does prıorıtızıng self-care mean betrayıng your patıent care?

Nazan Artun PhD, RPh ; Meybel Morales, PharmD
 
Sacrificing Self-care in the Chaos of Life
 
The importance of self-care within the healthcare workforce is essential when working in stressful environments and providing patient care. Currently, self-care tends to fall under the radar of the occupational health field and is not readily available to all of its laborers. This article’s focus is not to give self-care tips since this is a rather personal choice, as indicated (1) self-care is defined as a cadre of activities performed independently by an individual to promote and maintain personal well-being throughout life. Self-care can be spending time alone or with loved ones, reading, traveling or exercising: whatever activity of choice. The core idea is to be able to carve out a specific time from the daily routine of work and family responsibilities. The question to pose here is, is it truly possible to carve out ‘ME’ time all the while living in the hectic nature of daily routines?
 
Turning Providers into Patients 
 
To get a glimpse of the average working hours of healthcare professionals, let’s start by looking at healthcare workers in hospitals. According to the Bureau of Labor Statistics, the average working weekly hours have soared exponentially since the 90s until present day, to one where there is more to do, while unable to catch up with yesterday’s leftover work (2). Most healthcare workers put in more than 40 hours a week, usually up to 60-80 hours depending on the field . Furthermore, according to the results of a nationwide survey conducted among clinical pharmacists, too many working hours is the major factor causing burnout followed by inadequate management (3).
 
Burnout was entered into the official medical diagnosis list for the World Health Organization in 2019.  Institutions are realizing how this is impacting patient care, safety, return on investment of the healthcare system, etc. In January 2019, The Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute have officially labeled physician burnout a public health crisis that is slowly destroying the mental health of physicians and threatens to undermine the delivery of care throughout the country (4). Let us not underestimate the consequences of burnout, which comes about as a pathological syndrome in which emotional depletion, maladaptive detachment develops secondary to chronic occupational stress (5). In essence, the burnout rate among hospital clinical pharmacy practitioners overall was 61.2% and largely driven by high emotional exhaustion (52.9%) and high depersonalization (32.6%) of participants according to the national survey (3). Basically, burnout is turning the healthcare providers into patients themselves. This is a dilemma that if not addressed will ensue in a vicious cycle with not only psychological damage but monetary stress to the very institution that is trying to uphold health. 
 
Intangible Barriers set by Health and Wellness Centers
 
In 1976, the Wellness Wheel came into being after the co-founder Dr. Hettler of the National Wellness Institute developed it for the purpose of illustrating a wellness model containing the following dimensions: emotional, intellectual, physical, social, environmental, financial, and spiritual (1). The acknowledgement for the need was present then, the question is what have healthcare institutions done with the knowledge that wellness is integral to the person feeling depleted.  How are they promoting self-care into this culture, more than simply opening Health and Wellness centers that become like windows in a shopping mall to look at? Up to date, most institutions are focusing on providing techniques, workshops, and creating centers for the support of self-care, but the conundrum is that there is no set time or encouragement to prioritize this effort to empower its providers to care for themselves.  The laws governing self-care in the workplace are not completely set, the government speaks about wellness incentives given to employers, but what is in it for these employers besides money?(6) Incentivizing employers with financial gain may lead to a better culture, yet the hope is to promote the culture shift.  Institutions should empower its workers, especially in healthcare, to accept that self-care is not selfish--in fact, given the current conditions, it may be the most selfless thing to do. It is crucial now for the institutions to take a lead, and act by allocating time and resources for the providers to feel that there is acknowledgement and support for their struggle to find balance.  
 
Mirroring Legacy of Neglect in Self-care
 
When taking a closer look at some of the reasons where this culture of neglect in self-care is rooted from, who do we as healthcare providers look up to?  We look up to our managers, our leaders, and the standards they have set for their teams.  When seeing management hold off on caring to lead by example, such as not taking a designated lunch break and eating at their desk, they set the tone for all under their leadership to follow. It is worthy to note that according to neuroscientists when we receive different and ambiguous messages of what leaders say and what they do, our brain is programmed to follow the behavior instead of the verbal directions which in psychology is called “imitation learning.” Even if the intention comes from a good place, supporting their department’s urgent needs whenever there is a shortage in staff at the cost of their wellness.  In the interim, it may be the quickest solution yet in the long-term this is detrimental to the overall work environment’s sustainability. There will always be urgent needs, a time to reflect: is this the legacy that leaders want to leave behind which sets the standard of neglect of self-care?  
 
 
Prioritizing Self Care in the Hierarchy of Human Needs
 
Considering, long working hours, irregular work schedules and unrealistic expectations with limited resources; our current system is clearly not delegating time for health and wellness. Self-care is not very often promoted or prioritized by the healthcare culture and it is perceived as a luxury for healthcare professionals, who are trying to find a balance in their personal lives, being present for their family, and meeting the demands at work when asked to spend wellness time on themselves.  It is clear that a well-supported team will outperform an exhausted team. Until the culture has caught up with the notion to improve a work-life balance, such as other industries have (i.e. Google’s People’s Division), if we can all take a look within and understand that there are needs, thus there are options to use the rights and the voice given to know when exhaustion has set in. Our compassionate self can allocate boundaries and give rise to that much warranted time that is essential for the self.  Let’s aim to take better care and strides to change the chronic habit of neglect of the individual’s need for wellness within our institutions of health. At the end of the day, as Greg Mckeown says “ If you don’t prioritize your life someone else will.”
 
 
References
 
1. Sanchez-Reilly S, Morrison JL, Carey E et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013; 11(2): 75–81.
2. U.S. Bureau of Labor Statistics https://www.amnhealthcare.com/rise-in-healthcare-overtime/
3. Jones GM, Roe NA, Louden L et. al. Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey. Hosp Pharm. 2017; 52(11): 742–751.
4. Jha AK, Iliff AR, Chaoui AA et al. A Crisis in Health Care: A Call to Action on Physician Burnout, The Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute 2019 Report.
5. Thomas NK. Resident burnout. JAMA. 2004;292(23):2880-2889.
6. Kohll A, Seven Employee Wellness Trends And Opportunities For 2019. Forbes Dec 12 2018