Burnout among healthcare employees has reached crisis proportions due to the pandemic, prompting many stakeholders to urge systemic solutions to retain vital personnel while preparing a new generation to enter the field.
Top health care professionals discussed the major threat that burnout poses to the robustness of hospitals and health systems in a recent webinar organized by U.S. News & World Report. Front-line employees across the country have been faced with rising levels of stress brought on by systemic changes in care delivery, which have been worsened by COVID-19.
According to Dr. Victor Dzau, president of the National Academy of Medicine, physicians were twice as likely to experience burnout than the general population before the epidemic. Over 40% of those questioned reported despair and suicidal ideation. Panelists noted that increased patient volume, expectations to make health care more businesslike, pressure to satisfy additional regulations and procedures, and other reasons had left physicians overburdened and with less time to interact one-on-one with patients.
Since the outbreak, the situation has worsened, with 60 percent to 75 percent of clinicians expressing weariness, depression, sleep disorders, and PTSD, according to Dzau, while nurses areas, if not more, agitated. He estimates that about 20% of healthcare employees have left during this time, and 4 out of 5 of those who remain feel that personnel shortages have harmed their capacity to work safely and meet patient needs. According to research, burnout cost the healthcare system roughly $4.6 billion a year before COVID-19 spread, and that sum has undoubtedly escalated since then, according to Dzau.
“We knew we were in trouble before COVID,” said Dr. Redonda Miller, president of Johns Hopkins Hospital, stressing that while all segments of the workforce are pressured, the reasons differ depending on the job of each worker. Physicians, for example, worked longer hours and in different capacities than they were used to during the pandemic, forcing them to be away from their families longer; nurses worked lengthy shifts, which could include working full 24 hours in an uneasy personal protective equipment while also worrying about being exposed to COVID-19. As their partners’ employment has been lost or their child care needs have expanded, many minimum wage workers in food service, environmental care, and other jobs have suffered tremendous financial challenges. “We need solutions that target every distinct type of worker in the hospital,” Miller added.
“Moral injury” is at the root of these on-the-ground pressures, according to Dr. Robert Cherry, UCLA Health’s chief medical and quality officer. Physicians were already dealing with difficulties like an aging population, greater chronic diseases like diabetes and mental illness, and control medications and medical equipment for more complicated health issues before the epidemic. Many are also facing decreasing reimbursement rates to keep healthcare costs down.
Cherry explained that juggling these complex jobs is difficult, especially when additional labor shortages are present. Many physicians report feeling alienated, lonely, and separated from their belief in the significance of their work, another cause of burnout, he said, as many Americans express a lack of trust in health professionals and scientists.
These forces are nowhere more evident than in the looming nursing shortage. According to Dr. Ernest Grant, president of the American Nurses Association, the U.S. would require an additional 1.2 million nurses by 2022 to meet the grown demand for their services and replace those leaving. Grant recently wrote to Xavier Becerra, the U.S. Health and Human Services Secretary asked that he declare the nursing shortfall a “national disaster” and seek federal assistance. During the webinar, Grant stated, “This is something we can’t address on our own.”
Dzau emphasized the importance of healthcare executives focusing on “the long game” in coping with the pandemic now and in the future. He stated, “All health systems must invest in preventive techniques and system-level change.” He also advocated for hospitals and health systems to appoint chief wellness officers to oversee the well-being of all hospital employees, as well as a reduction in demands on physicians, such as dealing with difficult technology, particularly electronic health records systems, so that they can focus on patient care. He underlined that these front-line workers must feel comfortable speaking out about their mental health without fear of being judged.
Working together throughout hospitals and health systems, according to Miller, has been critical in avoiding burnout during the pandemic. It was “critical” to ask employees what they needed to determine what was working and what wasn’t. “Internally, some of the best ideas we heard came from,” she remarked. Workers were concerned about using PPE accurately and safely, so infection control experts and patient safety officers instructed personnel and worked as “hall monitors” to ensure better infection control. “It was a huge success,” she remarked.
In addition, the hospital formed a “prone team” of professionals who could assist patients in safely transferring from ventilators to their bellies, where outcomes were better.
The collaboration had the extra benefit of improving morale. She stated that employees “want to know that their voices are heard.” “Your Ideas at Work” initiative encouraged hospital employees to submit ideas and be recognized for those implemented. According to Miller, this helped alleviate certain burnout symptoms. “It’s not the whole solution — I understand that – but it helps.”
Cherry agreed that it is “essential” for employees to have their voices heard – for example, by implementing the Magnet nursing management model, which places a greater emphasis on nurses’ contributions. She also emphasized we pay attention to physician surveys and respond to specific comments from doctors. “It’s where you get some of the exponential returns,” he added of local decision-making.
As president of the American Nurses Association and a nurse himself, Grant pushed for the Magnet concept to be expanded and for nurses to be acknowledged as “change drivers” in general. On a macro level, he believes that well-being should be part of a strategic plan rather than a “reactive response,” with money and metrics dedicated to the strategy.
According to Grant, C-suite executives should “walk to the floors” and meet workers to analyze trouble areas. He also proposed conducting “stay interviews,” in which people are asked why they are still at work and what makes them consider leaving. “It’s a terrific opportunity to convey to that person that I value what they have to say; you’re a part of the family,” he added. Grant also highlighted free tools for financially limited institutions searching for methods to address nursing staff well-being, such as the ANA’s “Healthy Nurse, Healthy Nation” campaign.
The panelists noted that leaders are also under a lot of stress. Cherry emphasized the importance of being available 24 hours a day, seven days a week, with no time to “disconnect.” Health systems, he said, must be aware of this and become more “purposeful” in their support of leadership. The good news, according to Cherry, was that the epidemic was short-lived “Everyone’s communication has significantly improved. We worked out how to get the messages out in terms of the information that people require daily to complete their tasks.” According to him, this has increased staff confidence in leadership, which has resulted in increased productivity. “We feel more gratified and inspired as a result of people’s increased attachment to us. There is a silver lining to this whole situation.”
Miller went on to say that leaders should concentrate on two things: presence and optimism. She pointed out that being present entails more than just wandering the halls. Her leadership team volunteered at food banks and assisted staff with patient transportation, “walking in their shoes” to better understand their issues and ask the right questions. “At the end of the day, the head has to be the one who shows the path forward and has some element of positivity that we will get through this,” she remarked, despite the constant hurdles.
Dzau concurred but emphasized the importance of leaders working together across the country to fight for structural change, such as pressuring EHR suppliers to build better products. He told his fellow panelists, “Only your voice is that powerful to achieve these system-level changes.”
Dzau also mentioned an op-ed he published for the Los Angeles Times earlier this year. He advocated for a national strategy to confront, track, and measure healthcare burnout and support workers suffering it. The proposal was that Congress should play a similar role in the aftermath of the 9/11 attacks by providing long-term assistance to front-line healthcare workers. “Our people are entitled to the same,” he stated. The industry will “continue defying the war foxhole after foxhole” without a long-term national commitment.
The panelists discussed other issues contributing to healthcare stress, including insurance coverage denials, hurdles to admission into healthcare areas, such as lengthy and expensive training, debt, technology, workflows, and more. “The next epidemic is right around the corner,” Grant said, “and if we don’t make corrections now, we’re bound to replicate the same mistakes.” According to an ANA study of over 10,000 nurses, about 25% of respondents indicated they intended to resign from their job in the next six months. Another 30% said they were considering leaving due to work stress. “If this continues, there will be no health or healthcare system,” Grant warned. “It will implode in on itself. So, where do we stand now?” The care that patients have come to anticipate will “not be there.”
Dzau ended the meeting by renewing his call to arms to his colleague’s leaders to use their collective authority to promote the adjustments needed to restore the healthcare system’s resiliency at all levels. “The time has come because the public is seeing this and is aware that there is an issue.” By no means is this the first challenging time in health care, according to Dzau, who remains optimistic that the challenges can be overcome. “Let’s just think about the big picture,” he remarked. “Let’s join together and figure out how to address the situation.”