Almost every day, I feel pressured to override my own limits in the name of care. I care for a child, a home, a small business, keynote audiences, a work team, coaching clients, friends, mentees, pets, backyard birds, flowers, and many other people and things. Every day presents more for me to do than can be done. Most nights when I lay my head on the pillow, I feel both proud of all the caring I did and worried that it wasn’t enough. It never feels like enough.
When Care Feels Like A Trap
My friends in healthcare fields say they experience a much more intense version of this same feeling—the feeling of “I’ve done all I can today, but it doesn’t feel like enough.” Staffing and retention remain big problems in healthcare, which puts immense pressure on every clinician, every shift, to do all they can – and always more.
Recently, I asked my friend Dr. Kim Diminio, a senior nurse scientist (and experienced nurse clinician) at Hackensack Meridian Health Network in New Jersey: “Kim, how often would you say nurses stay past their official shift end-time versus stay to work longer?”
“Short answer: it’s about 50/50,” she said. (Then she sent me a bunch of research – she’s beautifully nerdy like that.)
So, about half the time, nurses are staying to work overtime. Sometimes the overtime is required; this is known as “mandatory overtime”, and it’s significantly tied to nurse intention to leave the profession.*[1]
But when overtime is not mandatory, why do clinicians stay? Who benefits when they do?
Why People Sacrifice (Even When It Hurts)
I think the answer to this question is more complicated than it would first seem. On the surface, the answer seems obvious: “No one! Nobody benefits from overworked, exhausted, unwell healthcare clinicians – not patients, not co-workers, and certainly not the clinicians themselves.”
On one level, that’s absolutely true. Heavy workloads fuel the fire of staff retention problems—namely, burnout.* To stop this vicious cycle of overwork-burnout-turnover, what’s needed is better boundaries with work cultures that normalize clocking out at the close of your shift. There’s deep truth to that statement, and I stand behind it.
Here’s the thing, though.
People don’t generally sacrifice themselves when they perceive no personal benefit. Clinicians who regularly choose overtime even though it’s burning them out must perceive some value in it. What is that value?
My hunch is that it has to do with inward needs—all of them eminently legitimate, eminently human (even if getting twisted by unhealthy systems, and/or met in unideal ways).
· The need to belong: Medical culture teaches clinicians to “normalize self-sacrifice,” as one physician recently told The New York Times. If everyone else is doing it and you aren’t, it’s easy to feel like “an outsider,” “not a good team player,” or worse. Everyone needs to belong.
· The need for self-validation: Many medical professionals find deep meaning, purpose, and significance in being a helper and a caregiver. If the belief, “I am someone who serves and sacrifices for others” is core to your identity, then ending your shift on time to exercise boundaries and self-care can feel like a betrayal of who you are. Everyone needs self-validation.
· The need for protection: Moral injury is a daily wound for many healthcare clinicians. When you know what a patient most needs, but are prevented from providing it, you suffer psychic damage. Staying past your shift might be a way to alleviate the moral injury of heading home when there’s a patient whose condition may worsen due to your leaving right now. Everyone needs internal integrity; everyone needs protection from moral harm.
Those are valid needs – each and every one. Effective burnout prevention and intervention must start by compassionately recognizing that validity.
Let me put it this way. If you’re a nurse struggling with burnout, will it help you to feel even worse about yourself for regularly choosing to override your limits? Of course not! What will help is when you realize you regularly make that choice because it usually feels like the “least bad” option, given your context. I mean, if it comes down to sacrificing a bit more sleep and sanity versus sacrificing your self-respect and moral integrity, it makes sense why you’d choose the former and put in the overtime. Even if it’s not sustainable. Even if it’s ruining your health. Even if you’re well aware that, en masse, individuals’ choices to push past limits is exacerbating the problem of burnout in healthcare. You’re just doing your best, in the situation you’re in, with the variables that are there.
Isn’t that a kinder, gentler, more honest and human place to start?
Addressing burnout in healthcare and service-oriented fields must go beyond the blithe command, “You need better boundaries! Clock out on time! Prioritize self-care!” I’m not saying those are untrue messages. But they are step 3 or 4, not step 1, of learning a better, more self-compassionate way of caring, working, and leading in a burnout-inducing system.
The Question That Comes First
Where we begin is by kindly, non-judgmentally, and honestly asking, “What legitimate human needs are driving self-sacrificial behaviors that, over time, undercut your wellness?”
Once you see the need (e.g., the need for belonging), you can normalize and empathize with yourself. As in: “Of course I want to belong – everyone does!”
Then you can ask what the limiting beliefs under the surface are. As in: “Oh wow, I really do believe that, to deserve professional respect and belonging, I must eschew personal boundaries.”
And then, finally, you can critically examine the extent to which that need-driven belief is serving you (and others), and whether you might want to gently begin to shift it toward something different. As in: “Healthy belonging in my professional community rides on my ability to guard the things that enable me to show up well – like sleep and time with my family.”
Leading yourself and others with compassion in a burnout-inducing context should not involve lectures about boundaries, especially when the right questions haven’t yet been asked. So ask the right questions – gently, and with compassionate openness to the honest answers. See if they don’t move the needle a bit more effectively in the direction of lasting wellness and real sustainability.
