House on Fire: The True Cost of Burnout

A mentor once described burnout to me as when the heart wants to quit the job but the body keeps showing up. 

Physiologically we see burnout as profound nervous system dysregulation experienced primarily by the dorsal vagal nerve root. Whether triggered by an understaffed shift or threatened by a mountain lion, we can assume humans have always strived for self regulation.

While coined by an American psychologist in the 1970’s to express the challenges of those serving in the high ideals and severe stress of “helper roles” (referring to nurses and physicians), [1] the phrase “burned out” has become a common part of our daily vernacular. And while claiming to be “burned out on oat milk lattes” (as I recently heard in a Starbucks) may be a correct use of the phrase colloquially, it takes on a different meaning when we discuss a paramedic fighting to remain in his or her career.

With a background of research in kinesiology and applied physiology and my own career in a “helper role”, I can’t help but take a scientific exploration of the topic. 

Starting with: a definition.

Burnout can be defined as exhaustion, alienation from activities and reduced performance [1] – all in relation to work. 

And now for the differential: what is NOT burnout.

Burnout is not depression. While someone diagnosed with depression may experience exhaustion, feeling down, reduced performance, similar to someone experiencing burnout, depression is characterized by hopelessness. Low self-esteem. Maybe even suicidal tendencies. 

Burnout is not overwhelm. Among paramedic students many are in class 3 days a week and work the remaining 4. Paramedic education is cheerfully described as a “firehose” of information of which we expect students to learn, understand and then apply all within 12-18 months. These students are consistently overwhelmed and may even find themselves in sympathetic tone (fight or flight) but they remain engaged and oftentimes even excited – not alienated from their work.

Burnout is not a personality trait. Some people are just assholes.

In my two decade career in “helper roles” I have experienced multiple rounds of burnout, and it’s the closest thing to heartbreak that I can imagine. We “helpers” choose our careers because we want to help, because we relish the feeling of (somewhat rare) gratitude and we appreciate the sensation of falling asleep knowing we did work worth doing. 

When burnout strikes, it is identity destroying. A general sense of apathy takes the place of the impassioned provider who consistently went the extra mile. We begin to see our workplace as hell and our coworkers and patients as the enemy. 

Which brings me to the true cost of burnout. When our “helpers” begin to lose their sense of compassion, our community pays the price. Whether we are the grandma who fell and needs a lift assist, the diabetic who’s learning to take insulin and is making frequent stops at the ER or the new driver who parked a little excitedly and nicked the neighboring police car, the level of care, respect and kindness we are offered will be dramatically reduced when our responding “helper” is exhausted, checked out and burned out. This is a community cost. When our providers are not supported their ability to support is incredibly diminished.

In a more literal definition, we hear burnout and think of the moment when a jet engine puckers out. So unbelievably bright, a few sharp flickers and then darkness. 

This is what happens to our bright, caring, self-sacrificing “helpers”.

While depression requires psychological, and oftentimes, pharmaceutical intervention (and there is no definitive treatment for being an asshole) the common treatment for burnout is simple: rest. Yet in a time of understaffed shifts and economical challenge rest isn’t as easy as it seems. And one may argue, if the symptoms associated with burnout mirror those of profound nervous system dysregulation [2], might be the vacation is only a bandaid and more often than not, burnout will yet again rear its angry head.

I can attest that in my experience, this has been the case. 

So how then do we recover from burnout? And how then to we maintain nervous system regulation to avoid a future occurrence?

Now bear with me because the answer may shock you. While we helpers sure do love helping, asking for help is where we consistently falter. 

And here we find our answer: support. 

And to receive support, we first must ask for help. 

My 1:1s are designed to hold heavy space for those who struggle with the asking,

so I’ve removed the asking from the equation.

Send me a note - and I’ll send you an offer of support.

Send a note

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