Hey. Burnout, it's not an optimistic topic, isn't it? Well, it's a real part of your chosen career, a lot of careers, but especially your career, which just makes so many strong stress demands on you. What do you do? To some extent, burnout is a failure of everything we talked about before, a failure of resilience, and etc. You've been trying to keep stuff together and at some point, you just reach the point of being burnt out. What I want to do here is talk about that a little bit, again, from a psychological perspective. Then I really want to talk about the power of perspective to help out then. It'll be a bit of a weird talk, but that's how it goes. Let's start here from the work of Hans Selye. Hans Selye, I've mentioned him a couple times, but he really did this critical original work on stress. It's his work that shows us clearly that our thoughts and our mental experiences have physical effects on the body through the release of cortisol. He identified this what he called general adaptation syndrome, where if you were undergoing stress, you have these three steps. Whereat first, you react to that stress, you're mobilizing resources as it were. We call that the alarm reaction phase. But then this is the one we've been talking about through most of this course, the resistance phase, the stressor is out there and you're trying to perform with it in your presence, and you're doing all you can. What this really suggests is you can only do that for so long. In fact, we like a little bit of stress. We can handle a bit of stress. You see that for a while we're actually performing quite well with the stress. But we reach a point where literally we can no longer resist it. We're marshaling forces against it and at some point that starts to drop, and that's where we see this arrow. That's really what we're talking about here, is a burnout step. When you just feel like, "Yesterday, I was keeping stuff together. Today, I don't feel like I got my stuff together." What do we mean? Let's go a little bit clearer here and separate out what we've been talking about, stress versus what we're talking about now, which is burnout. When we talk about stress, we'll say sometimes a person is putting in too much effort. They feel energized. To some extent when you're anxious, you're energized. When you're burnt out, you're not really energized anymore, you're just feeling. Again, stress, you feel emotions more strongly. When you're stressed, that's that fight or flight. We see this emotionality. When someone's burnt out, their emotions are actually blunted. It starts to be a blase attitude. Again, stress, you're hyperactive and anxious, burnt out, drained, and helpless. We're going to talk about this helpless word because it's an important word to understand burnout. Stress, you have less energy, but burnout you have less motivation. Stressed is a physical toll, burnout takes an emotional toll. Let's just look at the burnout column here. We have the contrast. But this idea hard to put in effort. Don't feel any strong emotions about much of anything. You feel really blunt and exhausted, drained, helpless, not motivated, you're just, why bother? It's taking an emotional toll often because we feel we are failing, we are giving up, that's it. That's not a good feeling to have. Let me bring in a little bit of psychology here to give you a sense and to really highlight this word helpless because this is a big part of the burnout feeling. This is an experiment I don't love. I will mention that at the outset. But I'm going to describe it to you because it makes a point and it'll probably stick in with you. I don't love it because I'm an animal lover in general, a dog lover especially, and this involves dogs and giving them electric shocks, which sucks. But here's the idea. We have a dog in a chamber like this. We have a side of the floor that can be electrified and a side that's never electrified. What we do at first is we teach the dog a simple association. We turn on a light, and just after the light, we're going to electrify the floor here. Every animal hates the feeling of electricity. We're not talking about enough electricity here to cause any damage, but every organism hates that feeling. The dog will quickly learn, okay. This light predicts electricity, I'm getting out of here. When the light goes on, it escapes the negative stimulus. Okay. That's easy enough. That's the beginning. Here's where it gets a little nasty. They then increase this barrier to the total height so the dog can no longer escape to the other side. What happens now? When you turn on the light at first, the dog tries to escape. It looks for every potential way to get out, but after a while, something happens. It stops trying. At some point, in fact, it just lays in the corner of that cage and the light comes on and the shock comes on and it just takes it. In fact, in the critical part of the experiment, after the dog has done that for a while, just sat in the corner, they again reduce the barrier, so now the dog could escape if it tried, but it doesn't try. It just sits there and it takes the shocks. This is work done by a guy named Martin Seligman, and Seligman argued that the dog has at that point reached something called learned helplessness, a state that he connected with depression, although some people argue that it's not the same as depression, but it is partly burnout. It's that feeling like, "My goodness, we've tried everything we can. We've been working like heck to get control of whatever and we're not getting there. Nothing we're doing is helping. The situation is continuing to be as bad or getting worse." When we're in those sorts of situations where we're trying like heck, and we just feel like our efforts are not enough, they are not doing it, we can reach this point of learned helplessness and it's very demotivating. Remember, part of burnout is that lack of motivation because it moves you from what we call an internal locus of control to an external. What we mean by that is, when you have an internal locus of control, you have this feeling like what you do matters, and with the right work or doing the right things will lead to certain outcomes that you want to see realized. You feel like you have the power to shape the future. An external locus of control is someone who doesn't feel that power, feels like things just happen and nothing I can do is going to change them. When we get that external locus of control, when it starts shifting that way, that's the path to helplessness, to learned helplessness, to feeling like, "Why bother, it doesn't matter." That's a very tricky state and it's a core part of the burnout feeling, and so a good state to understand, partly because there are some approaches to dealing with this. I have a URL here, this is the same URL, and it draws heavily from this book. This is the guy that did the learned helplessness experiment, but he has a book called Learned Optimism, which is all about trying to not fall into that learned helplessness state. It involves a number of different things, and if you go to this website, you can find out some of the details. I'm really going to highlight perspective taking and the power of that. I'm going to do it from a very big picture sense because we've gone through this long course, this is pretty much near the end, so I figured this is a time to zoom out a little big. I'm going to do that now. Take you back to the Industrial Revolution. In the Industrial Revolution, factories were having their hay day and we were getting people to work in factories but originally, they were working ridiculous hours in factories. There was a labor movement and this was their slogan. This is the creation of the eight-hour work week: "Eight hours of labor, eight hours recreation, eight hours rest." That's what they fought for and eventually won the eight-hour workday. I don't know how many of you guys enjoy our workdays, but this was a big deal. When you look at it like this, I like seeing the slogan because it really puts labor in its place. It puts their careers in their place, and that's really what I want to get you to think about. If you look at this, it's actually one-third of your life is spent in the workplace, one-third of your life is just sleep and getting that physical restrengthening, but eight hours of recreation, one-third of your life, and this is your pre-retirement life, his is your working life, one-third of your life should be about things that you want to do, things that make you feel good, and this is the part that fights burnout. These eight hours are critical in terms of re-balancing you mentally, almost just like the rest is necessary for our physical health and for our mental health by the way, but this recreation time, this time we spend with friends and family doing the events of our life. It's very important, and sometimes in situations where we have burnout, what we see is that somebody is really focusing heavily on their work and sometimes to the detriment of their recreation, and that can lead to burnout then there. So realize the importance of the rest of your life, the outside work. In fact, I'm going to make this point in a dramatic way here. When work feels overwhelming, remember that you're going to die. There is an nice optimistic thought for you, but yeah, I often like this deathbed perspective. It's a little morbid, but it's very powerful to every now and then, whether we're talking about using visualization and imagery. I every now and then visualize myself dying. Sounds depressing in a hospital bed, and then thinking, from that perspective, what's important to me right now. I think in what most of us will think is important is the family and the memories, and the things we've done with our life. I think this quote is interesting for putting things in perspective. If you died tonight, your employer, would have a job advert to fill your role by the end of the month, maybe less. I've heard other people say you will be so quickly forgotten in your place of work that it would make your head spin months after you're gone a month or two, you're mostly forgotten. But your friends and family would miss you forever. Don't get so busy on making a living that you forget to work on making a life. That's the recreation side. Notice that that's as important. It should be in your life, you should be investing as much time and effort into your own personal recreation as you are into your career. Now I fully understand that with health care work, sometimes, it's a little different, you read things so busy on making a living that you forget to work and you think about these people that are just working 60 hours a week to make as much money or 80 hours a week to make as much money as they can. Often I think you guys feel compelled to work because you're needed, and that's a different dynamic that brings in this whole psychological angle of what you're doing there, and I would say even then, you have to remember to think about yourself, especially when work is getting really overwhelming. One of the options I'm going to suggest is that you, realize the importance of the recreation side, and you every now and then say in a very assertive way, I need some time for the rest of my life. I need to work on this recreation side. I need to work on my personal enjoyment side because only then can I have to get that back in balance, and that's what we're talking about here. What my message is with respect to to burnout for you guys is, first of all, know what the symptoms are and we've talked about them. Sense that difference between anxiety and helplessness. When you get to that helplessness thing, that's a sign that you're feeling pretty burnt out. Understand, you and your employer should understand this that working while burnt out can be dangerous for you and your patients. You're not necessarily being noble by fighting through the burnout. You shouldn't see it that way. They shouldn't see it that way. I started by saying burnout is a failure, and I don't mean that at a personal level, but I mean, it's a symptom that somebody has been exposed to so much stress for so long that their system cannot handle it anymore. That person then needs a break. They need a chance to escape the stress. Keeping them in that situation is just going to be dangerous for them, and dangerous for the people they work with, including their patients. I'm stressing that because I think sometimes people feel self conscious about telling somebody I'm completely burnt out, I need a break, but when you feel that way, you need to get away and it's the right thing to do. That's what I want to impress on you. It's being assertive with potentially your employer or whatever and just saying, listen, I really need to get out of here. I need some time, and understanding that's just a truth. It's better to get away and get refreshed than it is to tough it out. You really want to give your patients the best you, and if you're burnt out, that is not the best you. This is a real place to be assertive and to represent yourself well, and your employer should respect that. Let's go to the employer side from the institution. What can an institution do to try to prevent burnout or to deal with it when it happens? First of all, to prevent, Heather talked in her video, about respite centers that she's created. They have centers right within the hospitals where people can escape the stress for a little while. Maybe they can do karaoke or maybe there's a yoga opportunity there or stress balls that they can interact with or comedy is playing that will make them laugh a little bit, etc. All the things we've talked about could be part of a respite center. You should certainly have that so that if somebody just needs to get away for half an hour, sometimes that's all it. I'm burned out. I need a half an hour, an hour just to get away from this. Then they can do that very easily. But if it's more than that, if it's not just I need a half an hour, an hour, I need a week. I need to be away for a week or two weeks or something like that. You really have to respect that. First of all, you want to ensure that the demands you're making are not hopefully putting staff in these uncomfortable positions. Realize that when you ask them to work an extra shift or anything like that, you are asking them to spend less time around those people and doing those things that support their mental health. It may seem valiant for them to say, "Sure, I'll do that." But in fact, it's not right thing to ask somebody because you want your staff at their best and you should almost see those eight hours of recreation as time they need to be their best when you have them for those eight hours. You really want to think about that. This isn't something where there's no cost to having somebody work extra hours. Those people are paying a cost for that and that could creep into their performance as well. What I would love, and I think this is probably not possible. I don't know for various reasons, but from my interaction with healthcare professionals, it seems like they're continually working different hours. That's not good. At the core, remember the foundations of mental health and remember that idea of a structured schedule where you put in some mental health things that all works when you can keep a structured schedule. But as soon as your work day starts shifting all over the place, A, you can't do that mental health habit forming as easily as you can, and you're recreation time gets messed up because your family never knows when you're off and when you're not. These inconsistent shifts, this is the single easiest thing I think that that could help mental health for a lot of health care workers is if they could. No, I'm working five days a week between X and Y and that's my shift. That's what it'll be, and my family can know that, we can plan around that, we can use our recreation time to refresh and that's really important. The final point here is we must respect our staff when they say they're feeling burnt out. They know when they're feeling burnt out, and we know that a burnt out staff member makes mistakes. They're exhausted. They can't think very well. They're [inaudible] , they've told you all these things. We have to realize, we do not want burnt out staff members working. We want them recharging. Yes, that could cause additional stress for other people. How do we manage that? I understand the complexities of the context that I'm talking about, but I'm just trying to give you a sense of the factors at play and how you can maybe work some of them to get the effect you want. It's all about the schedule. I'm just going to leave you with the schedule. Again, because this is really the overall thought I want you to have as you go into this, which is you have control. You can create a life whereby you are controlling what's on your mind. You do that again by focusing on the positive, not focusing on the anxiety, but what are the things I can do that I think will have a positive impact on me. We've talked about a lot of them throughout this course, but get serious about them. Schedule them, make sure they're part of your life. That recreation time we've been talking about, make sure it has some activities in here that charge you and make you feel good. If you can live a regular schedule, go to sleep at the same time, get up at the same time, that's a huge win. Excellent. We'll see you at the goodbye video, but I just want to say it's been a pleasure and I hope you found something useful out of this. I will see you in a moment. Bye bye.