Breaking Out of Burnout When a speech-language pathologist saw signs of burnout among her faculty-clinician colleagues, she set out to make over her division. Features
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Features  |   June 01, 2017
Breaking Out of Burnout
Author Notes
  • Josephine Sevier Alston, MA, CCC-SLP, is chief of the Division of Speech-Language Pathology in the University of Mississippi Medical Center’s Department of Otolaryngology and Communicative Sciences. She is an affiliate of ASHA Special Interest Groups 3, Voice and Voice Disorders; 11, Administration and Supervision; and 18, Telepractice. She co-chairs the Healthcare Committee for the Mississippi Speech-Language-Hearing Association and serves on the board of the Mississippi Council on Developmental Disabilities. jalston@umc.edu
    Josephine Sevier Alston, MA, CCC-SLP, is chief of the Division of Speech-Language Pathology in the University of Mississippi Medical Center’s Department of Otolaryngology and Communicative Sciences. She is an affiliate of ASHA Special Interest Groups 3, Voice and Voice Disorders; 11, Administration and Supervision; and 18, Telepractice. She co-chairs the Healthcare Committee for the Mississippi Speech-Language-Hearing Association and serves on the board of the Mississippi Council on Developmental Disabilities. jalston@umc.edu×
Article Information
Professional Issues & Training / Features
Features   |   June 01, 2017
Breaking Out of Burnout
The ASHA Leader, June 2017, Vol. 22, 44-50. doi:10.1044/leader.FTR1.22062017.44
The ASHA Leader, June 2017, Vol. 22, 44-50. doi:10.1044/leader.FTR1.22062017.44
So there I was, staring at the “send” button on my email, knowing that once I pressed it, my future may change in a big way. A few minutes passed as I fixated on it. My thoughts ran the gamut from pep talks to questioning my sanity to thinking I’d be really good at this. What if they actually pick me? Am I crazy?
I looked over at my husband as he asked, “Are you sure you want to do this?” I faintly said, “Yeah. I think so. Maybe.” (Sigh.) I hit “send.” I had just officially applied to be chief of the Division of Speech-Language Pathology at the University of Mississippi Medical Center.
This was a huge step for me. It meant taking a chance at doing something that may have led to failure, and I hate to fail. I was leaping out of my comfort zone, and I didn’t know what to expect. I had never managed a division, developed a budget, or implemented policies and procedures, and I surely had never attended a coding webinar.
If I got this position, it would mean more—more money and leadership, yes, but also more responsibility, more time away from my family and more challenges. So why was I doing this? Honestly, I had become complacent at work. I could easily predict what each day would be like; work, for me, was becoming repetitive, and I was not staying fully engaged. Covering clinics and seeing patients felt like more of a chore, and I found myself wondering if I had lost my passion to really have an impact on my patients’ lives.
Looking back over my 20-year work history, I realize I tend to make pivotal decisions when complacency in my position has brought me to the brink of burnout. Maybe this need for continued learning, projects and challenges was my inner defense system warning me that I needed a change from the mundane because, without that, burnout was inevitable.
I know I am not alone in dreading burnout. Job dissatisfaction is a reality among some health care workers, as reported in research published in the journal Lancet and supported by results of ASHA’s 2015 Work Life Survey of audiologists and speech-language pathologists. While most respondents reported being satisfied with their career choice, 2–7 percent reported dissatisfaction, with the highest levels for audiologists in hospitals and SLPs in nonresidential health care. Among contributors to burnout are feelings that one’s skills are inadequate for the job and that staffing levels are insufficient to meet job demands. Have you ever felt like there just wasn’t enough time in the day to not only get the job done, but done well?
SLPs frequently discuss common problems such as heavy caseloads in schools, mounting consults in the work queue in hospitals, or high productivity expectations at skilled nursing facilities. The emphasis on productivity can be suffocating, making anyone feel defeated and over-stressed.
Other precipitators of workplace burnout are unrealistic expectations and lack of support from supervisors and administration. Why should you work extra hard if there is no positive recognition or reward in place to make you feel supported for doing a good job or going the extra mile? The lack of this type of support in my department needed to change, I realized.

If I got this position, it would mean more money and leadership, but also more responsibility, more time away from my family and more challenges. So why was I doing this to myself?

When burnout sets in
I got the job. In my first few weeks as chief, I met with all the clinicians and found high levels of dissatisfaction and concern. Many were frustrated from working long hours, tired of their cramped working conditions and concerned about a lack of support. Several faculty members were seriously considering looking for new employment, and we had lost four SLPs (20 percent of our division) in the prior year. Another 20 percent had shifted to other positions in the division. So where was I going to begin to address the myriad issues feeding staff burnout?
You may be familiar with the telltale signs of burnout: dreading going to work, a growing number of confrontational relationships, increased stress, headaches, decreased energy, disorganization, depression and/or weight gain. Career burnout could be looming on the horizon if you are doing only the minimum to get by and wishing you were anywhere but at work.
For me, factors such as the introduction and ever-expanding role of electronic charting had contributed to burnout. In addition, working in a satellite clinic made me feel disconnected from my colleagues. Here I was, part of a large academic medical center and a fairly large division of 18 clinicians, but I rarely talked to colleagues because we were spread over eight areas of the campus. I also saw a real lack of inter-divisional and inter-departmental communication and limited professional leadership opportunities. Division-sponsored CEUs were nonexistent.
“Employee engagement” and how to achieve it has been a major focus at my hospital during the past few years. Engagement is important because it’s a key deterrent of burnout. We know that occupational burnout can cause people physical and emotional stress if they do not recognize and heed the warning signs. This commonly results in more tardiness, sick days or even the employee resigning from the job they were once excited about.
And let’s not diminish the fact that frequent employee turnover can be extremely costly to programs, departments or private practices, due to recruiting, marketing, lost income, training and time focused elsewhere. Now factor in that the employees left behind will have to pick up the slack, possibly causing them—you guessed it—burnout.
I looked to a 2011 ASHA Membership Survey for guidance on what most compels audiologists and SLPs to accept or stay in a job. The top three factors: compensation/pay, flexibility to balance life and work, and meaningfulness of the job. My pathway to eradicate burnout symptoms was becoming clearer. I had to figure out how to help my clinicians achieve these goals.

Career burnout could be looming on the horizon if you are only doing the minimum to get by and wishing you were anywhere but at work.

Goals for growth
The drive to try new and different things has always been a part of my psyche, and taking calculated risks has usually worked out in my favor. It’s provided me with new and varied experiences, and, I realize, has been my key to warding off burnout. In supervising 18 faculty clinicians, I recognized that my new challenge was to get them reinvigorated—and I had to do it fast. I worked with my chair to develop a plan to help them focus beyond just seeing patients—and more on their own professional growth.
We started with a clearly outlined pathway for clinicians’ professional career expectations. The pathway emphasizes support for new opportunities and our university medical center’s missions of education, research and innovative patient care.
Next we focused on goals. How can you change something if you don’t know what, exactly, you are trying to achieve? I had each speech-language pathology faculty member set three career self-motivating goals using the SMART (specific, measureable, attainable, relevant, timely) principle.
I also had the SLPs jointly choose divisional goals to promote team cohesion. Together we tackled the problems of how to improve patient education, how to ramp up and invest more time and effort in our own continuing education, and how to begin to implement best practices and a higher standard of care for all of our specialty populations. These projects finally had us working together and determining a common objective. We began to engage again in our day-to-day activities.
Positive change
Another focus of our new plan was promoting work-life balance and flexibility. We looked at each clinician’s daily time management and schedule and sought to increase efficiency. This led us to adjust some personnel staffing levels, and we then tweaked schedules to allow for more desperately needed charting and administrative time. More efficient staffing processes and administrative support led to shorter hours and more time for activities outside work.
One of my favorite lines from the movie “Jerry Maguire” is “Show me the money!”—said repeatedly by Cuba Gooding Jr.’s character Rod Tidwell as he sought a lucrative football contract. It’s no big secret that compensation is very motivating. It gives employees an increased sense of recognition for their hard work and can instill feelings of worth and appreciation. So, armed with ASHA’s latest salary survey, my chair, department administrator and I initiated salary discussions with our administration. As a result, we successfully implemented a market adjustment for all the clinicians, who now earn more than ever before.

Our plan to encourage each faculty clinician to pursue their own career goals has benefitted the clinician personally, but also our division, department, university and immediate community.

Another significant change was tying future salary increases to professional objectives instead of years of service. Now, those who do more, earn more. The faculty were no longer solely evaluated and recognized with a salary bump just for “sticking it out” another year. They were given clear objectives to achieve one of four professional levels. They were now the ones in control of their professional engagement. Through the goals and the professional levels, we show our clinicians a long-term pathway for developing their career and staving off the boredom of repetition.
As the objectives were presented, the clinicians began to suggest more improvements, and offer to take the lead. The plan was implemented July 1, 2016, and so far, we have made many positive changes, including these.
  • Half of the speech-language pathology faculty gave presentations to six statewide graduate programs.

  • We had our largest class of students being supervised and completing their practicum hours.

  • A third of department faculty had their papers accepted for presentation at our state’s annual convention.

  • Our pediatrics team had their offices renovated, doubling their space. This project had been initiated nearly two years prior but had stalled. The clinicians’ complaints of constantly searching for treatment rooms and inadequate areas for quality patient care were a top priority and, therefore, a renewed focus for us.

  • We grew our collaborations with other departments. Now we work with pediatric neurology to assess patients’ cognitive abilities after loss of consciousness, and psychology trains our clinicians in techniques to minimize behaviors negatively affecting clients’ treatment.

  • Web conferencing for meetings and webinars increased attendance and participation of clinicians at satellite clinics.

  • Clinicians were encouraged not only to join our state association, but also to volunteer for a committee within the association. All are now involved to some degree.

  • I asked clinicians to serve on a committee in our division and to report regularly on their committee’s progress at our new bimonthly faculty meetings. This has allowed for leadership opportunities and multi-specialty collaboration.

  • I encouraged all faculty clinicians to attend continuing education programs outside our area and share what they learned with our whole division. Our department allocated funds and training time to support travel and tuition for each SLP to complete annual CEU requirements and pay professional dues. In other words, we invested in our clinicians.

  • Many clinicians now are pursuing specialty board certification.

  • We revamped our monthly Journal Club. Now, instead of just assigning an article to one person to outline for the group, we invite a speaker from another department in our medical center. We have had guest speakers from pediatric gastroenterology, pulmonary, palliative care, psychology and research. (We have learned, for example, the difference between atelectasis and infiltrates on a chest X-ray).

  • We are hosting our inaugural Division of Speech-Language Pathology-sponsored ASHA CEU offering with a nationally known speaker.

  • As a group, we also decided to have a community outreach goal. Several clinicians made fidget quilts for our patients with Alzheimer’s. Next month, we are volunteering as respite caregivers for a local ministry serving children and adults with disabilities.

Our plan to encourage each faculty clinician to pursue their own career goals, independently and with their colleagues as mentors and supporters, has benefitted not only the clinician personally, but also our division, our department, our university and even our immediate community.
I had hopes, but I couldn’t really imagine the huge difference a well-designed career pathway would make in such a short amount of time. What’s more, it indirectly kicked those burnout symptoms to the curb. The good news is that no one is destined to remain mired in career burnout. You, like me and all my colleagues, can change your career outlook, experience and engagement. Like anything in life, it requires grit and determination.
I’ll admit that in my case, hitting “send” on that email application to become chief actually turned out to be the easy part. The journey that followed was the true test of engagement. Our professional-level pathway changes boosted morale, which fueled motivation and resulted in minimal turnover. We were on our way to beating burnout for good.
But what’s been endlessly rewarding for me is helping my colleagues revive their own balanced professional work and home lives. For those of you out there feeling stuck in a rut, try metaphorically hitting “send” on that email offering a change that you’ve been sitting on. Get engaged and involved again. It just may lead to a long and happy career.
Reignite Your Career

Have you lost your motivation and sense of purpose at work? It may be time to take stock, renew and refocus your energy in a different direction. Here are some pointers to get you started:

  • Look at your career ladder. What is your next step? Where do you want to be in two, five or even 10 years? What will it take to get there? How can you develop your skill sets to get there?

  • Frequently review your job expectations. How is productivity in your job assessed and rewarded? Do those assessments and rewards seem appropriate and adequate? Do your own and the job’s expectations for your output align?

  • Set clear goals to meet those expectations and break them into smaller tasks if needed. Decide what is most important and focus your attention on that. When you start to feel complacent, be mindful of why you are doing what you are doing, and be present in that moment as you tackle new, and sometimes scary, challenges.

Balance work life with home life and don’t forget about your community life. Renew, refocus and engage yourself.

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FROM THIS ISSUE
June 2017
Volume 22, Issue 6