Most of us have experienced job burnout – when we get bored with our work or sick of our colleagues, for example. But what happens when your work is all about other people? If you’re a doctor, or a nurse, or a teacher? This is what Berkeley PhD student Eve Ekman calls “empathy burnout.” Holly Kernan spoke with Ekman about her research.
EVE EKMAN: Luckily, this picture is not totally grim. As a social worker in the E.R. over the last six years, there is a high volume of suffering. The intensity is quite high and people are coming in every day with traumatic accidents and chronic illnesses. When I watch staff interact with these clients, I started to take note that many people, despite this high volume are still able to be human, present, engaged, and compassionate. Most people would believe that being exposed to that level of trauma on an everyday basis would shut you down. And often what is taught in medical school is to shut down – to withhold emotions in order to be able to perform your job. However, emotions are such a critical part of our job – especially quick momentary assessments that we need to do in the E.R. as well as these big transitions when you have a sudden mortality or a sudden loss of medical ability due to an accident in the E.R.
My interest was how do I understand the portion of the staff who are able to empathetically be engaged, seemingly endlessly to those who seem to have absolutely no empathy available whatsoever?
HOLLY KERNAN: Because they are too overwhelmed and stressed out by the caseload?
EKMAN: This is what I was wondering. I was lucky enough to start around the same time as about a dozen nurses around my age, which is early 30s now. When we started we were all 25 or so. They were coming from varied backgrounds, but had gone to the same nursing program and they were all hired around the same time during this kind of up-hire at that time. So it was a little bit of a perfect sample – naturalistic sample as we call it in the sciences. I saw that some of them, every single day, despite the kind of patient spinning, yelling, and some of our more difficult patients, were still able to be totally human – maintain their integrity and treat these people with respect, whereas others seem to have no patience whatsoever.
KERNAN: What do you think was the key difference?
EKMAN: There are some differences in the way that people are brought up and raised and in their education and training. But essentially what it comes down to is the model of stress. There is some stress that makes us feel threatened and some stress that makes us feel challenged. A response to stress that is threatening is to pull everything in, shut down, and not really engage. When we are challenged, we raise up to that. Our entire autonomic nervous system, our heart rate is engaged so we can meet this challenge so what I thought of was that some of these nurses are feeling incredibly challenged and some of them are feeling incredibly threatened. Luckily, there is a great deal of research from this field of stress, which helps us understand where this comes from. It is actually your perception of what is going on at this moment. If you feel that you have the resources available to you to meet the demands.
It’s not that some people have more education or more physical strength or more mental strength. There is a lot of equivalency across these. So it is your perception – the way you deal with this stress.
KERNAN: Can you give us one concrete example of somebody dealing with this? Maybe, not feeling empathy?
EKMAN: In the E.R., what you often see is chronic patients who come in, who seem hopeless. They are inebriates.
KERNAN: The drunks who are coming in everyday?
EKMAN: Yeah. Every month. They are barely making it to the parking lot before they fall down and then come back in. You feel like you aren’t getting any work done. They are awful rude and mean and they don’t smell good.
KERNAN: And they are taking up space.
EKMAN: Yeah. Taking up space from a little kid who has pneumonia and might not get into the E.R. It is often berating to the staff. So you get this vary difficult situation and you have staff whom are quickly dismissive of these patients. What we can actually know from research is that these patients are really sick. So by ignoring that this person, despite their difficultness, actually has medical issues – and this increases the likelihood that they will be coming back and will be getting more sick. They have chronic heart disease, they have pulmonary issues, they have diabetes –to bring them in and do a tertiary exam and then let them go due to your inability to see their suffering.
KERNAN: That is researcher Eve Eichmann and we are talking about the idea of clinical empathy and caregiver burnout. You give another example of a young man that came in with a bullet wound.
EKMAN: Yes. We have such a high volume of gang violence in the E.R. and it is very deeply upsetting for people who work there to see young men dying all the time. And the families are so affected in such a small community, unfortunately, so that when these situations occur, entire communities show up. Our staff has a negative reaction because this means there are a lot of emotional people in the E.R. and they have a young man who might be dying. So the first reaction is, “Let’s shut it down, let’s keep it safe,” which means let’s keep family members away from their dying loved ones. So how do you convince staff that it is really important that the family needs to be there in case this is the last time they get to see their son? Yes. They may be crying. Yes. They may be falling on the floor. But it is our responsibility to recognize that this is mother is loosing her son.
KERNAN: We’ve been mostly talking about healthcare. What about things like the education system? Teachers are so over stressed and very underpaid in a lot of cases. What is the relevance here for teachers and those working in juvenile hall?
EKMAN: Absolutely. My field research is in juvenile hall. It is a little bit of a stretch for people to consider guards in a juvenile hall to be care providers. I couldn’t disagree more. I think they have a lot of the same desires as schoolteachers have to make a difference in the lives of youth. My preliminary research there and the focus groups I’ve been doing, I’ve been proven right. All of them got into this work because they wanted to make a difference. A great deal of stress and frustration is when they don’t feel they can. It would seem common sense, but I was very shocked to hear that there are no trainings that exist for staff burnout in the criminal justice system. With schoolteachers, I feel that you have much of the same concern – that the majority of what brings people to the work is their desire to do well. Their desire to make a difference and do good. Unfortunately, that becomes an albatross around your neck, becomes a thing that can bring you down. Burnout research has identified a separate scale for schoolteachers that emphasizes how to get that feedback.
KERNAN: From students? From colleagues? From who?
EKMAN: From students and from colleagues. Sometimes we need that support from our co-workers. People are often surprised that my study on empathy isn’t just about the care provider to their client, but the care provider with their co-worker and with their client. Empathy requires that people are aware, understanding of what it happening to them in terms of how they relate to others. “Others” is not distinguished simply between their clients. This research is relevant to lawyers and folks in the corporate world and kind of across the board. My intent is to start with those who are in the deepest need, but I definitely see how these ideas can be used in many settings.
KERNAN: That is U.C. Berkeley Researcher Eve Ekman and we are talking about clinical empathy for caregivers and, particularly, on burnout in the workplace. Those that are on the front lines, particularly nurses, teachers, etc. And you have something of a prescription. Your research has led you to believe that there are things that you can do to increase empathy, clinical empathy as you call it.
EKMAN: The reality is that burnout is not an end point and it is not just some people. There are cycles of burnout. People will feel burnout and then they wont and then they will again. So how do you address burnout as a long-term job issue? I think there are a couple simple steps to orient yourself to your own physiology. So that means feeling your toes, feeling your knees, feeling your hips, feeling your elbows, feeling your shoulders, by the time you get to your head, you’re calmer.
KERNAN: Ok, so, number one: check in with yourself physically.
EKMAN: And another is, increase whatever support your can get from your co-workers. So, if that means that everyone brings lunch for everyone once a week or everyone has this time in which you check in. You don’t want to create more time in the workday. Folks are eager to leave. You don’t say, “Yeah. Let’s all stay after for an hour.” That is not realistic. However, creating these small ways in which folks someway support or celebrate one another. This is hugely important. And the third of course, and by many folks, the most important, is what is it that you do outside of your job that gives you meaning that gives you a break. And to make sure that you spend as much time as you can investing in that as you do in the workplace. So, I’m not saying hour to hour, but if you are going to work everyday, you need to bring a container for what you bring home. One of the things I am working on is a tool that will help folks check in through text message.
KERNAN: Or just a little chime.
EKMAN: Or just a little chime. Yeah. And you can do data collection through this so that you create in the end a little report. So at the end of the week someone can see: this is what I did, this is when I was stressed, this is how I felt. Interesting. To give people an opportunity to know what they are doing and feeling and not become robotic in their everyday work life.