More action needed to stem the tide of burnout, PTSD

So much has changed since the COVID-19 pandemic took hold in hospitals across the U.S. and the rest of the world. This is especially true of the healthcare workplace environment. The ways in which people work, from new personal protection protocols and varied work schedules to how caregivers engage with colleagues and patients, are all inherently different from the pre-pandemic world.

Nurses, physicians and allied healthcare workers were faced with changes at a rapid speed. Healthcare leadership also had to make decisions at breakneck speed. Not only were caregivers being told to change workflows they were previously accustomed to, but they were also being tasked with treating patients much sicker than they had ever experienced in the past. The sheer numbers of severely sick patients also grew at certain points during the pandemic, with surges varying strongly based on region in the country, as we’ve witnessed in recent weeks.

Higher levels of stress for nurses and other caregivers in the intensive-care units quickly became apparent. Professional challenges worsened: more patient morbidity and mortality in their workplaces, risk of exposure to COVID-19, and decreased ability to collaborate and commiserate with coworkers due to new barriers like personal protective equipment and distancing requirements. Personal challenges also worsened, including the potential risk of bringing COVID-19 home to their families and friends, and their own isolation from loved ones.

Burnout, the physical and mental exhaustion experienced by healthcare workers from chronic stress in the workplace, has reached astronomically high proportions. Numerous surveys have found that over 50% of all nurses have experienced burnout since the start of the pandemic in late 2019. And it was already a problem pre-pandemic, with 1 out of 5 healthcare providers reporting burnout. 

Unfortunately, nurses are leaving the patient-care field in high numbers, at a time when healthcare facilities need them most. A lot of this can be attributed to stress and burnout, but another large contributor for nurses leaving is their newfound and unwanted symptoms of post-traumatic stress disorder. 

PTSD is caused by witnessing firsthand an emotionally difficult or traumatic event. The nurses performed quick, life-and-death decisions, to help manage sick patients with COVID-19, with ups and downs over a sustained period. 

Symptoms of PTSD, as well as symptom severity, differ for each person. PTSD can manifest itself in heightened emotional and physical responses to unrelated events. It can also appear as nightmares, flashbacks, anxiety and depression, and avoidance of situations that caused the PTSD. For nurses who are going back to their workplace where they were exposed to continuous trauma, it can cause unbearable pain and suffering to them, often to the point where they decide not to go back.

Nurses leaving is problematic for many reasons. Hospitals lose experienced nurses, raising the risk that patient outcomes will suffer. Staff shortages cause stress for others on the unit. Hospital expenses increase with need to recruit, hire, and train new nurses. Higher costs get passed on to patients and communities, at a time when healthcare costs are already elevated. All of this is to say that leadership has more challenges than ever before.

During the pandemic, healthcare leaders have implemented protocols, based on the latest evidence-based knowledge, to help protect the health of their employees. Caregivers need to be physically and mentally healthy themselves in order to provide care for others. Healthcare facilities resorted to scheduling nurses for longer shifts to reduce potential exposure to COVID. Visitor policies were put into place, so human movement was limited. Alternative residential programs were available for staff, so they did not have to go home and expose their families to the disease.

The emotional and psychological needs of our nurses continue to need support from healthcare employers and their leaders as we endure yet another surge. While a great deal has been done to protect staff members physically from the virus, there is now an epidemic involving caregiver mental health issues. 

Much work has been done investigate what can help reduce the burden of PTSD on nurses and other staffers. Studies have shown that offering both online and in-person psychological support can improve emotional connectiveness. Healthcare administration should also offer a broad menu of wellness services free of charge through Employee Assistance Programs. Showing organizational support also reaps benefits for their employees; when they feel supported by their leaders, it’s easier to ask for help when they need it. 

With employer support, driven by committed leadership, we can stem the departure of experienced nurses and other caregivers who are so critical to a high-quality healthcare system.