Beyond Burnout

Helping Teachers, Nurses, Therapists and Lawyers Recover From Stress and Disillusionment

Cary Cherniss

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780415912068
• eBook ISBN: 9781136659386
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Why are so many in the helping professions perceived as lacking idealism or commitment? Beyond Burnout, based on a unique, in-depth, longitudinal study, explores the source of this problem. Professionals describe in their own words what happened to them when their idealism collided with the realities of their work.

Part One

Setting the Stage

1

Introduction

Each year thousands of people enter one of the helping professions in order to serve others. What they do affects how we live, how we feel, even what we become, and their impact on our lives has been growing.

Professionals have always been important for the public welfare. One author called them “the agents by which society dealt with its major problems” (Schein, 1972, p. 2). In the last century, however, the professions have become even more significant. Just in sheer numbers, the proportion of professionals in the population has grown enormously. In 1890, 3.8 percent of the adult population were professionals; in the next thirty years it rose slightly to 4.4 percent; but in the next 40 years, the percentage nearly tripled. In 1960 professionals constituted 13 percent of the adult population (Veysey, 1975).¹

Professions have also proliferated in the last century. The health care field, for instance, was initially comprised of lay healers and then, with professionalization, physicians and nurses—and even nursing didn’t emerge as a real occupation until the end of the nineteenth century. Today medical care is provided by a plethora of allied professions, including physical and occupational therapists, speech therapists, psychologists, chiropractors, social workers, and many others.

But numbers represent only part of the story. As the count of professionals and professions has increased, so too has society’s reliance on them. Many of the caring and socializing functions formerly provided by family, church, neighbors, and friends have been assumed by formal institutions. Schools, hospitals, day-care centers, social welfare programs, and mental health clinics have multiplied as people increasingly turn to them for help formerly provided by nonprofessional caregivers. We now use institutional help more than ever.

These formal helping agencies affect our lives in a variety of ways. Consider, for instance, the economic impact: between 1985 and 1991 the amount of money that Americans spent on food and tobacco increased 32 percent. The increase for clothing, accessories, and jewelry was 35 percent, while housing expenses increased 42 percent.

But the amount Americans spent on medical care during this same period increased 100 percent—more than three times as much as the increase in food expenditures. Costs for education and research increased even more: 116 percent. Expenditures for religious and welfare activities increased 89 percent. In other words, the amount of money we spend for health, education, and social welfare has increased at a much higher rate in recent years than the amount we spent on food, clothing, and housing.² In economic terms alone, helping professionals are becoming more important in our lives. What Lynn (1965) wrote three decades ago is even more true today: “The professions are triumphant in American life.”

The Fate of Professional Caring and Compassion

Entering a helping profession has always been regarded as a “calling.” Those who turn their backs on more lucrative occupations to enter a field like nursing or teaching are doing so because they want to help others. Meaning is at least as important as money. They want to work for more than just a paycheck or a special space in the corporate parking lot.

And that is as it should be. Without idealism helping professionals become less caring and compassionate, and when that happens, the quality of life suffers.

The lay public has become increasingly critical of the professions, and research supports the growing belief that helping professionals too often lose their idealism and commitment (Sarason, 1985). For instance, Daniel Goleman of the New York Times reported on a study of 1,000 letters from dissatisfied patients at a large health maintenance organization in Michigan. More than 90 percent of the complaints arose from the way the medical staff communicated with patients. The most common complaint was that physicians “lacked compassion” (Goleman, 1991).

Nurses have also come under fire. When Truax, Altmann, and Millis (1974) assessed the degree of empathy communicated by various occupations, registered nurses scored lower than ten other groups. The only group they found to be less empathic was manufacturing plant supervisors. LaMonica, Carew, Winder, Haase, and Blanchard (1976), in a study of communication patterns, found that registered nurses on the average fell at the mid-point between “hurting another person” and “only partially responding to superficially expressed feelings” (p. 450). Nurses, like physicians, have not fared well in tests of caring and compassion.

Medical personnel aren’t the only ones found to be lacking in empathy. All of the helping professions have come under attack at one time or another for failing to provide the caring and compassion that the public expects. Teachers, school psychologists, and other educational personnel, for instance, have also been viewed as insensitive and intolerant (Turnbull & Turnbull, 1979). Many parents believe that professional educators care more about their paychecks and vacation time than about education.

A recent example was a news article reporting that many teachers are refusing to write letters of recommendation, tutor students, or perform other duties not specified in their contracts because they are angry about budget cuts and meager pay raises. One teacher quoted in the article admitted that he and his fellow professionals have put their idealism “on hold” and that the students are suffering. While the teachers’ grievances are often legitimate, “many students and parents do not sympathize with the teachers” (Celis, 1992, p. D2). One parent-teacher association president was quoted as saying, “We need teachers who are completely committed. I understand the teachers’ outrage. But their priority should be the kids” (Celis, 1992, p. D2).

In the case of lawyers, one need only consider popular lawyer jokes that depict lawyers as venal, insensitive, and self-serving. Mental health professionals are sometimes viewed as cold, analytical, and more eager to get their share of health insurance reimbursement than to do what is in the best interests of their clients. The public has become profoundly disappointed with all of the helping professions.

To some extent, the human service professions seem to fall short because the public expects more from them now than they did in the past. Gow (1982), for instance, argued that the ideal in nursing care has changed considerably in the last two decades. A caring and committed nurse was formerly “responsible, orderly, tidy, neat, prudent, industrious, disciplined, and sensible.” Now nurses are supposed to be “empathic, giving, and in tune with the emotional lives of their patients.” Standards for caring and compassion have risen. We expect more of helping professionals than ever before.³

Not all human service professionals are guilty of the insensitivity and callousness that has been cited in popular news articles and caricatured in crude jokes. In fact most professionals are probably sensitive and caring most of the time, but too often professionals treat patients and clients as illnesses or problems rather than as persons in distress.

The professions are gradually coming to recognize the seriousness of the problem. Medicine provides a good example: both the American Medical Association and the Association of American Medical Colleges report that significantly more attention is now being given to the issue of empathy in the curriculum (Belkin, 1992). Organizations that accredit medical schools and grant licenses now require that medical students be taught how to communicate with patients. The National Board of Medical Examiners plans to add a section on doctor-patient relations to the licensing exam as early as 1995. Caring and compassion are becoming mandatory.

In response to this increased pressure, many new training programs are being created. Mount Sinai Hospital, for instance, launched a $1 million training program for doctors in response to concerns that “today’s doctors are more adept with technology and jargon than with compassion” (Belkin, 1992, p. A1).

But how much does training influence professional practice later in the career? Becker, Hughes, and Strauss (1961) argued that medical school socializes students to be medical students, not physicians. They conjectured that once formal training is over and physicians start practicing, they are exposed to a completely different set of social forces that influence caring and compassion in unknown ways. Training may have little impact on later attitudes.

Subsequent research on how professionals’ attitudes change following training has tended to support Becker et al.’s cautions. For instance, Gray, Moody, and Newman (1965) studied physicians during the three years following graduation from medical school. They found that the new physicians became less cynical and more concerned about human welfare. There was also considerable variability: many physicians became more positive in their attitudes, but others didn’t. Situational factors, such as the types of settings in which the physicians practiced, seemed to strongly influence their attitudes following the completion of schooling.

Blackburn and Fox (1983) took an even longer time perspective. They studied the social values of physicians who were at different stages of their careers, and they found that humanism and idealism increased during the first part of the career (when the physicians were on average between 32 and 43 years old), then dropped during the next five-year period, and then steadily rose for the remainder of the career.

In other words professionals don’t emerge from their training as “finished products”—they continue to grow and change as they respond to the role pressures of practice. Their perspectives shift as they make the transition from student to practitioner, and, as Blackburn and Fox (1983) discovered, they may continue to change throughout their careers.⁴

A Tale of Two Studies

I first became interested in the plight of helping professionals— and the fate of their idealism—during my graduate school days. As part of my training in clinical and community psychology, I worked in high schools, community mental health programs, and other “human service” settings. I consulted with the staffs, helping them to better understand the psychological dynamics of their most troubling cases. As I got to know many of these helping professionals, I saw what it was like for them at work. It wasn’t easy.

Many of the people in these settings were novices, and they found it difficult making the transition from student to professional. New teachers, for instance, were overwhelmed with the realities of public schools. Actual teaching wasn’t what they had expected. They felt unprepared for the demands that they had to face daily, and as these new teachers tried to cope with these demands, their attitudes changed. Many went from being committed, idealistic helpers to exhausted, cynical functionaries who simply tried to make it through each day. They began to do things that they vowed they would never do.

There was no word at that time for what was happening to these professionals. Later it would be called “burnout.”

When I completed graduate school, I took a position in a new, experimental program struggling to survive in a hostile environment. I experienced the same stress that my professional “consultees” had encountered, and, like them, I began to lose some of my own enthusiasm and commitment during those difficult first years. But I did have one advantage: as a faculty member in a university that valued research, I could step back and study the process. That was when I began to study the work lives of human service professionals. I have been studying them ever since.

This book is based on two of those studies. The first study focused on the stresses and coping efforts of new professionals, those who had just completed their formal training. I wanted to see how much stress these novices experienced, what the sources of stress were, and how these fledgling professionals coped with it. I also wanted to learn more about how this coping influenced their attitudes and behavior.

I focused on human service professionals who worked in public institutions because these settings seemed to be playing an increasingly important role in society. More professionals were going to work for large organizations, and fewer were going into private practice. Also, professional values and organizational demands tend to clash in public institutions. I wanted to learn more about what happens when they do.

Other than focusing on public service settings, I wanted the study to be as broad as possible. Human service professionals in public service face common problems. I didn’t want to study just one field. I eventually included four different fields: high school teaching, mental health, public health nursing, and poverty law.

In any research project, there’s a trade-off when it comes to deciding how many subjects to include. If you have a large sample, you can be more confident that what you find is generally true and not just an anomaly. But you can’t study the people in as much depth. On the other hand, if you have a smaller sample, you can study each person more intensively, but you can’t be as sure that your findings are valid for those not studied.

I decided to study each individual in depth over a period of time. This meant that the sample couldn’t be a large one, yet I still wanted to make it as large as resources would permit. The sample eventually contained 26 professionals—six lawyers, seven high school teachers, six public health nurses, and seven mental health professionals.⁵ There were 17 women and nine men. (Two of the occupations— nursing and social work—have traditionally been made up primarily of women. Thus it is not surprising that women outnumbered men in the sample.) The participants were recent graduates of local training programs.

Most studies in the social sciences use structured interviews and questionnaires. I preferred unstructured interviews because I wanted to discover how these new professionals felt about their experiences and how they saw their worlds. I was afraid that if I tried to guess what was most important to them and then designed structured instruments for measuring it, I might lose some of the most interesting facets of the experience. Structured research methods often get in the way of a penetrating exploration of how people truly feel about their lives. It was important that our subjects be able to tell their own stories in a relaxed and supportive setting that encouraged candor.⁶

When we had completed the interviews, I was faced with the awesome task of interpreting the material we collected. I spent a year poring over thousands of pages of transcripts. At last I identified a small set of themes that best characterized what it was like to be a new professional in public service—what was most stressful, how people coped, and how their attitudes and behavior changed.

The first year of practice was extremely stressful for most professionals. As a result the professionals lost much of the idealism that they had when they began their careers. In the face of unfulfilled expectations and a multitude of misfortunes, most of the novices became less caring and committed. Many seemed to burn out, victims of their own idealism and of the nonsupportive institutions in which they worked. There were some notable exceptions, and they helped us to learn how professional burnout could be prevented, but in genera] the picture was one of unmitigated stress, strain, and disillusionment. (Chapter 2 contains a more detailed summary of the results of the initial study.)

The original study culminated with a book (Cherniss, 1980), and I thought that would be the end of it. I never planned to contact the participants again for any follow-up research. In fact I carefully destroyed information that could identify the subjects in order to protect their privacy.

Then, about a year after the book appeared, a reader asked me if I planned to go back and see what had happened to the professionals after their first year of practice. Initially I demurred. “I’m burned out on burnout,” I protested, only half in jest.

But the seed had been planted. The more I thought about it, the more intrigued I became with the idea. As the tenth anniversary of the first study approached, I decided to give it a try.⁷

There was, however, the problem of the destroyed records. How could I track down a group of highly mobile professionals when all I had was their first names and last initials, and the places where they had worked ten years before? It seemed hopeless, especially because colleagues who had done follow-up research warned me about how hard it was to track down subjects even when a wealth of identifying information was available. I had been trained as a psychologist, not a private detective.

Fortunately, my original interviewers turned out to be pack rats. We discovered that we still had our daily appointment books from ten years before tucked away safely in our attics, and in those books we found the last name of every subject. I had been less diligent in destroying identifying information than i thought!

Tracking down the subjects still proved difficult, I initially contacted the agencies where they had worked. Most had left years before, but sometimes there was a person who remembered the subject and could give me a current address or phone number. I found other subjects through university alumni offices or professional directories, but in a few cases I had to try numerous leads before I finally found them.

A former colleague of one subject, for instance, remembered that she had moved to another city. He also remembered that her husband was a physician, an...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgments
• Part One Setting the Stage
• 1 Introduction
• 2 The First Year “Thought I’d Died and Gone to Hell”
• 3 From Stress to Burnout
• Part Two The Next Decade
• 4 The Flight from Public Service
• 5 More Compassion—For Those Who Deserve It
• 6 More Open to Change—On Their Terms
• 7 Why Work? Shifting Priorities
• 8 Fulfillment and Regret
• Part Three How Some Overcame Burnout
• 9 Five Who Prevailed
• 10 Antidotes to Burnout Finding Meaningful Work
• 11 Antidotes to Burnout Finding Greater Professional Autonomy and Support
• 12 Antidotes to Burnout What the Individual Brings to the Work
• 13 Some Implications for Policy and Practice
• 14 What’s Missing? The Quest for Meaning
• Appendix
• Notes
• Bibliography
• Index