Nazan Artun PhD, RPh

Sacrificing Self-care in the Chaos of Life

The importance of self-care within the health care workforce is essential when working in stressful environments and providing patient care. Currently, self-care tends to fall under the radar of the occupational health field and is not readily available to all of its laborers.

This article’s focus is not to give self-care tips since this is a rather personal choice, as indicated self-care is defined as a cadre of activities performed independently by an individual to promote and maintain personal well-being throughout life.

 Self-care can be spending time alone or with loved ones, reading, traveling, or exercising—whatever activity of choice.

The core idea is to be able to carve out a specific time from the daily routine of work and family responsibilities. The question this raises is it truly possible to carve out “me time” while living in the hectic nature of daily routines?

To get a glimpse of the average working hours of health care professionals, let’s start by looking at health care workers in hospitals. According to the Bureau of Labor Statistics, the average working weekly hours have soared exponentially since the 90s until present day, where there is more to do while being unable to catch up with yesterday’s leftover work.

Most health care workers put in more than 40 hours a week, usually up to 60-80 hours depending on the field. Furthermore, according to the results of a nationwide survey conducted among clinical pharmacists, too many working hours is the major factor causing burnout, followed by inadequate management.

Burnout was entered into the official medical diagnosis list for the World Health Organization in 2019. Institutions are realizing how this is affecting patient care, safety, return on investment of the health care system, etc. In January 2019, The Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute have officially labeled physician burnout a public health crisis that is slowly destroying the mental health of physicians and threatens to undermine the delivery of care throughout the country.

Let us not underestimate the consequences of burnout, which comes about as a pathological syndrome in which emotional depletion and maladaptive detachment develops secondary to chronic occupational stress.

 In essence, the burnout rate among hospital clinical pharmacy practitioners overall was 61.2% and largely driven by high emotional exhaustion (52.9%) and high depersonalization (32.6%) among participants, according to the national survey.

Basically, burnout is turning the health care providers into patients themselves. This is a dilemma that, if not addressed, will result in a vicious cycle with not only psychological damage, but monetary stress to the very institution that is trying to uphold health. 

Intangible Barriers Set by Health and Wellness Centers

In 1976, the Wellness Wheel came into being after the co-founder, Dr. Bill Hettler of the National Wellness Institute, developed it for the purpose of illustrating a wellness model containing the following dimensions: emotional, intellectual, physical, social, environmental, financial, and spiritual.

The acknowledgement for the need was present, so the question is what have health care institutions done with the knowledge that wellness is integral to the person feeling depleted? How are they promoting self-care into this culture, more than simply opening health and wellness centers that become like windows in a shopping mall to look at?

To date, most institutions are focusing on providing techniques, workshops, and creating centers for the support of self-care; however, the conundrum is that there is no set time or encouragement to prioritize this effort to empower its providers to care for themselves. The laws governing self-care in the workplace are not completely set, the government speaks about wellness incentives given to employers, but what is in it for these employers besides money?

Incentivizing employers with financial gain may lead to a better culture, yet the hope is to promote the culture shift. Institutions should empower their workers—especially in health care&mdash;to accept that self-care is not selfish; in fact, given the current conditions, it may be the most selfless thing to do.

It is crucial now for institutions to take the lead and act by allocating time and resources for providers to feel that there is acknowledgement and support for their struggle to find balance.  

When taking a closer look at some of the reasons from which this culture of neglect in self-care is rooted, who do we as health care providers look up to? We look up to our managers, our leaders, and the standards they have set for their teams. 

When seeing management hold off on caring to lead by example, such as not taking a designated lunch break and eating at their desk, they set the tone for all under their leadership to follow. It is worthy to note that according to neuroscientists, when we receive different and ambiguous messages of what leaders say and what they do, our brain is programmed to follow the behavior instead of the verbal directions that in psychology are called “imitation learning.”

Even if the intention comes from a good place, supporting their department’s urgent needs whenever there is a shortage in staff at the cost of their wellness is vital. In the interim, it may be the quickest solution, yet in the long-term, this is detrimental to the overall work environment’s sustainability. There will always be urgent needs, a time to reflect—is this the legacy that leaders want to leave behind that sets the standard of neglect of self-care?  

Prioritizing Self Care in the Hierarchy of Human Needs

Considering long working hours, irregular work schedules and unrealistic expectations with limited resources, our current system is clearly not delegating time for health and wellness. Self-care is not often promoted or prioritized by the health care culture and it is perceived as a luxury for health care professionals trying to find a balance in their personal lives, being present for their family, and meeting the demands at work when asked to spend wellness time on themselves. 

It is clear that a well-supported team will outperform an exhausted team. Until the culture has caught up with the notion to improve a work-life balance, such as other industries have (ie, Google’s People’s Division), if we can all take a look within and understand that there are needs, there are options to use the rights and the voice given to know when exhaustion has set in.

Our compassionate self can allocate boundaries and give rise to that much warranted time that is essential for the self. Let’s aim to take better care and strides to change the chronic habit of neglect of the individual’s need for wellness within our institutions of health. At the end of the day, as Greg Mckeown said, “ If you don’t prioritize your life someone else will.”

Sanchez-Reilly S, Morrison JL, Carey E et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013; 11(2): 75—81.

 https://www.amnhealthcare.com/rise-in-healthcare-overtime/

Jones GM, Roe NA, Louden L et. al. Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey. Hosp Pharm. 2017; 52(11): 742—751.

Jha AK, Iliff AR, Chaoui AA et al. A Crisis in Health Care: A Call to Action on Physician Burnout, The Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute 2019 Report.

Thomas NK. Resident burnout. JAMA. 2004;292(23):2880-2889.

Kohll A, Seven Employee Wellness Trends And Opportunities For 2019. Forbes Dec 12 2018

Articles

According to the results of a nationwide survey conducted among clinical pharmacists, too many working hours is the major factor causing burnout, followed by inadequate management.