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Midwifery Feature Articles

“Moral Distress” from Burnout

The Select Committee on Health and social Care , Chaired by Jeremy Hunt published its findings on Workforce Burnout and Resilience in the NHS on the 8th June, just as the stress of lockdown is to be extended a month.

Commenting on the report – Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said:

“Today’s report couldn’t be clearer: at the heart of our health and social care system are registered nurses, midwives and nursing associates. We need these professionals now like never before and we’ll need them in the future. Making sure we have a sustainable plan to address gaps and ensure appropriate support is available will be vital.

The detrimental impact of workplace pressures on people’s mental health and wellbeing was well-documented even before the coronavirus pandemic took hold and has been exacerbated since then. It is also one of the top reasons given by nursing and midwifery professionals for leaving the NMC register in our most recent annual leavers’ survey.”

The Select Committee report warns not to look for personalised solutions just in mental health improvement or wellbeing, important though they are but emphasis that the route cause is bad workforce planning, i.e. not enough staff, staff not adequately trained in the correct specialism and not enough training and supplies. The Government are spending £15 million on mental health services for staff and £15 million for wellbeing.

But have maternity staff not always been under stress? What is new? The report starts with the definition of Burnout.

So take a look and see if this is you.

What is burnout and what causes it?

The Royal College of Psychiatrists referenced the World Health Organization’s definition of workplace ‘burnout’ as:

“a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion.
  • increased mental distance from one’s job,
  • or feelings of negativism or cynicism related to one’s job;
  • and reduced professional efficacy.20

Professor Michael West of the King’s Fund gave the following definition of burnout:

  • when the demands on us exceed the resources that we have;
  • the level of work demands is very high and the resources we have to respond are not sometimes adequate,
  • whether to do with our own personal resources, such as lack of skills, lack of training, lack of equipment,
  • or the resources in our teams or organisations such as staff shortages, lack of PPE equipment, inadequate technologies or, more broadly, lack of the training and skills needed

He added that the term was often used to describe a constellation of three factors;

  • “emotional exhaustion”; “a sense of what is sometimes called depersonalisation:
  • “cynicism or detachment”
  • and a “lack of personal accomplishment—that they are not really making a difference”.

Pointedly Professor West says Burnout could also we described as “moral distress”, where the individual concerned believes that “I am not providing the quality of care that I should be providing for the people I am offering services for.”

How many midwifes and maternity staff will recognise that as a description of a common frustration?

Neil Stewart
Editorial Director
Maternity & Midwifery Forum