Latest / Dispatched & Dysfunctional / The Hidden Cost of Overwork in Healthcare — When Your Body Can No Longer Ignore It — Candice Elam

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The Hidden Cost of Overwork in Healthcare — When Your Body Can No Longer Ignore It — Candice Elam · Dispatched & Dysfunctional

• Chris Stockton: Don't want to work. Alright. So you were listening to Dispatch Dysfunctional. ⁓ today's guest is Miss Kansas. She came up as an ER nurse from a level one trauma center. Now she works as a family nurse practitioner in a community health center. So before the credentials, the initials, you know, the whole acronyms behind our names, the trauma centers, the clinical lives, and the professional stuff. Miss Kansas, who are you really outside the job and why is this conversation worth having today? Candice Elam: So outside of the job, I am a wife, I'm a mother, I'm a daughter, I'm a sister, I'm a friend. That's who I am at my core. I am a woman of my family first and foremost. And so that informs how I work because this job, any job, is really to enable me to support myself, support my family, be a meaningful member in my community. And ⁓ so my job can't interfere with that. Because the people who I live with, the people who I love, the people who are in my personal life are the primary people for me. Chris Stockton: That's awesome. And why was this conversation worth having today? Candice Elam: So we're talking about burnout, and you know, there's life burnout, there's career burnout. For a lot of us, our career figures extremely prominently in our lives, and that affects how we go home. That affects how we show up in our families and in our communities. So, you know, I've seen people get divorced, I've seen people in healthcare. become estranged from their adult children. You know, their children have a grudge against them because they were not fully able to parent effectively because of all the mayhem at work or the baggage and the trauma that they're carrying from work. I've seen people miss their window for having children, miss their window for partnering up. So this conversation's worth having because the work that we do is super important. The work that we do is something that our community needs. You know, we're not gambling away people's pensions like the people in whose hands our pensions are. You know, we're doing valuable, meaningful work, but it doesn't have to happen at the cost of having a fulfilling and satisfying personal life with relationships that are where where there's tranquility and solace in those relationships. Chris Stockton: Very true, and I think I think you're right. I think a lot of our job eats into our personal lives and sometimes, you know, we always hear the keep work life separate from personal life. That's not always the case in our fields, in my opinion. ⁓ you know, we bring a lot of it home with us and we try to keep it separate. It just doesn't work that way. ⁓ so one thing that jumped off the page for me that you wrote on your intake is the same selflessness that makes people write for this work is exactly what the system uses against them. That one hits hits hard ⁓ to every medic, nurse, dispatcher, firefighter, cop, first responder, caregiver, anyone I know really listening, ⁓ because, you know, that's what it feels like is we're the selfless ones and if we start saying we have a problem, w we could possibly end up losing our jobs, which goes back to what you were saying with the burnout. ⁓ so so I l let me just start here, I guess. So when when did you realize burnout was not proof that you were weak, but proof that the math was never going to work in the end? Candice Elam: I made that realization when I got sick, you know. ⁓ I had internalized the the throw yourself in front of everything, be the first to volunteer, be the one who never says no. I had internalized that from my days in the hospital, from my days in the emergency department. And that ethic is it's kind of like a badge of honor, it's a sign of valor, right? ⁓ but I've also had coworkers who drank themselves to death. I have coworkers who have died by suicide. I have coworkers who ⁓ diverted, dilated. you know, and and came to work intoxicated. So, you know, ⁓ on the one hand, we will give a standing ovation for the person who like leaves it all behind on the shift, but when they're going home to a a home life that's been wrecked or personal health, mental health that's been completely destroyed because of the demands of the job. Who's there for them in that case? Like the organization is not. ⁓ and it's unrealistic to expect the community to to come and step into that gap. So when I got sick, right, I and by the way, I've had multiple cycles of burnout. Like it's not like something that just happens once and then you recover and then you're fine the rest of your career. Like it happens a lot, especially like it the the Chris Stockton: ⁓ I'm sure. Candice Elam: work that we do, whether you're pre-hospital or in the hospital or or in community health, like that work. it there's a proneness to burnout for the people who are in that kind of work, right? So here I am, ⁓ my most recent bout of burnout. I'm working in the community health center. I have a scheduled vacation. I'm going to Peru. I'm going to Machu Picchu. I'm going to the Amazon. I can't wait. Okay. I wanna, it's eight days and I worked on Friday, which was the day that I was leaving because my plan was to sleep on the plane, land in Lima, be ready to go. Right? So I would have gotten like a a full night sleep from New York to Lima, right? But that whole week I was feeling sick. And I but I like I I figured, you know what, it's because I'm grinding. I'm doing I'm signing my charts same day, I'm responding to my my medication refill requests, like as they're coming in, because I'm gonna be gone for a week. My laptop's gonna be in New York. I'm not signing into Epic when I get to Peru. And I don't wanna leave a mess for my coworkers. And I also don't want to leave my patients feeling like I completely abandon them to go live my best life. Right? So I'm grinding all week, ignoring my body. I'm feeling tired. You know, the moment I get home, I knock out like I don't even feel like eating because I'm so tired. You know? Yeah. And I could eat. I could eat. so this is happening, I'm ignoring it, and then the day that I'm supposed to leave, I actually feel chills. I feel joint pain. I feel loss of appetite. And I'm still grinding. I'm still getting through my day because I got like my my luggage is packed. It's by the door. I'm ready to go once I leave work, head to the airport and get on my plane. And then there was a point in the day where I'm like, I think I have an infection. Like, I need to go get myself some antibiotics. So my colleague who I'm flying with, also at work, grinding alongside me, she writes me a prescription. We have an in-house pharmacy. I go down, I get my my ⁓ antibiotic. I start taking the first one. I took an antipyretic, I took some neproxin to bring my fever down because I'm feeling chills, right? Chris Stockton: Right. Candice Elam: It's October. I'm feeling chills. So it's it's kind of warm in New York, right? In October. Like not like, you know, you're not wearing a north face, right? But I'm feeling chills in a climate control building. I'm sick sick. But again, I'm determined to go on this trip. I've worked really hard for this. I've earned this. I take my antibiotics. I take my neproxin to reduce the fever. And I'm on I'm at the airport now. I checked my luggage again, committed to this trip. And then I start feeling a little delirious. And my my colleague who I'm my friend who I'm traveling with, she's talking to me. I have no idea what she's talking about. It's just chitter chatter, small talk, as friends do, right? And then she looks at me because she realizes that I'm not following the conversation. She says, Candace, what is wrong with you? And then she starts like pressing on like my chest, touching my face. And she's like, you are sweating and you're burning up. What's wrong with you? This is the one who wrote me the prescription earlier, by the way. And she's like, you're not okay. I said, yeah, I agree. I think I should go home, but I I feel bad. Like I don't want to leave you on this trip by yourself. She's like, no, go home. Because again, we're going to Machu Picchu. Like you think there's like an academic medical center, you know, up there in Machu Picchu? Probably not. Chris Stockton: I gotcha. Candice Elam: I was gonna get on that plane and I could have died because I was so sick. Turns I had sepsis. I had sepsis. So when I say I could have died, like it's literal. And I came home and I was back and forth to the doctors, and it took the entire vacation for me to not be sick anymore. And that was the turning point. That's when I realized that you know, all of this grinding. Chris Stockton: ⁓ wow. You'll die. Candice Elam: It's not because I was inefficient, it's not because I'm a procrastinator, it's not because I'm lazy, it's not because I don't use my time wisely, it's because the job doesn't fit in the 40-hour container that we had originally agreed upon. And all of that grinding was necessary so that I could leave to go on the vacation that I earned. And that's not my fault. And my body paid the price, and because of that culture of overwork. That we pass down, not just because of what we learn in school, but in how we train people. Because if you're if you're senior in your squad, if you're senior on your in your department or on your unit or at your clinic, you're involved in training people. And so when newbies come in, when students and residents come in, we model that overwork. We don't have to say anything. They watch what we're doing and they follow us in what we do. And so I picked it up from the people who taught me. And ⁓ that that culture of overwork forced me to override my body and ignore all the obvious signs in hindsight. And that was the turning point for me. It it wasn't me failing as an individual, it's the system. And it's built for this exploitation and it's built for extraction. Chris Stockton: You're right. And I think, like you said, a lot of it is is trained within ourselves. because heck, even when I went started EMS, you know, it was always follow the old guy, do what he says, you know, not as he does, do as he says, listen to him. And I I've got to the point to like you were saying before with burnout to where I wound up having a stroke due to it. So, you know, i it it's funny how our bodies cope and deal with the stress that we're causing it from our own jobs. ⁓ you know, we're causing our own selves o damnation in the end, i in my opinion. But ⁓ i and there's nothing There's nothing really anyone's doing about it now. ⁓ there's very few of us trying to even speak about it. And it it's I guess because of how old our jobs are, you know, healthcare is one of the oldest jobs in the world, that that's probably been that way since day one. You know, and that's I think that's where one of the biggest lies in my opinion from burnout comes ⁓ comes at is everyone says, you know, not everyone suffers from burnout. To me that's a lie. I think everyone suffers from burnout at one point in their life. And it's not just healthcare, that's everywhere. I think everyone has some kind of burnout at least once in their life. ⁓ what what do you think is the biggest lie about burnout? Candice Elam: biggest lie about burnout is that it's a personal failure. Like you're burnt out because you fail to maintain boundaries, you're burnt out because you procrastinate, you're burnt out because you're not using your resources well. ⁓ Yes, there are instances I mean because as employees, again, whether you're fire, EMS, dispatchers, a staff nurse, an MP, whatever you are, right? We're not perfect. We're human, we have our shortcomings, we have our needs, we have our failings, we have our weaknesses, and so for burnout to be as widespread as it is, like it's hard to if we're if burnout is viewed as a personal failure, are we to believe that everybody's a failure? Or is it more likely that we were set up to fail? And when we do, you know, again, if we're going to consider burnout a personal failing, if that's how we're going to look at it, right? If we were set up to fail and then we fail, whose fault is it? Because we didn't build this. We didn't build a system where, you know, if you're pre-hospital, right? Hospitals close and now you gotta travel farther. Now you're covering a larger area. And not only are not only does it change how you work, it's also changing what patients do. You know, so knowing that the hospital that's you know two miles away closed and the next nearest hospital is fifteen miles away, they're not going to call when they're a little bit sick. They're gonna call when they're on death's door. Right? And like I I had to you know, from every now and again I have to send patients to the hospital, right? But now if I'm calling from the clinic, and again, this is New York City, like there's hospitals everywhere, but there's also high population density, lots of traffic. So, you know, if you're dry like I'll give you an example. I live eight miles from my job. It takes me on a good day, on a good day it takes me 45 minutes to get to work. Right. To drive eight miles, it's 45 minutes. On a typical day, it takes me like 65 minutes to drive eight miles. So although yeah, although there's a lot of health care and lots of hospitals around, it's not easy to get there. Right. So if you've got a bunch of people calling for help for various things, you know, the regional EMS service has to triage these things. Chris Stockton: Wow. Wow. Right. Candice Elam: Now I'm in community health and my patient, primary care patient, is having a psychiatric break. And they're hallucinating and having paranoia because they've been off their meds. And I take care of them for like their hypertension and their diabetes, right? But here they are in acute psychiatric crisis. But you, Chris, got a whole bunch of calls at our rule out acute coronary syndrome. Rule out stroke. So my patient who's cutting up in the clinic because they've been off of their geodon for the past nine weeks, they become down triaged, right? They're not suicidal, they're not homicidal. This is somebody who's going to be sitting in the community health center for five hours, pulling on our resources until EMS can finally come because all of the acute coronary syndrome. And all of the rule out strokes have already been dispatched and finally there's a unit who's free. Right? Is that your fault, Chris? Is that my fault? Absolutely not. It's not the patient's fault either. And then the nurse in the clinic who has to keep that patient calm, keep them from eloping, keep the other patients from getting pissed off at this one who's screaming and hollering in the hallway. Like, yeah. Chris Stockton: I bet that's fun. Candice Elam: None of us are at fault for this. Right? But the venture capitalists who closed our hospitals because they financially ran it into the ground, it's their fault. But you know what they're doing? They're chilling. They don't have to see any of this. They consolidated, they closed, they sold to the highest bidder. And and and and they keep their hands clean of all of the mayhem. And then here we are, you know, you got the pre hospital people. Chris Stockton: Yeah. Candice Elam: Talking about, well, why is the clinic calling? Why can't they just handle it? And then the clinic people are like, Why is EMS taking so long? And then the ER is like, Why did they call for this guy? Like, he's not even suicidal. What are we supposed to do? Chris Stockton: Right. And I think like you said, i it's just it's an unnecessary evil on all of us in my opinion, too, because you know, we all do work together in the end, but and you've worked ER, you've worked you know, y y you've been all over it. So you you know exactly what I'm talking about here. There's always that Why the hell am I here? What are we doing here? Why why did you bring that guy in here? And y you know, from a pre hospital standpoint It sucks because we can't tell a patient, no, we can't treat you. You know, we just don't have that ability. If that was it for my understanding, I may be wrong. So if someone's listening to that can correct me and give me comments on this later. But in Europe, for my understanding, the medics over there have little papers that they can give out to the patients that say, Hey, you're not in emergency need. Here's a piece of paper. Go to your nearest clinic. If we were able to triage like that here in the in America, I think that would help a lot of the system. And I think we would be able to have a lot more community paramedics be able to do a lot more care as that as well in th in that. Or community nurses or like you were saying, in it just community healthcare, period. and it sucks because we are digging at each other for no reason because the patient is the one that needs what they need. You know. And as you said, that patient that you just described with a psychological break, it isn't his fault. It isn't her fault if they ran out of meds. You know, they they they can't help their own mental illnesses. And i it it it's it fathoms me because of the fact that we have so many people that are so down and out that they have to either choose their meds or food. That's another issue I see ⁓ working on the streets. And and a lot of the hospital street teams do a tremendous job at that now. ⁓ ten years ago that wasn't a thing, and we've seen a lot more of it. So that we are fixing a bunch of our issues, and and I think that helps a lot of the burnout in our own situations as well. But ⁓ you know, it it feels to me like we abandon each other when we try to Stab one another that way in the end. Candice Elam: Absolutely. I mean, fundamentally every single one of us, even at even those of us who work in healthcare, we will be patients. I was a patient multiple times over. You having had your stroke were a patient. You probably had to call EMS or it happened at work and somebody had to cart you to the to hopefully a certified stroke center, not like some ⁓ freestanding ER that has access to a neurologist through telehealth because that's a thing too. Chris Stockton: God, that would've sucked. Candice Elam: Right? Yeah. Yeah. Yeah. But but I don't know if this affects your region, but like we have emergency departments, hospitals that don't have a neurologist, you know, or don't have a neurologist 24 hours a day. So if somebody is coming in, rule out CVA, you know, it they they they will wheel a little screen in and and position it at at the end of the gurney. And the neurologist will be through the screen saying, Okay, let me see you smile. Chris Stockton: ⁓ wow. Candice Elam: Okay, raise your eyebrows, you know. All right, put your hands up like this. Yes, that is a thing. And so again, it's not your fault, right? It's not and and it it's very likely that the pre hospital people, like in in New York City, you don't get to choose where you go. Like you are you you pick up a patient and you drop them off based on where you pick them up. So there's no choice in the matter, right? So like if Chris Stockton: ⁓ that's Candice Elam: They are in the the the radius of the place that doesn't have the neurologist, you know, you end up where you end up. Yeah. And that's that's just how it is because the resources are so finite and because it's so hard to travel through the city, right? and so the this the situation that you describe in Europe, ⁓ I also don't have first knowledge of that being, you know, how things are done, but one Chris Stockton: ⁓ wow. Candice Elam: Important thing to notice about the difference between healthcare in Europe and healthcare in the United States is that the people in Europe have like nationalized health care, right? Like everybody's insured. Like I don't know if it's citizenship-based or residency-based or what, but we don't have that here. We have a large population of people who are uninsured and undoctored, you know, like they Chris Stockton: Right. Candice Elam: so many how many of your patients like what percentage of your hospital your pre-hospital patients have a PCP that they can go to you know because many people simply don't have that and so if you as a pre-hospital provider said okay this is not this this er visit this EMS ⁓ transportation is clinically unjustified go to your PCP tomorrow morning our system doesn't support that So because you say go to your PCP to somebody who doesn't have a PCP, where are they gonna go? And even somebody who does have a PCP, like I have a primary, but she has limited walk-in availability. So if I got sick today and I tried to see her tomorrow, I I might not be able to see her until what's today? Today's June 8th. I might not be able to see her until June 17th because that's how her schedule is. And maybe I could see one of her colleagues, you know, which I'll take it if if I need it. But you know, go see your PCP isn't real advice for many people. And a lot of times, you know, that's you people are discharged from the ER with advice to go see their PCP, but you know, many people just don't have it. Or many people are in employment situations where, you know. Their work hours are the same hours as my work hours in the clinic. And if they don't go to work, they can't put food on the table. They can't put they can't keep their lights on. You know, a person with children, that person blows through their sick days in the early part of the school year. You know, who's got the flu? Who needs to get vaccines? Who's got a toothache or a dentist appointment of their children? So when it comes to them as parents being sick, or if they've got Aging parents who they gotta take to the cardiologist and who they gotta take to the geriatrician, they can't even use their sick days on them on their own selves. You know, so the whole advice go see your PCP. With what time? How am I gonna pay my bills if I have to take off all half a morning or a whole day to manage my own medical needs? We just don't have that kind of system. Chris Stockton: Very true and it kind of falls back on that this kind of piggybacks off that at the end as well. ⁓ you know, we always hear about the nurses who go to prison, the medics who lose their license, and the person who's always close to the incidents. ⁓ but we rare we we rarely ask ourselves, why did it happen? You know, was it they were tired? Was it they were just sh a unit short, like you're saying? ⁓ was it the system built that way, pretty much like we just described, or you know, who's made these decisions. ⁓ you know, why does accountability have to stop with the worker in your opinion as well on this and even on that side of things, you know, like you said, we don't all get to call out sick because we have sick days that we've used because we can't we have families. You know, and then the accountability falls back on us because we're burned out, we're so tired that we've we just can't do it. You know, wh wh why is it that we're all accountable as the worker in the end, do you think? Candice Elam: Because it's the easy answer. it's the easy, I mean, it it's the easy answer, you know, it it's gratifying to see somebody, you know, like that that whole expression, ⁓ well, I want to see some heads roll. You know. and so the person who's standing there, the you know, the person who's at the scene of the crime, so to speak, is the head that's gonna roll, not their boss who built their schedule. Chris Stockton: I like it. Candice Elam: Not the legislator who you know who somebody lobbied to allow the sale of this small hospital that serves this region to be sold to a hedge fund or venture capital, right? And then venture capital is gonna do what venture capital is gonna do, they're going to liquidate that hospital. And then there's gonna be this song and a dance about why it has to close. And the nurses and the kitchen staff and the medical assistants and the EMS, they're gonna protest and they're gonna show up at town hall meetings when the decision's already been made. The place is closing. They're turning it into condos. It's not gonna be a hospital anymore. And that decision was made. by the people who have a financial incentive in liquidating and extracting as much from the community as possible. And and and so when the unit is short and when you know the fish hits the shan, so to speak, and you know somebody dies, and the nurse or the EMT or the officer who's standing beside that person, they're gonna be, ⁓ You made this mistake, you made this mistake, you failed to do this, you failed to do that. And of course, that failure very well might be true. You know, because it only sticks if it's true. Right? But what about all the other failures that had an impact? You're trying to say that, you know, the fact that I took the unsafe assignment and did the best I could do with a crappy assignments and almost no resources or support or safeguards in place that I'm at fault for this. And and and you're gonna pin it on me and you're gonna drag me out in front of the board of nursing. You're gonna drag me out in front of the the state the the state court for for the civil suit. Right? Like it's the easy answer. It's not the answer that says, okay, let's keep this hospital locally controlled. It's not the answer that says this politician has been bought by that lobbyist, and we can't believe a word that he or she says, and we need to vote that fool out because they don't work for us. They work for who funds them. That's that's the hard thing. That's the invisible thing. And it doesn't give you that that satisfying, okay, well, at least that person got fired. At least that person you know, is gonna lose their license. They'll never be able to do this. They'll never be able to hurt another patient again. You know, you don't get that satisfaction when you vote out the the the the donkey who sold out their community, you know, for for some campaign ads. Chris Stockton: Right. And that that's the biggest thing and and th and that causes so much of the burnout too, ⁓ y about everything we just talked about. But I think that's one of the biggest things too is everything is about money. It's not about the patience, not about the care. I don't care how many lies people want to tell us, it's not. It's about the money. And ⁓ I guess I got one one last question real quick before we wrap this up. ⁓ so picture the person listening alone at two AM Candice Elam: Absolutely. Chris Stockton: ⁓ maybe they're stuck in the truck after a bad call, maybe they're sitting in a car before going inside because they don't want their family to see their face yet. Maybe they're a nurse after shift, a dispatcher driving home in silence, a firefighter staring at the ceiling, a medic who is functioning but fading. They know the job is hurting them. They also still care. What do they need to hear from you today? Candice Elam: Remember why you did this. None of us came into this work with dreams of becoming rich. None of us came into this work thinking that we were going to be the boss, and that you know, like we we all came into this because we love our communities. We feel we're motivated by the virtue of what we are capable of doing, right? And so When you can't go in to face your family because you're crying about the patient that you lost, or the person who, you know, the person who you interacted with who you know their life is is changing irreparably after whatever it is that happened to them today, right? Remember why you're doing this. Because the the bloodsuckers and the leeches that make it so hard for us to do our work, that make it so hard for us to serve our community. They'll never have the dignity or the honor of really being useful to the people around you, of really having an impact. And if you can remember why you did this, you can maybe pull yourself together long enough to continue to do the right thing, to do the good thing that people are going to remember you by. So always remind yourself of your intention. Chris Stockton: a spam. So before I let you go, ⁓ if people want to follow your work, connect with you, or find out what you're building, where should they go or how can they find out more about you? Candice Elam: So you can find me at my website, signethechart.com, and you can also find me on YouTube where I share useful tips for strategic job selection, how to function in these clinical workplaces, and how to master your workflow on my YouTube channel at signthechart.com. Chris Stockton: Awesome very ⁓ thank you very much, Candace. I loved having you. Let me go ahead and stop.