Episode #15 Preventing Provider Burnout
If you have been listening to this podcast regularly, you know that the focus is on the interventions you can put into practice to improve patient outcomes and overall health with lifestyle modifications. But what about you? what about the provider?
What intervention can I offer to improve your overall health and well-being?
I definitely want to continue with additional podcasts that will assist you in your everyday practice. The practice of offering a different approach to managing chronic illness and hopefully preventing chronic illness through health interventions of lifestyle management, including nutrition, activity and stress reduction, as well as supporting relationships both personal and spiritual for complete overall well-being. I however do not want to forget that I also want to support the Practitioner as a person too.
When I say that I want to continue to support our profession, I want to be able to weave into the health interventions for our patient, the health interventions for ourselves. I have been in this profession for very long time. I became a registered nurse in 1997, after being a nursing assistant for several years. I have worked in the acute care setting of an emergency department, I have worked on a telemetry unit, dabbled in home health and worked in a neurology practice. Over this time, I have seen many things change in the way that we deliver care. I have seen it from multiple views with this history of mine that lead up to my advance practice role.
As a Nurse Practitioner I have worked for someone else to steady myself in the advanced level and have since moved on to open a few practices of my own. I can honestly say, that having my own practices has been the most fulfilling and rewarding part of my entire career. There's something to be said about making your own decisions and practicing in your own way without being dictated how to practice by someone else. With that being said, it has also been the most challenging part of my career. I had no way of knowing when I started this that it would soon become the pharmaceutical and insurance companies that dictated the way that I practice. I have been able to creatively find ways around some of that by learning the system of course and how to obtain prior authorizations for things, but it is still a lot of work. Is still beyond frustrating to have to justify everything you want to do for the patient through someone else before you can get it done. Most often these authorizations want to see tons of notes and want to go through a bunch of hoops that aren't really necessary to get to the end point. At least in my opinion. It is such a pain. They waste more time, money and energy in this process then they would have spent trusting the judgment of the provider that has been working with patients. And might I mention that all of this is for lower reimbursements rates to the provider for doing all that work.
Let's put money aside. Let's not talk about the reimbursement rates because many of you may not deal with reimbursement rates but know that you're working very long hours because you're doing it for humanity. You are doing it to make a difference. You were doing it because you want to help people. You're healing the sick, improving psychological wellness, preventing future illnesses and complications of poorly managed disease processes.
So why aren't you happy? If you're doing what you set out to do weren't you happy? That is assuming you have reached the point of burnout. Or the fear that you're going to become burned-out.
We unfortunately are almost an abused profession. We are taking one for the team from all sides. We have to fight with the insurance companies, we have to fight with pharmaceutical companies, we are the middleman when the patient isn't getting their test done in a timely fashion, whether it’s a prior authorization or scheduling hold up. If the pharmacy didn't fill the prescription on time, if electronic health record didn't complete the transaction of sending the prescription. If the cost of the medication is more than they can afford, that's your fault too. We're the ones in the middle trying to fix and coordinate all of these aspects of healthcare. It isn't the part of sitting listening to the patient making recommendations, educating the patient and initiating the plan of care. It's a part of the fight that I just mentioned and then the endless amounts of documentation required to justify evaluation and management codes submitted to the insurance company reimbursement.
If you have ever done your own billing and coding and had to modified claims to get them paid you know that this is even more infuriating. The insurance company can decide to not pay you because they no longer like the code that you submitted that used to be the code that got something approved. So, you saw the patient, you did the work and you did not get reimbursed. You can fix the codes but if you haven't done so within six months for many insurance companies you don't get paid at all. And when you're starting your own practice, if you have decided to start your own practice and accept insurance, you are probably trying to be cost-effective and manage much of this yourself. So, you're very aware of what is happening here. But apparently outcomes-based reimbursement is supposed to solve many of these problems, right? We will see. Now I feel like we are just in the role of tattling on our patients and spending a countless amount of time aside from seeing the patient giving insurance companies all the right data that they want input into their system in hopes of getting reimbursed for the service that we provided.
This sounds a little bit negative now doesn’t it? I promise you that no matter how disheartening this must sound so far, I have a purpose. My goal is to address many of these things that you are experiencing in your practice. Control some of these factors and how to prevent burnout. So that you may hopefully embrace the profession and the love for what you do as you continue to make a difference.
Not all in this episode, but as we progress!!
It is well documented that the healthcare profession, particularly nurses, tend to put themselves on the back burner for others. We are caretakers. We feel that we are obligated to take care of everything that comes our way, even if it is at the expense of our own needs.
This is definitely going to lead to burn out. Trust me, I have been there. Sometimes I am still in that phase but have to talk myself through the reasons I need to take care of me as well. Honestly, I always feel that I am being selfish if I take off time. I feel that I'm selfish if I don't answer every message from every patient. For several years I never took a day off. Not one day. I would see patients all week and do extra work and charting on weekends. Many times, I'm still guilty of combining vacation with a conference. Or actually I should say calling the conference my vacation. When saying that I am taking off for something that is going to better the outcomes of my patients rather than saying I am taking a vacation because I need to rejuvenate and recharge, I feel less guilty. Everything in my life was consumed by being available for whatever may occur. Because everyone depended on me, right? Something terrible would happen if I wasn't there right? I've committed myself to these patients, right? They won't understand right?
Guess what I found out....
My patients understand that I sometimes need a break. They understand that I too need vacation and a day off.
When I open up and allow myself to be human, I get much needed, honest feedback. I get lectured about my own health by them!! And of course, you know which ones you're able to speak a little more freely with and let down some of your professional guard to say you feel guilty if you take off. My loyal, and there are many loyal, patients know that I give them 200% of myself. They know that if they need me, I am there. I will go above and beyond. I will move Heaven and Earth if I need to get them what they need. And in return they will take a little inconvenience, if necessary, and wait for me to come back from a vacation.
I'm learning that is a give-and-take relationship. If I am not well, and I am burnt out, the day may come that I don't go the extra mile. The day may come that I don't listen that extra two minutes to them because I've lost the joy of what I do and I'm just going through motions.
What happens when I miss something important because of that? I'm not willing to take that chance anymore. And I say anymore, because I have been there. And I have seen myself losing the love for my profession and not being present, but thanks to some amazing people in my life, including staff and patients, I was pulled out from the dark side!
I now try to be very aware of my own sleep, nutrition, exercise and self-care. I am never going to change my workaholic personality, but I am better able to manage it. Awareness is an important key to success. Whether that success is in self-care and self-management or any other aspect of your life.
How often have you given the same advice to your patients? How often have you told them that they are no good to anyone if they are unable to be there for someone because of a decline in their own health.
My challenge to you is to start with a little self-care. Start with being aware of yourself and your own needs. Ask yourself if you need a break? And take that break. Don’t take your charting on that break. Even if your break is a three-day weekend. Do a little self-analysis and a little time to breathe.
I will be continuing a little more on this topic of self-care and managing the work overload in the next episode. I had to break this up a little bit into a two-parter. In the next part I’m going to share an encounter that I had with the significant other of a nurse practitioner. You won’t want to miss this one. Because after learning how to take care of yourself a little bit in this episode, do some self and flexion, I’m going to give you some insight into the perspective of the ones you love.
Have a great week! May it be filled with many Health Interventions!
LET ME KNOW HOW YOU PLAN TO DO SOME SELF CARE!
Now, if you have been on the fence about the Weight Management Course or want to know more… Click Below.