Preventing Burnout Among Hospice Care Providers

Hospice care providers play a critical role in the healthcare industry. They offer medical support for the terminally ill and elderly, helping them live safely and comfortably with their loved ones for as long as possible. But despite their importance, hospice workers have one of the highest burnout rates of all career fields.

To celebrate National Home Care and Hospice Month this November and to raise awareness around the difficulties hospice care workers face, let’s examine some of the leading causes of hospice work burnout and how to prevent it.

Factors that cause burnout among hospice care providers

According to a 2020 article published in the International Journal of Environmental Research and Public Health, the healthcare profession is considered one of the most stressful career paths. Having worked as a neurosurgeon for over 25 years, I can attest to this pressure. Unfortunately, this makes burnout common in most medical fields, especially among hospice care professionals. Below are some of the most frequently cited factors that contribute to burnout among hospice care providers:

  • Emotional exhaustion (aka compassion fatigue)
  • Feeling overextended (under-resourced)
  • Feeling underappreciated
  • Long hours and weekend work
  • High level of responsibility
  • Difficulty setting healthy boundaries
  • Ethical considerations of keeping terminally ill and elderly patients alive

What is burnout?

The International Journal of Environmental Research and Public Health article describes burnout as consisting of emotional exhaustion, or the feeling of exhaustion due to the physical and psychological load of the work; depersonalization, or a tendency to treat people as objects and to adopt a cynical attitude; and low personal accomplishment, or the feeling of dissatisfaction with one’s own work. 

Burnout often consists of emotional exhaustion, depersonalization, and/or feelings of low personal accomplishment.

Burnout rates can vary among palliative care workers based on the patients they care for, as well as their patients’ medical issues and prognoses. For those in hospice care, their patients always have a terminal prognosis and short life expectancy, thus they are constantly communicating unfortunate news. To make matters more difficult, hospice care workers typically become close with their patients’ families, which can cause added grief and anguish following a death. 

What does burnout look like?

Just as burnout rates differ per medical professional, so does the appearance of burnout. Some healthcare workers become so disconnected from their emotions that it can be difficult for them to identify feelings of sadness, grief, and stress, yet it is inevitable they will have to face these feelings eventually. Other healthcare providers wear their emotions on their sleeves, or let them flare up at intervals, but do not take the time to process them. Both approaches can lead to burnout and cause side effects ranging from insomnia and irritability to anxiety and depression. Furthermore, burnout can increase the number of mistakes made at work, reduce the quality and safety of care given, and increase the number of sick days taken.

Preventing burnout helps maintain well-being and job satisfaction

Burnout is contagious in the healthcare industry; when one health care worker experiences burnout, their peers will usually feel it. In hospice care, it is often the patients and their families/caregivers who feel a healthcare worker’s burnout most directly, as they are the most intimately connected to them. 

Preventing burnout can help healthcare workers maintain their well-being and their job satisfaction, benefiting both themselves, their patients and families, and their employers. Because I believe it is important for both healthcare employers and providers to work together to address burnout, I have compiled a list of suggestions for both groups.

Suggestions for caregivers:

  • Practice being vulnerable. As medical providers, we often distance ourselves emotionally from our patients, either intentionally or unintentionally, in an effort to protect ourselves from the pain of grief, loss, and failure we are exposed to on a daily basis. While we may think this “emotional armor” will help defend us against burnout, it can actually be our downfall, causing us to feel disconnected and intensifying our feelings of loss. The antidote? Vulnerability. Allowing ourselves to be compassionate, empathetic, and honest can help protect us from burnout because we are able to show up fully and be completely present. It enables us to make mistakes and feel emotions—in other words, it encourages us to be human. Being vulnerable can be scary, but it is almost always incredibly rewarding, and it needs to be incorporated into medical schooling and on-site job training. 

Practicing vulnerability can help protect us from burnout because we are able to show up as our true selves and live in the moment.

  • Develop a rich support system outside of work. This should include a combination of family members, friends, and mentors. Diversifying your support network from just your co-workers and supervisors is important to prevent burnout because it allows you to get different perspectives on your work issues. (Just ensure patient confidentiality is maintained by omitting identifying details, like patients’ names and locations.)
  • Squeeze in time for healthy eating and exercise. As a medical professional, I know how difficult it is to find the time to cook nutritious meals and exercise after working 10+ hours a day. While there is no way to make more time in your day, here are a few tips for incorporating healthy living into your routine: 
    • Sign up for a meal kit delivery service. This reduces planning time and trips to the grocery store and makes it easy to assemble a healthy, tasty meal fairly quickly.
    • Do some light exercises whenever possible. For me, this looks like doing squats, calf raises, or lunges whenever I have a free 5 minutes. I also try to get outside and walk around my facility every chance I get.
  • Fill your time off with things you love that support your mental health. What do you love to do during your free time? Whether it is making crafts, reading, listening to music, communing with friends, going on nature walks, writing letters, gardening, or meditating, spend at least some of your downtime doing these calming things. Avoid spending your time off binge-watching television, consuming social media, or drinking alcohol, as these activities are likely to contribute to feeling exhausted and unfulfilled. A good rule of thumb is to listen to your body: if you are tired, sleep; if you are lonely, call a friend or loved one. The key is to rest and unwind while nourishing your mind and soul.

Suggestions for employers:

  • Ensure administrative processes are running smoothly. According to a 2021 study in Medscape, 58% of physicians attributed their burnout to having to deal with too many bureaucratic tasks. As a healthcare leader, taking care of behind-the-scenes processes that will facilitate a smooth workflow will allow your employees to focus more of their time and attention on caring for patients rather than cumbersome administrative tasks. An example of this would be investing in a quality electronic medical records (EMR) system that will save workers time filling out paperwork and searching for physical records.
  • Equip workers with necessary resources. One of the key factors of burnout amongst hospice care workers is feeling over-extended, which comes from a lack of resources needed to do their job comfortably and efficiently. As an employer, you should make sure your employees have the resources they need to do their job properly within their work hours. This may include adequate (and qualified) staffing, regular training, and opportunities to check in with supervisors.
  • Offer employees a support group. If your facility does not already offer a support group for employees, I encourage you to establish one. Providing hospice care providers the opportunity to check in with one another, share stories, be vulnerable, and offer support is critical to their well-being and, therefore, the well-being of your medical facility. Establishing a support group is an easy measure that will likely result in cost savings and higher employee retention rates down the road.

Help us improve healthcare—join our community & share your story.

We are building a community for healthcare workers, patients, caregivers, and loved ones, and we need your help. In my book, Grief Connects Us, I advocate for more empathy, compassion, and vulnerability in the medical field. To help accomplish this, I invite you to share your personal experiences with burnout, as well as your thoughts on this month’s post. You can leave a comment below or on my Facebook, Twitter, Instagram, or LinkedIn.

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