Medium.com, Published June 28, 2024
Dr. Amber Kool discusses minimizing medical burnout with Jake Frankel.
Written by Authority Magazine Editorial Staff.
Set manageable nursing hours as much as possible: Working 12-hour shifts (that often turn into 14-or-more-hour shifts) three days in a row is not sustainable for anyone. It’s a fast track to burnout. Staff scheduling should avoid putting individuals in situations that are beyond anyone’s capability to manage.
The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example)
What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Dr. Amber Kool.
Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
We were one of those families that moved around a lot — I grew up back and forth between California, North Carolina, and beyond. I was a typical teenager and had no idea what direction I wanted to take with my career. I had a bubbly personality and sometimes was perceived as a silly teenage girl. That motivated me, as I wanted to prove that notion wrong. If someone told me I couldn’t do something, that would make me want to do it more.
As a high school senior, I had my first professional job working as an HR business manager while finishing up school. Later, I became an esthetician, which is how I eventually found my way into nursing.
What or who inspired you to pursue your career? We’d love to hear the story.
I started out in skincare and aesthetics and thought that was going to be my career. Nursing presented a pathway into plastic surgery cosmetology. However, during my clinical rotations, I ended up in oncology, working with patients with incredible pain and acute needs.
I remember one patient vividly that had a tremendous impact on me. She came from a lower socioeconomic background and never received diagnostic healthcare. By the time she was in the hospital, she had very advanced symptoms of cancer. I remember sitting by her bedside and talking with her for most of my shift. I couldn’t do anything to heal her medically, but she expressed her gratitude to having someone with her. It was at that moment I changed course.
I had come into nursing thinking I’d go into the cosmetic field, but this patient made me realize what it means to help other people, provide a safe space for them, and help them feel cared for and seen. That is the art of nursing, and the art of nursing is often more important than the science of nursing. I fell in love with that work.
After graduation, I worked in the neonatal intensive care unit for four years. I wanted to teach, earned my master’s degree, and joined Arizona College of Nursing as a part-time adjunct. It was at the beginning when the college had one campus and a handful of students. I continued to work as a clinical nurse before joining as faculty full-time.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
As Associate Provost at Arizona College of Nursing, I oversee all areas of our work concerning our students and their learning. We ensure that we meet students where they are, respond to how they learn, and equip our faculty to offer them support inside the classroom, as well as implementing campus services to support them outside the classroom.
One of the things I am most excited about now is the use of simulation to enhance student learning. Clinical rotations and direct learning are important, but those can be observation-heavy and what students see varies. We want students to learn in a fully realistic environment. We have simulation labs on all campuses that mimic different clinical settings, like hospitals and home care, and allow students to practice their skills on very advanced mannequins that mimic real physiological responses. Compared to how nurses learned their practical skills in the past, there’s just no comparison. Expanding and deepening these opportunities for students is a huge focus.
Additionally, we’re strengthening and expanding our curriculum’s focus on stress management, self-care, work-life balance, and other practical elements of being a nurse that are often left out. When you think about training the next generation of nurses and beating burnout, there’s really no excuse for not bringing that into our curriculum. We want students to be ready for practice and the workplace, which includes teaching them how to manage stress and stay on top of burnout.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
- Perseverance. I’ve never taken ‘no’ as an answer. I’m a problem-solution person and I train my teams to always come back to me with proposed solutions. “It can’t be done” is not an option. This is my approach to all things in my life.
- Respect for other people’s experiences. We often take this for granted. While I might be an expert in academics or nursing, or another piece of a puzzle, I respect the perspectives and experiences others bring to the table and try to bring those out as we work together to find the best solution possible.
- I talk a lot about this with nursing students. When you’re a student, you tend to say, “I don’t know anything.” But we all bring experiences to this field that help us. Maybe they were a medical assistant, or an EMT, or a teacher, or they’re a parent. You might not know how to be an RN yet, but you know how to do all these other things. We try to help students hone their previous experiences for growth in nursing.
- Passion. I wouldn’t have lasted nursing school or as a bedside nurse if I wasn’t passionate. Passion is what drives me. As I moved into a leadership role, it translated — I’m passionate about growing nursing students, leading our faculty, and everything we do. Passion drives learning, so I spend my life trying to hold onto that passion for what I’m doing.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
I define burnout as complacency — when you’re so exhausted that you just stop caring. When someone stops caring, you’ve lost them.
Poor job satisfaction can be a part of it, but you could love what you do and still hit a breaking point where you just can’t do it anymore.
The best analogy I have is thinking about a relationship. Maybe you’re having disagreements or arguments, and it doesn’t feel good. But arguing isn’t necessarily a bad sign — you both care, and you’re trying. It’s when you stop fighting, stop having an opinion, stop caring. Then, it’s really over. That’s burnout.
How would you define or describe the opposite of burnout?
The opposite of burnout is passion! You might be tired or overworked or struggling, but if you have passion, it will carry you through. Someone who brings passion to the job is always looking to improve, driving best practices, coming to the table with new ideas, supporting colleagues, and taking the weight off those around them.
From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?
Burnout in healthcare is a vicious cycle. Even before the pandemic there was a shortage of healthcare workers; we did not have enough resources or time to adequately support the number of patients. We knew more than ten years ago that we were going to have a shortage of healthcare workers, and that was partly because we had a significant number of baby boomer-aged nursing staff who were going to retire.
When you’re short of staff, the burden on existing staff is increased. You have people who burn out from the workload, and when they leave, it gets tougher for everyone else. The pandemic coinciding with that only made it worse.
Now that we’ve been through that and seen how it impacted our healthcare workers and the system as a whole, we have an opportunity to change things for the better. We made it through, but we have to learn those lessons.
Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?
I’ve seen burnout in nursing, and I’ve seen burnout among students. Nursing can be a stressful profession, and a nursing degree is not an easy course of study! As educators, we have a role to play in stopping that from happening by providing support, mentorship, and individualized learning opportunities.
Those of us training the next generation of healthcare workers have to change how we think about preparing our students. They need to be prepared to deal with loss, stress, tough decisions, and to avoid burning out. That’s what being truly prepared for nursing means.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
Often, educators wait for students to seek them out or ask them for help. We take a proactive approach, pairing each of our students with a success coach and having early conversations about potential roadblocks to their success. Frequent check-ins and candid conversations build trust and help us identify risk factors and potential issues before they begin to impact the students and cause them to really fall behind.
If students are struggling, we work with them proactively to identify community resources and get them the support they need. That could be access to mental health services, help with childcare, transportation resources, or other services that help people manage their health or their life and ensure they can stay on track with their education at the same time.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
From my own experience and conversations with our clinical partners, there are certainly benefits to reducing administrative burdens through new technology. If we can find those efficiencies by using automation to narrow redundancies and time-consuming administrative work, that increases flexibility and time with patients for workers.
What we can’t do is take away the human touch. I spoke before about the art of nursing; there is a human side to what patients need. That’s why most of us become nurses.
Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout? (Please share a story or example for each.)
- Consideration of support roles: Hospitals and practices must remember nurses, operations, and administrative roles are critical to supporting a functioning healthcare environment. Support roles impact every area of healthcare, from patient care to equipment maintenance. Ultimately, the support roles help everyone cope with shortages.
- Partnering with nursing programs: There must be relationships of mutual support between clinical partners and nursing programs. Addressing shortages and breaking the cycle of burnout requires training new skilled nurses. Engaging with us helps us properly prepare new nurses to be ready for clinical practice. Working together, we can also help students manage the transition into the workplace in a way that doesn’t contribute to stress and lead to “first year burnout.”
- Set clear minimum staffing ratios: Staff-to-patient ratios need to be set at a manageable level. It’s right for patients, and it’s right for workers who are trying to provide the best patient care.
- Set manageable nursing hours as much as possible: Working 12-hour shifts (that often turn into 14-or-more-hour shifts) three days in a row is not sustainable for anyone. It’s a fast track to burnout. Staff scheduling should avoid putting individuals in situations that are beyond anyone’s capability to manage.
- Leverage technology: Whether it’s administrative burdens, scheduling, or communication, there is an opportunity for technology to take some of the stress off healthcare work. Whatever we can do to ease that burden on individuals, the better.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
Helping someone recognize they are burning out is one of the most helpful things you could do. There is a lot of talk about burnout, but many people who have never experienced it before have trouble recognizing it’s happening to them. Asking someone whether they feel a loss of interest or passion for their work, whether they feel they’re on a path to not being able to do the job anymore, those kinds of specific questions can help them recognize what’s happening and take steps to stop it.
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
People try to solve the problem themselves, without asking for help. They try to change their attitude or just pretend they’re excited and think they can beat back the feeling of burnout.
Ultimately if you are burning out, something needs to change in your environment. Reach out to colleagues, a trusted mentor, your managers, or supervisors, and tell them that you are feeling in danger of burning out at work. Bring specific examples and reasons why this is occurring. Ask for help, new resources, or a schedule change, in order to reduce the burden on you. It’s not selfish to do this — you’re reclaiming the space you need to keep doing your job.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
When I was a nurse in the NICU, we had a specific process for asking for a feeding tube for a patient. Early on, I had a patient who I believed needed one based on this process, and I called the doctor to request an order for a feeding tube.
Without hesitation, he looked at me and asked why the baby needed it. I gave my rationale based on the process I was told to follow. He said, “That’s not good enough. Why do you think this baby needs a feeding tube?” He proceeded to tell me that in my role, I needed to be a critical thinker and give my own clinical and medical recommendation and judgment. He said, “If that’s not following the ‘process,’ so be it.”
That conversation made me realize I was responsible for my patients, and the importance of honing my own clinical judgment and speaking my mind. Nursing is not taking orders and following processes; you are an integral part of a patient’s care team. The doctors, specialists, and ultimately patients rely on you and your training to help make the best care decisions for them.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
“I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.” — Clara Barton
I appreciate this quote and the meaning behind it as it highlights that we get to impact change. We should not make decisions or changes from a reactive place, but we should also not simply accept the status quo. Live from a place of improvement and critical thought.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
I want to inspire a million people to become nurses. Or more! The nursing workforce is the largest healthcare workforce in the country with more than 4.5 million RNs working today, and there still aren’t enough of us to meet today’s healthcare needs, let alone the future. Nurses are integral to quality healthcare, and nursing is a fulfilling, rewarding profession that’s in demand everywhere. It’s not just a calling, it’s a great career. Patients, and the healthcare system that we all rely on, would be immeasurably better off with more nurses.
How can our readers further follow your work online?
Arizona College of Nursing has a great blog featuring more thoughts on nursing, education, and the future of healthcare from us — including amazing perspectives from across our faculty, students, and leadership. Follow us here!
This was truly meaningful! Thank you so much for your time and for sharing your expertise!