Nearly 1 year ago, everyone from kindergarten students to business executives was tasked with altering life as they knew it in the name of public safety during the COVID-19 pandemic. The trauma of social isolation, the virus’ carnage, and lack of access to typically available resources is universal, though healthcare workers (HCWs) have been affected in ways unlike the general public.
In a panel discussion titled “Pandemic Burnout: Healthcare Workers and Beyond” hosted by Physicians for Human Rights, clinicians — Felton Earls, MD, Jessica Gold, MD, MS, and Matthew Howard, DNP, RN, CEN TCRN, CPEN, CPN — outlined the ways in which COVID-19 has profoundly impacted the mental health of HCWs.
In what ways does the pandemic affect HCWs’ mental health?
Clinicians “tend to not want to talk about emotions, so we tend to not get ourselves involved in the conversation about feelings,” stated Dr Gold, assistant professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis. “We are much more likely to advocate for patients than to advocate for ourselves.”
Dr Gold indicated that it is rare for HCWs to take a moment to analyze how the pandemic has impacted their mental health since the public health emergency is ongoing and there has not been ample time to digest the events of the pandemic.
“It has been over a year of constant trauma. It has been over a year of not sleeping. It has been a year of maybe getting sick and bringing that home to our families or bringing that home to ourselves. It has been a lot of really new challenges that can risk our and our families’ lives,” Dr Gold said.
In addition to on-the-job stressors, Dr Gold pointed out that HCWs also experience the same issues as other Americans during the pandemic: school closures, financial losses, and social isolation, to name a few.
Healthcare workers “are allowed to have feelings. They are allowed to be struggling. Coming to me is not a weakness in any sort of way,” Dr Gold said. “I think that is one of the reasons why health care has had such a problem for so long — we have had high depression [rates] already, and we have among the highest suicide rates of any profession.”
What is it like to work in a COVID-19 unit?
Dr Howard explained that clinicians who treat patients with COVID-19 are wearing multiple forms of personal protective equipment (PPE) at all times, which can pose physical challenges that lead to burnout.
“We were busy before the pandemic, especially in the emergency department, but now we don’t even go to the restrooms; we don’t hydrate in that 12-hour time frame because you have to take everything off to be able to do that,” said Dr. Howard, a nurse practitioner at Eskenazi Health in Indianapolis, and a member of Sigma Theta Tau International Honor Society of Nursing.
What are the long-term impacts of burnout?
Dr Gold noted that burnout can lead to increased risk for depression, substance use, suicidal thoughts, and car crashes; for HCWs specifically, burnout can lead to a decrease in quality of care for patients, decreased patient satisfaction, and higher turnover in job roles.
“Burnout is not a mental health diagnosis … so I can’t see someone and diagnose them with burnout,” Dr. Gold said. “We talk about it a lot like it is a mental health diagnosis, but when we think about it, it actually can contribute to somebody getting a mental health diagnosis.”
What are some coping mechanisms that can help with exhaustion and stress for HCWs?
“The individual, which I hate to say, is the first place to start because I never like to tell people they need to fix themselves,” Dr Gold said.
Dr Gold explained that she feels “the system is broken,” and mental health professionals can help their patients learn to thrive despite living in a broken system. She stressed the importance of finding a coping skill that fits each individual; there is no one-size-fits-all approach to coping with anxiety and depression exacerbated by the pandemic.
“Figure out what works for you, and do that,” Dr Gold said. “Second, have some self-compassion. We are very mean to ourselves, and we like to be mean to ourselves particularly in medicine. Talk to yourself like you would a friend, or like you would when you were a kid.”
Do employers recognize the mental health impact of COVID-19 on HCWs?
“The easy answer is yes, they do care,” Dr Howard said. “I think that they have a desire to care. Sometimes, I will admit, it is difficult to feel that when you are in the trenches on the front line … to feel that you are being cared about, not just the dollars and cents of health care.”
Dr Howard noted that hospital systems and other employers may be limited by financial constraints, but that from his experience, they do care about the mental wellbeing of their employees.
For clinicians experiencing COVID-19-related burnout and/or mental health issues, Dr Howard suggested visiting the American Nurses Association’s COVID-19 Resource Center, or Sigma’s FIND YOUR FORWARD: Resources for Advocacy and Strength.
How is the pandemic affecting children’s mental health?
“There is not 1 example I can think of, with the exception of UNICEF, where children’s voices in this pandemic have been elucidated, and systematically recorded and documented,” Dr Earls said.
Dr Earls, of Harvard T.H. Chan School of Public Health, Harvard Medical School, expressed concern that as providers address the growing need for children’s mental health services, the voice of the child may be lost in the process.
Dr Earls is eager to “hear directly from children about their mental health, caregiver arrangements, and educational progress given the impact of the pandemic on schools closing and reopening, parents working, and healthcare services that are required because of the increased burden of depression and anxiety from traumatic experiences,” he said.
If you are experiencing a mental health crisis, call 1-800-273-8255 to talk to a trained professional.
Pandemic Burnout: Health Care Workers and Beyond. Presented at: Physicians for Human Rights broadcast; February 12, 2021. https://phr.org/our-work/resources/pandemic-burnout-healthcare-workers-and-beyond/?CID=7015G000001dFyNQAU&ms=FY21_WebinarAppeal_Email10_registrants_attendees&utm_medium=email&utm_source=webinar_attendees_registrants&utm_content=Email_10&utm_term=02132021&utm_campaign=FY21_WebinarAppeals&dm_i=4GV7,DIE8,624F3H,1ER3P,1