NUR 7069 Module 6 Well-Being Paper: Burnout Evidence and a Plan That Is Not Only Self-Care Example

Not Only Yoga: A Burnout Plan for Myself and My Newark Practice

Student Name

M.S. in Nursing, Family and Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University

NUR-7069: Professional Identity Development for Nurse Practitioners

Mentor Name

Month Day, Year

Not Only Yoga: A Burnout Plan for Myself and My Newark Practice

Why This Matters to Me

The practice and the people in this paper are invented. I am a family nurse practitioner in my fourth year at a group practice in Newark with eight physicians and five nurse practitioners. Over the past year, two physicians and one nurse practitioner left, and the remaining clinicians absorbed their patients. My panel grew from 1,300 to 1,650. I spend about two hours each evening finishing notes and answering portal messages. Last month I snapped at a medical assistant over a minor scheduling mistake and later sat in my car for twenty minutes before I could drive home. I recognized emotional exhaustion, the first sign of burnout. This paper asks what the evidence says and what I and the practice can do.

How Common Is Burnout?

A consensus report concluded that between 35 and 54 percent of U.S. nurses and physicians have substantial symptoms of burnout (National Academies of Sciences, Engineering, and Medicine, 2019), a syndrome marked by exhaustion, a growing distance from patients and a feeling that one's work achieves little. The report described burnout as a response to the work system, not a personal failing. It argued that burnout harms clinicians, threatens patient safety and quality and costs organizations through turnover and lost productivity, and it called on health care organizations to redesign work, reduce administrative burden and support clinicians.

What Drives Burnout

West et al. (2018) reviewed the drivers of physician burnout and grouped them into workload and job demands, inefficiency and inadequate resources, too little control or flexibility, trouble fitting work and home together, organizational culture and values that conflict with clinicians' own, and loss of meaning in work. They concluded that both individual and organizational strategies are needed, but that the main drivers are in the system. Although the review focused on physicians, nurse practitioners in primary care face the same electronic record, the same inbox and the same productivity targets.

What Works

West et al. (2016) pooled studies of interventions to prevent or reduce physician burnout. Across 15 randomized trials and 37 cohort studies, overall burnout fell from 54 percent to 44 percent. The share with high emotional exhaustion dropped to 24 percent from 38, while depersonalization improved less, falling from 38 to 34 percent. Strategies aimed at the individual, like mindfulness, stress management and small-group discussion, and structural or organizational strategies, such as changes to duty hours or workflow, were associated with improvement. The authors noted that the studies varied in quality and that organizational approaches deserved more testing.

The meta-analysis tells me that personal strategies help but are not enough on their own, and that the practice has a part to play.

My Personal Plan

I will protect sleep and exercise, aiming for seven hours of sleep and three walks a week. I will join a monthly small-group discussion for clinicians that the hospital system offers, a format with some trial support. I will stop charting after eight in the evening and will instead block thirty minutes at the end of each clinic day. I will tell the medical director when my panel is beyond what I can safely manage rather than absorbing more quietly. I will also book a few sessions through the employee assistance program, because sitting in my car unable to drive is a sign that I need more than habits.

What I Will Ask the Practice to Change

I presented the drivers table and the meta-analysis to the medical director and the practice manager and proposed four changes. First, inbox support: medical assistants and nurses handle prescription refills and test result letters for normal results under standing orders, which could cut my portal messages by about a third. Second, panel limits: no clinician absorbs more than 200 patients from a departing colleague until replacements are hired. Third, schedule control: each clinician chooses one template from three options. Fourth, a quarterly well-being survey whose results go to leadership with a response plan.

The medical director agreed to the inbox standing orders and the survey and will take the panel limit and template choice to the partners.

Why the Practice Should Act

The practice has its own reasons to act. Replacing a clinician in primary care takes months of recruitment, and while a position is open, the remaining clinicians absorb the work, which raises their own risk of leaving. The National Academies report describes this cycle in which burnout leads to turnover and turnover deepens burnout. Losing three clinicians in a year has already cost the practice in recruitment and lost visits. A modest investment in inbox support and panel limits is likely to cost less than another departure, though the practice has not yet calculated the figures, and I suggested that it do so.

Measures

I will track my hours of after-clinic charting, my sleep and how often I feel exhausted at the end of the week using a single-item burnout question. The practice will track inbox volume per clinician, panel size, clinician turnover and survey results.

Limits

I am also an imperfect judge of my own state; exhaustion can make a person underrate how much help they need, which is one reason the plan includes a counselor and a colleague who will ask me how it is going. Most of the evidence comes from physicians, and nurse practitioners may face different pressures. The meta-analysis included studies of uneven quality. A plan on paper does not guarantee that the practice will follow through, and if it does not, I will need to decide whether to stay.

Conclusion

My exhaustion reflects a system that lost clinicians and gave their patients to those who stayed. The National Academies report and the review of drivers placed most of the cause in the work, and the meta-analysis showed that both personal and organizational strategies help. My plan includes both, because self-care alone would leave the system that caused the problem unchanged.

References

National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: A systems approach to professional well-being. The National Academies Press. https://doi.org/10.17226/25521

West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516-529. https://doi.org/10.1111/joim.12752

West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X