The COVID-19 pandemic has challenged everyone, but none more than the front-line healthcare workers making extreme sacrifices every day. The physical strain of keeping up with relentless surges in caseloads can be simply brutal, but we know that the catastrophic harm to mental health and well-being lasts long after the crisis ends.
COVID-related trauma will affect the U.S. healthcare workforce for years to come, making it crucial to provide the support they deserve right now.
The American College of Emergency Physicians estimates more than 276,000 COVID-19 diagnoses and 900 deaths among healthcare professionals. The Guardian and Kaiser Health News are investigating nearly 3,000 U.S. healthcare worker pandemic deaths, primarily among nurses.
Even before the pandemic, roughly half of U.S. physicians reported symptoms of burnout. In an August survey of nearly 1,000 physicians, 71% reported feeling burned out and 65% said the pandemic worsened those feelings. Increasing numbers reported anxiety, depression, substance abuse, and insomnia.
Nurses face extraordinary stress: longer, more traumatic shifts; the cumulative impact of patient losses; and moral injury and distress from complex decision-making, limited resources, and mounting responsibilities. In a June survey of ICU nurses, 57% said they felt overwhelmed; 53% anxious or irritable; and 44% sad. They reported increased difficulty with sleep, relationships, appetite, overeating and alcohol use.
Given the large COVID-19 surges since those surveys, the effects have undoubtedly intensified.
Their distress is compounded by the disconnect between the devastation caregivers see daily and the irresponsible public statements from some prominent voices who still fail to promote mask-wearing, social distancing and staying home. The hardship also falls heavily on their families, more than half of whom say worrying about their loved ones’ safety has negatively impacted their own mental health.
Inevitably, COVID’s impact will mirror that of previous natural disasters such as the 9/11 attacks, which saw increased suicides, mental health disorders, and PTSD among first responders and front-line personnel.
We must all do what we can and share what we know to minimize this trauma. Health systems are coming together to fight burnout. In Arizona and Colorado, Banner Health is collaborating with more than eight other health systems.
Putting competitive differences aside, we all understand that we will only get through this crisis if we work together to keep healthcare workers as physically and mentally healthy as possible.
Evidence must guide our path as we work vigorously to foster open conversations among clinician teams about emotional and mental health, promote self-care to mitigate stressors, and directly provide vital resources to nurture well-being. Maintaining a sense of purpose and meaning is essential.
After the 2019 launch of Banner Health’s evidence-based program, Cultivating Happiness in Medicine, clinician burnout fell from 9.6% in 2018 to 8.8% in 2019; “great place to work” metrics improved 53% among physicians and advanced practice providers, whose turnover fell to its lowest in three years. The program promotes wellness, builds social communities, eliminates annoying “pebbles” in workflow, and supports “second victims”—providers involved in an adverse patient event or injury.
Since the pandemic, Banner started providing childcare and housing for front-line clinicians and even hired musicians to perform during shift changes. Reducing unnecessary EHR alerts by 500,000 per month addressed staff frustration without compromising care. We started or expanded forums to share experiences and promote resiliency.
Banner and a dozen partners formed the Well-Being Collaborative to share vital resources and models for self-care, resiliency training, clinician support calls, forums to share questions and stories, and workflow impediment reduction. Resources are available at wellbeingcollaborative.org.
The pandemic has already harmed the mental health of far too many healthcare workers. We owe it to them to keep this damage to a minimum.