Improving wellbeing and preventing burnout

Introduction: the burden of psychological distress & burnout

The World Health Organization (WHO) defines positive mental health as “a state of mental wellbeing that facilitates coping with the stresses of life, the acknowledgement of one’s abilities, learning well and working well, and contributing to one’s community”. It goes on to suggest that mental health is an essential part of wellbeing and a basic human right. Additionally, the organization believes mental health to be a fundamental element of personal, community, and socio-economic development [1] – yet this so-named “basic human right” has been, and continues to be, compromised for veterinary professionals worldwide. Workload, financial stress, extensive working hours, difficult interpersonal experiences, unanticipated outcomes, the emotional toll of pet euthanasia, and fear of complaints or making mistakes are most acknowledged as the reasons for psychological distress for veterinary professionals [2].

What’s the level of the problem? 

While research that solely focusses on registered veterinary nurses (RVNs) and veterinary technicians remains scarce, the recent research available does speak to the concerning levels of burnout, compassion fatigue, and stress that exist among this cohort (Figure 1). A 2018 study by the Irish Veterinary Nursing Association indicated that 45% of respondents planned to leave the profession within five years due to various workplace stressors, and this was before the constraints caused by the COVID-19 pandemic. The number of RVNs intending to leave the profession had increased by 15% at that time, with financial stress or pay scales cited as the main reason behind this decision [3]. Clarification regarding intent to leave the profession in 2025 is needed, but an increase beyond 15% seems plausible, given that research as recently as this year documents poor professional quality of life and a global workforce shortage [4], [5] .

A 2022 report by the Veterinary Council of Ireland noted that 42% of RVNs surveyed showed abnormally high levels of anxiety in comparison to their peers; the report also suggested that they were more susceptible to psychological distress and self-harm [6]. The disproportionate female-to-male ratio within the participating cohort could lead some readers to hastily conclude that these results speak to the predominance of women in the sample, with the problematic assumption that the gender is inherently “more emotional” or less resilient. However, to reduce this complex issue to assumptions about women is to ignore the more urgent systemic factors that demand critical attention, alongside the understanding and compassion required when considering the nuanced experiences of gender on a spectrum.

While a UK-based study from 2024 did conclude that more research is needed to address some ambiguities around mental health trends among RVNs [4], it can at least be agreed that burnout has significant impacts on wellbeing, workplace retention and animal welfare. It has also been suggested that compassion fatigue is a daily occurrence among some professionals, and that alongside burnout, it may also be linked to resignation levels [7], [8]. The effects of COVID-19 on the mental wellbeing of veterinary teams, in addition to effective solutions to that specific crisis, have also yet to be addressed. Equine nurses in more rural settings seemed more susceptible to poor mental health during COVID-19 [9], and workplace incivility in the form of difficult interactions with colleagues and clients seems to directly impact the mental wellbeing of all veterinary professionals. However, the influence of the pandemic on this specific difficulty remains conspicuous. Interestingly, though, one study noted that senior colleague incivility predicted veterinary surgeon turnover intention, whereas client incivility predicted burnout [10]. Despite the remaining ambiguity in the literature, it is clear that self-care strategies will assist RVNs with reducing burnout symptoms and aid recovery [4], [7], [8], [9], [11]. Mindfulness-based practices could be a promising starting point for the exploration of tangible solutions to the veterinary mental health crisis by improving resilience among a community vulnerable to consistent emotional adversities.

Mindfulness for resilience 

Resilience is a multifaceted process through which individuals draw on personal and contextual resources to strategize and learn from a situation without being overcome by it [12]. Within the context of the modern veterinary practice, resilience seems to be a key player in reducing the effects of psychological distress and moderating staff turnover [13]. It is currently unknown whether predisposition to the acceptance of mindfulness-based methods as both a prevention strategy and intervention method for mental ill-health is linked to career stage or age, but noting existing differences among certain cohorts may be beneficial.

A (non-veterinary related) study showed that older adults often avoid seeking psychological treatment, thus challenging their ability to cope effectively with anxiety, stress and depression. However, the researchers concluded that mindfulness-based group interventions did effectively decrease anxiety and simultaneously had a positive impact on attitudes toward psychological treatment among their cohort of older adults [14]. Few longitudinal studies have been conducted to assess the effectiveness of mindfulness-based interventions among veterinary students, but one study [15] did find that regular participation in a mindfulness-based practice significantly decreased anxiety and depression symptoms (Figure 2). Cognitive Behavioral Therapy (CBT) is often used as a therapeutic approach that enhances resilience, and, when paired with mindfulness, is more effective [16], [17]. A Mindfulness-Based Cognitive Therapy (MBCT) intervention among human healthcare nurses was shown to reduce PTSD (post-traumatic stress disorder), anxiety and depression symptoms [16]. Other research among human nurses suggests that the existence of structured and monitored organization-led programs, rather than solely relying on a self-directed approach, seem to light the way forward in the context of resilience building and burnout reduction [18], [19]. A study with a cohort of high school students showed that just 8 sessions of MBCT significantly improved resilience and motivation [20], while other researchers have highlighted the benefit of regular small group discussions for veterinary students, aptly named “compassion fatigue rounds” [21]. The presence of a structured and consistent guidance seemed to influence the effect of the mindfulness-based techniques used across all mentioned studies, but further research is needed to confirm the ideal ratio between self-directed participation and a program-based approach. 

As organization-led initiatives are not yet universally accepted within the veterinary industry, self-directed mindfulness practices – such as journaling and body scan meditations – may foster empowerment during times when inaction from decision-making figures is particularly evident. Given their effectiveness in helping with anxiety, depression and stress reduction, regular engagement with these activities could be helpful for individuals who wish to ward off psychologically compromising experiences and avoid burnout.

Journaling: pen, paper and peace

Journaling (Figure 3) is a simple and versatile tool that seems to have few barriers to accessibility and application, while simultaneously reducing stress and depressive symptoms and thus improving resilience. A 2015 study amongst a mixture of human healthcare professionals showed that the additional incorporation of a gratitude-related prompt (i.e., including a reason to be thankful whenever completing an entry in the journal) was even more effective in reducing these symptoms. Stress and depressive symptoms were measured before and after a 4-week journaling period, with only one group completing a gratitude exercise as part of the study. This group showed fewer depressive and stress symptoms post-journaling than their colleagues who were not asked to add gratitude to their journaling routine [22], [23].

Journaling facilitates a healthy way to express oneself in times of overwhelm, and could prove to be essential for some nurses and technicians where acknowledgement of problems, fears, concerns and mental-health symptoms is necessary for planning relevant interventions. Physiological regulation (i.e., regulating heart and breathing rate), alongside the positive mental health benefits, means that journaling can be regarded as both an intervention and a method of facilitating the planning of further interventions. Journaling also provides an opportunity to practice positive self-talk, thus challenging and counteracting any self-criticism and self-deprecation. Clarity around the source of negative emotional experiences (stress, anxiety, depression, etc.) is also facilitated by journaling, which may guide the participant toward rectifying presenting issues and building resilience [24].

Many readers at this point have likely begun to wonder how to incorporate journaling into their daily routine, with time management being one of the most prominent concerns that the author has come across when involved in psychotherapeutic work with veterinary professionals. While further academic research is of course required to measure the wider collective success rate, Figure 4 may at least offer some guidance and clarification around self-directed time management strategies in accordance with what resonates at an individual level for journaling, based on the author’s 1:1 and group work with veterinary professionals over the last few years.

Scheduling and setting reminders counteract decision-making fatigue that can hinder action and subsequent progress, while setting boundaries with loved ones ensures that the chosen time is uninterrupted. Exploring the time of day that one commits to journaling may encourage optimal results and awareness of progress. For example, journaling in the morning may allow for initial mental clarity at the beginning of the day, whereas journaling at night may enable improved sleep quality if day-to-day events elucidate worry and concern for the next day’s “to-do” list. Avoiding multitasking and limiting time spent journaling allows for reduced stimulation and encourages mindful presence, ultimately securing positive results. The use of intention, through utilizing dedicated stationery and identifying the method that best aligns with one’s symptoms and lifestyle, promotes an empowered approach to one’s mental wellbeing. Intentionally following prompts (and many are accessible for free online via Pinterest, Instagram and other social media sites), also allows for progress assessment via structure.

Tense to tranquil: body scan meditation

Body scan meditation can lower blood pressure, reduce pain, improve sleep, reduce anxiety and stress, regulate emotions, and increase self-awareness [25] Either used paired with journaling or by itself, it can further support stress reduction and improve both sleep and the ability to relax during restful periods. A combination of body scan meditations and journaling may enhance the effectiveness of planned intervention strategies, as these will be implemented based on an individual’s increased awareness of their specific needs for symptom improvement. 

A key feature of anxiety is fearing the future and the prediction of unpleasant circumstances or events. Body scan meditations assist with grounding the participant in the present moment and encourage a more mindful approach to what the future may hold. If practiced regularly, this may in turn improve resilience, as it can result in acknowledgement of one’s capability to manage whatever adverse event may occur (Figure 5). Further research on the use of body scan meditations to specifically target resilience development among veterinary staff is needed, but the possibility of this tool having some positive effect seems likely, given the supportive research that already exists around the technique generally. While the time management sentiments in Figure 4 also apply to body scan meditations, understanding and executing the steps of a body scan is most likely a prominent concern for veterinary nurses/technicians, and step-by-step instructions are shown in Figure 6.

Spending some time exploring and experimenting with various resources (again most are available online for free) is recommended for optimal results. However, it is important to remember that while a “trial and error” approach does exist by default when exploring ways to care for oneself, a rulebook does not exist. Some time determining what works best on an individual level is encouraged, and taking inspiration from both the notable failures of an intervention, alongside its successes, is potentially essential for improving the efficacy of the said intervention. Whilst we wait for positive improvements to the approach to mental wellbeing maintenance among decision-makers in veterinary practice, individual exploration as a method of empowered symptom management and resilience improvement is imperative.

Mindful movement towards mental health

It appears that the basic human right for good mental health may continue to be hindered for practice staff if those in leadership and/or decision-making roles do not engage with the exploration of essential and research-supported interventions to create organization-led and sustainable programs to combat stress, anxiety, and depression within their workforce. Veterinary staff are consistently exposed to workplace stress, financial stress, unpredictable working hours, interpersonal incivilities, unanticipated adversities, the psychological impact of euthanasia, and fear of complaints and errors [2]. However, these negative experiences can be counteracted by proactive engagement in mindfulness-based activities that build on resilience and reduce unwanted symptoms.

While awaiting the development of supportive organization-led programs, self-directed engagement in mindfulness-based activities like journaling and body scan meditations can empower veterinary nurses/technicians to improve their mental wellbeing. These activities may also highlight the source of symptoms, prompting lifestyle changes for individuals. Mindfulness-based cognitive therapy, either 1:1 or in a group program format, also offers benefits to those experiencing unpleasant mental health experiences, and exploring one’s mental health through talk therapy or with the support of a third-party professional is encouraged. No matter the activity that one chooses to partake in, the exploration of time management to support regular engagement is fundamental to ultimately incorporating these activities into one’s routine and reaping the benefits of these activities.

Conclusion

Empowering oneself by exploring both the failures and successes of mindfulness-based activities to identify a routine that aligns on an individual level seems to be a key element that facilitates optimum results. Additionally, remembering that a “trial and error” approach without a concrete rulebook allows for exploration that may be enjoyable and does not negatively reflect one’s capabilities or skills where mental health is concerned. Nurses and technicians are powerful additions to all veterinary teams, and the mental wellbeing of these individuals who are keen to remain in clinical practice should be explored with utmost regard, compassion, and understanding. Self-directed exploration of one’s own mental wellbeing is crucial, but it is markedly evident that urgent intervention is required, both at an individual and organizational level, to counteract the many psychological adversities that support staff are susceptible to as they add their intrinsic value to the veterinary industry.

 

References

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