Leadership Burnout: Urging Leaders to “Put Their Oxygen Mask on First”

Abstract

Purpose:

Burnout, recognized by the World Health Organization as a medical condition, has been linked to decreased productivity, disengagement, and hopelessness among employees. While burnout in frontline staff has received increasing attention, the unique challenges of leadership burnout remain underexplored and often underdiscussed.

Summary:

According to the Development Dimensions International’s Global Leadership Forecast, nearly 60% of leaders reported feeling “used up” at the end of the workday. Yet, stigma and shame often prevent leaders from acknowledging burnout openly. Recent initiatives have provided resources to help leaders recognize and mitigate burnout within their teams; however, the literature addressing burnout among leaders themselves is scarce. Understanding the institutional impact of leadership burnout is critical for cultivating a sustainable culture of well-being. Simply put: leaders must be well in order to lead well.

Conclusion:

Leaders play a vital role in recognizing, measuring, and addressing burnout risk factors across their organizations. However, unaddressed burnout at the leadership level can amplify organizational dysfunction and jeopardize long-term success. By acknowledging these risks and prioritizing their own well-being—putting their oxygen mask on first—leaders can better navigate uncertainty, safeguard their teams, and strengthen the resilience of the healthcare workforce.

Introduction

Are you feeling exhausted, mentally distant from your work, increasingly negative toward your role, or noticing a decline in professional proficiency? ¹ If so, you may be experiencing burnout. According to the 11th Revision of the International Classification of Diseases (ICD-11), burnout is classified as an occupational syndrome, “a result of chronic workplace stress that has not been successfully managed.” Importantly, it is specific to the occupational context and not intended to describe challenges in personal or home life. In today’s fast-paced, high-stress, and constantly evolving professional environment, workplace burnout has become an epidemic.

These symptoms are often intensified in leaders because of the very nature of their roles and responsibilities. Leaders are expected to overcome challenges, solve problems, and inspire their teams—often with little room to acknowledge, let alone express, their own stressors. When left unaddressed, leadership burnout does not remain isolated to the individual; it can ripple across an entire department or organization, undermining engagement, productivity, and culture.

This paper explores the concept of leadership burnout, its unique impact on healthcare organizations, and practical interventions to mitigate it. The guiding metaphor is borrowed from airline safety instructions: “Should the cabin experience sudden pressure loss, oxygen masks will drop from above your seat. Secure your own mask before assisting others.” ² Leaders, too, must prioritize their own well-being first—only then can they effectively support and sustain those they lead.

What Is Leadership Burnout?

Leadership burnout is the state of physical, emotional, and mental exhaustion experienced by high-performing leaders who overextend themselves through excessive work demands or by neglecting personal well-being. ³ Unlike depression or anxiety—though it may share similar symptoms—burnout is specifically tied to occupational stressors and is often compounded by professional isolation.^3,4 Alarmingly, research indicates that nearly 73% of healthcare leaders report feeling burned out.⁴

Burnout extends beyond simple fatigue. It is not merely “I am tired” but rather “I have no mental stamina left.” Leadership burnout develops when long-term stress, chronic uncertainty, and unrelenting work demands erode resilience. While the effects of stress and fatigue have been well documented among frontline healthcare workers, these same forces also impact leaders in equally profound ways.

If unrecognized or left untreated, leadership burnout can progress to emotional exhaustion, disengagement, indifference, and even depression—ultimately diminishing a leader’s ability to inspire, make decisions, or support their teams. Table 1 highlights key warning signs of leadership burnout, providing a practical tool for identifying risks within leadership teams. ⁵

Table 1.

Leadership burnout warning signs.

(1) Increasing cynicism—for example, making comments such as “Well, I just work here”—or difficulty maintaining usual professionalism. (2) Noticeably lower energy levels. (3) Declining enthusiasm and motivation. (4) Negativity spilling into personal life (eg, lacking energy to engage with family, feeling distracted at home). (5) “Brain fog,” including forgetfulness, mistakes, missed appointments, and slower responsiveness. (6) Loss of perspective, including difficulty recognizing the broader impact on oneself, the team, or the organization.

Source: Adapted from Bahmandar et al. ⁵

Leaders should routinely self-assess for burnout to ensure they continue to show up authentically for themselves and their teams.

How Does Leadership Burnout Impact Those in Healthcare?

According to Gallup survey data from 2020 and 2021, “manager burnout is only getting worse.” Experts attribute much of this to late-stage pandemic fatigue, which has placed unprecedented strain on leaders and managers across industries, with healthcare leaders among the most affected. ⁶ The 2023 Pharmacy Forecast further underscores this reality, with 85% of panelists predicting that at least one-quarter of seasoned pharmacy leaders will exit their positions earlier than expected due to rising stress and complexity in their roles. ⁷

Healthcare is fundamentally different from many other industries because it never stops. Leaders are expected to be “always on.” The hospital doors do not close, and patient needs do not end at 5 p.m. For pharmacy leaders in particular, persistent shortages—of staff, medications, and supplies—create daily emergencies that stretch already limited resources. The pressure of constantly managing crises contributes to a relentless cycle of stress and fatigue.

The pandemic accelerated workforce instability, highlighted by the so-called Great Resignation. In 2022 alone, 1.7 million people left healthcare jobs, representing nearly 3% of the workforce exiting each month. ⁶ This exodus created major leadership challenges: loss of experienced employees, erosion of “tribal knowledge,” and the need for leaders to invest significant time and energy in training new staff. Perhaps most taxing was the void left by long-tenured employees who had previously guided teams informally—now leaders were expected to shoulder this responsibility on top of their existing workload.

Beyond staffing challenges, the pandemic left lasting financial scars on health systems. The American Hospital Association estimated losses of $202.6 billion in just the first 4 months of the COVID-19 pandemic. ⁸ Years later, many hospitals are still attempting to recover financially. For pharmacy leaders, this means navigating cost-cutting measures at the same time drug prices continue to rise due to inflation, innovation, and ongoing drug shortages. The paradox of “do more with less” has only intensified leadership burnout.

What Causes Leadership Burnout in Health Care?

Leadership in healthcare is uniquely demanding. Leaders often experience pressure from above to meet organizational goals while also feeling responsible for supporting the needs and well-being of their teams. They are expected to serve, solve problems, maintain positivity, and provide certainty in uncertain times. The resulting pressure, isolation, and weight of responsibility can make leadership feel overwhelming and, at times, hopeless.

The Constant Unknown

In recent years, healthcare leaders have operated in a near-constant state of emergency preparedness. Every decision during the pandemic was labeled “unprecedented,” leaving leaders without proven playbooks to follow. Continually “fighting fires” without reliable tools or solutions has compounded mental and emotional fatigue. Leaders may wonder how long they can sustain engagement, positivity, and direction when their metaphorical extinguishers no longer work.

Drug shortages, now considered a national security risk by the U.S. government, add another layer of pressure. In late 2022, a Senate committee report documented a 5-year high of 295 active drug shortages. ⁸ Pharmacy leaders are tasked with solving shortages in real time while simultaneously being expected to anticipate and prevent future supply disruptions. This constant demand for prediction and rapid response creates a climate of perpetual stress. ⁹

Global and national political events also influence workplace culture. Leaders face difficult choices: speaking out may draw criticism, while remaining silent can appear insensitive to issues that deeply affect their teams. The fear of missteps and the emotional labor of weighing every word add to the mental toll. Leaders may come to dread the next email, meeting, or phone call, knowing it may demand yet another sensitive decision in a no-win scenario.

Staffing instability has shifted from being an occasional problem to a daily reality. Managing call-offs, maintaining minimum staffing levels, and filling last-minute schedule gaps has become routine. New leaders quickly discover that scheduling is one of the most grueling and unrelenting aspects of management. Often, they must abandon planned administrative or strategic work to step in directly and keep operations running. Over time, this cycle erodes their capacity to meet broader leadership responsibilities and leads to deep frustration—especially when financial incentives or retention strategies no longer motivate staff.

Many of the problems pharmacy leaders are asked to solve lack clear policies or precedents. Navigating these “gray zones” demands continuous judgment calls, which can wear down mental stamina. While pharmacy education emphasizes clinical expertise, it rarely prepares professionals for crisis management, ambiguity, or the persistent uncertainty of leadership.

Overcoming the Constant Unknown

To combat burnout, leaders must learn to embrace discomfort with uncertainty rather than attempt to eliminate it. ¹⁰ Building trust with teams requires honesty and vulnerability: openly admitting “I don’t know” or “I am struggling” demonstrates authenticity, not weakness. This kind of transparency fosters resilience and cohesion within teams.^11,12

Isolation compounds leadership burnout, especially when sensitive issues cannot be shared with direct reports. The long-standing adage of being “lonely at the top” remains true, yet intentional efforts to overcome professional isolation can be effective. Creating strong peer networks—inside or outside one’s organization—provides leaders with sounding boards for problem-solving and support. Emerging evidence suggests that even virtual peer communities (eg, LinkedIn or Facebook groups) can provide meaningful connection and reduce isolation for healthcare leaders. ¹³ While further research is needed, these communities may be a valuable tool for leaders seeking to strengthen resilience in an era of constant uncertainty.

Emotional Fatigue

When stress accumulates from ongoing negative or challenging events at work and home, leaders can find themselves emotionally drained and unable to recover—this is known as emotional fatigue. In recent years, leaders have been fighting stress on two fronts: work and personal life. Research suggests that leaders perform emotional labor at rates comparable to frontline service workers, who must consistently demonstrate compassion and deliver high-quality care. ¹⁴ Unlike frontline workers, however, leaders often face compounded stressors: external regulatory demands, internal productivity pressures, and the constant emotional needs of their teams.

External pressures are relentless. Leaders must prepare for accreditation reviews (eg, Joint Commission, URAC, ACHC), comply with regulatory requirements (HRSA, CMS, DSCSA, USP), and navigate frequent audits to ensure compliance. At the same time, internal financial pressures mount as executives and consultants challenge leaders to do more with fewer staff. In pharmacy specifically, leaders are routinely asked to absorb gaps left by other disciplines, stretching their bandwidth even further.

This emotional labor matters because of its downstream impact: leaders profoundly influence group mood, morale, and organizational performance. Leaders are expected to safeguard employee well-being, demonstrate boundless empathy, and support flexibility and work-life balance—while simultaneously balancing budgets, addressing staffing shortages, and ensuring compliance.

To meet these demands, many leaders adopt a “game face”—staying calm while pushing through exhaustion, mediating conflicts, and supporting team members through personal struggles. Yet over time, this mask erodes mental stamina, amplifies cognitive fatigue, and accelerates the physical wear of long days and sleepless nights.

Overcoming Emotional Fatigue

• Establish boundaries: Leaders must ask, What am I taking on personally, and what can I delegate? Transparency about competing roles inside and outside of work helps set realistic expectations for both the leader and their team.

• Schedule with intention: Back-to-back meetings without breaks are unsustainable. Leaders should reclaim control over their calendars by blocking time for recovery—whether to leave work at a set hour or simply to pause for lunch.

• Prioritize intentional time: Walking through the department or holding one-on-one conversations can seem time-consuming but often prevents endless emails and task lists. These personal connections also reinforce trust and provide real-time solutions.

Still, for many leaders, even small acts of self-preservation—like leaving on time or taking a lunch break—can feel “wrong.” This tension leads directly into another root cause of burnout: leadership guilt.

Leadership Guilt

Leaders are often perceived as superheroes—expected to shoulder enormous responsibility without pause. As Spiderman reminds us, “With great power comes great responsibility.” ¹⁵ Yet with that responsibility often come certain privileges: dedicated office space, opportunities to attend conferences, or flexibility in scheduling. These perks are not unearned luxuries but rather trade-offs for the additional stressors, accountability, and visibility inherent in leadership roles.

Despite this reality, many leaders wrestle with guilt when making use of these benefits. They may feel compelled to justify their choices to their teams or minimize their advantages to avoid resentment. This sense of guilt is rooted in a misconception—that taking advantage of leadership perks makes one less of a leader. In truth, every role has its own pros and cons, and leadership is no exception.

Overcoming Leadership Guilt

To overcome guilt, leaders must confront the shame that often drives it. See Table 2: Perks and Counter-Perks of Leadership for examples specific to pharmacy leaders. ⁵ Shame whispers, “Who do you think you are to use these perks?” As researcher Brené Brown notes, shame fuels disconnection, blame, and lack of authenticity. ¹² Leaders who fail to recognize the origins of shame may unintentionally show up inauthentically, undermining both their own credibility and the trust of their teams.

Table 2.

Perks and counter-perks of leadership.

Perk	Counter-perk
Flexibility	Always “on call” or perceived as available anytime
Work from home	Expected to come onsite as needed (PRN)
Salary	No overtime pay
In charge	Personally responsible for funding team engagement
Ability to delegate	Ultimately accountable for all outcomes
What you say matters	Words carry lasting consequences
Lunch away from hospital	Risk of skipping lunch altogether

Source: Adapted from Bahmandar et al. ⁵

While leaders often experience guilt around the “perks” of leadership, it is important to recognize that these benefits are balanced by significant counter-perks that are easily overlooked.

Practical strategies include:

• Cutting negative self-talk: Leaders can reframe their internal dialogue by imagining they are advising a trusted colleague. Most would encourage a peer to take a day to work from home to catch up or to attend a conference for professional growth; offering themselves that same compassion fosters balance.

• Reframing perks as tools for growth: Leadership privileges are not indulgences but enablers of effectiveness. Used wisely, they allow leaders to recharge, stay current, and make better decisions for their teams.

• Empowering the team in your absence: As Sheryl Sandberg highlights in Lean In, a leader’s absence can be an opportunity for others to step up. A strong team thrives even when the leader is not present, providing space for informal leaders to demonstrate and develop their own skills. True leadership is not about constant presence—it is about cultivating resilience and capability in others. ¹⁶

By embracing this mindset, leaders can move past guilt and recognize that utilizing leadership perks is not a weakness. Instead, it is a mark of confidence and trust—both in themselves and in the teams they have built.

Conclusion

Pharmacy leaders must intentionally reflect on both successes and setbacks to identify strategies that will sustain them and their organizations into the future. Central to this process is the practice of self-care—putting on your oxygen mask first—so that leaders are equipped to guide their teams through the turbulence and uncertainty that define modern healthcare.

Letting go of perfectionism, embracing calculated risks, and taking meaningful action can be difficult for pharmacy professionals, who are trained in precision and caution. Yet these qualities are essential for adaptive leadership. Today’s leaders are not only steering their organizations through present challenges but also modeling resilience and authenticity for the next generation of pharmacy professionals.

Leaders are uniquely vulnerable to burnout, and ongoing self-assessment for early warning signs is critical. Burnout must be treated with the same seriousness as any other diagnosis: prevention, early recognition, and intervention are vital. By prioritizing their own well-being and modeling healthy behaviors, leaders set the tone for their teams and foster environments where resilience and engagement can flourish. Ultimately, creating a culture of well-being starts at the top—and leaders who invest in their own health ensure the strength and sustainability of the entire healthcare system.