The Polyvagal Perspective on Healthcare Professional Burnout

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The issue of healthcare professional burnout is crucial and significantly impacts the entire healthcare field, including other professionals and patients.  There are several contributing factors to any one individual developing burnout.  These include system issues, cultural aspects, and individual factors.  It is important to emphasize that even while considering individual level factors, blame should never be placed on the individual if they develop burnout. 

A more complete understanding of the multi-factorial nature of healthcare professional burnout is necessary in order to implement strategies to address the situation for everyone.  While a prior article addressed the concept that promotion of health, wellbeing, and sustainable high performance may be an objective with more widespread benefit than focusing exclusively on burnout, it remains the case that a more complete comprehension of the causes of burnout is necessary.

This article will consider this important issue of healthcare professional burnout from a different perspective than what is typically discussed.  Specifically, this issue will be analyzed from a polyvagal informed paradigm in an attempt to provide a different, and hopefully contributory, perspective to our understanding of the issue and, ultimately, to promote additional tools to address burnout for all healthcare professionals.

At the outset, it bears repeating that the individual who develops burnout is not at fault or to blame for the situation.  That said, understanding what individual factors may be contributing either to development of burnout or to improvement in health, wellbeing, and sustainable high performance is not only relevant but crucially important.  Without such a consideration, the potential for improving the situation for all healthcare professionals is inherently limited.

While there is no doubt that features specific to the organization and structure of the healthcare system as well as its culture contribute significantly to the development of burnout amongst healthcare professionals, it is also the case that the system and culture are largely similar for all professionals and not everyone develops burnout.  Given this is the case, it becomes important to consider how the healthcare system and culture may differentially impact professionals such that some develop burnout and others do not.

From a polyvagal informed perspective, the demands and stressors attributed to the healthcare system and its culture can be expected to result in neuroception of cues of threat by the healthcare professional.  This process is similar amongst individuals exposed to similar cues in any context.  As a result of these cues, the physiological state of healthcare professionals would be expected to descend in the hierarchy towards a sympathetic state and, eventually, a dorsal vagal state.  In fact, many of the symptoms and signs which are typically associated with professional burnout can be fit within the physiological states described by a sympathetic predominant and/or dorsal vagal predominant state.  For instance, the classic definition of burnout, including extreme exhaustion, loss of fulfillment within the individual’s role, and depersonalization can be readily incorporated within the dorsal vagal shutdown state.

The polyvagal informed perspective also provides an understanding regarding why some healthcare professionals may not develop burnout despite being exposed to similar factors within the healthcare system and its culture.  Individuals who are presented with cues of risk may descend the performance hierarchy towards sympathetic and dorsal vagal states, however if there are also sufficient cues of safety within their internal and/or external environments, then they would be expected to maintain some degree of ventral vagal tone, thereby allowing for safety for their nervous system and mitigating prolonged and sustained descent on the performance hierarchy.

This understanding has not been empirically tested within healthcare professional populations.  It is however extrapolated from professional athletes who are also exposed to high demands and stressors within their respective culture and system.  It is evident that some professional athletes may descend the performance hierarchy and, when this occurs, is frequently mis-labelled as ‘choking’ or ‘not having enough heart’.  In reality, however, it is the cues of risk to these athletes without sufficient cues of safety that leave their nervous system feeling unsafe resulting in a sympathetic and/or dorsal vagal state which may persist over time.  When sufficient cues of safety are provided, they are readily able to climb the performance hierarchy towards their Play Zone (as defined by Michael Allison and described in a previous article) and the ventral vagal state and, thereby, reclaim their high level of performance.

By extrapolation, a similar process is likely to occur amongst healthcare professionals.  This understanding is important for several reasons.  Firstly, it provides a more complete understanding of the interplay between the internal and external factors affecting all healthcare professionals.  Secondly, it provides a paradigm for how we can develop skills and habits, specifically of safety for the autonomic nervous system, to readily improve the situation for all healthcare professionals.  Thirdly, it provides a framework which demonstrates why an approach that over-indexes on the healthcare system and culture will not ultimately resolve the issue of healthcare professional burnout.  While reducing cues of threat emanating from the system and culture will be helpful, it is also the provision of cues of safety and, optimally, the development of skills and habits to modulate the autonomic nervous system that will be able to provide the utmost benefit for all healthcare professionals. 

Through development of polyvagal informed skills and habits, it becomes possible for all healthcare professionals to promote health, wellbeing, and sustainable high performance for themselves and those around them in all areas of life.  This is the ultimate goal of The Practices of the Healthcare Athlete.

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