I was a burned out medic. Past tense. I was able to cure my burnout by changing how I thought about my job.
What is burnout?
Burnout is a common term, first coined in the 1970s by the psychologist Herbert Freudenberger. He described burnout as being 鈥渆xhausted, listless and unable to cope鈥� due to the 鈥渟evere stress and high ideals experienced by people working in helping professions.鈥�
Burnout may be part of depression or PTSD, and not a separate condition, but there is not a consensus. The Code Green Campaign, an organization that raises awareness of mental health issues among EMS providers and provides related education, doesn鈥檛 have an official opinion, but does acknowledge that whatever burnout is it falls under the mental health umbrella.
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How I got burned out on EMS
I鈥檝e been in EMS since 2003 and a paramedic since 2006. I could perform rapid sequence intubation before I was legally old enough to drink. I鈥檝e worked in a mostly urban 911 system since 2009 and by 2011 I was burned out.
I was angry at everyone all the time. I was frustrated that things like apneic oxygenation and selective spinal immobilization were unheard of in my system. I was pissed off that when crap rolls downhill in medicine, it ends up piled on 911 and the hospital emergency department.
When I nearly broke down crying in the ED over transporting a patient that should have never been transported I knew I was at a tipping point. The patient was an elderly woman with dementia who had an advanced directive indicating that she didn鈥檛 want to go to the ED unless she was having a comfort issue, which she didn鈥檛, until a couple of strangers showed up and pulled her out of bed, put her in an ambulance, and hauled her off to the ED for her fever. This, despite the fact that the same advanced directive clearly specified that she did not want antibiotics for any reason, even to prolong life.
I realized that something had to change. And it wasn鈥檛 going to be the system, so it had better be me or I wasn鈥檛 going to last much longer in EMS.
Here are the four things I did and advise you to do to cure your burnout:
1. Accept what your job isn鈥檛
I accepted that the lines I was fed in EMT class about snatching people from the grasp of the Grim Reaper and dealing with all emergencies all the time were bullpucky. I accepted that life and death emergency calls were a very, very, small part of my job and relying on them for job satisfaction was setting me up to be permanently dissatisfied and was leading me down a bad road.
Once I accepted what my job wasn鈥檛, I was able to accept what my job was.
2. Accept you are there to help people
I accepted that my job is doing what I can to make situations better, not necessarily saving lives. The vast majority of the time, my job is providing care and transporting the patient to the hospital, but not always.
Asking myself 鈥淲hat can I do to try and make this situation better?鈥� has resulted in my rate of administration of patient comfort medications, like Zofran and fentanyl, skyrocketing, much to the exasperation of the guy who orders the supplies. I鈥檝e also become more focused on providing education about things like proper medication storage and fall prevention.
3. Appreciate the small victories
I found that when I focused on making situations better I also became satisfied with the small victories instead of relying on the rare big victories. Knowing that the medications I gave made the patient feel better, that I might have prevented a future fall, or that I made it possible for the ED to provide faster or better care for the patient gives me a sense of satisfaction with my work.
I accepted that everyone is playing a different game of life with a different set of rules and playing pieces.
4. Don鈥檛 expect others to know what you do
Nursing homes have their own protocols to follow; families don鈥檛 have the same understanding of the role of the ED as I do; there are people who don鈥檛 know about the sliding scale clinic or how to get around town when the buses aren鈥檛 running. Of course they aren鈥檛 approaching the situation how I would, they don鈥檛 have my knowledge, experience, and resources. I had been judging them as if they did, which in retrospect is pretty appalling.
Burned out no more
By changing how I think about and perform my job, I am completely cured of burnout. Sure, I still get exasperated and upset (just ask any of my partners), but I am no longer constantly angry with everything and everyone. When I start feeling angry about a situation I stop and re-evaluate why I鈥檓 getting mad and if it is really worth the energy (hint: nope, it usually isn鈥檛).
Curing my burnout was essential to improving my job satisfaction, my patient care, and my mental health. Hopefully these suggestions will help you cure or prevent burnout.
Share your experiences of burnout in EMS and, if you worked through it, how did you do it?
This article, originally published on Nov. 19, 2015, has been updated.
