Beating Physician Burnout in the COVID-19 Era

COVID-19 presents challenges that underscore the already-prevalent issue of burnout among healthcare workers. What can your facility do to combat it?

Professional burnout is a persistent problem among healthcare workers, even in the best of times. Consider a 2019 National Academy of Medicine study that found as many as half of U.S. doctors and nurses experiencing significant symptoms of burnout. Then there’s the National Physician Burnout, Depression & Suicide Report 2019, which found 44% of physicians reporting feelings of burnout, with another 11% describing themselves as colloquially depressed—defined in the study as feeling down, blue or sad. An additional 4% of physicians said they are clinically depressed, experiencing prolonged, severe depression that’s not caused by a normal grief-associated event. 

The long shifts, lack of sleep and life-and-death situations that healthcare professionals routinely find themselves in are just a few of the factors typically driving burnout in the industry. And the effects are serious: mental fatigue, physical exhaustion and the type of inattentiveness that can lead to grave medical errors. 

Naturally, the coronavirus pandemic has only exacerbated burnout throughout healthcare. In fact, studies are already emerging that examine this issue and the lessons to be learned to help quell burnout and fatigue in healthcare professionals. 

What can leadership within your healthcare system do to identify workers at-risk for burning out, and to help create a work environment that helps your talent mitigate the risk of becoming overloaded in the first place? 

Dealing with additional stress

The coronavirus pandemic has introduced a number of factors that contribute to a greater risk for physician burnout, says Anna Dermenchyan, MSN, RN, CCRN-K, director in the department of medicine quality at UCLA Health, Los Angeles.

“The surge in patient care demands, the ongoing risk of infection to self and family members, balancing work and family obligations and the physical and psychological demands of the job have put a lot of strain on a profession that is already struggling with burnout,” says Dermenchyan, who is also a member of the national board of directors for the American Association of Critical-Care Nurses (AACN).

“The cumulative toll of these occupational exposures can lead to burnout, anxiety and depression. Additionally, these issues cause the distancing of staff from patients and their families, and can result in missed care, medical error and patient harm.” 

Like most individuals that pursue a career in healthcare, your staff likely has a great passion for helping others, and take great satisfaction in doing so, says M. Bridget Duffy, MD, chief medical officer of Vocera Communications Inc.

“One sign of burnout is when one no longer finds joy in their work,” she says. “What that means is that, while they are still getting the job done, they no longer have any energy or enthusiasm for it. When they no longer bring that energy, or they no longer seem to celebrate the victories along the way, it could be a sign they are burning out. It’s important to look for signs of stress, fatigue, cognitive overload and depression.” 

Such signs might not always be easy to see from the outside, says Tasha Holland-Kornegay, PhD, LPCS, founder of Wellness in Real Life, a platform designed to connect healthcare and mental health professionals through an online community and through offline wellness events.  

“I think the biggest issue with management identifying physician burnout isn’t a lack of [caring] about employee wellness, but a misunderstanding about how ‘visible’ it is,” she says. “Workplace culture, ‘workoholicism’ and employees just trying not to appear weak or unwell can all make evident cases of burnout practically invisible.”

Caring for the caregivers

As Holland-Kornegay points out, spotting signs of physician burnout and, moreover, mitigating its toxic effects, requires building a culture where employees feel comfortable coming forward with their symptoms.

One key step on the way to creating such a culture is frequently checking in on frontline staff during and, eventually, once the pandemic ends, says Duffy.  

“Observe behavioral changes and be aware of the risks and signs of burnout. Most importantly, give healthcare workers a safe place and platform where they can openly share their feelings and talk about their fears and concerns without judgment. 

“One way to do this,” she continues, “is to more frequently take a digital pulse survey to assess for signs of burnout and to gather input on how to address it.”

Care teams must also have the right equipment and technology to do their job “free of administrative hassles,” adds Duffy. 

“Human-centered leaders make staff well-being a top strategic priority and put resources in place to help monitor and mitigate burnout. … We would not send a warrior into battle without protective equipment or a means to communicate safely with their comrades.  Why would we do that to our healthcare workforce?” 

Ultimately, there aren’t any top-down policies that will simply solve the physician burnout problem, says Holland-Kornegay. 

“It’s a much more nuanced and abstract issue. It requires creating a healthier workplace culture; one that doesn’t promote the workaholic mindset that so many healthcare workers pick up in medical school.”

Mental health must be a valid reason to excuse oneself from taking on too much work, she adds. 

“Discussions about depression and fatigue need to be acceptable, even if they’re uncomfortable. All in all, the metrics that management cares about shouldn’t just be productivity metrics, but also those concerning well-being. And if management has no way of measuring well-being, and no measures in place to ensure wellness, then this is a good starting point.”

Working on the frontlines during COVID-19 can compound issues such as depression and fatigue, says Holland-Kornegay.

“Many of the heroic efforts of healthcare providers come at a great price, in terms of personal well-being. Most don’t feel like it’s fair for them to take time off; that they’re far less in need than their patients.”

This is where management can step in, she says, and make it clear that fighting through burnout actually hurts healthcare workers—and their patients. 

“Taking this angle can help healthcare professionals justify taking time off, and in feeling like their own well-being is both their personal and professional duty.”

References

  1. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, National Academy of Medicine, 2019. Accessed June 28, 2020

[https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional]

2. National Physician Burnout, Depression & Suicide Report 2019. Accessed June 29, 2020. 

[https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1

3. Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Sasangohar F, Jones S, et al. Anesthesia & Analgesia, Vol. 131, Issue 1. Accessed June 29, 2020

[https://journals.lww.com/anesthesia-analgesia/FullText/2020/07000/Provider_Burnout_and_Fatigue_During_the_COVID_19.17.aspx]

SIDEBAR

Reducing Stress in Extraordinary Circumstances

Increasing resilience and reducing stress can be a challenge in the midst of the current pandemic. The American Association of Critical Care Nurses provides some strategies designed to help healthcare professionals do just that. For example:

Monitor yourself. Be alert for signs like anger, guilt or rumination that suggest your stress levels are too high. Reach out to trusted colleagues, mentors or counselors for support. Seeking help is a sign of strength. 

Manage your physical health. Nutrition, hydration and sleep are necessary for patients and healthcare professionals. You’ll feel better if you address these needs regularly. 

Take breaks. Whenever possible, take a break during a shift. Away from work, engage in activities that relax the mind and are meaningful to you. Read a book, listen to music, spend time with family or enjoy a favorite hobby. 

Practice self-compassion. Grant yourself the same kindness you would show to a friend. If you knew that someone you cared about was going through what you’re facing, what advice would you offer? Apply that advice to yourself. 

Stay connected. Social distancing is a barrier to connection, a key element in cultivating resilience. Use text, phone or video calling to reach out to friends and loved ones. Support colleagues at work with kind gestures. Many people find connection in social media interaction, but others don’t. Do what feels comfortable for you.

Honor your own contribution. Take one minute during each shift to acknowledge that you are present and doing your best in extraordinary circumstances. Your presence means the world to your patients, families and colleagues. And that resonates across the country and the world.

Reference

  1.  American Association of Critical Care Nurses, 2020. Accessed June 29, 2020. 

[https://www.aacn.org/blog/stress-resilience-and-covid-19]

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