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Shannon L. Gollnick, MSM, NRP, FP-C
Over the last several years, I have studied burnout and its impact on EMS with the intent to better understand the problem and be a part of the solution. The burnout research I’ve reviewed contains three common themes:
1. The first is that there is no fully agreed upon definition of what exactly burnout is
2. The second is that those in the healthcare environment are more susceptible to experiencing burnout
3. And third, is that the terms “burnout,” “stress” and “compassion fatigue” are used synonymously in the general public, and yet nothing could be further from the truth
Compassion fatigue, a concept that requires its own discussion is, however, at its surface, a cost of caring for others. Burned out and stressed out, though often used interchangeably, are not the same thing. Stress, while cumulative, is mental or emotional strain or tension resulting from demanding circumstances. Stress, however, is not always bad. In fact, many of us in the EMS industry laud ourselves over our ability to work well under and thrive in stress.
Burnout, however, is not in any definitive way the same as stress. Placing burnout and stressed out on the same level would be the equivalent of comparing the pain of a broken bone with a broken heart. The first is painful but fixable, the latter is a deep emotional aching that manifests in ways words cannot fully encapsulate.
What is not in the research is the impact of anger in the role of burnout. When we assess those who are burned out, we must first understand that self-diagnosis is a problem in and of itself. No other symptomology lends itself to such prolific self-diagnosis as burnout. Secondly, nearly all those who do describe themselves as burned out do so out of frustration. It is here, I believe, the true source of burnout lies.
Anger, frustration and aggression
In EMS, there are a litany of things we as EMTs and paramedics must learn to “deal with.” This includes late calls, mandatory holdovers, non-compliant and rude patients, documentation requirements that take more time to complete than the actual call, etc. The list of things we must learn to deal with is protracted, however, we never really talk about “how” to deal with it. Like the ripples across a still pond from a tiny rock, these frustrations continually grow larger. This extensive and continually growing list of frustrations eventually leads to chaos. Chaos leads to a loss of control, and that loss of control leads to anger – anger that we see and hear impacting our medics day in and day out.
Anger is a very basic, primal, human emotion. At its base, it is our first-line defense against an antagonist who threatens any aspect of our self-identity. It is our natural impulse to any perceived attacks on our psychological self-esteem, our identity or our public persona. The Frustration-Aggression Hypothesis developed over 80 years ago by social psychologists posits that aggression is the result of blocking or frustrating a person’s efforts to attain a goal. Sound familiar?
In some research, there is significant comparison between burnout and depression. Here also lies a base of anger. Sigmund Freud noted in 1917 that depression was anger turned inward: the frustration of some psychological loss but without self-recrimination. This a philosophy that is still prominent amongst psychologists today.
The root of turnover
The research on burnout is extensive, however, as academics and clinicians, we must always consider if we are asking the right questions. Often, what we are searching for the most is what is right in front of us. Our EMTs and paramedics are leaving our industry in droves, and for reasons that are common across organizations and geographies; low pay, poor work-life balance, poor leadership, etc. We see the results in engagement scores. We see the results in turnover rates. The reality is that many providers are frustrated. They are angry. We consistently tell them to “deal with it,” but never provide solutions on how.
My dissertational research found that rates of burnout were actually lower in tenured (10+ years of service) medics than in younger ones (<3 years of service). If stress is cumulative, then how can that be? As stated previously, burned out and stressed out are not the same. Perhaps these season veterans have learned to “deal with it?” Perhaps they have managed to successfully fill the gap between expectation and reality.
Either way, our efforts to combat burnout have thus far been unsuccessful. The declining EMS workforce is at crisis level and simultaneously at a time when the need for response to increasing pandemic outbreaks, natural disasters and a struggling healthcare system are increasing.
I am not suggesting that anger is the sole root of our challenges; I am simply inquiring if we are asking the right questions? Rather than asking providers if they are burned out and why, should we be asking what is ticking them off? In addition to resiliency training, should we provide anger management training?
As an industry, we cannot continue this path without first assessing whether this is the right path to be on in the first place. If we are to be successful in the future, we must ask better questions. Is it anger that needs addressing as a prevention to burnout?
About the author
Shannon L. Gollnick is a nationally registered paramedic and a certified flight paramedic with 20 years of experience. He serves as a project manager for Emergency Medical Services Management and Consulting (EMS|MC) in Winston-Salem, North Carolina, and a practicing paramedic for Fort Mill EMS and Piedmont Health EMS in South Carolina.
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