RT Mental Health and Burnout

ISRRT’s Position Statment

RT Mental Health and Burnout

ISRRT Position Statement
Keeping radiographers/radiological technologists in good mental health and
free from burnout

The ISRRT considers that employers should protect radiographers/radiological technologists from burnout by having suitable working conditions that facilitate good mental health. Additionally, employers have a duty of care to assess the prevalence of burnout amongst their staff and to facilitate measurers to promote recovery. Employers should regulate the maximum hours of shift work and patterns of work i.e., consecutive night shifts worked and the number of hours of rest after such night shifts. Employers should have an agreed stress policy with annual review mechanisms and a way to drill down on the areas of concern e.g., excessive working and line management in accordance with government directives (see Annex A).

Background

The COVID-19 pandemic has put in the spotlight the stress that radiographers as frontlineworkers experience in the line of duty 1. As the worldwide radiographer/radiological technologists’ staff shortage is becoming evident, it is important that employers take their ‘duty of care’ of employees seriously and become accountable for the mental well-being of their radiographers/radiological technologists and engage in providing working environments and
conditions that safeguard and support their mental health and wellbeing.

Fatigue leads to mental stress with the danger that some staff become over tired and suffer ‘burnout’.

The World Health Organisation (WHO) through the Division of Mental Health has issued guidelines for the primary prevention of mental neurological and psychological disorderincorporating ‘Staff Burnout’ 2 . Many radiographer/radiological technologist professional organisations  3,4,5  have also issued position statements and guidance to their members.

Notable Considerations
The following terms and definitions are helpful for those addressing this issue: –

• Definition of burnout including signs/symptoms
  While there is no universally accepted definition of burnout, numerous researchers have
  found that healthcare workers of all types have expressed multiple presentations at both
  the individual and institutional levels. An operational definition may include signs and2
  symptoms of burnout such as emotional exhaustion, depersonalisation, a reduced feeling
  of personal accomplishment, disillusionment, and withdrawal.
  The condition manifests itself both physically and mentally.
•  Physically burnout can manifest as chronic fatigue, decrease energy, headaches, sleep
  disturbances, gastrointestinal disorders, changes in weight, muscle tension and pain,
  overall weakness, hypertension, and generalised illness.
• Mentally the emotional symptoms of burnout may include depression, overwhelming
  hopelessness or helplessness, anxiety, increased incidence of impatience, irritability, and
  anger, and decreased positive personal interactions. Emotional burnout can cause conflict
  with family, friends, and colleagues.
  Practitioners may become dissatisfied with their job and life in general. Self-esteem is
  reduced and there may be a sense of inadequacy and failure. The practitioner may
  become apathetic and cynical. The radiographer/radiological technologist may engage in
  destructive behaviors like substance abuse or committing suicide as a last resort.
• Prevalence
  In 1994 the World Health Organization indicated that the personal or professional
  performance of up to 30-40% of doctors may be negatively affected. More recently
  (2019) a mental health survey conducted by the Canadian Association of Medical
  Radiation Technologists (CAMRT) reported that burnout was widespread amongst all
  radiographic disciplines. More than 57% of responding radiographers/radiological
  technologists reported moderate to high levels of emotional exhaustion. Similar results
  have been noted amongst other healthcare professions.
•  Causes of burnout
  The causes of burnout are myriad. On an individual basis, burnout tends to be most
  prevalent in those who are required to control their emotions while regularly dealing with
  the needs of the public as is typified by the care delivered by radiographers. On an
  organisational level, systemic factors that may stimulate burnout such as working under
  high-stress conditions that involve decisions with significant consequences and shift
  work. This may include fatigue from working consecutive hard shifts and especially
  alternating day and night.
  The stress, uncertainties, and isolation caused by the recent COVID-19 crisis serves to
  exacerbate the effects of burnout on both individual and organisational levels. The
  pandemic has resulted in inadequate or insufficient equipment and human capital
  resources, an increased workload, longer work times, poor communications from
  management, and deficient specialised training all of which intensified burnout.
•  Impact on healthcare professionals and on patient care
  In addition to the negative impact on the individual practitioner described above, burnout
  may adversely influence the entire healthcare system. Practitioners affected by burnout
  are prone to increased absenteeism and turnover which worsens an already shortage of
  practitioners. The quality of care and patient satisfaction are diminished by a reduced
  adherence to standards of practice leading to reduced patient safety and potentially to
  medical errors. Additionally, there is also the increased risk of human error with loss of
  concentration due to tiredness resulting in the potential increase in clinical care errors.
  Recommendations for support
  1. The ISRRT encourages radiographers/radiological technologists to establish selfawareness in recognising the signs of burnout in their own practice.
  Radiographers/radiological technologists should take active steps to prevent and seek
  support or treatment to avoid any adverse changes to their mental health.
  2. The ISRRT encourages healthcare leaders to create mentally and physically healthy
  workplaces. This would include provisions for mental health support for workers and
  mental health assistance programmes.
  3. Healthcare organizations should support employees and provide employment assistance
  programmes (EAPs) that include mental health services for prevention, early
  intervention, and ongoing treatment.
  4. The ISRRT supports research on the causes, prevention, and treatment of
  radiographer/radiological technologist burnout.
  5. The ISRRT encourages its members to participate and contribute to recognising and
  limiting the effects of burnout by maintaining a positive attitude and exhibiting
  constructive behaviors in the face of these adverse conditions. This also includes strong,
  supportive communication between colleagues, management and with the public to
  minimize the impact. Additionally, employers should work with trade unions to find
  ways to tackle mental health and burnout.
  6. The ISRRT endorses the development and use of checklist tools such as 6,7
  : –
• Early Signs of a Stressed Employee Checklist
• Mental Health Discussion Openers Checklist
• Mental Ill Health Warning Signs Checklist
• Mental Health Specialist Resources Guide
• Stress Risk Assessment
  References
  1. Radiographers/RTs are frontline Health Care workers | ISRRT
  2. Guidelines for the primary prevention of mental, neurological and psychosocial disorders.
  5. Staff burnout (who.int)
  3. Position-Statement-Burnout-Jan-2021.pdf (camrt.ca)
  4. Search Results (sor.org)
  5. Search (asrt.org)
  6. Stress Symptom Checklist 183434.pdf (baylor.edu)
  7. Stress and mental health at work. Managing stress at work. Stress at work – HSE
  https://www.hse.gov.uk/stress/assets/docs/stress-talking-toolkit.pdf
  Further reading
  Health and Safety Executive (HSE) Management standards – UK
  https://www.hse.gov.uk/stress/standards/index.htm
  https://www.hse.gov.uk/toolbox/organisation/stress.htm
  Note: Links to external websites may change without notice.Annex A
  Healthcare provider stress policy and review mechanism (suggested content) –
  based on Health and Safety Executive (HSE) UK.
  https://www.hse.gov.uk/stress/standards/index.htm
  Statement of intent
  This will be a statement at the beginning of the policy making a commitment to preventing,
  managing, and reducing the causes of stress.
  Context
  This aspect reflects the employer’s duties and responsibilities to manage stress in the workplace.
  Definitions
  The employer defining ‘stress’. Linking in with the HSE six management helps the
  understanding in relation to this of how stress can manifest and how it can be controlled.
  Process for identifying stress
  This be through an annual audit which could be targeted at specific departments, for instance
  who have been involved in critical incidents or significant change.
  A good tool for this is the HSE Indicator tool. This is an online audit tool comprising 35
  questions. Examples include: –
• Identifying priorities – this enables data to be assessed and to identify where risk exists in
  an organisation.
• The employers’ policy should state the process for implementing action and ensuring
  progress on priorities.
• Systems should be put in place to monitor and review the effectiveness of the policy.
• Staff involvement in action planning
•  Action plans to be sent to through to staff and made available to health and safety
  committees for performance management purposes.
•  Available resources
•  Reference to what internal and external support is available to staff who suffer from
  stress on an individual basis.
• Responsibilities – making reference to who is responsible within the organisation for
  implementing and supporting the policy e.g., Chief Executive, Senior Manager, HR etc.
•  Cross reference to policies which already exist-embedding the policy into those policies
  that are already existing e.g., Dignity at Work or bullying and harassment or flexible
  working policies.
• Working Time Directive guidance
  o The Daily Rest Break – to allow an uninterrupted 11-hour period between shifts.
  o A Weekly Rest Period – of at least 1 uninterrupted break of 24 hours in every 7
  days or 48 hours in every 14 days.
  o The right to a rest break after 6 hours – this can be applied flexibly but they must
  happen during a shift and allow a genuine uninterrupted break. They cannot be
  put at the start or end of a shift.
  o Medical Assessments for all Night Workers