In these unprecedented times, another thing that's unprecedented is the audacity on behalf of healthcare leadership in devaluing the lives and contributions of healthcare professionals.
Just when ya think things could not possibly escape common sense, the CDC goes ahead and urges infected health care professionals to keep going to work.
I get it, were short-staffed- but why isn't there more being done to prevent people from leaving in the first place?
How is capping nurses' salaries instead of capping the salaries of high-ranking hospital executives the first go-to move?
Seems that common sense has left the building a long while ago.
In my assessment of the dumpster fire that has somehow become the norm for working healthcare professionals- I have come to realize that it is not our job to fix healthcare.
At least not right now.
Hear me out.
We are in survival mode. This pandemic has been a lot like war-time medicine. Although technology has advanced in a few ways such as the expedited vaccine & the robust advancement of virtual services including in the medical space, Healthcare professionals and the systems built to keep people safe are being heavily stress-tested, & they’re all beginning to fracture.
At a time when health care professionals are physically and morally being pushed far beyond their abilities to cope, they are not in the best place to have the bandwidth to solve such an overarching problem that existed far before the pandemic & has just exploded since then.
So as healthcare professionals, what can we do to survive this, while still upholding our morals when we're forced to work in a system that has chronically deprioritized our patients & the healthcare workforce?
Well since ending the pandemic and fixing healthcare is not up to us at the moment, can we at least do what we can to minimize the damage?
The Great Resignation
I think we can.
There are things you can do, as an individual to mitigate the damaging effects of burnout. There is a way to do it while also keeping your sanity & protecting your energy and stamina for the longevity needed to endure this season & beyond.
“The massive shift that’s been happening in the workforce in response to the pandemic is often referred to as the Great Resignation. But according to Arianna Huffington, founder and CEO of the behavior change technology company Thrive Global, people aren’t just quitting their jobs. They’re experiencing a “Great Re-evaluation.”
The great resignation is upon us and it threatens to collapse the system with over 66% of healthcare professionals leaving their jobs.
I’m not here to encourage you to stay or go or take a sabbatical, that is a purely personal decision.
I am simply here to assist you to identify ways that you may be allowing systemic abuse, evaluate solutions & help you to create and uphold better boundaries to safeguard yourself against further systemic oppression.
The Culture of Self Sacrifice
The culture of self-sacrifice is so deeply ingrained in medicine that even the Hippocratic oath fails to mention the value of our own lives, wellbeing, and health in entering the covenant to serve patients to the best of our abilities.
The long hours of our medical training reinforces the idea that our basic human needs come secondary.
The old medical-academic adages you hear in training like eat when you can, pee when you can, and sleep when you can- set the tone early in our careers to expect to put your basic human needs before your patients.
However, there are different & better ways to go about things that do not involve abandoning patients.
Safe Staffing Ratios
In an ideal world, there would always be plenty of staff to provide better overall patient coverage & personalized attention without individual healthcare professionals (HCP) habitually having to sacrifice their well-being to make the medical system run.
Yes, there can be a healthcare business model that does not rely on the good hearts of HCPs, their exploitation & their sacrifice.
However, since our current healthcare business model depends on the vulnerability of good-hearted HCP who hold the ultimate burden of responsibility for their patients near and dear to their hearts, it also opens a clear avenue for systemic abuse.
This is why setting boundaries around the conditions you work in as well as a commitment to rewire our self-sacrificial tendencies is important in mitigating the damages of systemic abuse.
Let’s begin by examining the system & the ways in which abuse is normalized.
The System that Birthed Us
After graduation, we are spit out into a working environment that intentionally or not, glorifies working beyond our abilities & routinely give of ourselves to depletion, shift by shift.
Moreover, in medicine working yourself to physical and moral depletion is actually celebrated!
Let's look at the way that the healthcare system rewards the healthcare workforce to routinely overwork by setting unrealistic & arbitrary key performance indicators.
Have you ever been part of an organization that:
✔Celebrates employees who maintain unrealistic levels of productivity in the foreground of unsafe staffing ratios and ever diminishing resources to do their jobs well.
✔Celebrates employees who excel at maintaining administrative burden with checklists, protocols, extended documentation, etc that take away from actually serving patients.
✔Celebrates Employees who comply with all changes even if they negatively affect staff and patients
✔Have Mandatory Burnout prevention training while encouraging employees to deal with burnout on their own time with "more self-care".
✔Creating Empty titles without raises or real power to change things
✔ Has a "Heroes work Here" sign.
Just to name a few.
In addition, the system also covertly punishes any compensatory actions we may take to offset the toll of doing our jobs like
✔Denying time off requests
✔ Getting administrative resistance for
✔Taking your own PTO
✔Declining extra shifts
✔Taking time off for your mental health
Then other things come into play that further muddy the waters & cause unnecessary harm to health care professionals such as:
✔Unsafe staffing ratios
✔Positioning health care professionals as infallible (healthcare hero)
✔Resorting to blackmail or guilt-tripping for asking to work at a humane pace
Many of us who feel an almost divine calling to medicine to help heal, do identify our very sense of self with that of our jobs.
I feel as though administrators are acutely aware of the pride we take in that and all the sacrifices, blood sweat, and tears we endured for the privilege of practicing medicine. Moreover, I feel that since they know how hard it would be to leave a profession we have worked so hard for, they can keep moving the goal post & can count on our cooperation.
So how can we continue to work in this broken system without breaking ourselves?
I believe it starts with controlling the controllables on our end.
Medicine is as inherently hard and unpredictable as humanity itself, however, minimizing exposure to unsafe & prolonged morally injurious work environments is pivotal when attempting to rewire our self-sacrificial identities because they are actively being used against us.
Why Boundaries at Work Matter
In its simplest definition, a boundary is an imaginary line that separates your physical, mental, and emotional space from others. In its essence, they are safeguards against abuse, & teaches others how to treat you.
When looking at healthcare as a system, there has always been a hierarchy of perceived importance.
The lower on that hierarchy you are the less and less personal boundaries seem to be taken into consideration. This is a normalized part of medical culture.
For instance the Hospital Executive vs the working clinicians in the trenches of the pandemic. If the CEO needs personal time off it is generally not met with resistance and very likely there is no back talk about abandoning the team or finding someone to replace them.
Inversely if a hospital-employed clinician does the same- they may be more than likely met by resistance, back talk, guilt-tripping, and in some cases even punishment by having their PTO declined.
All of a sudden the burden of responsibility for being short-staffed falls on the clinician, & not on the system that created it.
There is certainly a double standard on this more often than not exacerbated by chronic staffing issues that we ourselves did not create.
However, we have directly or indirectly agreed to keep working under these standards repeatedly, have we not?
So then the question becomes, what boundaries do I need to have in place to limit the potential for abuse in my healthcare job?
I have spent the better part of the last decade attempting to rewire my chronic tendency to people please and overgive far past my energetic reserve. I have been highly motivated to understand how my life experiences & training have contributed to multiple episodes of burnout I have had in my career as a CT Surgery PA. I am even more motivated to find a way to keep the career I love, without sacrificing myself or my life to have it.
For me, the search for balance has been highly personal. As a woman in medicine, dealing with the intersectionality of fertility, mental health, career advancement & the perpetual search for the coveted work-life balance- the holy grail of most career-driven women.
I have tried yoga, meditation, therapy, world travel & pretty much most forms of self-care to try and find a way to keep the career I love, my sanity & having a full life. But I have noticed that no matter what I did I always fell short in some areas regardless of my marathon efforts.
Then I came to see that the systems I was navigating in, made it really hard to have successful work and life integration without falling short somewhere.
It wasn’t until I set boundaries & became a ruthless steward of my finite energy that I began to feel true freedom, self-value & self-respect while still working in a broken system.
My Deal-Breaker Boundaries
Here are some of my deal breakers and non-negotiable guards I utilize to uphold better safeguards against workplace abuse. This is not an exhaustive list.
I will not work more than my ability to fully recover from my work in the short term. Physically, mentally & morally. So anytime I am asked to work past my contractual obligations I have developed a keen assessment of where I am, & what I’m able to offer to do my job bringing my very best to the best of my ability. I have learned to identify Healthcare Hangovers & how to recover from them, shift to shift, to permanently eliminate its progression to burnout.
I don’t work when I’m sick. No matter what the reason is.Whether it's infectious or not. Whether society deems it a valid excuse or not. For instance, my menstrual cycle is unforgiving & for most of my career I have shown up to work on a steady state of prescription-strength ibuprofen so that I could function & do my duties. I have been first assisting in many a surgery where the cramps are so bad I know to wear a mask with a shield so that my tears do not fall into the sterile field, because I know I will be crying. Like why. Why have we done this for so long in the first place? When you really think about it- it makes no sense at all for you, your patient or the staff.
Takin' on extra shifts is an option,for me, it’s not mandatory. Having my financial priorities dialed in for optimal security against the unforeseen has created so much freedom in this aspect. I understand that not everyone has the financial viability to be able to not go in when you're scheduled or decline extra work, but this is something that you can begin to work towards by creating a financial cushion for more freedom to decline things not in alignment. They created the problem & the burden of responsibility falls on them, not you. Your responsibility is to take care of your patients to the best of your abilities with the resources they provide you to do so.
I don't take work home. The work needs to be finished at work. If there is administrative burden overflow- I do it on the clock while getting paid, & if time is a problem & I can't get away from my primary duties with my patients-I shift the burden of responsibility to my higher-ups to create the time. No more weekend charting, compliance modules after hours/holidays or weekends.
Emails are not an emergency. I check it once per week & I have an epic autoresponder that stays on all the time & guides people through common solutions that do not require my immediate input. I have trained people not to expect immediacy from me. I love slow living like in the 90s. This culture of urgency isn't going to get me.
Unless I’m on call, phone calls are not an emergency either. This is a personal choice, but unless you’re one of the less than 5 people in my life I love to chit-chat with for pleasure, I do not like being on the phone at all. Any calls outside of my Fab 5 must be succinct, to the point, purely transactional & also nothing that can be solved via text or email.
Access to me is on my terms. As a recovering people pleaser, I always felt like I was never done with anything because since I offered my time without limits non-surprisingly people would find a way to fill that time for me. That led to nowhere but burnoutsville.
What to Say to People When you Want to Enforce a Boundary
The first question I get when I discuss the boundaries I have built with curious colleagues is what do you say to people when upholding a boundary?
Here is the great part.
No lying, no excuses, no explanations. Just the truth- delivered kindly & with conviction.
Explanations are truly not necessary. They are simply a social construct based on the other person’s lackadaisical curiosity or desire for external validation from you that has nothing to do with you.
Think about it.
When telling someone you can’t do something the other person will almost always reflexively ask you: ” Well, why not?
& then proceed to take whatever your reason personally, followed by making an attempt to make you feel guilty about it.
This is not your issue. It is theirs. Put down that backpack full of heavy rocks because it does not belong to you.
When asked why you can’t do something, The life hack is that you literally don’t have to answer.
No. Is a full-sentence its own right.
Here are some others in case just no feels too harsh for you:
I am not available.
I have a previous commitment. (to myself hahahahahhahahha)
I do not have the bandwidth at this time.
I am overscheduled.
Or if you want to negotiate:
I am not available and made plans already but would be willing to consider coming in last minute for time and half +20 an hour.
Other Boundaries to Consider
Sneaky Unpaid work
Notice if you are routinely asked to do time-consuming things that are beyond your job responsibilities- that take you away from your primary responsibilities and/or create overwhelm, breaks in focus or unnecessary energetic depletion.
For me it has been stuff like Oh well you speak Spanish so go help speak to the Spanish patient even though it's not even a patient of yours- over and over again. Eventually, I was the go-to person which eventually added an unnecessary workload and offloaded other people's workloads- all while not getting paid extra to do it.
The issue for me is not that I don’t have the desire to help patients that share my culture- I actually love that- my issue was that I became the default for this for a long list of people & it became unmanageable. What I have come to realize is that being fluent in more languages rarely ever gets you paid more- it just makes it an added free perk for your employer. Which is fine, but can be a way that you let abuse in.
Calls & keeping you updated on the goings-on at work while you are off are intrusive. Make sure you don’t allow yourself to stay open to this by continuing to answer the phone, text, and request while you're not at work. You gotta train people.
Truly, what goes on with your health and personal life is your business & yours to share on your terms. Consider that any employment that demands information along these lines whether by co-workers or management may be infringing on your rights.
Time off does not equal you are available. Uphold it.
This is non-negotiable. If you are asked to do something that you feel will put you in danger, you have the power to decline & evaluate your relationship with your employer.
Your Mental Health
Workplace abuse in all its forms, verbal, physical, cyber, bullying, yelling etc have to be a hard no. Contrary to popular belief toxicity is not a part of working in Medicine. It has simply become commonplace. Also, repeated self-betrayal of your ethics, morals, and beliefs must also be closely examined.
Your Life Choices
This boundary is necessary more with co-workers than management typically, but I need you to understand that you don’t need to share anything you’re not comfortable with sharing in order to fit in at work. If your personal choices are not being respected or constantly being challenged this warrants a closer look at how you may be perpetuating this & how you can stop it or move on.
Things to Remember
When you have no boundaries with your job in Healthcare you may eventually feel
✔Like you have to put up or shut up
✔Regretful of following the calling to medicine
✔Like our lives don’t matter
✔in the worst of cases in poor physical and mental health
When people are used to you saying yes to everything, they very well will get angry at you when you first start to say no and create boundaries.
This is normal, it will decrease in intensity over time & that is not a reason to go back to your old ways of betraying yourself for the sake of pleasing others.
People-pleasing may be a trauma response you took on to survive certain periods in your life. It served you well at the time, but if it's hurting you now, upholding boundaries and your nonnegotiables can help rewire that pattern.
Having and upholding strong boundaries doesn’t have to be done in a mean or snarky way.
If being kind and graceful in expressing your needs and boundaries incites anger in other people that is their problem, not yours.
Having and upholding boundaries around working in healthcare will help you regain control of your energy, your time & your relationship with work. It may free you to work at a more sustainable pace and set you up so that if you have been struggling with finding meaning in your work like you used to, you may feel that spark again.
I know healthcare is a ways away from changing on our behalf, but tolerating abuse, staying quiet and following rules that may cause you harm is not a solution- it is oppression.
Build your boundaries, take care of yourself the best you can. When you take impeccable care of yourself you do your best work, & your patients will greatly benefit from you functioning optimally inside and out.