Student Perspective...

by Rene L. Prentki

Burn-out is a term that has been defined as a debilitating condition involving the development of negative emotional, psychological and physical reactions to occupational stress (Patrick, 1979). It has often been used to describe the lack of satisfaction and feelings of inadequacy common among personnel in direct human service contact. Burn-out involves the "resignation" of the individual "due to a lack of power—the perception that no matter how hard you try, you cannot make a difference in the situation" (Storlie, 1979, p. 2109). As in other health service fields, practitioners in therapeutic recreation, particularly those in treatment settings, are extremely susceptible to this condition due to the unique pressures of constant direct service contact with handicapped individuals. The syndrome is of increasing concern because of its negative effects on individuals, other staff members, agency operations, and client service which are now being recognized.

Individuals involved in the burn-out process frequently exhibit a change in behavior over a period of time. A normally cheerful and energetic person may appear physically run-down, irritable, cynical and even depressed. Employee absenteeism, resulting from minimal physical disorders such as headaches, gastro-intestinal problems or excessive fatigue tend to increase for affected individuals. A decline in productivity may also be evident even though the individual with burn-out appears to be working as hard or harder than he or she usually does. "Practitioners who burn-out are unable to deal successfully with the overwhelming emotional stresses of the job. This failure to cope may be manifested in a number of ways ranging from impaired performance or absenteeism to various types of personal problems" (Maslach and Pines, 1977, p. 101).

Personal lives are frequently subjugated as work becomes the major and sometimes the only force in the life of an individual suffering from burn-out. The realignment of priorities is frequently followed by disengagement or withdrawal which is often a self-preservation effort, by the practitioner, to reduce the emotional, mental and physical drain created by therapist-client or counselor-client relationships. Labeled as dehumanization or detached concern, disengagement refers to the way an individual with burn-out responds to and treats clients as objects or categories of disabilities rather than as individual human beings. This form of behavior usually exemplifies an attempt by the practitioner to control vocational stress created by client contact.

Central causal factors for therapeutic recreation professionals experiencing burn-out in direct service situations arise from the pressures and demands formulated by the agency, its clients and society as a whole. These expectations dictate that the health service professional be continually available and constantly "giving" to clients, even when the practitioner's energy and emotional resources may be exhausted. The inability of individuals to cope with these constant demands is often evidenced by increased frustration visible in both work and nonwork situations. This frustration increases as the individual begins to feel a loss of control over his life and an inability to effect change in work situations or to reach client goals. Guilt and/or feelings of anger often accompany this general feeling of helplessness.

The prevalence of burn-out among staff has been identified as being related to high rates of job turnover, reduced staff morale, poor quality of client care, and lack of job satisfaction in addition to the previously noted increased absenteeism and lowered productivity (Veninga, 1979). Indirectly burn-out affects the quantity and cost of client care as high levels of job turnover raise time and fiscal expenditures through the needs to advertise, hire, train, and closely supervise new staff. Staff turnover also tends to lower the quality of care through the disruption of treatment team continuity and the loss or absence of established working relationships among interrelated disciplines and staff members. Turnover resulting from the departure of individuals suffering from burn-out also tends to negatively affect remaining staff. The instability of treatment teams, the loss of expertise and the frustration of training new personnel frequently lead to the lowering of staff morale (Campbell, 1977).

Illinois Parks and Recreation 12 July/August, 1980

Rene L. Prentki is a graduate student in Therapeutic Recreation at Southern Illinois University, Carbondale, and coordinates recreation services for the university married student housing complex. A graduate of Fairleigh Dickinson University, she was previously employed as a recreation therapist at Children's Specialized Hospital, Westfield, New Jersey. Her professional goal is an administrative position in the area of therapeutic recreation with the physically handicapped. Rene is an equestrian who is also interested in racquet ball and various forms of outdoor recreation.

Administrators, supervisors, and practitioners frequently appear to be unaware of burn-out and its negative potential. They may be concerned about obvious staffing problems and the frustration of attempting to hire and retain qualified personnel but they are often unable to recognize or deal with the related and often causal problem of staff burn-out. An awareness of its symptoms or the identification of burn-out as a problem does not in itself constitute a resolution of the process or of its negative outcomes. Of primary importance to effectively dealing with burn-out is administrator recognition of the innate properties of health service professions such as the long hours, extensive direct service, and large client to staff ratios that often lead to burn-out. Secondly there must be a realization and acceptance by both the agency and the practitioner of the burn-out potential of each individual and identification of the specific stresses associated with each direct service position before intervention or prevention strategies can be implemented successfully.

Supervisors or administrators in therapeutic recreation settings can use several constructive measures to aid in the prevention of burn-out in their organization. Supervising personnel can create "time-out" periods for direct service staff involving tasks that do not require direct client service and allow the practitioner to temporarily withdraw from stressful contact. In addition the establishment of appropriate client to staff ratios and defined limits on duration of daily direct contact can serve as preventive measures. Pines and Maslach (1977) reported that staff who must face many clients for extended periods receive less satisfaction from their work and provide a lesser quality of care. Therapeutic recreation personnel tend to be confronted by this burn-out factor even more than other related fields, i.e., occupational therapy or physical therapy as many adjunct professions have agency established client-staff ratios which serve to limit client-staff contact. Therapeutic recreation programs, however, usually do not have this safeguard built into their professional system.

In a related approach, the rotation of work schedules can also aid in elimination of potential burn-out causes. Individuals who always work weekends or evenings have a strong tendency to become overinvolved at work while neglecting their personal lives. Schedule rotation allows the individual the freedom to maintain and develop relationships and interests outside of work.

The proper utilization of physical exercise as a relaxant and/or an activity for a "work to home" transition period can be very important in the prevention of or intervention in the burn-out process. The opportunity to release work accumulated stress can help the burn-out candidate in his/her attempt to achieve balance between work and nonwork segments of daily life. In addition the constructive use of nonwork time to develop other recreational and outside interests can aid the individual in maintenance of a good self-image and a positive attitude toward life in general.

Burn-out can also be combated by involvement in professional organizations. The opportunities available through active participation in committees and conferences present practitioners with an opportunity to unwind and exchange information with their peers. The support group structure allows the individuals to voice common concerns and shared problems in a relaxed atmosphere of peer acceptance. The sense of belonging and the identification within the profession can boost the morale of the practitioner and help him/her cope more effectively with the daily pressure of human service.

Burn-out is an occupational hazard of therapeutic recreation. Effective response to the syndrome requires an initial recognition that it has the capacity to disrupt all aspects of professional and personal life ultimately resulting in diminished client care. Every individual is a potential burn-out candidate and must accept the personal responsibility of establishing a balance between work and nonwork life. The awareness of the burn-out process by practitioner, supervisor, and administrator is of primary importance to the implementation of effective prevention strategies. A sensitive awareness of individual vunerability and positive established procedures for alleviating vocational stress is essential in maximizing productive, effective client care and agency service. Failure to respond to these concerns does a disservice, not only to the direct service practitioner, but to the client as well.

REFERENCES

Campbell, W. Looking at the when and why of staff turnover. Health and Social Service Journal, September 1977, 1272.

Maslach, C. and Pines, A. The burn-out syndrome in the day care setting. Child Care Quarterly, 1977, 6(2), 100-130.

Patrick, P. Burnout: Job hazard for health workers. Hospitals. November 1979, 87-90.

Pines, A. and Maslach, C. Characteristics of staff burn-out in mental health settings. Hospital and Community Psychiatry, 1978, 29(4), 233-237.

Storlie, F. Burnout: The elaboration oia.cov.cept. American Journal of Nursing, December 1979, 2108-2111.

Veninga, R. Administrator burnout—causes and cures. Hospital Progress, January 1979, 45-52.

Illinois Parks and Recreation 13 July/August, 1980