More than two-and-a-half years into the COVID-19 pandemic, the healthcare workforce is still struggling to rebound from years of burnout, stress, and PTSD.
As we transition toward recovery, all sectors of the healthcare workforce – from nurses and physicians to community and public health workers – are continuing to feel the impact. Many have seen their own mental health and well-being decline, even after nearly three years of the pandemic.
The U.S. Surgeon General released an advisory earlier this year that addresses health worker burnout and the effect it will have on the workforce. With over half a million registered nurses anticipated to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses across the U.S.
A Mercer Health Care Market Analysis report projects a national shortage of more than 3 million low-wage health workers within five years. These workers consist primarily of women of color who are caregivers within the community, in nursing homes or are nursing or medical assistants in health care settings.
Similarly, according to The National Association of County and City Health Officials, since 2008, the estimated number of local health department full-time employees decreased by approximately 16% in 2019. The Association of American Medical Colleges projected in 2020 that physician demand will continue to grow faster than supply, leading to a shortage of between 54,100 and 139,000 physicians by 2033, with the most alarming gaps in primary care and rural communities.
Even before COVID-19, the National Academy of Medicine found that burnout had reached “crisis levels” among the U.S. health workforce. 35-54% of nurses and physicians and 45-60% of medical students and residents reported symptoms of burnout. For a system already near the breaking point before the pandemic, this must be a wake-up call to do more to take care of our workforce.
Feeling emotionally exhausted
Now, emotional exhaustion may also be taking its toll on the workforce. According to research published recently in JAMA Network Open, healthcare workers experienced varying waves of burnout depending on their roles throughout the pandemic. But more reported feeling emotionally exhausted as they worked through the second year of the public health crisis than the first.
Consider these statistics:
- From September 2019 to September 2021, the study found that healthcare workers reported emotional exhaustion rose from 32% to 35% and then again to 40% through January 2022.
- Nurses reported an increase in emotional exhaustion from 41% to 47% during the first year of the pandemic and then again during the second year to 49%.
- Physicians, however, reported a decrease in emotional exhaustion during the first year, from 32% to 28% then a rise during the second year to 38%.
A second pandemic of mental health
In fact, Ceridian predicts there will be a second pandemic of PTSD and burnout due to the COVID-19 public health crisis. The COVID-19 pandemic has put a tremendous strain on a workforce that was already understaffed and facing a shortage of workers. With staffing shortages, the resulting increase in absenteeism and higher turnover is only likely to further exacerbate burnout, ultimately resulting in a lower quality of patient care. A 2019 report from the ECRI Institute on Top 10 Patient Safety Concerns listed burnout as Number 3. This list is designed to support organizations in their efforts to proactively identify looming patient safety challenges. It offers suggestions and resources for addressing them.
What can be done to help the workforce?
It’s vital for healthcare organizations to make caring for the caregiver a priority all the time, not just during times of crisis and public health emergencies. According to the Ceridian report, as organizations continue to embrace and accelerate the adoption of human capital management technology as a way to improve operational efficiency and training, they should also seek to understand how these tools can help to improve workforce mental health and wellness. One way is by reducing the administrative burden on clinical staff with more efficient scheduling and workforce management workflows, allowing more time to focus on patients. Another is through tools like sentiment analysis, which measures patterns in the emotional states of employees through data analytics and employee pulse surveys. These tools allow managers and leaders to better understand how their employees are doing, and what factors are actively causing disengagement, stress, absenteeism, and turnover, so that action can be taken.
The surgeon general’s report lists a number of ways that healthcare organizations can implement evidence-based policies, programs and solutions that identify, address, and help prevent adverse health outcomes and burnout for health workers. The pandemic has highlighted opportunities to strengthen organizational cultures and environments to be safer, more generous, and more just for all health workers. These recommendations span a variety of public and private healthcare organizations, including hospitals, health systems, community health centers, as well as government-funded or operated healthcare delivery organizations.
The recommendations include the following:
- Transforming workplace culture to empower health workers and be responsive to their voices and needs. This goal can be achieved by listening to health workers and seeking their involvement to improve processes, workflows, and organizational culture. The Institute for Healthcare Improvement offers tools, strategies, and nationwide learning networks for engaging health workers and fostering a culture of constant improvement.
- Showing health workers how much they are valued by recognizing their work-life demands. This positive expression requires transparent communication, competitive wages, and affordable health coverage that is inclusive of mental health and substance use care, family-friendly policies such as parental leave and support for child care and care for older adults, and a periodic review of staff workloads, patient caseloads, working hours, and hazard or retention pay opportunities.
- Building a commitment to the health and safety of health workers into the fabric of health organizations. For this, leaders must ensure health worker well-being at the highest levels of leadership, regularly assessing, measuring, responding and intervening to prevent occupational distress and burnout using validated tools. In addition, they must encourage and build in time for all health workers on staff to take paid leave, sick leave, family leave, and rest breaks. In addition, organizations should establish a zero-tolerance policy for violence, institute a violence prevention program to address violence and abuse (physical, verbal, and/or cyber-based) in the workplace, and commit to the safety and health of the workforce by prioritizing adequate personal protective equipment.
- Reviewing and revising policies to ensure health workers are not deterred from seeking appropriate care for their physical health, mental health and/or substance use challenges. The deterrence can stem from examining questions on applications, renewal forms for jobs, and hospital credentialing. Additionally, employers should normalize conversations about the use of mental health and substance use care for health workers.
- Increasing access to high-quality, confidential mental health and substance use care for all health workers. Organizations can ensure that all health workers have access to confidential mental health services for themselves and family members, including hotlines and Employee Assistance Programs.
- Developing mental health support services tailored to the needs of health workers. Leadership can consider programs such as in-person “rounds” by mental health professionals who regularly visit units and workplaces, support groups for health workers with time available for participation, and expanding opportunities for telemedicine and other virtual care services. Healthcare organizations should also incorporate a proactive, evidence-based approach to suicide prevention, including risk identification and response in the workplace.
- Rebuilding community and social connection among health workers to mitigate burnout, loneliness, and isolation. Decreased social support is related to increased rates of burnout, increased stress and anxiety, and decreased sleep quality among nurses. For this reason, employers should invest in model peer support programs, learning networks, opportunities during working hours to reflect on challenging circumstances and ethical dilemmas, and interprofessional training and initiatives.
- Helping health workers prioritize quality time with patients and colleagues by implementing strategies and approaches developed by the 25×5 Symposium to reduce administrative burdens by 75% by 2025. This will allow health workers to spend more time with patients. Organizations should also optimize technology to increase the time spent between health workers and patients and consider increasing workers’ schedule flexibility and autonomy.
- Combating bias, racism, and discrimination in the workplace by promoting health worker diversity, equity, inclusion, and accessibility. When racist and discriminatory behavior is identified it should be called to account in order to inform solutions. Organizations should also build equity-centered infrastructure for data systems.
- Working with health workers and communities to confront health misinformation. Leaders should ensure that patients and health workers have adequate time for and access to credible information. Credible information should be consistent with the best scientific evidence available at the time. Organizations should also commit to providing professional education on proactively addressing health misinformation.
- Investing in health prevention and social services to address health inequities. Such investments will improve patient health while reducing strain on the healthcare system and on health workers. Many healthcare workers report ongoing stress and moral distress due to the complexity of societal factors and social determinants of health that impact their patients.
Healing Breaths self-care and resilience programs have helped healthcare professionals cope with stress. Click here to see our upcoming programs. To learn more, click here to speak with one of our wellness team members today.