The COVID-19 pandemic has upended life as we knew it worldwide, generating much anxiety, uncertainty and fear. Through it all, healthcare workers on the front lines are dealing with the dual stressors of working to save as many lives as possible, sometimes with limited resources, and grappling with the uncertainties facing the rest of the world: When will this end? Will things ever go back normal?
Burnout and stress were already problems in the healthcare workforce, and the pandemic threatens to make it worse, Derek Feeley, president and CEO of the Institute for Healthcare Improvement, said in a recent interview with Becker's Hospital Review.
Statistics show that twice as many physicians die by suicide annually compared to the general population, and the rate of depression among nurses is twice the national prevalence, Mr. Feeley said. And that was pre-COVID.
"Imagine what the long hours, the stress, the fear and sometimes the family separations are going to do to those numbers," he said. "They're only going to intensify."
Reports out of China already show the damage to mental health being brought on by the pandemic. Researchers surveyed 1,257 nurses and physicians at 34 Chinese hospitals equipped to treat COVID-19 patients from Jan. 29 to Feb. 3 and published the results in JAMA Network Open. About half of the respondents reported symptoms of depression, and 44.6 percent reported anxiety. Survey results also show that 34 percent reported having insomnia, and 71.5 percent said they felt distressed.
Some of the strain on the mental health of healthcare workers is linked to the physical stress they are under and to their legitimate fears about physical safety, Mr. Feeley said. Healthcare workers around the country are putting themselves at risk daily, at times working without adequate personal protective equipment and other resources to provide the care their patients need. There is also a potential worst-case scenario in which U.S. healthcare providers would need to ration care among patients, as clinicians in other countries have had to do.
In addition to the high-stress environment at work, healthcare workers are worried about the health and safety of their families, Mr. Feeley said. They are worried about bringing the infection home.
And it's possible that healthcare workers stretched thin during this pandemic will carry the effects of it long after the pandemic ends. Some healthcare workers, particularly those working in critical care units, may develop symptoms of post-traumatic stress disorder which do not go away rapidly, Mr. Feeley said.
Giving healthcare workers the support they need
The requests healthcare workers on the front lines of the pandemic are making fall into roughly three categories, according to Mr. Feeley: Protect me, listen to me and care for me. Fulfilling these requests means meeting both the physical safety and emotional needs of the workers.
While there has been a focus on meeting the physical safety needs, with regard to personal protective gear and other equipment, healthcare leaders must also remember to check on the mental health needs of their employees. Here are seven ways healthcare leaders can provide emotional support to their teams during the pandemic:
1. Help them regain joy in work. The Institute for Healthcare Improvement defines the concept of "joy in work"as more than just the absence of burnout — it is about cultivating a sense of purpose, meaning and fulfilment, which is crucial particularly during times of incredible stress. The institute has developed a four-step process to guide healthcare leaders as they support their teams, Mr. Feeley said.
The steps include: 1) asking staff what matters to them 2) using that discussion to identify the barriers to joy in work 3) making it clear to the workforce that their well-being is a priority, and 4) actually making changes to enhance their well-being and removing the barriers when possible.
2. Articulate a constancy of purpose. In the world of COVID-19, healthcare workers could lose sight of why they chose to work in healthcare, Mr. Feeley said. It's important that leaders remind them of why they are in their chosen profession and that they will get through this.
"[Leaders] need to be transparent, they need to face the brutal facts, but they [also] need to be reminding people that we will come through the other end of this," he said.
Leaders also need to be visible, working alongside their staff and reminding them of their purpose, he added.
3. Help enhance workers' resilience. Leaders need to make sure healthcare workers feel as though they have support, whether it's being able to take a few days off or spending more time with their families, said Mr. Feeley. These simple things can go a long way to help healthcare workers recharge and strengthen their resolve at work.
4. Reinforce team support. Staffing has been a challenge during the COVID-19 pandemic, as the influx of patients have nearly overwhelmed hospitals across the country. Teams have sometimes had to be split up to accommodate the quick rise in patient volumes.
Leaders need to find a way to retain the camaraderie and support people get from their teams, Mr. Feeley said, whether it is encouraging people to call each other and check in or using technology for virtual socialization.
"Make it OK for people to still find a way to laugh with their colleagues and to have some fun," he said. "I know these are the hardest possible times for people, but we're still human. We still need social interaction. And our pool of resilience will be enhanced if sometimes we can smile together and laugh together, even in the face of the terrible consequences of COVID-19."
5. Provide psychological safety. Now more than ever, healthcare workers need to feel psychologically safe — that is, to be able speak their mind without fear of retribution, Mr. Feeley said. They need to feel safe to be able to ask any question, to speak up if they don't feel supported or if they feel fearful.
6. Celebrate the successes. There has been a debate on social media about healthcare workers celebrating COVID-19 patients being discharged alive from the hospital, Mr. Feeley said. Some people have been critical of the viral videos of healthcare workers clapping or dancing during this time.
But allowing teams to celebrate the successes is important, he said. Cut healthcare workers a little slack. They should be allowed to come together for some (socially distant) fun and moments of celebration, he said.
7. Take care of yourself. The familiar airplane safety rule is applicable here as well, said Mr. Feely — healthcare leaders should put on their own oxygen masks first.
"Leaders are not to think that they are somehow immune to all of this," he said. "Because they are not. So, practice self-care. I'm asking leaders to invest in their teams, but I'm also asking leaders to invest in themselves."
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