Problems of Professionalism
A healthcare provider is a person who is operating in a professional role. The health and wellness of the provider is directly linked to his/her ability to be professionally effective – able to assimilate complex information and make decisions, while maintaining sensitivity and awareness to interpersonal and business factors. Hence, a provider’s professionalism is the source of healthcare service delivery.
Addressing problems of professionalism has become a matter of increased focus and concern in healthcare, specifically concerning acute, high liability areas involving the conduct and impairment of providers. Television series’ House and Nurse Jackie show us that there are other professionals like them out there working in the healthcare system suffering difficulties which put them, their patients, and organizations at a very high risk. They teach us that there is generally more to their problems than what is presented or what “meets the eye” – that their problems have not surfaced overnight, but have developed over the course of time. Even the most severe issues, involving addiction, mental health, or disruptive behavior have many contributing factors at play – both triggering the problem and keeping it active. Therefore it is important that risk factors be identified so that steps toward prevention and intervention may be taken with minimal negative fallout.
Healthcare has changed and continues to evolve. There was a time when a healthcare professional could provide care to patients and enjoy doing work that was humanistic and patient centered, with little interference related to business process or detail. Those days have ended long ago. Managed care has had the most significant impact on the professional operation of the modern healthcare system. However, there are other business changes which also bear influence on the day-to-day functioning and serve as a source of stress for healthcare professionals in doing their jobs – including mergers, technology, regulations, staffing issues, and reorganizations. On the clinical end of things, changes include the increase of patients with chronic disease or multiple conditions, increased use of medications, and emphasis of pain medications. There is more information to manage, more providers with whom to communicate, and more details to manage. Being a healthcare professional is a fast paced job requiring rapid decision making and precision. Any change introduced into the routine of an already demanding job can produce increased stress, especially into a risk adverse job.
Identification of Risk Factors
There are many stressors which, over time, can accumulate and develop into what we, at Integrated Treatment Solutions, call “Dis-ease” for healthcare professionals. Many of these issues are not talked about or processed as part of a healthcare professional’s job.
A few of the most prominent risk factors include, but are not limited to:
Secondary traumatization, or otherwise referred to as vicarious trauma a term used to describe the “cumulative transformative effect of working with survivors of traumatic life events.” Continuous exposure to intense material takes a toll on healthcare providers. What is seen, heard, and interacted with imbeds itself within the mind and body of a professional and can impact their mood, thinking, energy, attitude, relationships, and overall health.
Repressed grief and loss can lead to many problems and can cause personal anguish, increased anxiety, multiple physical complaints, functional impairment, strained relationships, disrupted sleep, increased substance abuse — tobacco, alcohol, drugs, tranquilizers – clinical depression, and other illnesses.
Compassion fatigue is often a byproduct of care giving, involving feelings of being drained, tapped out, and having little energy to give others. The more intense and personal the care given, the more vulnerable the care giver. Professionals who work with severely traumatized individuals are at highest risk. Healthcare professionals can also be vulnerable to getting overinvolved with patients / cases which can impact the development of fatigue.
Isolation is common, especially those who work middle or night shift because it separates them from friends, family, and activities which bring them pleasure and connection. Feeling depleted after a shift / work day of communicating with many people and working through complexities may also prompt the lack of interest in talking and being with others. Over the course of time a professional’s life can shrink and “get small” as all the things that made up their lives have no room to happen anymore or there is no energy.
Decrease in self-care. When time caring for others supersedes the ability to care for oneself, problems health and behavior related problems can happen – decline in sleep, healthy eating, exercise, social life, and recreation can erode at one’s resiliency making way for illness.
Imbalance between work / life involves the blurring of boundaries between work and personal life. This can include work responsibilities and work load entering into home and family time. This involves talking or thinking about work when not at work, or picking up shifts when having already worked what is normal.
Chronic stress involves ongoing stressors, one on top of the other, over the course of time with little to no recuperation – not taking vacation time, a much needed break, pushing oneself through each challenging circumstance.
Unfortunately, most times it is not until there is a crisis involving a medical issue, addiction, mental health problem – or an exhibition of misconduct – that a healthcare professional will seek counseling, treatment, or gets help. However, by this time, occupational problem involving job risk or license-related issues are then also occurring, making it more challenging for the healthcare professional to focus on him/herself and benefiting from the help that they need. Prevention is paramount but, unfortunately, most times overlooked for a number of reasons by individuals and organizations – but cost, time, and business processes remain as barriers.
A tailored approach to each individual or organization’s needs requires prevention and intervention strategies aimed at reducing and managing stress and negative fallout. When a healthcare professional comes in for counseling or treatment, we need to consider all the factors related to health, social, and occupational history and status. We need to review other information in order to start gaining clarity on “Who is this person?” and “What’s going on here?”
Some potential solutions include, but are not limited to:
Establish or re-establish medical support. Attain a Primary Care Physician who is current and has knowledge of stress and addictions, and who has treated other healthcare providers and, therefore, knows the types of problems to detect. Follow directives. Focus on creating a nutritious diet plan and getting support in healthy eating.
Consult your Organization’s Occupational Health Physician. Access this resource if available. Ask for help with managing shiftwork and developing health habits which will sustain your health while operating on a non-traditional work schedule. Get educated on sleep, metabolism, and prevention of chronic health conditions.
Take Vacation Time and PTO. Believe it or not, many people do not use their accumulated time off. This is money – and it is part of your compensation. It’s there for the taking; otherwise it’s just like giving your own money away. You may need to learn to overlook other people’s input or bias when you take a vacation (short or extended), especially if it is not part of the culture of your unit or organization.
Learn to “Say no!” to additional shifts or work schedules that compromise your health. It may feel like a lot of pressure when asked to work extra shifts / days. If you say no, you might feel that you will be looked at as not being a team player, but know your limits. People who always say “yes” continue to receive requests – and, eventually, will get “burned out.”
Consult a Career Development Specialist. Is it really possible or realistic to expect a healthcare professional to work in service delivery for their entire career? Many healthcare professionals are not aware of the work options available to them. There is very little information or resources available to professionals to plan their career, offering options to engage in different types of work or functions which may provide new experiences and variety, enabling them to contribute their skills and to increase their career longevity. A career consultant can be of help in looking at options and goals. Having a career plan can help navigate through your career and help you see that there are many different opportunities in the healthcare industry.
Get support. Most healthcare professionals do not receive any type of mentoring or supervision that helps balance their lives. A mentor can help the professional continue to learn, grow, and accommodate ongoing change or process some of the difficulties associated with their careers – including patient death, loss, and crisis. Seeking out a support group or stress management program for care providers can be helpful, as can a mentor.
Ensure that people are a constant in your life. Make plans to be with friends or family. Schedule an event or activity on your calendar, and check off the days leading up to it. Make time to be outside and enjoy nature and some of the simple pleasures of life. As they say, “Make time to smell the roses.”
Change takes time – One change begets another – It all counts. Remember that reshaping our lives takes patience and care. And self-care is also other care as we become more present, composed, and able to access our talents more readily. It’s all about bringing the “care” into healthcare.