Beyond the OR: A CRNA's Guide to Combating Burnout
Burnout is real. We have all experienced a period of extreme stress. It could have been leading up to final exams, time with the extended family, or during a tough stretch at work. The unique pressures of being an anesthesia provider place CRNAs at a high risk for burnout.
Burnout is more than day-to-day stress. It’s emotional, physical, and mental exhaustion. It’s the additive effects of constant work stressors, demanding schedules, and compassion fatigue. Often the combination of interpersonal, intrapersonal, and workplace stress.
An inferior state places all of us at risk of performing poorly. For CRNAs, nurses, physicians, and other healthcare providers, poor performance directly influences patient care and impacts outcomes. It’s essential to identify, manage, and combat burnout to maintain personal wellness, optimize patient outcomes, and maximize career longevity.
Here are strategies proven to help achieve a fulfilling and sustainable career.
Understanding and Recognition
Burnout manifests physically through brain fog, chronic fatigue, poor sleep, headaches, muscle aches, and frequent illnesses.
Emotional manifestations include irritability, anxiety, depression, cynicism, and loss of empathy. You may feel overwhelmed, helpless, or trapped.
These physical and emotional symptoms will inevitably show in your behavior. Think about a coworker who was performing poorly or made frequent errors. Someone who was lost and couldn’t concentrate on what needed to get done. Someone who was difficult to speak with or standoffish.
Maybe you formerly spent time with this coworker after work. Now they are constantly exhausted and just want to go home and sleep. Or you notice a change in habits. What used to be a Monday morning beer after working the weekend night shifts turns into a Monday of overconsumption. Or adopting the use of any number of unhealthy coping mechanisms, many of which are commonly misused among anesthesia providers.
Take note of these behaviors. Do you know anyone like this? Do you or have you displayed any of these signs of burnout?
Recharge Effectively
Prioritize self-care. Sleep is huge for me. I take a bunch of call, so my sleep is regularly irregular. Interrupted at some sites more than others. I don’t want to know what my sleep debt might be.
Optimize your sleep. I’m passionate about all things sleep, but I’ll keep it short with a bulleted list of actions:
Constant Wake Time
Constant Bedtime
Minimize Screen Time 2 Hours Prior
Wind Down 1-Hour Prior
And a bulleted list of non-negotiable interventions:
Cold Room
Blackout Curtains
Red Motion-Activated Lights
Progressive Relaxation
Utilize progressive Relaxation or a hypnotic induction technique to fully relax. Best sleep ever.
Habits to Optimize Wellbeing
If you work all night, don’t think you can make up the sleep debt in a day or two. Anything beyond 10 hours of sleep doesn’t help, so don’t waste all of Saturday sleeping. A 24-hour wake period can only be repaid with 10 hours of sleep per night for 5 consecutive nights.
Nutrition is important. Fuel your body with whole foods. I’m talking about protein, fats, and carbs for whatever macro amount meets your goals. Avoid processed and sugary foods. These aren’t satisfying.
Hydrate, especially in the morning. I drink 20 ounces of water within 10 minutes of waking for years. Great wakeup for the morning, plus I'm fixing the overnight fluid deficit. You consider fluid deficit during surgery, consider it for yourself as well.
Then like any good anesthesia provider, black coffee. Coffee is one of three pillars of anesthesia. Because you were wondering, chairs (comfortable with a back, armrests, and wheels) and frequent monitoring of stock portfolios are the other 2.
I avoid high calorie drinks such as soda, juice, and coffee with all the barista mix-ins. Junk food is good for the soul, but tough on the energy supply. I just don’t feel great with fast food or other easily available foods.
Diet and exercise is a thing. Diet is arguably more important, but there are plenty of benefits with exercise. I try to make the gym 4 days per week. I like 20 minutes of low-impact cardio followed by strength training. No PRs, just maintaining at best.
I gym (Yes, it’s a verb) every day the opportunity presents itself because there are plenty of days where work and life get in the way.
If the gym rat life isn’t for you, walk around the block (or the hospital if you are in-house call). Get out and move. Again, a topic where I could go on all day about strength training, cardio, etc. Do something. Anything. You will feel more energized and burn a few calories along the way.
Meditation is an avenue regularly recommended that I should really get into. Simple as quiet time alone, reflection, or journaling. Anything that eases the mind.
Reading works well for some. Lost in a good book – or audiobook. Hobbies are another release. Focus on quilting, baking, or leather craft for a few hours. The options are endless.
Establish Healthy Boundaries
This is the work-life balance thing I keep hearing about. This is leaving work at work. When your 8-hour shift ends, shift your focus away from work. Physically and mentally exit the hospital.
Think about your family, diet, exercise, hobbies, and all of the important things in life. Healthcare is a 24/7/365 game. Someone will take over for you. They will take the next case or the next patient.
I find this difficult because I take +/- 200 days of solo call per year, so there isn’t anyone coming to relieve me. I work 25 weekends annually. This means the hospital always has my number and I’m responsible for answering and responding.
I don’t take much time off from work. However, when I have a weekend off or that rare vacation, I’m impossible to contact. It feels amazing to leave the phone turned off for the weekend or locked in a hotel safe for a week. I do my absolute best to give the family all of my attention.
If you are in a place looking for coverage, it’s okay to say “No.” As an employee, it’s not your responsibility to pick up extra (pros and cons of helping out). If you are experiencing the signs of burnout, just say “No.” fulfill your work obligations and maintain your sanity and wellbeing.
Protect your time off. If you have a trip planned. Keep it. I’m still learning to do this. Over the past year, I scheduled a block of time away from work as family time. I sold back a bit of this time. This deserves it’s own post, but in short, we found a way to make it work. The money was good, but the time is irreplaceable.
Take time off work and enjoy it. Consecutive weeks if needed. Get some ever-needed R&R. Work is demanding and requires your focus, attention, and commitment. Recover when able.
Optimize Your Work Environment
When looking for a job, consider the schedule. I know many CRNAs who want nothing to do with call or weekends. Good for them. They are probably smarter than me and know something I don’t. This balance comes at a cost because call and callbacks comprise 40% of my annual compensation.
Most groups share the call burden. Consider call frequency, workload, and post call day responsibilities. Sustainability resembles call 1 of 6-8 nights with 6 weekends per year. Combine this with 6+ weeks of PTO and 1 week of CME. Ideally post call and post late days off.
Optimize intraday workflow. It’s nice to have a system allowing for coffee breaks or lunch breaks. Good questions to ask before accepting a job. Don’t ask management, ask a practicing CRNA.
Does the facility finish the day on time? Will someone be available to relieve you at the end of your shift? Not a deal breaker to stay late occasionally, but don’t let a salaried job of 5x8s turn into 5x12s.
It’s nice to have a leader open to suggestions and concerns. Someone who will make changes if staff is struggling.
Peer Support Systems
I’m not pressuring anyone, but watch out for your coworkers. We have all experienced at least a few burnout symptoms. Hopefully transiently. We all fight our own battles. It's nice to have a friendly face offering support. An outlet. A resource.
This could be a spouse, family member, friend, or coworker. Any stable pillar in your life.
Reactive Strategies to Contain Burnout
Aka, repairing the seemingly unrepairable. Is there a way to rekindle the spark for anesthesia? Here are some thoughts…
Seek professional help. There are many types of therapy available to treat your symptoms and manage your underlying complications. Therapists focus on stress, anxiety, and/or depression. Find one specializing in your problem areas.
Re-evaluate your career options. What about your life is stressful? Is it the finances, work hours, call burden, commute, or toxic environment? If you can identify the problem area(s), there is likely a solution. You may not like the solution, but it may be better than the dreadful feeling of burnout.
In the CRNA world, I see providers taking jobs with minimal call, nights, and weekends. It’s worth the fast-paced environment of a surgical center to never carry the beeper. Never having to spend weekends away from family. Being available to pick up the kids from school every single day.
Many speak of problems with management -- Policy changes, PTO restrictions, and chronic understaffing. We have all experienced these things. If they are contributing to your burnout, it will require a move. Likely a different city or healthcare system. This creates problems on its own.
There is always the option of cutting back. Consider part-time or PRN work. Two on, two off. There is always the option to leave clinical practice all together. I know more than a few CRNAs who made the transition into academia late in their career. Partially to give back and partially to take less call.
There are other career paths besides anesthesia. There are endless opportunities. It may be difficult to replace CRNA level income with a job change.
Mindset
After the proverbial dust settles, I'm incredibly fortunate to be where I am today. I was lucky to find the CRNA career path, then put in the work to see it through.
I willingly place a great deal of stress upon myself in the workplace. I strive to maintain a full scope of practice. I take significant call in rural areas with minimal support.
The 5,000 ft view shows a satisfying career that pays me handsomely relative to the average bear. Well enough to retire after just a few years of working. Not that I will, but options are nice.
Being a CRNA has me on the short path to financial independence. Thankfully the TFC family doesn’t need to decide between groceries for the week and paying the electric bill.
The career choices I have made such as locum work, taking frequent call, working many weekends, and not prioritizing personal/family time take a toll. Burnout in my situation is a “when" not an “if.”
I say this to caution you from making too many radical decisions for the wrong reasons, especially financially motivated reasons. It’s okay to work a lot for a while. A means to pay off student loans and build a financial foundation. A solution to get ahead.
Please don’t be that guy or gal who works like mad through their 50s to pay for their $2M personal residence and two lake cabins.
It's more financially lucrative to be a healthy and happy CRNA for a career than turn sour and dangerous with burnout. One malpractice episode changes things quickly. Take care of yourself before extending your help to others.
Summary
Burnout manifests differently for each of us. It’s important to recognize the emotional and physical signs of burnout early. The manifestations are ugly at best and life-threatening at worst.
Optimize your body, mind, and career. If something troubles you, identify the source and make a change. Your support system will be by your side during the process.
Always remember the importance of your job. As a CRNA, patients rely on us for a comfortable surgical experience. And most importantly to wake up at the end. Take care of yourself to best care for your patients. They need you. Thanks for reading!
