Defining and Identifying Burnout in Wound Care

Have you heard much about burnout over the past few years, either in publications, at conferences, or in discussions with colleagues? Chances are, you hear about burnout less than you did a few years ago when COVID-19 emerged. True, the immediate pressures of the pandemic have waned, but surely and often silently, burnout continues to put thousands of our wound care colleagues at risk.  

We can’t let the issue disappear and become a new hidden pandemic in our profession. Burnout affects everything from staff engagement to patient outcomes to an organization’s financial well-being. 

That’s why we need to keep the spotlight on this far-reaching condition and ensure that, as an industry, we do all we can to support colleagues suffering from it and organizations experiencing its profound effects. 

What is Burnout? 

Burnout has many definitions. In Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce, it’s described as an “occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.”  

The World Health Organization (WHO) defines burnout as a syndrome characterized by three key dimensions:  

1. Emotional exhaustion 
2. Depersonalization (increased mental distance from one’s job) 
3. Reduced professional efficiency due to chronic workplace stress  

In addition to the WHO’s definition, burnout can manifest as moral injury, compassion fatigue, and moral distress, particularly in fields like wound care, where professionals consistently face complex, high-stakes decisions.

Does Burnout Present Challenges to the Wound Care Industry? 

Understanding burnout in general industry terms and within the context of the wound care profession is essential. However, other specialties are more well-known for contributing to burnout than wound care. Some in healthcare perceive wound care as less stressful than other specialties. Some wound care groups are courting physicians in high-stress specialties like surgery to transition to wound care. While the industry always welcomes new providers — and they are much needed — wound care presents unique challenges and stressors contributing to burnout and related conditions. 

While burnout in healthcare is a well-recognized issue among those in the profession, few studies have specifically focused on wound care professionals. One study conducted in Saudi Arabia — a country with an advanced and well-funded healthcare system (which still has healthcare disparities) — revealed alarming levels of burnout among wound care professionals: 84.7% reported high disengagement, and 83.1% reported exhaustion. These findings underscore the need for targeted interventions in this sector. 

Why Does Burnout Happen? 

Multiple factors contribute to burnout in healthcare, and these factors are particularly intense for wound care providers.  

One of the issues often mentioned in our industry is working too many hours. An article on burnout in WoundSource noted that with every extra hour of work beyond 51.8 hours per week, burnout symptoms increase by about 2%. While recognized as necessary, the burden of extensive documentation and administrative tasks, such as adhering to standardized care procedures and compliance with value-based care metrics, adds to the stress. Additionally, the need for ongoing education to keep up with new research and continuously changing regulations and guidelines can make workloads even more demanding. 

Operational inefficiencies, such as poorly integrated systems and redundant processes, can exacerbate burnout. For instance, wound care providers are often bogged down by documentation requirements and regulatory demands related to value-based care, making workflow inefficiencies significantly frustrating. 

There are also personal health issues to consider. Workers with anxiety or a history of depression may be more susceptible to burnout. Lack of sleep or personal problems at home can also play a role.  

However, the CDC’s Vital Signs study noted that systemic problems contributed most to burnout. The study said that while personal factors may contribute, they should not be the focal point; instead, leadership should recognize them as part of a comprehensive approach to addressing employee mental health needs. 

Burnout stems from both internal and external stressors. These include emotional exhaustion, long working hours, and the feeling of a loss of autonomy. According to Rand, systemic issues, such as staffing shortages, recruitment challenges, and regulatory pressures, make it difficult for providers to regain control over their work-life balance and perpetuate the burnout cycle. 

Who Is Impacted by Burnout? The Provider Story

Answering this question is easy; it affects everyone along the healthcare continuum. Let’s start with the providers’ story. Burnout affects providers across various settings, from hospitals to private practices. Hospital providers often deal with more complex cases, as well as the high demand and stress of coordinating large teams and meeting regulatory requirements. Private practice providers face additional burdens when running a business. Rural providers, who often also deal with complex cases, face issues like staffing and lack of professional support.  

“Rural providers don’t have a lot of outside resources to rely on,” said Dr. Vilayvanh Saysoukha, DPM, MS, FASPS, FACPM, AACFAS, founder and CEO of Premier Foot and Ankle Centers of Tennessee. “We have to wear many hats, and that contributes to burnout for everyone on our team.”   

Wound care nurses face their own set of challenges.  RNs often have excessive patient loads, especially in areas with staffing shortages. The previously noted WoundSource article said nurses are 23% more likely to experience emotional exhaustion for each additional patient, exceeding a 4:1 patient-to-nurse ratio. The American Nurses Foundation and McKinsey noted in a special report that other factors, including too much time spent on administrative tasks, contributed to burnout. 

LPNs and CNAs who must constantly lift and reposition patients at risk for pressure injuries, especially those who are immobile and larger, often face physical strain that can lead to back and neck injuries. The prevalence of work-related musculoskeletal (MSK) injuries among nurses and allied professionals is, in some cases, much higher than in other occupations. The Occupational Safety & Health Administration (OSHA) reports that nursing assistants have a five times higher rate of MSK complaints than all other industries. 

Burnout also affects an individual’s professional performance and, therefore, their career goals. Providers experiencing burnout are more likely to have: 

• Reduced quality of patient care 
• Increased likelihood of errors 
• Decreased job satisfaction and morale 

Burnout’s Cost and Consequences: Patients and Organizations 

Burnout doesn’t just affect healthcare providers — it profoundly impacts patients and their outcomes as well as organizations in terms of quality ratings, revenue, and more. Because it touches virtually every step along the care continuum, addressing the organizational impact of burnout is critical. For example, burnout leads to higher turnover rates, which leads to staffing shortages and increased workload for remaining staff. Errors related to burnout can lead to oversights, such as failing to identify existing pressure injuries upon admission, which can lead to costly penalties and reduced reimbursement.  

Financially, burnout is estimated to cost healthcare facilities billions, with physician burnout alone costing $4.6 billion annually. Healthcare Dive reports that hospitals’ burnout costs for nurses are more than $9 billion annually, a total of $14 billion for the U.S. healthcare system overall. 

In terms of how it affects patients, studies have shown that burnout among healthcare professionals is associated with lower patient satisfaction and poor quality of care. Another study that highlighted the relationship between clinician burnout and patient safety outcomes noted that burnout can lead to depersonalization and decreased personal accomplishment at work, negatively impacting patient care.

And there are other issues to consider. “Most wounds occur in seniors, particularly those over the age of 75, with about 65% falling into this category. These patients face numerous challenges, and prevention is crucial in their long-term management. When physicians experience burnout, they tend to stop asking the important questions, especially since they are often pushed to see patients quickly. In this process, the wound is the only thing that wins,” said Sheryl Riley, RN, OCN, CMCN, Clinical Consultant and Patient Advocate at Clarion LLC.  

Diagnosing Burnout: Recognizing the Signs 

With the case made for addressing burnout, the next step is to ask ourselves if we’d recognize it if we saw it and if we’d be willing to do something about it.   

Regarding personal interaction with colleagues, ask if a normally pleasant colleague seems withdrawn and angry. Are they avoiding conversations? Has their performance changed? Do they talk about quitting? These are all symptoms that could indicate burnout. 

Self-assessment tools can help providers and managers quantify and identify levels and the effects of burnout.  

There are several recognized self-assessment tools for burnout among healthcare workers. One of the most widely used and validated tools is the Maslach Burnout Inventory (MBI). The MBI measures burnout in individuals who work with people, such as healthcare professionals. It assesses three dimensions: 

• Emotional Exhaustion (EE) 
• Depersonalization (DP) 
• Personal Accomplishment (PA) 

Another widely used diagnostic tool is The Copenhagen Burnout Inventory (CBI), developed by Danish researchers in the early 2000s. Healthcare facilities use the CBI to assess burnout levels among staff by measuring personal, work-related, and client-related burnout, providing valuable insights into the specific stressors faced by healthcare professionals. 

Some of the questions include: 

• Personal burnout: How often do you feel tired? 
• Work-related burnout: Is your work emotionally exhausting? 
• Client-related burnout: Do you find it frustrating to work with clients? 
• Work-related burnout: Do you feel worn out at the end of the working day? 

What We Can Do Now 

There’s no single solution to burnout, and nobody will fix it overnight. Step one is acknowledging the problem. Step two is committing to ongoing programs and support at the interpersonal and organizational levels. It will require focus and hard work, including comprehensive strategies that reduce workload, improve work-life balance, and emphasize innovative solutions. 

Those are efforts well worth the time and energy. Hospitals that implement burnout programs for nurses save up to 30% annually. Also, favorable working conditions, such as trust in management and supervisor support, have been associated with lower odds of burnout and poor mental health. Additionally, healthcare workers reported less burnout when they had enough time to complete their work and be productive. Mental health experts believe another important attribute to promote is resiliency. Resilience helps with burnout by enabling individuals to manage stress better, maintain a positive outlook, and recover quickly from challenges. 

“When we think of resilience, we think about mental and physical toughness and the ability to withstand challenging situations,” said Julie DeLoia, PhD, Chief Academic Officer for Opus VI, a national healthcare workforce development firm. “When something gets thrown at you, you’re able to think quickly in your feet, adapt quickly, recover quickly. It’s really about how you respond to the unexpected.”  

Healthcare organizations don’t have to tackle burnout alone. The CDC’s Impact Wellbeing™ Campaign, spearheaded by the National Institute for Occupational Safety and Health (NIOSH),  offers vital resources to help leaders within the healthcare industry improve staff mental health. This initiative includes a guide with actionable steps for creating supportive environments for healthcare workers. Key strategies include: 

• Building trust between staff and management 
• Fostering proactive, supportive supervisors 
• Encouraging participation in decision-making 
• Implementing stress prevention measures 
• Ensuring adequate time for task completion 

Addressing burnout is critical for the wound care industry. To meet current challenges, a positive and resilient workforce that is satisfied with their jobs is needed. By building comprehensive programs to identify and address burnout, hospitals, clinics, and private practices can strengthen the mental outlook and health of their valuable workforce, retain talent, and empower providers to meet their colleagues, patients, and profession’s physical, emotional, and mental health needs.