To ask NHS or other pubsecs for your stories of first steps to recovery from burnout...

[Pipsinjam]

Warning, there may be drip feeding as my thoughts are a bit ragged. I am an NHS emergency consultant and I am pretty sure I have hit the wall of burnout. I am clinical lead for my department and have been determined to improve things but we have had 3 years of endless ill considered target-focussed top down changes imposed by senior management who don't understand or care about the service or the team, and we have seen a steady but unarguable deterioration in our performance.
Our own ideas have been overruled and ignored. We are now such a wounded depressed disenfranchised team, it breaks my heart. We have lost 3 consultant colleagues to stress and 5 more are considering leaving. I am a pretty positive resilient type of person and I really think I have tried to maximise the postives and deflect the worst of the negatives and look after the team but all of a sudden I have just run out of juice. I am still mostly enjoying and doing ok in my clinical work, but I literally cannot bear to go into one more pathway mapping, finance improving, process reviewing meeting with my middle managers who allow us zero autonomy but performance manage us against arbitrary performance targets dreamt up in a service improvement room in corporate HQ. Based on data which is out of date and miscoded.
Sample convo "We expect you to put x patients on this pathway, why have you not done so?" "Hang on a minute, where did you get x from?" " Its the number we need to make the bed flow work" "Er, well for the last 5 years clinical data shows only y patients needed the pathway". "Well relax your exclusion criteria". "Um, they are there to exclude people from the pathway who won't benefit or won't be safe." "Well, you will just have to find others"...etc
I am so sad about the wasted time, and tax payers money, the wasted efforts, the lack of care, especially when we could have been taking forwards some really exciting bottom up changes and getting stuff done. We have made some great changes before but have not been trusted or included in any of the recent strategy.
I have had a small personal health scare today and if things dont settle I may need some investigation to exclude cancer. And my first thought is "Oh thank God. Some time off work" and that has rung a warning bell for me. Pretty loudly.
Anyway, the question is to those who have reached burnout in similar scenarios, is there anyway through? What is the way through? I feel such a strong sense of duty and desire to do better for our people and our patients but I just do not think I can fight one more battle. Personal cost is so so high. I think I an going to have to make a major change. But I am so tired I am not sure I can even begin to consider how to do it.
Hope this makes some sense?!

This is heart-breaking and so angering to read. Afraid I can’t help, OP, but I appreciate you sharing your insight. I don’t think many people realise the grinding reality that still exists at consultant level.
You sound amazing, I hope you find a way through to a more manageable life.

OP we do pretty much the same role. I had to walk away for a year, it broke me.

As bad as it sounds, I don’t see things improving in the NHS. I wish there was a solution but there isn’t. For me the wake up call came when my 8 year old was asked what she wants to do when she grows up and she replied- “not sure but I will never work for the NHS”. I had no idea that my work stress was recognisable by my young kids.
You need to prioritise your well being OP. If it means cutting down your hours then so be it. If the trust is not prepared to take on board your suggestions, then let them bring their own to do the work. There is only so much you can do.
Wishing you well xx

Thank you people for taking the time to read such a long! brain dump and being so lovely. I didn't realise I had had quite such a ramble. Not sure what I will do next but I recognise the stress aware children and I keep vowing I will take more time to have quality time with them, be less exhausted, cook better, play more, listen more etc but that's another thing that's just not getting better. I was actually nearly in tears with the kind feedback which I suppose just goes to show how I currently feel my worth is valued.
I honestly think our boss feels that us "moaning" clinical staff just get in the way and that the problems with their pathways are that the clinical staff are being negative...

i’m in a similar situation (in industry though). I just stopped caring, it makes life a lot easier. if they want diseaster, i just make sure i document who exactly asked for it, log my thoughts, and then just get on with it. i moved into a role where the worst thing that can happen is a launch going wrong (no injuries etc), so i don’t care. work is there to pay the mortgage, its not something i’m passionate about anymore. there’s non point, so i get my successes somewhere else

In 3-5 years i will change jobs to something less well paid, but where i actually care. the next 3-5 years, i’ll just do what is required, but nothing more

I’ve just stopped caring. I used to want to try and improve things or do things better. Now, I just turn up to work, do as I’m told, get paid and go home. I work in the NHS. The constant circus from management is exhausting.

I left a full time leadership + clinical role and took a much lower paid part time just clinical role. I could not have carried on another 6 months in my job before I was broken beyond repair. It's still stressfull and I would love to leave completely because it's still working against unachievable NHS targets/expectations in a decimated service but I am no longer personally responsible for those targets, and can walk away with a shred of self left at the end of the day.

Some trusts and some departments differ OP- depends on your geography, but is a different trust an option? Otherwise agree maybe dropping to PT clinical, and maybe look for a teaching or research PT role alongside?

I could cry reading this. . What morons are behind this sort of NHS fuckwittery ?

I'm not in the NHS myself but my husband is a consultant. He broke his wrist recently, best thing he could have done, he was an absolutely different person for those few weeks off.

All I can say is don't beat yourself up, you do a brilliant job even if the managers are twats. You make such a difference and I bet your kids are very proud of you.

I was in a similar role to you OP.
Out of hours patients were triaged as either emergency , urgent or routine .

They had targets for each category. I still have no clue why.
The targets for emergency I recall was 4%
I used to argue with the managers that this made no sense.

My advice ? Develop a thick skin.
You are a senior clinician. Stand up to them. Refuse to go along with their pointless schemes. We need more people like you to do this.
Concentrate on patient care and staff morale.

TELL the managers you are doing so. What can they do ?
You might be unpopular with the managers but patients and staff will love you.

And read Henry Marsh’s latest bio. He has stuff to say on this

Henry Marsh - Admissions

I’ll say it again.

PLEASE STAND UP TO THEM

I feel for you I really do. I was a senior nurse, I burned out pretty spectacularly and had 6 months off work, couldn't go back so went off to train as a podiatrist which is far less stressful and same money but I've never recovered.
I'm just trudging through my last 10 years of work just trying to get through the days.
My spark and drive has gone. I just don't care any more and zone out most of the time.
My GP felt much the same and has gone to live in Australia.
When this happens you need a change urgently, don't ignore it.

Hi , I've worked in A&E for 17 yrs as a nurse, the last 9 of which were as a senior sister, I could echo your post.

The speciality I fell in love with nearly broke me. I loved the challenges, the detective work involved with a really sick pt in resus, the constant changing pace of work. I even loved the busyness (when there is downstream capacity). The evolution of "corridor medicine" (what a horrible but scarily accurate phrase), the pressures associated with exit block when the never ending demands outstrip what my amazing team could provide. Watching care suffer because there just aren't enough clinicians to attend to everyone at the same time.
The constant changes imposed from above by non clinical managers is just crazy - I've been around long enough to see the same ideas cycled through a few times
It got to the point where I couldn't cope, the pressures were impossible but never ending and it broke me.
I was lucky, I was able to train as an ENP, I now work (within an ED) seeing the minors patients (showing my age there). It has enabled me to provide a high level of clinical care whilst not sacrificing my mental health

People like you have saved my life on three separate occasions and loved ones lives on other occasions. They might not realise how bloody wonderful you and your colleagues are, but we do. And we are so, so grateful.

Illness can make you take stock/ make changes. I hope you are ok.

What are your realistic options? Reducing your standards/ self expectations?
Demotion? Different department? Go off sick? Reduce your hours? Medical sales? Other job? Downsize? A combination of any of these?

I left frontline medicine and switched my specialty to something a bit less hands on. It was an instant improvement in mental health, I was borderline depressed and so burnt out, I was so cynical and hated everyone I spoke to. Now life is better but it will be even better when I fuck off abroad after I CCT.

I got out. I was a Senior Nurse so different circumstances to you, OP but much of what you've said resonates.

I wasn't sleeping. My days off didn't feel like days off because I spent them worrying about work. I was snapping at DH and the kids. I lost weight. I kept thinking "what's wrong with me?" Then it hit me as I was sitting in yet another soul-destroyingly pointless meeting with senior management, looking around the room at all my lovely colleagues I realised that every single one of them looked unhappy, exhausted and just utterly ground down by it all. I realised it wasn't me, it was the job.

I tried moving departments, tried out different roles within the NHS and some I enjoyed for a time, the clinical side of things anyway. But it made no difference in the long term. I tried meditation, exercise, all the usual stuff people tell you to do when you're stressed. I went part-time but spent my days off thinking about work and dreading going back so may as well have been there full time.

That thing some posters have said about "not caring" making it easier. Ghat's what I was afraid of. In the end, that's why I left the profession because I was afraid that if I carried on the only way I would be able to cope was to detach myself completely and not give a shit. But people deserve to be treated by a Nurse who gives a shit and I couldn't resign myself to spending the next 25+ years in a job I didn't give a shit about. Not when I used to love it so much and be so proud to do it. So I left, and I wouldn't tell anyone else to do the same as it's such a personal thing but it was definitely the right decision for me.

There was an excellent piece on radio four today with Adam Kay about this very subject; it's well worth a listen.

Thank you for what you do; there's a reason we call it front line medicine- you really are fighting an endless war.

Please remember that you can walk away. You've got transferable skills, and there is more to life than this. I think when you're in the thick of it, you can't see a way out because you've no time to reflect. I read today that another junior doctor took their own life this week and it makes me so sad that we take these naive 18yos and feeds them into a system that will destroy the mental health of so many. I know doctors don't like admitting they're in trouble, but I really think from what you're saying that you need to take an extended period of time off and work out what you need to change.

Different role/level, but can empathize re the burnout part. Its a very weird realisation when you're used to dealing with things that you know other people wouldn't cope with, and all of a sudden you just... Can't. Its like a switch has been flipped.
On the path to burnout, I worked at caring less - developing a thick skin for criticism of things not done, because the reason they weren't done is it was because my workload had no basis in reality, it wasn't possible to do half my work in my contracted hours - so I stopped trying to catch up.

IF you have a supportive work environment I do think burnout can be managed through personal resilience - self care/time with family/exercise etc. However if it's not a supportive system, then no amount of working on yourself while staying in the same job will be enough. My advice would be, if you can afford to do it, is to take a job in a less stressful role for a year. Something with more regular hours and reasonable targets. Something that will give you your headspace back. Your current employer isn't going anywhere, you're highly skilled, you can always go back to it.
I want to stay in my profession for the next twenty years, I genuinely think they only way I'll be able to do it is to take a break from it every five years or so.

Its such a shame that NHS pushes its workforce to this point, I do hope you find a way through it.

Please keep shouting
The very idea that the stress comes
From non clinical managers imposing stupid targets on medical staff is so crazy and insane I actually could weep

We taxpayers are paying for inefficient middle
Managers that waste time and cause re work
And - your stress is understandable
In the short term
You need a break either
Some leave or something to
Clear your head

Then you can decide what to do

But this breaks
My heart to read this and I think it has
To change