, but this is the ideal hospices should strive for this if they want to sustain their workforce.”
