APTA Nebraska Podcast
The APTA Nebraska Podcast dives into the stories, challenges, and innovations shaping physical therapy in our state. We’re here to advance, promote, and protect the practice of physical therapy, build our community, and optimize the health and quality of life for all Nebraskans.
APTA Nebraska Podcast
E15 - Member Spotlight: Nikki Sleddens Burnout and Balance in PT
We unpack burnout in physical therapy with new Nebraska data and lived stories, moving from clear definitions and risk factors to practical fixes for clinicians and leaders. The conversation closes with concrete resources, ongoing research, and an invitation to act together.
• Defining burnout across emotional exhaustion, depersonalization, and reduced accomplishment
• Nebraska study design, funding, and why the state focus matters
• Frequency of engagement vs burnout in PTs
• Demographics linked to risk, including early career and debt
• Workload, autonomy, and leadership support as primary drivers
• Cultural red flags like leaderboards and misaligned incentives
• Personal costs to health, empathy, and career decisions
• Individual strategies for sleep, exercise, nutrition, and boundaries
• Organizational actions: assess, listen, redesign metrics, protect flexibility
• Advocacy through APTA for reimbursement and regulation change
Don’t forget to subscribe, share, and join the discussion. Because together, we’re driving the future of physical therapy forward.
Episode Links:
The Emotional PPE Project https://emotionalppe.org/
988 Lifeline / National Suicide Prevention Website https://988lifeline.org/
A Multiple Methods Study to Describe the Manifestation of Burnout of NE Physical Therapists: https://digitalcommons.unmc.edu/etd/791/
Manuscript citation: Sleddens N, Beam E, Meyer KP, Stamler LL, LaFramboise LM, Sayles H, Wengel SP 2025 Examining the frequency, severity and associated factors of burnout in Nebraska physical therapists. Physiotherapy Theory and Practice [In Press] https://doi.org/10.1080/09593985.2025.2571795.
Welcome to the APTA Nebraska Podcast, where we dive into the stories, challenges, and innovations shaping physical therapy in our state. We're here to advance, promote, and protect the practice of physical therapy, optimizing the health and quality of life for all Nebraskans. Join us as we connect with experts, share insights, and build community throughout our profession. Welcome back to the APTA Nebraska podcast. My name is Brad Dexter, your host, and today I'm joined by Nikki Sleddens. Hi, Nikki. Hi Brad. So Nikki has been around for a little while in the PTA profession, and it may be a familiar name to some of you. From 2009 to 2015, Nikki, you were at SEC as part of the PTA program, correct? Right. Yes. And probably had a lot of PTA students going out to a number of clinics there. And in 2015 you transitioned to faculty at UNMC, where you've been the director of clinical education for the last decade, correct? Correct.
SPEAKER_01:Yes.
SPEAKER_02:Yes. You were telling me earlier Kyle Meyer still holds a record for longest tenured director of clinical education, correct?
SPEAKER_01:Yes, he's very proud of that. And um, I think he's 14 years, maybe 15.
SPEAKER_02:Okay.
SPEAKER_01:So I'm getting up to almost 11 now in January. So I'm I'm coming for him.
SPEAKER_02:So you're aiming for at least 16, minimum of 16, right?
SPEAKER_01:I mean, it's looking that way, right?
SPEAKER_02:Then you can hold it over him after that.
SPEAKER_01:That's right. That's right.
SPEAKER_02:So while Nikki's the director of clinical education, she wears a number of other hats as well. You're also the associate program director for the PT program and an associate professor within the college, too.
SPEAKER_01:Yes.
SPEAKER_02:So, and that that comes with a number of different roles. Uh, before we jump into our content today, though, you brought up that you love tortilla chips. Any kind of tortilla chips, doesn't matter what it is.
SPEAKER_01:Nope. No, they can be the cheapest bag from the grocery store, they can be the delicious homemade tortilla chips at a restaurant, not picky, they can be plain, they can have seasoning on them. Does not matter.
SPEAKER_02:So tortilla tortilla chips that are maybe like a little bit thicker with you know lightly salted, where where does that rank for you?
SPEAKER_01:Um I mean it's still a tortilla chip. So I would say if I was if I if I was given the option, it's always gonna be more the thinner tortilla chip, but if you know, if the thicker, lightly salted is what you've got, then I'm in for that too.
SPEAKER_02:Yeah, I'm I'm a fan, I'm a fan of the thinner, salted lime, you know, has that lime flavor to it. That's that's up there for me.
SPEAKER_01:But yeah, lime, queso, paprika, it it and chilli powder, any of the other yeah.
SPEAKER_02:It's just that's great.
SPEAKER_01:Kind of a problem. But as I mentioned, I can I can pass on the ice cream, just not the tortilla chips.
SPEAKER_02:That's right. Do you and is it just straight tortilla chips, or do you have to have like guac or salsa or something to go with it? Either or.
SPEAKER_01:I mean, I can't play, but I do love all of the things that you just mentioned as well. Along with embarrassingly, pump cheese. Pump cheese? I also like pump cheese. Yep.
SPEAKER_02:Okay.
SPEAKER_01:Well that goes back to my 7-Eleven days.
SPEAKER_02:Did you work at 7-Eleven?
SPEAKER_01:No, we just went there.
SPEAKER_02:You just went to 7-Eleven. Got a fountain soda and some pump cheese. Slurpee.
SPEAKER_01:Yep. Yep. You didn't know this about me, Brad, did you?
SPEAKER_02:I did not know this about you, but I I love little, you know, snippets of conversation like this that are fun. Okay, so we did not, we did not put a podcast together today to talk about pump cheese or tortilla chips. We sure didn't. Or or even Nikki's accolades, right? Though I I think we should highlight more that you're you're going to be passing Kyle Meyer at some point as a director of clinical education. We'll we'll make sure we highlight that. Put it in the title or something. Yes. Well, what I actually wanted to talk to you about was burnout. Um, burnout specifically within the physical therapy profession. And you know, this is this has been a topic for a number of years now. I think the pandemic probably highlighted it more within healthcare professions, maybe physical therapy too, but I'm not the expert on this. You are, which is why I'm gonna start asking you the questions. So can you just start to tell us a little bit more about your background uh in regards to wanting to dive into burnout within the physical therapy profession? What led you to that?
SPEAKER_01:Yeah, so really the what got me there was really deciding to pursue my PhD, which I mean, if you had said that I was ever gonna do that, I would have told you you were crazy. But in a like 2016, I started taking some graduate classes to work towards my PhD and then eventually settled on, yep, this is what I'm gonna do. So I obviously had to come up with a topic for my dissertation. And really, as my role in clinical education, you know, I frequently, you know, talking to clinicians and DPT students that are out in the clinical environment. And I just was struck by, you know, the discussions about the different caseloads that that they were describing and the productivity standards. Um and then also just being a clinician out in the field for, you know, working full-time for 15 plus years. I kind of, while back then, maybe there wasn't necessarily a name to burnout, or I certainly, you know, maybe experienced some of that myself and certainly saw it in some of my colleagues. So kind of landed on this topic of burnout just through through pursuing a PhD. So that became my the topic that I decided was going to be my focus. And when I dug into the literature a little bit, just found that there was at especially at that point. So this would have been in maybe 20 um 17, 18, there was really just not much out there related to PT, um, especially PT in the United States and in kind of the current environment. There were just a few studies that were out there at that time. Now there's been a lot more research since then, but at that time, most of the work had been done in the late 90s, early 2000s. So there was definitely a need that I had identified for additional research in that area.
SPEAKER_02:Excellent. So did you, I guess as you were looking into some of the older research that was out there, I think you ended up settling on wanting to focus or yeah, focus your research more on PTs in Nebraska, not necessarily nationwide, but I'm I'm assuming you you needed to trim that population a little bit more for your research. And yeah, I would just love to hear how you process through some of that.
SPEAKER_01:Yeah. So as I started on the the process for, you know, exploring burnout in the profession and and pursuing my PhD, you know, you have your supervisory committee. And fortunately, my committee was wonderful and they really challenged me to, they called it finding my pee, right? So, you know, you you have these grand ideas about what you're gonna do, but at the end of the day, you know, the best dissertation is a done dissertation. So they said you need to find your pee. You need to pair this down. And so, what better population to study than my own colleagues in the state of Nebraska to find out how, you know, those that are that I'm directly working with or that, you know, my students are working with, what is our, how are we doing in the state of Nebraska? And so that's really how I landed on Nebraska. Also, my committee, you know, we assumed that I would probably have a better chance of getting the recruitment numbers that I needed, just because, you know, I I do know a lot of the PTs practicing in Nebraska. And so when that email came through to recruit for my study, it would be a familiar name. And so more likely to click on that link. So that's really how I landed on Nebraska. And then I was very fortunate because studies cost money. So I wanted to do a study where I collected some quantitative data using the MASLOC burnout inventory, and there's a cost to utilizing that assessment tool. I also wanted to be able to follow up with some interviews, and I wanted to be able to, you know, compensate those individuals for spending time participating in my interviews and then just, you know, costs like a statistician to help and you know, data analysis software. So I was very fortunate that I was able to receive the George Blanton research grant through the Nebraska Foundation for Physical Therapy, um, also some support from the UNMC physical therapy program, but that's really what allowed me to do a study of this nature. So very fortunate in that.
SPEAKER_02:You know, just having previous conversations with you, I think this project is just kind of unique in a sense in those ways too. And not to be a Nebraska homer, but I am, you know, you you're thinking about putting students out into clinics in, you know, in the state of Nebraska. You're thinking about your colleagues in the state of Nebraska. You're supported, Nikki, and you've given back in a lot of ways to the association, the Nebraska APTA, right, over the years too. And and then this is also funded and supported by the BLAM grant through the Nebraska Foundation for Physical Therapist. So I just I kind of think that's fun. It's unique. You know, this is a study about PTs in Nebraska, for PTs in Nebraska, by a PT in Nebraska.
SPEAKER_01:We'll probably get into this later, but I'm doing some additional research around this area with some colleagues from Colorado. As part of that, we're kind of doing a larger study, but it still includes Nebraska PTs. And they're always like, oh my gosh, how how do you get these Nebraska people to participate like this? So it's pretty impressive for our state that we really are willing to take time and contribute to science.
SPEAKER_02:I love it. All right. Well, let's let's kind of dive into some of the nitty-gritty then. You've given us a great background for how you got there, but help us help help the audience understand what is burnout. When we talk about that, what are what are some of the symptoms? How do they affect a person's professional and personal life?
SPEAKER_01:Yeah, so you know, we we hear the term burnout, I think, thrown around a lot. Yeah. But really, when you're, you know, I draw upon the definition that's by Masloc and Leader, who have really been some of the pioneers just in in burnout research in general, and who ended up developing the Masloc burnout inventory. But really, burnout is is three dimensions, and it's defined by experiencing high emotional exhaustion, high depersonalization, and low personal accomplishment. And where emotional exhaustion is really just feeling exhausted and overextended, specifically by one's work. Um, depersonalization is you just have an impersonal response towards one's the recipient of one's service or care. So you just don't feel that connection anymore towards your patients or clients. And then personal accomplishment is really just that achievement in one's work. And so those are really the three key dimensions that define burnout. And burnout is is really really has some detrimental effects to it. So, you know, they the literature shows that it it results in fatigue, irritability, you can have musculoskeletal issues. They've talked about increased absenteeism, job dissatisfaction, an increased intent to leave. They have also found that providers who have it that are experiencing burnout have a higher risk of substance abuse. And really, most concern concerning it they can experience suicidal ideation. So really can have some pretty negative effects on the provider themselves. But in addition to that, burnout also can impact um a decline in patient care. So there's statistics about twice the odds of unsafe care when care is provided by a provider experiencing burnout. And by unsafe care, that includes adverse events, medical errors, and a higher mortality. And then they've also found an impact of burnout is an increase in health care costs. So all things that are really pretty significant.
SPEAKER_02:So you you did a great job of really kind of defining what burnout actually is, but I want to come back to the the point where you said, you know, burnout can be used pretty loosely uh these days. Again, you said high emotional exhaustion, depersonalization, like giving impersonal responses and a lack of personal accomplishment are kind of the three main domains that would describe burnout. Does a person need to have all three of those to have burnout? Is it just one of them? Like what is, you know, because I I think there's a difference between maybe being tired or having a season where you're just a little bit more worn out, as opposed to getting to a point where all three of these are maybe hitting at the same time. So can you just talk to us a little bit more about that concept?
SPEAKER_01:Yeah, so I mean, really by definition, to be burned out, you would be experiencing all three of those dimensions. The high emotional exhaustion, the high depersonalization, and the low sense of personal accomplishment. Now, the one thing that we found in PTs, in in my research as well as some of the previous literature, is a lot of PTs, if you're if you're looking at, you have to pick one dimension, right, where PTs are most impacted, it would be emotional exhaustion. So you see a lot of PTs with that high emotional exhaustion, less so into the depersonalization or the low sense of personal accomplishment. PTs tend to do a pretty good job of, even though maybe they're experiencing this emotional exhaustion, of still maintaining that empathy and that connection with patients and still feeling really good about the work that they do and feeling that it's meaningful and there is a sense of accomplishment. But eventually, you know, there's different models of the development or the sequence of burnout that show that many times emotional exhaustion can sort of be the first dimension that individuals experience.
SPEAKER_02:Okay.
SPEAKER_01:And then you kind of progress into deep low de or high depersonalization and low personal accomplishment. Okay. So there's just some different models out there, theories out there about the development of burnout, but one that in my opinion seems to fit PT a little bit or is consistent with PT is that the first really dimension that's impacted for us is emotional exhaustion.
SPEAKER_02:Okay. And now I'm I'm assuming as you talk to PTs around Nebraska, that was that was something that came out often.
SPEAKER_01:Yeah. In my study, the the first phase or aim of the study was really just kind of a quantitative A. And so we really looked at using the Maslowc burnout inventory, actually assessing the frequency and severity of burnout. So that was kind of the first piece. And and the MASLAC burnout inventory is is the tool that we utilize to um to accomplish that. And you know, what we found on a positive note, really, was half of the sample, so about 55% of the sample was considered engaged. And engaged by definition on the MASLAC burnout inventory is really opposite a burnout. So it's a low emotional exhaustion, low depersonalization, high personal accomplishment. And 50% of our sample was engaged. So that's fantastic. The not so fantastic piece of it is the other half, about 45%, were experiencing at least one component of burnout. So they either had high emotional exhaustion, high depersonalization, or low personal accomplishment. 22% were in that high emotional exhaustion phase, showing that if PTs are only experiencing one dimension or PTs in Nebraska, it's it's most likely going to be emotional exhaustion. When we talked about that definition of, you know, burnout, where it's all three of those dimensions, you know, 10% of our sample in Nebraska was experiencing burnout.
SPEAKER_02:Were there any other elements from your research that were surprising to you as you looked into it?
SPEAKER_01:I would say as far as the frequency, it wasn't really surprising. There's some, you know, the the one thing that I found in the burnout literature and PT is it's it's really still relatively new in the current environment. So if we're not looking back at 1995 or 2001, if we're you know, we're if we're kind of looking sort of 2015 and beyond, it's one of the things that we found is hard because it is new, is there's so many different tools that are not so many different, but people use different tools. And so in making comparisons between, you know, what I found for for my frequency and severity versus maybe what another study found, we're not necessarily comparing apples to apples. So they might have utilized a completely different tool, or they might have defined burnout a little bit differently. So, you know, there was a 2015 dissertation by Ellen Zambo Anderson, and and she used the MASLAC burnout inventory and used the same, you know, definition of burnout. And according to that, you know, PTs in Nebraska were at a higher level than her national sample.
SPEAKER_00:Okay.
SPEAKER_01:That was also in 2015. Um certainly things, you know, changed pretty significantly over, you know, my data was collected in 2021. That timing could have impacted those scores. Something happened in 2020.
SPEAKER_00:Yeah.
SPEAKER_01:Just yeah, just a little thing called COVID. But so if I wouldn't say anything was surprising. And then if you even look at some of the studies, like more recent, more recently published studies that were done during a similar time period, 2021, 2022, the burnout rates are not significantly different.
SPEAKER_02:Okay.
SPEAKER_01:From Nebraska PTs to some of the other populations that were studying.
SPEAKER_02:Okay. Interesting. What what about any findings, trends along the lines of demographics? So are we talking in your in some of your own research, are we talking, you know, more men than women, women than men, urban versus rural, younger PT, middle career PT, older PT? Like what talk to us a little bit about that. Who's out there?
SPEAKER_01:Yeah, probably one of the the more, I would say, significant findings in in terms of if we're just looking strictly at demographics. If you're looking at demographics, you're really looking at, and and these were not necessarily, so let me back up. So when I when I looked at associations, I looked at, you know, was it associated with with burnout, all three dimensions, or was were there certain factors that were associated with like one particular demographic or work environment characteristic? So interestingly, the only sociodemographic factor that was associated with all three dimensions of burnout was the presence of children, specifically that they didn't have children. So individuals without children, that was statistically associated with burnout. Then if you just look at some of the factors that were associated with one dimension of burnout, and so this then starts to, I think, tell a little bit of a story, but younger therapists was associated with at least one dimension of burnout. Male physical therapists had higher levels of depersonalization than female therapists. There was also a positive association between depersonalization and student loan debt. So higher debt equaled higher depersonalization. And then single participants also displayed higher levels of depersonalization. All of that to say it seems like if you're looking at individuals, you know, who don't have children, they would typically be younger, not married. Those younger therapists likely have more student loan debt because they would have graduated more recently. And so really a lot of the data was really looking at, you know, kind of this earlier career therapists we're seeing tend to have more association with burnout than mid-career or later therapists.
SPEAKER_02:Okay.
SPEAKER_01:In in my particular population.
SPEAKER_02:Right, Nikki, I think some of that information is really helpful just thinking about the the you know sociodemographic aspects. Primarily that the main thing was the presence of children. You know, those that didn't have children were more associated with burnout. Um what about like workplace or the culture within the workplace? Is there anything within those environments that you picked up on within your research?
SPEAKER_01:Yeah, so as I said, you know, when you're looking at those sociodemographic characteristics, there's just the just the one that was associated with all three dimensions. And then there were, you know, the few others that I mentioned that were sort of the one-offs, right? That were associated with at least one factor. But really the the biggest impact, or I guess the the factors that were most likely to influence burnout or most associated with burnout were work-related work environment characteristics. Um, and so this was things like the workload being manageable, feeling supported by your supervisor, supported by your coworkers, provided autonomy, provided flexibility in your work schedule and time off, working in a place where you felt your judgment was valued. And then also being confident that you felt like your employer would do what was right if in in you know ethical type of situations. And then certainly, as we have already mentioned, COVID-19 was also associated with burnout.
SPEAKER_02:Can you, okay, so kind of the sociodemographic factors, the workplace factors, can you speak maybe more specifically about our Nebraska PTs? What's the effect this is having on PTs from Nebraska?
SPEAKER_01:Right. So, so as part of the study, you know, we did this survey and then I interviewed individuals who were in the burnout category, and then also those that were in the overextended category or the emotionally high emotional exhaustion category, just knowing that that was a large piece of the population. And we talked about a lot of these, we talked about these factors, you know, like yes, I had this quantitative data that, you know, told me these things were statistically associated, but like what did that mean? Right? What did that mean for for them individually? And so what really came out in some of those interviews was that there are some intrinsic factors, right? There's just there are some factors, uh, individual factors that seem to place you at risk for burnout, according to to some of the interviews I completed. And and some of those things are like just having really, really high personal standards and being a perfectionist. Um, it was very clear that that those individuals that I was interviewing that were burned out were perfectionists. And so that was a pretty, pretty common theme. They also had a hard time establishing boundaries just between their personal life and work. Some of them were dealing with some just personal stressors in their life, maybe an illness in the family, a chronic illness in the family. And then the other piece that was interesting was, and this I would say this was an interesting piece of it, is related to just like this disparity between what they thought their career was going to be and what the practical realities of the profession were. So those were some of those intrinsic factors that were explored in the interviews. And then one of the other things was very consistent with my quantitative data in regards to workloads. So just unrealistic productivity benchmarks, which gave rise to ethical dilemmas, talking about not having autonomy for making patient care decisions. And then some also mentioned just the workload and the emotional and taxing nature of the job was a concern for many. They also talked about the impact of the work environment in terms of culture. So working in a culture that was prioritizing the number of patients seen versus the quality of care provided or a workplace environment that lacked a sense of psychological safety or promoting a feeling of community. There were participants that spoke of having leaderboards in their workplaces and fostering this sense of competition amongst colleagues to who had the best productivity for that day. So not feeling respected by patients or employers or other healthcare providers or insurance companies or regular regulatory bodies just not adequately valid valuing physical therapy. So I thought that was really just digging into some of those factors outside of you know just that strict quantitative data was really interesting. And then moving on with that, we we dug into so so what? Yeah, you know, so what? And so, you know, you know, like I had mentioned previously, the literature was like, oh, there's you know, substance abuse and and you know, mood disorders, and you know, some of those things are the impact of burnout. And so when I actually spoke to therapists in our state, it was the the the impact is really quite significant of burnout on individuals. So, first just personal health issues, so very consistent with some of that previous literature, but they had a a range of of health challenges that they spoke about, both physical and and physical illnesses as well as mental health issues. Um they found themselves neglecting self-care routines, so just not sleeping, not exercising, not prioritizing nutrition, things like that. Really, sadly, one participant expressed to me that burnout had taken such a toll on them that they really had gotten to the point where they no longer had a purpose to live. You know, that's in PT, right? Like you hear about that in in medicine, and but this was a PT. And then very consistent with despersonalization, they they would just express how they just really did not care anymore. They did not care uh about their patients anymore, did not have that empathy anymore, struggled to find empathy, and that resulted in them just kind of going through their motions in designing treatment sessions, you know, no creativity, no thought for for how they can make sessions better, and just not developing those meaningful connections that are so important in PT. And then finally, a lot of them ultimately either left their positions, their current positions, or they reduced their work hours. And unfortunately, many of them were looking at pursuing career changes, which is really unfortunate. And so the toll of burnout is is quite significant.
SPEAKER_02:Yeah. Yeah, I so question for you on those lines, Nikki. I I know like we we are not just linear, you know, in in our nature as people. There are a lot of different things that are impacting our lives and how we see the world, right? For example, like we we understand that what can happen in our personal lives can bleed over into work, and what can happen in the workplace can bleed over into our personal lives. It's it's hard to just strike a balance there or to just compartmentalize, right? But how much how much of this is maybe just the workplace versus the profession? You you talked about each of those things. So my question is, you know, I've I've seen a lot of PTs that are just thriving and love what they do and the connection that they have to the people that they're working with. Um is it the case that, hey, maybe if it if something's going wrong in the workplace or you're feeling at least one of these dimensions of burnout, is it the profession or is it more likely the workplace? And it just might be a cue that might need to step out of that place that you're at and and look elsewhere. Is that right?
SPEAKER_01:So, you know, while the the impact was certainly significant, at the end of the day, you have to remember 55% were engaged. So 55% were not experiencing any dimension of burnout. And and so really were thriving, right? And so we have to keep that in mind. So I think there's definitely, you know, this organizational piece, right? So there's definitely the piece and of how your facility is managed, what type of leadership you have, the relationship with your coworkers, how documentation is managed, how productivity standards are managed. So that's definitely a piece of that. But then we have to look at what is driving some of that. So what's driving these very, very high productivity standards or driving this need for all of this documentation, you know, that goes to a higher level. And so certainly there's there's some clinics, some hospitals, some facilities that are are able to manage this more effectively, I would say, at least for preventing burnout. But there's also just this larger issue just with maybe not the profession, but the societal view of the profession and how, you know, kind of what road we're going down in terms of being able to provide services and how we're reimbursed and things of that nature. That it's just multifactorial, really. There's, you know, I I certainly saw there, you know, one of my themes for qualitative was individual, right? There were some individual factors for sure. But then there's a just kind of this workplace piece, but then there's just also that bigger, broader societal piece. So, you know, it's it's not something that's just easily solved. Let's say that.
SPEAKER_02:Okay. Well, that's a that's a good jumping off point because we've been talking about a lot of the problems. We've been talking about how burnout impacts us. Uh, but let's turn our attention to, okay, so now what? So yes, yes, this is here. And you know, it's not just physical therapy, it's not just healthcare professions, like, you know, people experience this across the board. Um, we just happen to be zooming in on this because listen, you've done some research, that's great, and it fits our profession really well. So let's name that. So, but let's let's turn our attention to not just like what's going wrong, but how do we be a part of the solution? What kinds of things can we do to prevent this from happening? How do we build resilience in ourselves? So, can you just maybe talk to those things, right? Are there are there strategies or habits that in our profession as physical therapists we can start to adopt to protect ourselves from burnout?
SPEAKER_01:Yeah. So, you know, obviously we know it's this multifactorial problem, but there's still something to say for just generally taking care of yourself. I mean, we know that exercise, sleep, nutrition, stress management, setting boundaries, right? Do you does a does a patient need your cell phone number so they can contact you at all hours? Right. So there's also that piece of of setting some of those boundaries, being willing to say no, which I think is hard for PTs in general. And so, you know, there's there's certainly a piece of that on an individual level. You know, I also think going back to just some of those, uh, you know, that strong sense of just this uh perfectionism and these very, very high personal standards, you know, can we can we be okay with just being okay? That seems like an easier said than done, but certainly something to think about if you're if you're in, if you're if you are feeling burned out, right? That something that maybe that needs some work. But then from an organizational standpoint, you know, there's it's kind of and I mean it's an old older article now, but there is an article in 2016 by Shana Felton Noseworthy, and there kind of have been some big researches in medicine, and they have an article that where they provide like nine organizational strategies, you know, to help address burnout. And they really talk about, you know, step one is just acknowledge it and assess it. So at your organizations, assess it. And if you're if you find that there's a problem, acknowledge that there's a problem and be curious about exploring it, right? And and talking to your people and and finding out what some of those challenges are.
SPEAKER_02:You have to be willing to have the conversation about it.
SPEAKER_01:Right. Okay. Right. Kind of step one.
SPEAKER_02:Yeah.
SPEAKER_01:But and then they, you know, talked about just having good leaders. And so do your leaders have leadership training and and are you holding your leaders accountable? You know, that's that came through loud and clear in my sample, you know, feeling supported by your supervisor. And I think that goes back to too, just being willing to listen and have those conversations with your employees. They also talked about um if you find, you know, if you are assessing and you have conversations, then target your interventions based on your assessment. Seems like that would make sense that, you know, if you identify the problem and then you target the interventions, just like what we do every day as PTs, right? It's not one size fits all. And so don't just throw, you know, throw what you think might work. You know, really individualize or cater those interventions to what you're finding in your particular facility or work work unit. Okay. Cultivating teamwork and community. So, you know, I mentioned, you know, people talking about having these leaderboards. I mean, what a way to not foster community. Teamwork, yeah.
SPEAKER_02:Right. Pitting one another against each other.
SPEAKER_01:Yeah. And then you, and then, you know, then you're adding on to that. Here you have these individuals who are already perfectionists, right? And then you're telling them that they were number 10 out of the 10 people on productivity yesterday. I mean, talk about setting people up for failure.
SPEAKER_02:Yeah. There, there's there's an interesting concept there of, you know, I've I've heard this put before, keep the main thing the main thing, right? If if our if our patients and their care, their outcomes is supposed to be the main thing, how do we make that the main thing? Now, don't get me wrong, the business aspect is really important. And we have certainly we have to make money, right? For sure. Yes. But if that becomes the main thing that is going to influence culture and it has a trickle-down effect, right?
SPEAKER_01:Well, Brad, it sounds like you should have written this article because really that speaks to the next two things that they really talked about, which were using rewards and incentives wisely. So do is productivity what we should be rewarding? Um, and then also check in and see are you are you actually having individuals practice according to your values and mission at your facility?
SPEAKER_00:Yeah.
SPEAKER_01:Everyone has a mission statement, right? And so are you is that consistent? And so checking in with that and and and checking in with your employees, right?
SPEAKER_00:Yeah.
SPEAKER_01:And then uh one of the other strategies they talk about is promoting flexibility and work-life integration. So, you know, we one of the things that I mentioned even in our in my own in the Nebraska PTs was related to having some flexibility in your workplace. Can you allow people to tailor their hours? You know, does everybody have to work between eight and five or seven and six? Like, is there some flexibility in that? Um, can can you give people time off to go, you know, take a chunk of time in the afternoon to go to their kids' event? Are you allowing them the ability to take their vacation time? So looking at those practices. And then certainly promoting self-care. So, you know, providing those risk those those resources. And I think institutions are getting, you know, that's that's been probably the easiest thing for most to do is is providing some sort of, you know, we're gonna do yoga or you know, do a potluck or something like that, which are all really good things, can't be the only thing, but they are good things to do.
SPEAKER_02:Well that's how potlucks differ, you know, they're they can be all wide ranging, right? That's right.
SPEAKER_01:That's right. And maybe it needs to be new and good nutrition, really getting tapped to it. But so there's definitely things that can happen. And then, you know, the other piece I think is, you know, here we are doing a podcast for APT in Nebraska, but is you know, we have to be involved in our profession. We are a large group. PTs and PTAs are a large group, and we can have a big voice, but it has to be a collective voice. And so if we really want to know how we were saying, you know, what's driving these high productivity standards, well, reimbursement for one, right? So that's a a larger issue that requires changes at a much higher level. And so I would just encourage people to to also make sure that they're staying involved in their in the APTA, in our professional organization, where we can have a collective, a collective voice.
SPEAKER_02:Uh hey, putting on my membership committee hat real quick. Thank you for the intro, Nikki. Uh absolutely, right? We're we're we're going to we're going to make more happen if we have a collective voice. There's also a sense of community there, right? If you feel isolated, you feel alone, you feel like you can't do something about a particular issue, that's why our organization exists. But it can't, it cannot be an organization that relies on eight people to do the work, right? We we have, I don't know the number. How many thousands of PTs do we have in our state? NPT? Twenty five hundred thereabouts. Right? Yeah. I should know that number, but I don't. Um that's that's a large group. That's a large voice. And uh again, we can do that together, but it it does, it does, it does take some small sacrifices, whether that's paying your membership, just and just doing that faithfully on a on a regular basis, or getting involved at different levels, getting involved in a committee, even just in an ad hoc way, someone that is involved saying, Hey, if you ever need anything, let me know what you need. I can't be involved at this level right now because of X, Y, and Z. But let me know if you need something, I'd be happy to try to pitch in where I can, right? Those things are so valuable. Okay.
SPEAKER_01:I I agree. So I'm I think it's really important. And I think that's when when we're talking about addressing the issue, that is one of the ways that we're gonna be able to do that.
SPEAKER_02:Yeah. It is interesting talking to some uh individuals that are probably moving, you know, toward retirement within our profession in the next few years, and just to hear them talk about the the way that the PT community would have looked 30 years ago, right? And the connections that you maybe had with one another. And technology has changed some of that, right? You can connect in ways like we are right now over Zoom. People, you know, maybe even lead a different type of busyness within their lives right now and and or are connected in different ways to other organizations, and it's not as much connected to the state, it's more regional or even national in some ways. So I realize those things are are different and things have changed, but uh it's also okay to hopefully reinforce we we need this community, we need to have a collective voice. That's how we're gonna get things done from a legislative standpoint. And with that, I'm I'm gonna drop off the membership committee hat and I'm gonna ask you one last question here, Nikki. This has been great. I really appreciate your time. I appreciate the thought that you put into this, and I really hope that it's helpful to many of our listeners, whether they can share it with somebody else or it's helpful to them in particular. But, you know, if you could give even just one piece of advice to any of our listeners, fellow PTs, PTAs that might be struggling with burnout, what would it be?
SPEAKER_01:Get help and don't be too proud. And there's, you know, there there might be resources through your institution, you know, employee assistance programs, things of that nature. You might be able to get support from your leadership or your coworkers. Um, if you're not able to do that, I'm just gonna throw out if if any of this, you know, as we were talking about those dimensions of burnout, or, you know, when I was describing what some of those individuals were experiencing, if any of that was resonating with you, please make sure that you get help because it won't just go away. So if you don't have those resources at your facility or or you know, within your realm, there's there's a great organization. It's called Emotional PPE, and it's just emotional PPE.org. And there's volunteer counselors specifically for healthcare providers who are experiencing burnout. So something you could possibly seek through there. And there are local providers on that website. And then certainly, if you're to the point of despair, that I certainly that one of the my participants had certainly experienced, there's the National Suicide Prevention Hotline, 1-800-273-talk, or the National Suicide Prevention website. So my biggest piece of advice would just be that it's real, um, and it has real impact on your own well-being as well as the care that you might be providing to your patients. And so it's it's not something to take lightly. And and so getting the help that you need, and and maybe you've got to look at some changes in terms of you know what's gonna be a good fit for you. That's good.
SPEAKER_02:The last thing for you if a podcast wasn't enough for some of our listeners and they want to know a little bit more about the work that you've done, they want to learn a little bit more, how can they how can they get access to some of the information that you're sharing?
SPEAKER_01:Yeah, so I I just had the the manuscript, the quantitative manuscript has just been published in physiotherapy theory and practice. So you would be able to read the the full article through that. I'm hoping to get the qualitative, or at least maybe for sure, at least one of the qualitative manuscripts published as well. So stay tuned. My dissertation will be published on UNMC Digital Commons after December 6th. So my full dissertation would be available there, which has lots of, you know, pretty extensive literature review, things like that for some of those different resources. Um, and then I'm still involved in in research related to this topic. So some colleagues of mine from University of Colorado are looking at both engaged and burnout because we're we also want to see if we can find out maybe what that secret sauce is, right? So, you know, we've kind of looked at what are some of the things that are influencing burnout, but on the flip side, what are some of the things that are influencing engagement and how can we really, you know, grab hold of that and and promote that?
SPEAKER_02:That's great. That's great. Well, we'll make sure that we get your dissertation linked, you know, if anyone needs a light read at some point.
SPEAKER_01:Very short.
SPEAKER_02:Yes, we'll make sure we get that linked in the show notes. And I know you've you've shared a couple other resources throughout the time too that we'll try to get linked into the show notes. If if anyone is interested uh in in uh partnering or maybe even being like a subject for some of your research, is it okay for them to reach out to you? Absolutely, for sure. Okay, absolutely, would love it. Fantastic. Nikki, thanks again for the conversation. Appreciate you joining the podcast and and also you know a belated thank you because you've done a lot of work within TA Nebraska as well in the past. And so thank you for the ways that you have served in that way.
SPEAKER_01:Of course. Enjoy it at all.
SPEAKER_02:All right, listeners, hopefully this was helpful to you and look forward to getting any feedback and sharing our next podcast with you as well. Thanks for tuning in to the APTA Nebraska podcast. Stay connected with us for more conversations that elevate our profession and improve the lives of Nebraskans. Don't forget to subscribe, share, and join the discussion. Because together, we're driving the future of physical therapy forward.
