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Stress and burnout

Stress and burnout

How to spot the signs

In this article, you will learn how to tell the difference between being stressed and burnout, why it is important to notice this in yourself or your colleagues and what steps you can take to reduce the risk of stress and burnout for yourself and others.   

Stress is the impact of there being ‘too much’. Too many demands, too many changes, too much to do and too many decisions to make. Chronic stress has the potential of depleting your energy, undermining your belief in your own abilities and efficacy, and can lead to burnout. 

Burnout, on the other hand is feeling there is just ‘not enough’.  Not enough time, energy, enthusiasm, ability and not enough inner resource. It is commonly described as ‘being emotionally drained’, ‘feeling empty’ or ‘just not being able to be myself anymore’. 

In May 2019 the World Health Organization defined burnout specifically as ‘energy depletion, or exhaustion, increased mental distance from job, negativism or cynicism and reduced professional efficacy’. These three key terms, which describe an occupational not medical condition, are important as they give us some clarity about whether what we are noticing in ourselves or in our colleagues needs urgent action and what we can do. 

Here we provide clarification and guidance on what changes to look out for. 

  1. Energy depletion, being exhausted and drained of emotional resources, overwhelmingly tired and chronically fatigued. Colleagues may lack any enthusiasm and motivation. 

This doesn’t necessarily mean they will stop working, in fact research shows that burnout can be evidenced by absenteeism but also presenteeism and workaholism. The staff member maybe in a vicious cycle, trying to improve their professional efficacy but unable to do it. In fact, up to a third of people studied displayed vigor and exhaustion.  

  1. Cynicism and distancing themselves from work. Showing or expressing cynicism and negative attitudes towards their work or the working environment in general. This may be accompanied by frustration, avoidance, distraction, and disengagement. Burnout is the opposite of engagement. They may be in denial about their situation or be reluctant to accept any plans that can improve it.  
  1. noticeable loss of professional efficacy, competence, and productivity and in some cases viewing their own past and present accomplishments negatively. They may also be blaming themselves unduly. 

Factors that might increase the risk of effects of stress and thus potentially burnout:  

  • The higher the level of stress experienced and the longer the person is stressed the greater the risk of burnout. 
  • Individuals who are not emotionally self-sufficient and engage in avoidance coping strategies such as denial, disengagement, or substance misuse are at greater risk.  
  • Individuals with higher levels of perfectionism for themselves or others, especially if they typically compare themselves poorly to others or react negatively to situations not meeting their high standards may also experience burnout. 

It is important to appreciate that burnout and depression can co-occur and can lead to suicidal thoughts and to suicide completion. Burnout can ‘creep up’ on people, so considering how your colleague or you were functioning 3, 6 and 12 months ago regarding these three characteristic traits could be helpful. 

Symptoms associated with stress and burnout 

NB: You are looking for a change from what is normal for that person. 

Chronic Stress Both  Burnout  
Easily agitated or overwhelmed  Fatigue /exhaustion Reduced effectiveness and productivity 
Anxiety, nervousness, unreasonable fear Overeating or undereating Cynicism  
Palpitations or fast heart rate Insomnia Absenteeism, presenteeism, workaholism 
Poor concentration  Absenteeism, presenteeism, Lacking motivation 
Cannot relax  Increased use of alcohol, nicotine, drugs Heightened levels of frustration, negativity.  
Worrying or ruminating and disorganized thoughts Headaches, GI problems, aches pains Unable to see anything positive or be creative 
Low self esteem  More irritable than is normal with self or others Lack of emotion / becoming dispassionate 
Exhibiting nervous habits such as avoiding certain people or places  Disengaged 
  Feelings of hopelessness and helplessness 
  Possible dual diagnosis of depression  
  Life may not seem worth living
symptoms associated with stress and burnout

If you notice yourself in these descriptions, seek support and help sooner rather than later. Recovery from burnout can be a slow process and may require long term professional care however the sooner you seek support the better the outcome will be. Similarly, if you notice indicators in a colleague then raising your concerns quickly is crucial. Please check out the health and wellbeing offers and NHS England resources

How to reduce the risk of stress and burnout 

Research amongst war veterans, trauma victims and others has shown that having the ability to reinterpret or reframe a challenging situation supports our coping mechanisms. Reframing needs to be optimistic yet realistic, and we need to believe we can achieve what’s suggested. This reframing approach can be done with the support of others so leaders can model and encourage this realistic, optimistic approach with individuals or teams to support those who find it more challenging. 

Stress is increased when we don’t know what’s happening, so predictability helps settle the mind and allows us to continue to be creative. Balancing being ‘business agile’ and predictable is a challenge but leaders can aim to keep predictability in communication systems and styles, established meeting formats and maintaining routine processes wherever possible. When changes do need to be made the more notice that can be provided the better. 

It is important we feel as if we have some control and keep some self-determination in our lives however minor that personal control might be. Sometimes the importance of knowing that we can exert that control means we feel we can deal with what is ahead. For example, allowing a request for a small even temporary variation to a working day or week can offer that control.  

Ideally having work patterns where you or your colleagues have a planned break from all work responsibilities every week can make a big difference to your resilience to stress. Knowing we can turn off phone, mobile or laptop contact for 24 hours might be a luxury but it’s worth trying to achieve, because we will be more productive and resilient afterwards.  

Finding the space for selfcare is a foundation stone of resilience and leaders reinforcing this by being seen to value it for themselves can be a powerful reminder to others. It’s easier said than done in a crisis yet perhaps it’s worth planning and then sharing that you have a reminder on your phone to take 2 minutes to stretch, move, look out of the window and take a calming breath every hour. Or could you hold 1-1 walking meetings in the fresh air, it will give you both a different perspective and some exercise. 

Having strong social support systems is another foundation stone to emotional resilience and so it can help to endorse time for impromptu mutual support and peer to peer listening as both can be helpful coping mechanisms in the short term. These are not enough on their own. However, because research has shown that those who come to rely on venting emotions and seeking emotional support from others in place of developing active coping strategies for themselves are more likely to struggle with stress.  

References: 

Bourne, S (2020). How to recognise the warning signs of burn out BMA.org.uk. Available at https://www.bma.org.uk/news-and-opinion/how-to-recognise-the-warning-signs-of-burn-out [Accessed March 2021]

Makikangas, A and Kinnunen, U (2016) ‘The person-oriented approach to burnout: A systemic review.’ Burnout Research 3 pp.11-23
https://doi.org/10.1016/j.burn.2015.12.002 [Accessed March 2021]

Oxford Review. Perfectionism, coping and stress Oxford Review Research Briefing www.oxford-review.com 2016-2019  

Oxford Review. ‘The COPE Scale – assessing coping strategies Oxford Review Research Briefing www.oxford-review.com 2016-2019  

Oxford Review. ‘The 2 factors which predict burnout and your personality isn’t one of them. Research Intelligence Brief – The Oxford Review www.oxford-review.com 2016-2019  

Salvaioni DJ et al (2017) Physical, psychological, and occupational consequences of job burnout: A systemic review of prospective studies. BMC Public Health PLOS one  DOI:10.1371/journal.pone.0185781 [Accessed March 2021]