An executive of a healthcare company recently asked me to speak to their annual employees’ meeting on the topic of Boundaries in the Workplace. I asked her to describe the problem she was trying to solve. She indicated that there are two issues. Her first concern is specific to those in caregiving professions. This is when the staff becomes over involved with their patients, sometime to their emotional detriment, and sometimes to the point that they inadvertently cross legal and professional boundaries. The other concern is common to many workplaces. This is when employees become over involved with one another to the point that they cross professional and personal boundaries.
As an Executive Coach, I began to ask myself what kind of advice I could give a healthcare executive who is trying to create a culture of compassionate service to their patients, while preventing the crossing of these professional, personal and legal boundaries. I also put on my therapist hat and began to think about what it must be like to be in the shoes of the caregivers who are serving long-term critically ill patients. This was not too difficult for me, because my own daughter is a Neonatologist who cares for critically ill babies day in and day out. My wife and I have been her emotional support many times when the stress simply becomes too difficult for her to bear alone.
It would be easy and supposedly safe to advise them to draw the line on the side of imposing Professional Distance, where the boundaries and rules are very clear, the liabilities are limited, and the consequences of crossing the line are swift. However, this is not likely to engender their desired culture of Compassionate Service, nor do I believe it would make for an attractive workplace for people who are drawn to this profession because of their compassion for people and desire for meaningful work.
So, why do people cross these boundaries that were clearly taught during their professional training? It can help to consider the challenge of offering compassionate care day in and day out, sometimes for months or years to critically ill patients, many of whom don’t survive. If a caregiver has compassion at all, they are likely to grow fond of the people they care for, as well as their families. They are as likely to grieve their deaths as they are to celebrate their recovery. My client’s company had done a good job of helping their caregivers celebrate patient recoveries, but had not done as well helping them deal with their grief and loss. Compassionate care combined with the stress of that care and the grief of loss can lead to Compassion Fatigue or even Burnout. Crossing boundaries is not uncommon when people are in such stages of emotional exhaustion.
It might help to review the symptoms of these Compassion Fatigue and Burnout; People withdraw from their work, avoid patients ( or customers for those of you outside of healthcare), use excessive leave, overreact to seeming injustices, lose their joy, and become cynical, irritable, anxious, adversarial and/or depressed. It is natural for people who are feeling overstressed or overwhelmed to seek relief. While some seek relief in appropriate ways, others may seek comfort from food, alcohol, the abuse of other substances, or from an empathetic colleague. During these times people don’t always think clearly, and it is easy for them to blur the boundaries and become more vulnerable to someone who shows the least bit of compassion or understanding towards them. When you compound these workplace stressors with other life stressors that may be occurring in an employee’s life, it is easier to understand why boundaries may be crossed in these workplaces.
First and foremost, employees must take responsibility for their own well-being and behaviors. If you chose to be in a line of work where you take care of patients, or for that matter customers, on a daily basis, you have to know that there is potential for stress and fatigue that come with the territory. You have to take steps to build resilience. That takes focus and discipline. Since you are on the front lines of very challenging situations you must prepare yourself physically and emotionally for such engagement. Think about it, the athlete prepares well before the race. The Special Forces soldier goes through rigorous training to prepare for the challenging assignments they will face. And their training is far beyond the technical/task oriented training. Preparation that builds resilience for those on the front lines includes Eating Healthily, Sleeping Well, Staying Fit in all areas of life, i.e. relationships, physical, social, spiritual, financial, and mental. Those of you who are on the front lines must also improve your Emotional Intelligence (EQ) so that you are fully aware of your own emotions and stressors, and know what to do with them before they result in inappropriate or unhealthy behavior, i.e. when to take a break, when to collaborate with a colleague, when to seek help for a supervisor or other professional, etc.
Secondly, companies can and must take greater responsibility to help their employees build resilience. The most important step a company can make is to acknowledge the dilemma. Talk openly about what we are asking our employees to do, i.e. to keep that pendulum of emotions closer to the mid-range where there is a balance between compassionate care and professional distance. Let them know that we, the company leadership, know this is a challenge and that we are here to support them in achieving this worthwhile goal. Such an acknowledgment can go a long way. It did for David Glass, retired CEO of Wal-Mart, who once instructed a group of us trainers, “Tell our managers that we are speaking out of both sides of our mouth and we mean it.” What he meant is that we are attempting to build a great, people oriented culture while we are attempting to bring the best value to our customers by keeping our expenses low. Another executive asking me to help train his pharmacy managers instructed me to acknowledge with them that “We know there is more on their plate than you can ever get done in a day, but their job is to establish priorities, and we are here to help them get better at doing just that.” Those simple acknowledgements help the front line people realize that they are not going crazy, and the stress they feel is not abnormal, but that it comes with the territory, and the better we acknowledge it and find strategies to better manage it, the more effective we will be.
Another step employers can take is to acknowledge the losses and the grief as much as you celebrate the victories and recoveries. They can also provide wellness and/or fitness programs. They can provide training on stress management and building resilience. Employers can insist that their managers be fully engaged with employees so they can recognize employees who are stressed and know how to help them through stressful situations, and to help them find effective ways to manage their emotions so they are not left to stuff them in an unhealthy ways. They can train their managers to manage performance in a way that minimizes the drama and conflict in the workplace. They can also provide Employee Assistance and/or Chaplain services so employees can talk confidentially about work related and personal stresses with trained professionals who can help them find healthy solutions. And finally, to be effective, employers must create a psychologically safe workplace of open communication where employees are not afraid to speak up, acknowledge the stressors of their work, seek help, ask questions, offer feedback, make suggestions and criticize the process.
I am convinced that these steps have the greatest likelihood of keeping the pendulum from swinging too far in either direction.