Burnout: Wound Healers, Beware

My passion for wound healing started as a young child, when I had sustained a puncture wound with the penetration of a dried piece of wood (a stick) “deep” into my right foot. The radiographs did not show the foreign object lodged between my tiny bones, so non-analgesic supported exploration on the examination table was initiated. That was followed by countless hours of painful wound dressings, surgery, weeks of hospital time, and months of recovery. The pain will never be forgotten, but I was fortunate enough to keep my limb. In addition, because of that experience I developed empathy and compassion toward people with wounds. 

I also gained first-hand knowledge about fear, with the only hope and consolation coming from the eyes of clinicians and care providers. It was the “can heal” energy that they demonstrated that later led me to become a nurse who would always strive to offer that same hope to my patients. It was a noble mission until I was faced with burnout and realized that I had no “light of hope” in my own eyes to share with my patients and colleagues. It is from this place of vulnerability that I share my story, in hopes that others will avoid this potentially destructive path.  

Burnout is often used loosely to describe exhaustion, fatigue, stress, or “burning the candle at both ends.” However, it is much more extensive, as outlined by the the World Health Organization. Their latest edition of the International Classification of Diseases (ie, ICD-11) lists burnout as an occupational phenomenon that is characterized by the following 3 dimensions:

• feelings of energy depletion or exhaustion;

• increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; or

• reduced professional efficacy.¹

This definition implies that the root cause of burnout lies within the culture and structure of the workplace. It may be directly related to chronic workplace stress that has not been managed successfully. The common thread among those affected by burnout is that the work that was once important, meaningful, and challenging has become unfulfilling and meaningless; those who are most likely to burn out are those who are the most dedicated and committed.² 

It is impossible to separate self from system when discussing burnout; therefore,  stress in the forms of excessive bureaucracy, unclear goals/expectations, poor workflows, inconsistent teamwork, unhealthy team dynamics, and inadequate individual coping strategies must be taken into consideration as burnout is addressed. Compassion fatigue (“a heavy heart hurts”³) and moral distress (“I know what I ought to do”⁴) may be used interchangeably with burnout, but these more often reflect a personal response to life and workplace. 

Burnout is rampant in the world of health care, so wound healers, beware! With the onset of COVID-19, the complexities of providing wound care have become even more complicated due to factors such as new infection control considerations, additional personal protective equipment, heightened concern for at-risk patients, essential versus non-essential debates, constant rhetoric through media channels, social distancing, unhealthy coping mechanisms, burning the candle at both ends, and fear within our patient populations. Burnout is a crisis and has been directly connected to alcohol/substance misuse, broken relationships, poor physical and emotional quality of life, irregular and poor self-care, anxiety, depression, and even suicide.^5–7  

It is in the best interest of the wound care community to seek to protect itself through understanding the best practices of resilience and process improvement. I speak from personal experience when I say that the lessons are worth learning. 

Burnout should not be a blame game but an opportunity for self-reflection and proactive collective actions. A new job is most often not the solution. Although a toxic workplace can displace all efforts of individual contribution, it is worth reflecting on the words that Confucius is sometimes credited as saying: “...and remember, where you go, there you are.” However, it is imperative that values and role expectations are closely aligned between employer and employee to avoid burnout.   

For those in the field of wound prevention and healing, keeping the passion alive may equate to better clinical outcomes, better personal health, and a more rewarding career. There is power in the wound healing world and stories of success to be shared. 

Do you have insight that would benefit others? Maybe a suggestion for workflow in a wound center or suggestions for improved electronic health record documentation processes, communication strategies for employee relations, team building ideas, personal health/wellness suggestions, or something that promotes better work-life synergy? If so, please contact the author at sharon.goldsmith@thesalsal.org to share your story and suggestions, and become an active partner in the quest to address burnout. It is the author’s hope to share this information in another issue of Wound Management & Prevention so that we can face the destructive force of burnout head-on, with unified synergy and determination.

This article was not subject to the Wound Management & Prevention peer-review process.

Sharon Goldsmith has been a wound practitioner since 1992 and has professional experience including inpatient bedside, outpatient wound center clinical operations, and wound product/industry representation. Currently, she is an advocate for Save a Leg, Save a Life (SALSAL), a non-profit organization.