Reducing Burnout using Emergency Planning: A Literature Review

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Reducing Burnout using Emergency Planning: A Literature Review Reducing Burnout using Emergency Planning: A Literature Review

Taylor Vaughn

University of Nebraska Medical Center

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Emergency Planning to Reduce Burnout 1

Reducing Burnout using Emergency Planning: A Literature Review

Taylor Vaughn, Emergency Preparedness

University of Nebraska Medical Center- College of Public Health

Committee:

Chair- Keith Hansen, MBA

Committee Member- Leslie Scofield, MPH

Committee Member- Lisa Walters, MSHSM, BSN, RN

Emergency Planning to Reduce Burnout 2

Introduction

Emergency Preparedness allows plans to be created to respond promptly to

situations that disrupt daily life. Public Health's Emergency Preparedness workforce

responds to health-related emergencies. COVID-19 has highlighted the burnout from

extended emergency response and its burden on the workforce. This literature review

will identify specific strategies for emergency planning to reduce burnout, specifically for

public health workers.

Objectives

1. Analyze the literature to define burnout.

2. Determine causes of burnout, specifically in the public health workforce on

both an individual and organizational level.

3. Examine current plans at the local health department level to determine

whether burnout prevention is incorporated.

4. Make recommendations that can be added to current emergency plans to

reduce burnout.

Research Question

1. What can be added to public health emergency plans to reduce burnout?

Emergency Planning to Reduce Burnout 3

Background

Description of the health problem

COVID-19 highlighted the lack of mental health care in the workplace. Burnout is

a term that many employees started to use to describe how they felt about their

situation. Chronic workplace stress that is not successfully managed results in burnout

which is defined as exhaustion, increased mental distance, and reduced professional

productivity (Burn-out an “Occupational Phenomenon”: International Classification of

Diseases, 2019). According to the Cleveland Clinic, burnout is “physical, emotional or

mental exhaustion, accompanied by decreased motivation, lowered performance and

negative attitudes towards oneself and others” (What is Burnout, paragraph 5, 2022).

Burnout can look different for each person, but most people feel sluggish, tired, or have

difficulty completing their everyday functions. The Mayo Clinic suggests that symptoms

of burnout include being cynical at work, being irritable and impatient with coworkers,

lacking the energy to be consistently productive, lacking satisfaction in

accomplishments, or using food, drugs, and alcohol to make yourself feel better (Job

Burnout: How to Spot It and Take Action, 2021).

History of the term burnout

Burnout is a concept but not a medical diagnosis. The first time it was described

was in 1974 by Herbert Freudenberger, a clinical psychologist in New York City. He

volunteered at a free clinic and noticed emotional depletion among volunteers; his

definition was “exhaustion resulting from “excessive demands on energy, strength, or

resources in the workplace, characterizing it by a set of symptoms including malaise,

fatigue, frustration, cynicism, and inefficacy” (Reith, 2018).

Emergency Planning to Reduce Burnout 4

Christina Maslach, psychologist, determined that there are three dimensions of

burnout: emotional exhaustion, depersonalization, and a diminished sense of personal

accomplishment. In 1982 she created the Maslach Burnout Inventory (MBI). The MBI

measures the extent of individual symptoms in each dimension. The MBI is still the most

used instrument to measure burnout (Reith, 2018).

Prevalence in public health

Lately, there has been widespread feeling of burnout, especially while working in

public health. COVID-19 has been an extended response and has required battling

misinformation from unreliable sources. Stone and colleagues (2021) surveyed 225

public health workers in the United States to determine burnout rates. They found that

66.2% of respondents reported feeling burnt out, and people with more work experience

in public health were more likely to report having feelings of burnout. This study also

reported that in January 2020, 85.2% of respondents planned to stay in public health for

three or more years; however, when surveyed in September of 2020, 9 months later,

61.6% of respondents planned to stay for three or more years (Stone et al., 2021). The

study highlights the possibility of a loss of seasoned workers in public health.

Ibrahim and associates (2022) studied 366 public health professionals in May of

2021 and determined that 45% of respondents reported feelings of burnout. Additional

findings were that public health professionals involved in the COVID-19 response for six

months or longer had twice the likelihood of experiencing burnout compared to those

who had not been involved in the pandemic response for as long (Ibrahim et al., 2022).

Emergency Planning to Reduce Burnout 5

Methods

Academic Journals

Search Strategy

The literature review was completed to identify the causes of burnout and

recommended preventative measures. The search was conducted in three academic

databases: ScienceDirect, PubMed, and PsycINFO (see Figure A). The key terms and

phrases were burnout, burnout prevention, burnout causes, emergency preparedness,

public health, first responders, emergency planning, burnout prevention using

emergency planning, stress, job satisfaction, accomplishment, and job performance.

Inclusion and exclusion criteria

The items included in the search were published from 2005-2023 and written in

English. Types of literature included academic journals, review articles, research

articles, dissertations, peer-reviewed journals, credible sources that are health-related,

and federal guidance documents,

Data extraction

The following items were extracted from each article: abstract, sample size, study

design, study method, study findings, and discussion.

Emergency Planning to Reduce Burnout 6

Figure A: Selection process

Organization Search

There was an additional search for burnout prevention sources from the Centers

for Disease Control and Prevention (CDC), World Health Organization (WHO), Mayo

Clinic, Cleveland Clinic, Substance Abuse and Mental Health Services Administration

(SAMHSA), and Federal Emergency Management Agency (FEMA). These

Initial studies found from a search

through ScienceDirect, PubMed, and

PsychINFO using key terms (215)

Articles Remaining after initial scan through both abstracts and titles,

removing any articles that were not primarily regarding the research

question or the objectives including reviewing burnout in a workplace,

determining causes of burnout or what can be done to prevent it (36)

Articles Remaining after excluding articles that

did not address research questions after

reading full articles (17)

Articles Remaining after final exclusion of

directly addressing research questions

and objectives (12)

Emergency Planning to Reduce Burnout 7

organizations were included because of their national and international credibility in

public health preparedness and mental health.

Community Plans

Three local emergency operations plans were also reviewed to determine

whether they include strategies for burnout prevention. One plan was selected from the

west coast, one from the mid-west, and one from the east coast. The emergency

operation plan was chosen because they are a general overview of the operations

behind various disasters. The criteria included plans that were published on or after

2018 and were in a format that could be searched to find the key search words and

phrases. The emergency operations plans are anonymous in this paper to protect the

organizations’ identity. They are referenced as the section of the country they are from

(East Coast, Midwest, and West Coast).

Emergency Planning to Reduce Burnout 8

Table A: Academic Journal Results

Overview of Studies

Author and

Year

Article title

Number of

participants

Method and

Design of Study

Purpose of Study

Key Findings

Awa, W. L.,

Plaumann, M.,

& Walter, U.

(2010)

Burnout

prevention: A

review of

intervention

programs

N/A

Literature Review

Evaluate of

intervention

programs regarding

burnout are effective.

A total of twenty-five

interventions were

reviewed. Person-

centered approaches

were effective for the

short term (less than six

months), a

combination of person-

directed and

organizational had long-

lasting results (over 12

months).

Cavanaugh,

K., Cline, D.,

Belfer, B.,

Chang, S.,

Thoman, E.,

Pickard, T., &

Holladay, C. L.

(2022)

The positive

impact of

mentoring on

burnout:

Organizational

research and

best practices

N=14,500

Organizational

survey

Chi-square test

Does mentoring

have an impact on

employee burnout

rates

Employees, regardless

of gender, ethnicity,

different job

classification, and

generation, were less

likely to report burnout if

they were in a mentoring

relationship.

Haar, J., &

O’Kane, C.

(2022)

A post-

lockdown

study of

burnout risk

amongst New

Zealand

essential

workers

N=955

Essentials

Workers

Survey Panel

Comparing burnout

rates between

essential and non-

essential workers.

Employee and employer

pressures contribute to

essential worker burnout

risk.

Emergency Planning to Reduce Burnout 9

Author and

Year

Article title

Number of

participants

Method and

Design of Study

Purpose of Study

Key Findings

Hofer, Waadt,

M.,

Aschwanden,

R., Milidou, M.,

Acker, J.,

Meyer, A. H.,

Lieb, R., &

Gloster, A. T.

(2018).

Self-help for

stress and

burnout

without

therapist

contact: An

online

randomised

controlled

trial.

N=119

participants

Online Survey.

A randomized

controlled trial.

Determine a self-

help book's

effectiveness on

stress and burnout

without talking to a

therapist.

People who received a

self-help book had better

perceived stress,

exhaustion, cynicism,

and personal efficacy

than those in the control

group.

Ibrahim,

Samsudin, E.

Z., Chen, X.

W., & Toha, H.

R. (2022).

The

Prevalence

and Work-

Factors of

Burnout

Among Public

Health

Workforce

During the

COVID-19

Pandemic.

N=366 public

health

providers

Self-Administered

Online Study.

Multicenter cross-

sectional study.

Determine how

prevalent burnout is

for public health

providers during

COVID-19.

Forty-five percent of

respondents reported

burnout. Burnout was

associated with

prolonged COVID-19

involvement, younger

age, and perceiving

medium and high

emotional demand. As

well as low and medium

role clarity and medium

job satisfaction.

Koutsimani,

Montgomery,

A., Masoura,

E., &

Panagopoulou,

E. (2021).

Burnout and

Cognitive

Performance.

N=104

participants

Assessment is

taken by

participants.

Cross-sectional

study.

Determine the

relationship between

burnout and

cognitive functioning

Cognitive deficits,

anxiety and depression

are common in burnout

Emergency Planning to Reduce Burnout 10

Author and

Year

Article title

Number of

participants

Method and

Design of Study

Purpose of Study

Key Findings

Mao, Hu, Y.,

Feng, Z.,

Wang, R.,

Chen, X.,

Zhang, W., &

Yang, G.

(2020).

Job burnout

and correlated

factors of

three‐tiered

public health

workers: A

cross‐

sectional

study in

China.

N=1328

Public Health

Workers

Online Survey

Cross-sectional

Study

Determine burnout

levels among public

health workers in

China and determine

if there are any

influencing factors to

lead to higher

burnout.

Low training satisfaction,

low income, and fewer

years of experience all

lead to higher levels of

burnout.

Montgomery,

Panagopoulou,

E., Esmail, A.,

Richards, T., &

Maslach, C.

(2019).

Burnout in

healthcare:

the case for

organisational

change

N/A

Literature Review

Approaches to burnout

are usually on an

individual basis, but it is

beneficial to look at the

organization and see

what changes can be

made from this

perspective. It is

suggested that a lack of

resources, including the

number of staff, leads to

higher stress and

exhaustion.

Emergency Planning to Reduce Burnout 11

Author and

Year

Article title

Number of

participants

Method and

Design of Study

Purpose of Study

Key Findings

Otto, M. C. B.,

Van

Ruysseveldt,

J., Hoefsmit,

N., & Dam, K.

V. (2020).

The

Development

of a Proactive

Burnout

Prevention

Inventory:

How

Employees

Can

Contribute to

Reduce

Burnout Risks

N =343,

N=201

Employees

Online Study

Two Wave

Longitudinal

survey

Assess employee’s

proactive burnout

prevention

behaviors, and

explore proactive

burnout prevention

behaviors

Twelve proactive

behaviors were studied.

Nine of the twelve

behaviors showed a

negative effect about

one month later.

Increasing resources will

take less than a month

to reduce burnout, and

reducing demands takes

more than a month to

prevent burnout.

Otto, Van

Ruysseveldt,

J., Hoefsmit,

N., & Van

Dam, K.

(2021).

Examining the

mediating role

of resources

in the

temporal

relationship

between

proactive

burnout

prevention

and burnout.

N=617

employees in

healthcare,

government

agencies, and

education

Online Study

(taken twice a

month apart)

Two-wave

longitudinal panel

Can employees be

given tools to be

proactive to prevent

burnout.

Employees were able to

prevent burnout

proactively; however, the

initial level of burnout

plays a role in how

effective it will be.

Emergency Planning to Reduce Burnout 12

Author and

Year

Article title

Number of

participants

Method and

Design of Study

Purpose of Study

Key Findings

Stone,

Kintziger, K.

W., Jagger, M.

A., & Horney,

J. A. (2021).

Public Health

Workforce

Burnout in the

COVID-19

Response in

the U. S

N-=225 public

health

workers

Online Survey

Cross-sectional

Study

Assess mental

health, physical

health, and risk of

burnout. Also,

determine career

decisions during the

response to the

pandemic.

Anxiety, burnout,

depression, and poor

physical health were

commonly reported.

66.2% of respondents

reported feeling burnout,

feeling the increased risk

of attack, leadership

turnover, and reduced

capacity due to budget

restrictions all are

reasons for increased

burnout.

Van den

Broeck, Elst,

T. V., Baillien,

E., Sercu, M.,

Schouteden,

M., De Witte,

H., &

Godderis, L.

(2017).

Job Demands,

Job

Resources,

Burnout, Work

Engagement,

and Their

Relationships:

An Analysis

Across

Sectors.

N=2585

Online

Questionnaire.

Cross-sectional?

Determine the

importance of

resources and job

demands regarding

burnout.

The public sector needs

to pay special attention

to 1) role conflict, 2) job

demands, and 3) job

resources. Specifically at

an organizational level

Emergency Planning to Reduce Burnout 13

Recommendations from Literature

Twelve academic journals were used for this capstone; an overview of each

journal is shown in Table A.

Causes of burnout

Burnout is prevalent in public health, especially after the pandemic. Haar and

O’Kane (2022) studied essential versus nonessential workers, compared burnout rates,

and studied the causes. They found that stressful workload, higher than normal

expectations, an improper work-life balance, and a decrease in staff members were

commonly reported by essential workers experiencing burnout (Haar & O’Kane, 2022).

The increase of expectations with a decrease in resources, including staff, leads to

difficulty in maintaining a work-life balance, especially in the face of a prolonged

emergency.

Mao and colleagues (2020) studied public health workers and measured burnout

rates and causes of burnout. They concluded that a large contributor to burnout was

improper training. Workers who reported strong training satisfaction were less likely to

report burnout. Workers also reported that the higher the workload, the higher the

chance of burnout (Mao et al., 2020). This result agrees with the study by Haar and

O’Kane and confirms the need for manageable workloads for staff members.

The study completed by Koutsimani and colleagues (2021) suggests a

correlation between cognitive function and burnout. Specifically, they determined that

people who report cynicism have a higher risk of burnout than those that report

exhaustion regarding cognitive function. Cynicism is believed to develop after

Emergency Planning to Reduce Burnout 14

exhaustion, and the authors suggest looking at the problem of burnout from a multi-

dimensional viewpoint. They also suggest that depression, and anxiety are commonly

reported in burnout (Koutsimani et al., 2021).

Individual approach to burnout prevention

Three studies looked specifically at what an individual can do to prevent burnout.

The first study, by Otto and colleagues (2021) concludes that staff who initiate individual

burnout prevention suffer less burnout in the future. They also state that burnout

prevention should take place before feeling the effects of burnout (Otto et al., 2021).

Burnout prevention must happen before employees feel the effects and cannot take

appropriate action.

One intervention that Hofer and colleagues (2018) tested was giving individuals a

self-help book as their only intervention for stress and burnout. They determined that

individuals who got the self-help book had better perceived stress, exhaustion,

cynicism, and personal efficacy (Hofer et al., 2018).

Twelve different proactive behaviors were studied by Otto and colleagues (2020)

The list included “increasing/maintaining job control, increasing/maintaining supervisor

social support, increasing/maintaining co-worker social support, feedback seeking,

seeking/performing tasks that energize, reducing hindering job demands,

increasing/maintaining home autonomy, increasing/maintaining home social support,

reducing work-home conflict, improving/maintaining physical health,

improving/maintaining psychological wellbeing, and engaging in relaxing activities” (Otto

et al., paragraph 31, 2020). Nine of the twelve behaviors reduced burnout symptoms

Emergency Planning to Reduce Burnout 15

within a month. The ones that did not have a negative effect were feedback seeking,

reducing hindering job demands, and increasing/maintaining home social support (Otto

et al., 2020).

Organizational approach to burnout prevention

Many of the papers included in this literature review suggested that

organizational changes need to be made to prevent burnout among employees. Five

articles outlined interventions and steps taken. In a survey by Ibrahim and colleagues

(2022) targeted interventions are mentioned because the cost of burnout prevention for

organizations is less than that of burnout. Specifically, they found that people who felt

they were treated unfairly at work can result in withdrawal and disengagement, which

are burnout factors. They determined that staff members who perceived high and

medium levels of emotional demand and low levels of clarity for their role experienced

more burnout (Ibrahim et al., 2022).

The study completed by Stone and colleagues (2021) discovered that compared

to what was reported in January 2020, 23.6% fewer respondents planned to stay in the

public health workforce for three or more years because of the pressures of the

pandemic (Stone et al., 2021, paragraph 1). The authors determined that burnout risk

factors included leadership turnover and reduced capacity due to budget restrictions. A

crucial organizational approach is to maintain leadership. Role clarity and consistent

responsibility without overwhelming staff members are vital to reducing burnout and

preventing staff turnover (Stone et al., 2021).

Emergency Planning to Reduce Burnout 16

Montgomery and colleagues (2019) reviewed the literature and determined that

approaches need to be completed at the organizational level. They highlight from an

organizational level that resources are vital, including proper supplies needed to do the

job, and enough staff. They mention that an organizational approach is more important

than a personal approach because it is usually a broken system leading to burnout

(Montgomery et al., 2019).

The public sector must pay special attention to role conflict, job demands, and

resources. This was confirmed in the study completed by Van den Broeck and

colleagues (2017). Role conflict is understanding what is required in the role and

includes proper training. Job demands pertain to having a workload appropriate for the

qualifications and what is doable in the amount of time somebody is working. Job

resources include physical items, time, and staff members (Van den Broeck et al.,

2017).

Another step that organizations can take is creating a mentoring program.

Cavanaugh and colleagues (2022) found that it was statistically significant for people to

experience less burnout if they were part of a mentoring relationship. They compared

the staff who were in the mentoring program to those who were not and found that the

ability to talk through stressors and get advice from people who are experienced in the

field is beneficial for a reduction of burnout (Cavanaugh et al., 2022).

Mixture of Individual and organizational approaches

Awa and colleagues (2010) studied the impact of personal interventions,

organizational interventions, and a mixture of both. Awa evaluated the effectiveness of

Emergency Planning to Reduce Burnout 17

twenty-five different interventions. The interventions that focused on person-centered

were 80% effective at reducing burnout, but the reduction only lasted six or fewer

months. The interventions that focused on both organizations and person-directed

lasted, on average, twelve or more months (Awa et al., 2010).

Emergency Planning to Reduce Burnout 18

Recommendations from organizations

Table B: Burnout Prevention Recommendations from Governmental & Clinical Organizations

Overview of Organizational Suggestions

Name of Organization

Summary of Suggestions

CDC (Centers for Disease Control and Prevention)

• Breathing exercises and Meditation.

• Communicate with those around you about stress.

• Remember that resources are limited, and you are doing

your best.

• Keep a consistent daily routine as much as possible.

• Limit shifts to no more than 12 hours.

• Talk to family and friends.

• Healthy diet and routine exercise.

• Being okay with creating boundaries.

WHO (World Health Organization)

• Set clear goals for staff members.

• Frequent training on coping strategies to increase role

effectiveness.

• Encourage support groups and resource exchange networks.

• Maximize participation in decision-making.

• Training in conflict resolution.

• Encourage safe staffing levels to optimize workload and

regular breaks.

• Focus on appropriate shift lengths.

SAMHSA (Substance Abuse and Mental Health Services

Administration)

This guide discusses organization-level strategies to improve

workplace culture and climate by modifying six drivers of burnout:

workload, control, reward, community, fairness, and values. (pg. 4)

Burnout may seem costly at first, but the cost of the consequences of

burnout in the long term far outweighs that.

Emergency Planning to Reduce Burnout 19

Organizational approaches to burnout are more effective than

individual approaches.

FEMA (Federal Emergency Management Agency)

No page with recommendations, but there is the 2022-2026 strategic

plan that mentions that COVID-19 was an extended response, and

that FEMA must transform the support that the agency delivers to

increase capacity. They mention burnout but do not define it or give

specific ways to increase capacity.

Mayo Clinic

Risk Factors:

• Heavy workload/ Long hours

• Unbalanced work-life balance

• Working in a helping profession

• No control over your work

Handling job burnout:

• Proper sleep

• Being mindful and using breathing exercises

• Talk with coworkers, supervisors, friends, and loved ones.

• Prioritize your workload.

• Exercise

• Relaxing activity (yoga, meditation, or tai chi).

Cleveland Clinic

• Build breaks and personal check-ins.

• Exercise

• Practice mindfulness

• Work-life boundaries

• Try to stick to a daily routine.

Preventing it in the future:

• Notice when the signs and symptoms are there and

communicate with your support system

Emergency Planning to Reduce Burnout 20

Six organizations were reviewed, including websites and materials that were

published, regarding signs of burnout and recommendations for prevention (see Table

B).

Clinic Recommendations

The websites of two clinics were reviewed for this paper: the Cleveland Clinic

and the Mayo Clinic. Both clinics suggest personal ways to prevent burnout. They both

suggest exercise and practicing mindfulness. Mayo Clinic also suggests getting proper

sleep, talking with supervisors, coworkers, friends, and family, prioritizing workload, and

relaxing activities such as meditation, yoga, or tai chi (Coping with Stress: Workplace

Tips, 2021). The Cleveland Clinic suggests including breaks and personal check-ins,

work-life boundaries, and sticking to a daily routine (What is Burnout, 2022).

Three interventions were recommended by both clinics: prioritizing workload,

work-life boundaries, and talking with supervisors, coworkers, friends, and family. These

are both organizational and personal approaches by looking at workloads, offering

supportive communities, and allowing boundaries to allow employees to have a proper

work-life balance.

United States and World Health Organization Recommendations

The websites of three organizations were searched for the keywords used in this

study. They were the Centers for Disease Control and Prevention (CDC), Federal

Emergency Management Agency (FEMA), and the World Health Organization (WHO).

According to the CDC, ways to combat burnout include breathing exercises,

communication about stressors with people you trust, keeping a consistent daily routine,

Emergency Planning to Reduce Burnout 21

and reminding yourself that there are limited resources (Support for Public Health

Workers and Health Professionals, 2021). They also suggest not having shifts longer

than 12 hours, eating a healthy diet, exercising routinely, and creating boundaries to

protect your mental health (Emergency Responders: Tips for Taking Care of Yourself,

2018). Most of the suggestions are on a personal level, but an important suggestion

made by the CDC is the suggestion of 12-hour shifts. This goes back to workload and

keeping the workload manageable.

FEMA’s 2022-2026 Strategic Plan has only one mention of burnout. They

recommend working with community partners to understand what their response

capacity is and help them to increase it. Also, tailoring approaches based on that

capacity and the resources that are available while not over-extending (Federal

Emergency Management Agency, 2022). There was nothing on the FEMA website that

defined what burnout is, and there were no suggestions listed on ways to prevent

burnout for the workforce in the future.

The WHO suggested many ways to prevent burnout. They included: setting clear

goals for staff members; frequent training on coping strategies to increase role

effectiveness; encouraging support groups and resource exchange networks; active

participation from staff for decision making; conflict resolution training; appropriate shift

levels; and encouraging safe staffing levels to optimize workload (Occupational Stress,

Burnout and Fatigue, n.d). This organization emphasizes how an employer can provide

resources for employees to reduce burnout.

Emergency Planning to Reduce Burnout 22

SAMHSA

Substance Abuse and Mental Health Services Administration (SAMHSA) has

provided a resource for burnout prevention. In the document, they highlighted specific

burnout strategies. The six organizational factors are workload, control, reward,

fairness, community, and values. Workload is identified as having chronic excessive

workload and can result from excessive hours, working under pressure consistently,

and doing things outside of their job responsibility. Strategies to help this include

ensuring an appropriate number of staff and ensuring that processes are time efficient.

Control allows employees to feel ownership over their job and encourages active

decision-making. Implementation includes flexibility with job descriptions and processes

to confirm that employees have the resources needed to complete their job; resources

include supplies and the ability to speak with peers to discuss best practices. Rewards,

Promotion, Career Development, and proper pay are ways that organizations can

recognize employees. Community is when an organization has a shared sense of

support, and employees feel they can contribute without retaliation. A popular

intervention is team building to promote staff members feeling comfortable with each

other. Fairness is impacted when employees do not think that their supervisors or

leadership are being transparent. One way to implement this is to have input from

employees for policies and more direct communication between leadership and staff.

Lastly, values include when employees feel a connection to their work. Implementing

this includes aligning organizational changes to match performance goals with the

organization’s values (Substance Abuse and Mental Health Services Administration,

2022).

Emergency Planning to Reduce Burnout 23

Currently in Plans

Table C: Key Word Search Results from Local Plans

West Coast

Midwest

East Coast

Burnout

Stress

Behavioral Health

Mental Health

Shift Length

Training

182

174

Resources

308

245

274

Leadership Turnover

Appropriate Staffing

Emergency Planning to Reduce Burnout 24

Midwest Plan

Three local public health emergency operations plans were searched for the

keywords used in this literature review (see Table C). One plan was selected from the

East coast, the West Coast, and the Midwest.

The Midwest emergency operations plan (EOP) does not mention burnout,

stress, or mental health, in regard to burnout. While Behavioral Health is mentioned ten

times, it is directed at helping survivors rather than the staff responding to the

emergency. Adherence to shift length is not mentioned. Resources are mentioned

regularly in the context of confirming adequate supplies, staff, and support. The Midwest

plan mentions training many times and suggests regular updates to training so that staff

clearly understand their role and their responsibilities (Midwest Plan, 2021).

West Coast Plan

The West Coast Plan does not mention burnout. Stress is mentioned eleven

times, however, only two times regard stress on the organization and resources.

Behavioral health is mentioned fourteen times, but all under the coordinator’s

responsibilities to set up services for survivors. Mental health is mentioned once,

concerning only survivors. Shift length is not mentioned, including what the maximum

shift length should be. Resources are mentioned frequently and include guidance on

what to do when resources are depleted. Training is also frequently mentioned,

specifically in the preparedness phase, to ensure that staff members clearly understand

their responsibilities (West Coast Plan, 2019).

Emergency Planning to Reduce Burnout 25

East Coast Plan

The East Coast Plan does not mention burnout in its EOP. There are five

instances of stress mentioned regarding the stress of the survivor and two instances

where they specifically mention services for responders. The one mention of behavioral

health is regarding services for survivors. Mental health is mentioned seven times, and

each is referencing providing mental health services to both the survivors of the

disaster, as well as the responders. Shift length is not mentioned. Training and

resources are both mentioned substantially. Training is regularly written about to include

any organization that would be part of each kind of response and prepares as much as

possible so that roles are clear. Resources are mentioned to confirm that a set number

is determined for various emergencies and what to do once the resources are not

enough to respond to an emergency (East Coast Plan, 2019).

Emergency Planning to Reduce Burnout 26

Discussion

Organizational Changes

Before discussing additions that can be added to emergency plans, a discussion

of organizational practices is important. Many of the suggestions and recommendations

found in the literature focused on the workplace rather than things that could be added

to plans. Role clarity, and consistent responsibility decrease the likelihood of employees

getting overwhelmed. A mentorship program was found to be beneficial for people to

increase emotional support and allow for institutional knowledge to be passed down.

The mentorship program is also imperative for employees to talk through stressors that

are specific to their field. Setting clear goals for staff members, frequent training, and

allowing active decision-making are all encouraged to create a sense of control. Work-

life balance is important; when not working, they should not be worried about missing an

email or a phone call. There should be clear boundaries on when they are expected to

respond to work matters so they can enjoy their personal time. Limiting leadership

turnover allows for consistency in the organization and adds to consistent role clarity

and expectations from the leadership. It is also important that workplaces confirm that

the workload for each employee is appropriate and that there are enough staff members

to effectively do the tasks that are required.

Plan Changes

Each of the plans included resource management and requesting more help

when the resources were not adequate to respond to the emergency. The East Coast,

West Coast and Midwest plans mentioned behavioral or mental health assistance to

Emergency Planning to Reduce Burnout 27

survivors. Lastly, all plans mentioned training numerous times to confirm that those

responding clearly understood their responsibilities. Resource management and training

were suggested in the literature, and the plans did mention them substantially. The East

Coast Plan was the only one to mention any behavioral health services for the

responders.

Based on what was suggested by the literature and the organizations, a few

items could be added to plans to reduce burnout in responders, specifically at the

county level. Recommendations include shift length requirements of no longer than

twelve hours, training before disasters on individual coping mechanisms that can be

used while responding to the emergency, and evaluations to confirm the appropriate

workload for each staff member. It also may be beneficial to add time for those

responding to the emergency to meet with supervisors if it is a lengthy response. These

meetings will allow for further role clarity, understanding job-specific expectations, and

improve supervisors knowledge of employee needs. Frequent training should remain in

plans as well as determining the correct amount and kind of resources that are needed.

These steps will help to confirm that all the above is working and that enough resources

are being provided.

Summary

There are many ways to reduce burnout on an individual level, including eating

balanced meals, getting proper sleep, exercising regularly, work-life balance, breaks

from work, and understanding what interventions work for the individual. At an

organizational level, there needs to be more training, more resources, less leadership

turnover, and active staff participation in policies and decision-making. It will take a

Emergency Planning to Reduce Burnout 28

combination of working on burnout from an individual level and organizations to reduce

the prevalence in our workforce.

Limitations & Gaps in Evidence

Few of the articles looked specifically at emergency preparedness workers.

Research and recommendations for other industries and healthcare workers were

applied to the field of Emergency Preparedness. The second limitation was using real

plans instead of templates to determine whether plans contained strategies for burnout

prevention. It is possible that templates suggested mental health strategies, but the

health departments omitted those sections. Finally, not all articles were from studies

conducted in the United States, and people from other countries may respond differently

to the prevention measures used.

Future research and action

Future research should include burnout prevention techniques, specifically

regarding responders and emergency preparedness workers. It also would be beneficial

to complete a survey before, and after a disaster to test the techniques; however, this

could be challenging due to the unpredictability of emergencies. Finally, studies to

determine what an appropriate workload is for employees would be beneficial in

assisting employers with setting realistic expectations.

Conclusions

The cost of burnout outweighs the cost of burnout prevention. To reduce frequent

staff turnover, organizations should look at a combination of what they can teach staff to

do on an individual level, as well as look at how the organization contributes to burnout.

Emergency Planning to Reduce Burnout 29

Public health is underfunded and understaffed, so it is vital to care for the employees

who choose to stay in this field and care for others.

Emergency Planning to Reduce Burnout 30

References

Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of

intervention programs. Patient Education and Counseling, 78(2), 184–

190. https://doi.org/10.1016/j.pec.2009.04.008

Burn-out an “occupational phenomenon”: International Classification of Diseases.

(2019, May 28). https://www.who.int/news/item/28-05-2019-burn-out-an-

occupational-phenomenon-international-classification-of-diseases

Cavanaugh, K., Cline, D., Belfer, B., Chang, S., Thoman, E., Pickard, T., & Holladay, C.

L. (2022). The positive impact of mentoring on burnout: Organizational research

and best practices. Journal of Interprofessional Education &Amp; Practice, 28,

100521. https://doi.org/10.1016/j.xjep.2022.100521

Coping with stress: Workplace tips. (2021, June 16). Mayo

Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-

depth/coping-with-stress/art-20048369?reDate=08022023

East Coast Plan. (2019). Emergency Operations Plan.

Emergency Responders: Tips for taking care of yourself.

(2018). https://emergency.cdc.gov/coping/responders.asp

Federal Emergency Management Agency. (2022). FEMA Strategic Plan- Building the

FEMA our Nation Needs and Deserves.

https://www.fema.gov/sites/default/files/documents/fema_2022-2026-strategic-

plan.pdf

Haar, J., & O’Kane, C. (2022). A post-lockdown study of burnout risk amongst New

Zealand essential workers. Social Science &Amp; Medicine, 306,

115157. https://doi.org/10.1016/j.socscimed.2022.115157

Emergency Planning to Reduce Burnout 31

Hofer, Waadt, M., Aschwanden, R., Milidou, M., Acker, J., Meyer, A. H., Lieb, R., &

Gloster, A. T. (2018). Self-help for stress and burnout without therapist contact:

An online randomised controlled trial. Work and Stress, 32(2), 189–208.

https://doi.org/10.1080/02678373.2017.1402389

Ibrahim, Samsudin, E. Z., Chen, X. W., & Toha, H. R. (2022). The Prevalence and

Work-Related Factors of Burnout Among Public Health Workforce During the

COVID-19 Pandemic. Journal of Occupational and Environmental

Medicine, 64(1), e20–e27. https://doi.org/10.1097/JOM.0000000000002428

Job burnout: How to spot it and take action. (2021, June 5). Mayo

Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-

depth/burnout/art-20046642?reDate=23012023

Koutsimani, Montgomery, A., Masoura, E., & Panagopoulou, E. (2021). Burnout and

Cognitive Performance. International Journal of Environmental Research and

Public Health, 18(4), 2145–. https://doi.org/10.3390/ijerph18042145

Mao, Hu, Y., Feng, Z., Wang, R., Chen, X., Zhang, W., & Yang, G. (2020). Job burnout

and correlated factors of three‐tiered public health workers: A cross‐sectional

study in China. Health & Social Care in the Community, 28(4), 1241–1251.

https://doi.org/10.1111/hsc.12957

Midwest Plan. (2021). Emergency Operations Plan.

Montgomery, Panagopoulou, E., Esmail, A., Richards, T., & Maslach, C. (2019).

Burnout in healthcare: the case for organisational change. BMJ (Online), 366,

l4774–l4774. https://doi.org/10.1136/bmj.l4774

Occupational stress, burnout and fatigue. (n.d.). https://www.who.int/tools/occupational-

hazards-in-health-sector/occup-stress-burnout-fatigue

Emergency Planning to Reduce Burnout 32

Otto, Van Ruysseveldt, J., Hoefsmit, N., & Van Dam, K. (2021). Examining the

mediating role of resources in the temporal relationship between proactive

burnout prevention and burnout. BMC Public Health, 21(1), 599–599.

https://doi.org/10.1186/s12889-021-10670-7

Otto, M. C. B., Van Ruysseveldt, J., Hoefsmit, N., & Dam, K. V. (2020). The

Development of a Proactive Burnout Prevention Inventory: How Employees Can

Contribute to Reduce Burnout Risks. International Journal of Environmental

Research and Public Health, 17(5), 1711. https://doi.org/10.3390/ijerph17051711

Reith, T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative

Review. Cureus. https://doi.org/10.7759/cureus.3681

Stone, Kintziger, K. W., Jagger, M. A., & Horney, J. A. (2021). Public Health Workforce

Burnout in the COVID-19 Response in the U.S. International Journal of

Environmental Research and Public Health, 18(8), 4369–.

https://doi.org/10.3390/ijerph18084369

Substance Abuse and Mental Health Services Administration (2022). Addressing

Burnout in the Behavioral Health Workforce Through Organization Strategies.

https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep22-

06-02-005.pdf

Support for Public Health Workers and Health Professionals.

(2021). https://www.cdc.gov/mentalhealth/stress-coping/healthcare-workers-first-

responders/

Van den Broeck, Elst, T. V., Baillien, E., Sercu, M., Schouteden, M., De Witte, H., &

Godderis, L. (2017). Job Demands, Job Resources, Burnout, Work Engagement,

and Their Relationships: An Analysis Across Sectors. Journal of Occupational

and Environmental Medicine, 59(4), 369–376.

https://doi.org/10.1097/JOM.0000000000000964

West Coast Plan. (2019). Emergency Operations Plan.

Emergency Planning to Reduce Burnout 33

What Is Burnout? (2022, April 19). Cleveland

Clinic. https://health.clevelandclinic.org/signs-of-burnout/

Emergency Planning to Reduce Burnout 34

Taylor Vaughn

(952) 452-3823 | [email protected]

EDUCATION

Master of Public Health Emphasis: Emergency Preparedness expected May 2023

University of Nebraska Medical Center

Bachelor of Science: Community Health Education, Minor: Sociology

Minnesota State University, Mankato

PROFESSIONAL EXPERIENCE

Immunization Coordinator Charles Drew Health Center FQHC

December 2020-September 2022

• COVID-19 Vaccine rollout management, including education for healthcare clinicians; inventory

management for the Pfizer and Moderna vaccines; subject matter expert on clinical logistics

(e.g. wait times, vaccine storage, vaccine transportation, etc.)

• Upgraded billing department procedures which took the vaccine program from a net loss to a

net gain in revenue.

• Vaccine inventory management, forecasting, ordering, storage, and distribution for eight clinics

• Conducted daily audits of vaccines given and completed regular visits to clinics to confirm that

the organization met the federal and state requirements for the vaccines for children and adult

immunization programs.

• Served as on-call coordinator for vaccine equipment to ensure the quality of the vaccines.

Advanced Practice Experience Appleton Health Department

May 2022-June 2022

• Revised and updated the Emergency Operations Plans and identified additional policies,

plans, and procedures to include in plans.

• Engaged community organizations and other health department staff as part of the plan

revision process.

• Created educational materials for the health department’s social media platforms.

• Researched contents, budget, and specific materials for emergency preparedness go bags to

be distributed to all staff members of the health department.

• Reviewed the contents of the health department’s website, updated links, and suggested new

content specific to preparedness.

Public Health Coordinator Charles Drew Health Center

October 2019- December 2020

• Coordinated case management for upwards of 70 clients per day during peak times of COVID-

19. This included data management, public information, and providing documentation for

clients for employment and workers’ compensation.

• Educated patients on COVID protocols, including isolation times, symptom management, and

transmission prevention.

• Coordinated future care and provided preliminary counseling for patients newly diagnosed with

HIV.

• Created monthly reports for the state and county government with patient demographics of STI

testing, HIV testing, Hepatitis C, and Lead testing.

Emergency Planning to Reduce Burnout 35

Senior Human Services Representative Hennepin County HSPHD

October 2016- September 2019

• Provided excellent customer service by explaining policies and approving SNAP, approving

Medical Assistance payments, approving Emergency Assistance, and providing Cash Assistance.

Community Health Educator Sustainable Resources Center

October 2015- October 2016

• Conducted outreach and local community events that included education and testing regarding

lead exposure.

• Coordinated classes geared towards parents about how to safely renovate their home without

spreading lead particles, including registration, preparation of materials, payment of class, and

preparing refreshments.

• Taught classes to children about identifying lead paint and what to do when they find it

• Assisted the application process for families to get new windows to reduce the presence of lead

in their homes.

Certificates

ICS

100- Introduction to Incident Command System

120- An Introduction to Exercises

200- Basic Incident Command System for Initial Response

700- An Introduction to the National Incident Management System

703- National Incident Management System Resource Management

706- NIMS Intrastate Mutual Aid, An Introduction

800- National Response Framework, An Introduction