Alphabet 2.0 | W is for Work: From Burnout to Balance

As a child life specialist and health care provider, it is common for us to hear the buzz words ‘burnout’ and ‘self-care.’ If I were in a room right now and asked, “How many of you have heard about burnout and thought it could never happen to you?” I am sure some of you would be nodding your heads and laughing. I would have been, too.  I was only in my first job as a child life specialist and doing what I truly believed was my calling in child life, end-of-life support for children and families in the hospice setting, when I experienced burnout. Do not get me wrong, I love working with families facing end of life, and it is a huge part of what I still do today. The difference is the realm in which I do this work, how I do this work, and the personal and professional growth from my experiences to know how to advocate for myself. As I sat down to write this article and reflected on my experience with burnout, I realized that I was not able to fully process this experience until several years later. Now that I am five years out of that situation, I am hopeful that sharing my experience with burnout and the lessons I learned will help others within our field.

To start, we need to understand what burnout is and what it can look like in helping professionals. Maslach and Jackson (1981) define burnout as “a syndrome of emotional exhaustion and cynicism.” Burnout is recognized as a common phenomenon among those who work in health care, due to the significant emotional toll that arises as we continue to give of ourselves to others. When developing the Maslach Burnout Inventory scale, Maslach and Jackson (1981) identified three factors impacting burnout: personal accomplishment, emotional exhaustion, and depersonalization. These dimensions encompassed aspects like anxiety, tension, behavioral shifts, frequent complaining about clients, fatigue, increased anger, and even job performance. In the following lessons, I will walk through each of these three aspects, explain more about what burnout looked like for me, and reflect on my personal journey of overcoming burnout.

"As I sat down to write this article and reflected on my experience with burnout, I realized that I was not able to fully process this experience until several years later. Now that I am five years out of that situation, I am hopeful that sharing my experience with burnout and the lessons I learned will help others within our field."

Lesson 1: I’m Not a Tightrope Walker

I think we can all agree that there are times when our census becomes too much. This could be a smaller number of patients with extensive psychosocial needs that take a majority of your time, a high number of patients that have you running from room to room without the opportunity for a break, or even a combination of the two. Maslach and Jackson (1981) discuss how “lowered personal accomplishment” is a common aspect of burnout within helping professions. They also address how this aspect of burnout can involve an individual having a negative view towards their job performance. I remember a week where I had three patients die within a two-day span. While it was common for me to experience multiple deaths in one week, this week was different. I felt an exponential amount of guilt over the services I was unable to provide for these families leading up to those moments. When I was hired, my position involved one-third of the state I was living in, which made my farthest patient no more than 90-minutes away. However, that quickly changed. Within four months, I was now covering half the state, and my farthest patient, at that point, was 2.5-hours away, one-way. I had about twenty patients on my list, and I could not keep up. Of the three patients that died that week, I had only met with two of those families one time. They had been on service for about a month, and I had only seen them once. I had every intention of seeing them again because I knew their time was short, but other patients’ end-of-life needs had taken precedence. I felt incredibly guilty about not being able to serve these families in a way that, I believed, they deserved, and I believed I had failed them. In hindsight, did these families know any different? No, but I did. I knew they were not getting what they should have, and I found myself in the back of a funeral home more and more often. Families were receiving hand/ footprint keepsakes I had made rather than having the opportunity for memory-making and legacy work prior to their child’s death.

Additionally, I was trying to balance unreasonable work expectations outside of patient care, both within my scope as a child life specialist (i.e., budgets, supply purchasing, professional presentations, bereavement camp) and externally as a member of a growing organization (i.e., re-creating our program’s website, helping with marketing efforts, assisting with scheduling and planning of “lunch and learns” about the services our team provided to area referral sources). I did not know how to speak up for myself. I was the new child life specialist to the team, and I believed that saying something would be complaining. I thought I was being a team player by staying silent and “just handling it.” I could not keep up and felt like I was walking a tightrope. One wrong move and everything would come crashing down.

Organizational variables, such as “role demands that are inconsistent with either the helper’s abilities, goals, values, and/or beliefs” can attribute to burnout within child life specialists (Holloway & Wallinga, 1990). From my experience, role conflict greatly impacted my experience of burnout. The demand was too much, which resulted in the loss of myself. Anything that had to do with me as a person, or my life outside of work, kept falling away just so I could stay balanced on that thin little wire called work. I think this is something we, as child life specialists, can often fall prey to at work. We wear so many hats and are helpers through and through, so we naturally want to be able to meet every expectation put before us. The reality? We cannot always do it- and that is okay! We are not tightrope walkers in a circus (well, some of you might be), and it is okay to stand up and say something when you need help. It is important to be able to recognize when work becomes too much and to put yourself first. In my next job as a child life specialist, I was incredibly blessed by a manager who taught me how to balance a work load, verbalize when I needed help, and who advocated for us to prioritize work-life balance. Now, I better understand the value of debriefing with colleagues or even acknowledging when you feel the need to talk to a professional. Personally, I knew that I needed help and chose to see a licensed professional counselor for the next two years. It was very helpful because I not only learned better coping strategies, but I also learned how to recognize these signs in myself earlier, which now helps me to avoid reaching the point of burnout again. It was a lot of really hard work on myself, but I am a better professional because of it.

"It is important to be able to recognize when work becomes too much and to put yourself first. In my next job as a child life specialist, I was incredibly blessed by a manager who taught me how to balance a work load, verbalize when I needed help, and who advocated for us to prioritize work-life balance."

Lesson 2: Don't Drink the Tea

When people talk about implementing acts of self-care, you might hear preferences like yoga, working out, happy hour with friends, reading, bubble baths, eating healthy, date nights, or traveling. Maslach and Jackson (1981) share another aspect of burnout in helping professionals, which is “emotional exhaustion- feelings of fatigue and depression coupled with depleted emotional resources.” Often, self-care is recommended to help alleviate part of the exhaustion that comes with the emotional work we do as child life specialists. While working in hospice, I ran. I tried to eat healthy. I engaged in things outside of work that were important to me, such as volunteering and being involved with my sorority. I thought I was doing all the right things, and to an extent, they were good things for me. But they were not enough. I was working 12+ hours a day, and even though I tried to take that time back when I could, there were some weeks that it just did not happen. The same week we had three deaths in two days, we also had our annual bereavement camp weekend. I clocked so many hours that week that I was able to take the entire next week off and still got paid overtime. When camp was over, I hopped in my Ford Escape and left to see my parents in Tennessee. I had not planned on going home after camp, but that week was my last straw and I ran. After a week at home, I did not want to go back. I realized I needed to find a new job, and so I tearfully headed back to figure out my next steps. I cried most of that nine hour drive, and I think that was one of the first times I had cried during my time in that role.

"I was working 12+ hours a day, and even though I tried to take that time back when I could, there were some weeks that it just did not happen. The same week we had three deaths in two days, we also had our annual bereavement camp weekend. I clocked so many hours that week that I was able to take the entire next week off and still got paid overtime."

When it came to taking care of myself, the stress of my job was overpowering the small acts I incorporated on a weekly basis to try and balance my life. I was engaging in the acts of self-care, but I was not truly acknowledging and coping with the emotional weight of my job. In 15 months, I gained 60 pounds. Two of my three meals a day were fast food in my car. The more stress I experienced, the more my body lived in a ‘fight or flight’ mode, which is shown to increase cortisol in the body, and overexposure to cortisol can result in increased appetite (Lindberg, 2019). For me, fulfilling that increased appetite came in the form of sweet tea from a certain fast-food restaurant. When I felt stressed, I would hop in the drive-thru and order a sweet tea. Tired? Same thing. Hungry, bored, angry, or emotionally drained? You guessed it - get the tea. Two weeks before I left my hospice role, I was diagnosed with pre-diabetes. After evaluating my diet and exercise, the doctor told me that if I would quit drinking the sweet tea, I would probably drop my fasting glucose back to a normal level, and fortunately I was able to do this within a few months. 

For me, do not drink the tea means do not allow your body to become physically overwhelmed by the physical stress, emotional burden, and pure mental exhaustion of work that you lose your health. Physical health is a good way to monitor how you are handling stress, especially when it comes to the work environment. Looking back, I should have also seen these signs months in advance. No matter how much I ran, how many protein shakes I drank, or how much salad I ate, the scale continued to rise. After starting my new position and befriending the dieticians across the hall from my office, I learned that I was utilizing food to cope and was stuck in a never-ending cycle of stress eating. With support, I was able to overcome the physical deterioration I had experienced as a side effect of burnout, and I now understand how to take care of myself in a physical sense.

Lesson 3: Watch Out for Snapping Turtles

Speaking of counseling and coping, another contributing aspect to burnout, is “depersonalization- treating people like objects or becoming negative or cynical about clients” (Maslach & Jackson, 1981). As the weeks went on in the job, I became increasingly cynical. I would read emails where others would share about situations they were experiencing and see it as someone trying to put the spotlight on themselves, manage themselves up, or gloat. I watched things go on within the organization that did not align with my personal and professional beliefs and values, and I did not trust those around me. While there had been some specific situations that led to those feelings, overall, I became reactive in every sense of the word. I should have seen it months before, but I was blind to knowing how to recognize these changes within myself and had become a human version of the snapping turtle. If you know anything about common snapping turtles, you know that they typically do not attack unless provoked or they are experiencing feelings of threat. What does a snapping turtle have to do with this, you ask? I remember a moment when our pediatric social worker asked me about a visit I had facilitated with one of our patients. I was quick to defend my intervention and validate how it was appropriate, rather than hearing what she was asking and giving her what a colleague of mine calls ‘generous assumptions.’

"Becoming a snapping turtle was my big, red flag moment of realization. I was done. I was burnt out. I could not take it anymore, and it was time to step away."

Reflecting on that situation, I believe she was trying to express concern for me and the late hours I was working, rather than being critical of me working late to meet a family’s needs. Another interaction I remember is a staff meeting where we were having a team debriefing. There was a lot of built-up tension among the team, and it was an opportunity for us to express our feelings in a safe environment with a mediator. I do not remember what was said exactly, but what I do remember is what happened when I finally spoke up. Over a year of unexpressed anger and emotions exploded out of my mouth as tears ran down my face, and I told the team I was done. I revealed that I had an in-person interview for another job later that week, and no matter what happened, I was leaving. This was not my finest moment, professionally or personally. This was not me at all, and I am still mortified by it over five years later. Becoming a snapping turtle was my big, red flag moment of realization. I was done. I was burnt out. I could not take it anymore, and it was time to step away.

Me and my previous child life team on my wedding day.

Where was I going to go from there?

I knew I needed the boundaries that a hospital setting would provide: a way to clock in and clock out in order to truly leave work at work, not having to live in my car, and definitely not with a phone that stayed on 24-hours a day, seven days a week. I needed a way to rebuild myself as a child life specialist, but I still wanted to be able to do a significant amount of grief work in my next role, since that was my passion. Through this really hard time in my life, I found my love for working with well children of seriously ill adults. I was very lucky that my next job allowed me the opportunity to do that exclusively, but within the boundaries of a hospital. I came into that role as a broken and hurting child life specialist. My new child life manager exhibited a lot of patience and understanding to help me grow from my past. When I left that role a few weeks ago for a new opportunity, I laughed as I apologized to her for all that I had put her through my first few years on the team. I am sure I was a nightmare, but the reality is, burnout can leave you in a bad place. If you do not put in the work to change, it can also be easy to stay in that place. In addition to valuing the boundaries of a hospital setting, I have learned a great appreciation for having a family of child life specialists who are willing to put in the work with you. They challenged me to grow, and in that process, we grew as a team. I developed many skills in the areas of communication, emotional intelligence, secondary traumatic stress, vicarious trauma, self-care, how to function within a team, and the list goes on. The growth I experienced during that time was a season of rebuilding and re-establishing myself as a child life specialist. It is the reason I was able to recently make my next career move, and I am forever indebted to those that were involved in the process of putting this humpty dumpty back together again.

For those reading this and who may relate to one or more of the things I talked about, I hope you know you are not alone. I share this experience because I believe that it is not only important for us to continue educating our field on burnout and the importance of self-care, but to acknowledge that this is a reality: there are child life specialists out there who have hit this breaking point, and you can come back from it. My experience was hard, and it took a lot of time and effort to truly find myself within child life again. Would I change what I went through? I do not think so. This is a part of my personal and professional journey, and plays a significant part in who I am today: a child life specialist who now feels confident enough to stand up for herself, recognizes when she needs a break, and knows how to incorporate boundaries that help her maintain the ability to do what she loves.

REFERENCES:

Holloway, D., & Wallinga, C. R. (1990). Burnout in child life specialists: The relation of role stress. Children’s Health Care, 19(1), 10-18.

Lindberg, S. (2019). Stress and weight gain: An unhealthy connection. Retrieved July 3, 2020, from https://www.healthline.com/health/stress/stress-and-weight-gain#risks

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99-113.