Countering the Quieter Crisis: Addressing Staff Burnout and Strain

Long predicted, the next wave of the COVID-19 pandemic has arrived at our doorstep in full force. The United States is shattering daily case records, states are enacting a patchwork of inconsistent lockdown measures, and field hospitals—often the same ones that were dismantled as cases dropped in the summer—are being quickly re-erected as the country braces for an even greater deluge of infection over the coming months. 

This surge, though, is a markedly different animal than the initial wave the novel coronavirus unleashed last winter and spring. Fortunately, months of experience with the virus is aiding in developing more effective treatments and care plans. Two vaccines have received FDA Emergency Use Authorization with additional promising vaccines in the pipeline, and an ostensible finish line almost within sight.

On the negative side of the ledger, however, this wave isn’t confined to specific geographic areas like New York City and Portland—it’s everywhere. Areas that are sparsely populated, with fewer facilities to bear the brunt of an uptick in cases, are seeing the type of rapid growth we saw in dense cities at the beginning of the pandemic, with many hospitals already at full ICU capacity. Given that nearly every hospital, doctor’s office, and treatment center is feeling the brunt of the pandemic, that also means that resources and staff can’t be reallocated to areas of intense need.

Perhaps most significantly, the newest swell is being borne on the backs of a country of exhausted and traumatized health workers. They’ve spent the better part of a year on the physical and mental frontlines of the battle against the virus, and the explosion in case counts is a match in a mental health tinderbox. 

Since the outbreak began, healthcare and treatment workers have not only had to go into workplaces that are fundamentally more dangerous, they’ve had to work with fewer resources and have witnessed death on a level that has redefined their definition of scale. In places where hospitals have restricted visitation, nurses and doctors have taken on a new kind of emotional burden as well, serving as stand-in family members, providing comfort in final moments, or holding a phone or tablet so a family can say their goodbyes to a patient. 

The situation is exacerbated further as staff members leave their workplace to see broad swaths of the population willingly ignoring mask-wearing and social distancing guidelines, as well as traveling and gathering with friends and family, leaving them defeated as they fight a virus that some people refuse to believe exists. 

The cumulative strain is unprecedented for most healthcare and mental health workers in the country, and the fallout has already been enormous. As healthcare workers are beginning to be vaccinated across the country, it brings with it some relief, but it doesn’t change the overwhelming stresses they currently face and the damaging mental toll of the last nine months.

Healthcare workers, particularly those in emergency care or intensive care settings, are already at a higher risk for post-traumatic stress disorder. The pandemic has only added fuel to that fire, significantly heightening the risk for PTSD, burnout, trauma, depression, and other mental health problems. As they’ve been placed in higher-stress situations since the beginning of the pandemic, doctors and nurses have left the profession in droves, and experts worry that the perceived dangers and stress of the occupation could reduce nursing school enrollments. 

It’s not just traditional hospitals that are being overloaded, either. In the wake of the COVID-19 pandemic has come a shocking increase in substance abuse, as more than 40 states have reported rising opioid-related deaths since the start of the pandemic. In San Francisco, in fact, overdose deaths have outpaced COVID-19 deaths by 359%. The result is an addiction treatment system that’s overloaded and staff members that are pushed to their limits.

Hospitals, care systems, and treatment centers, therefore, have had to take new measures to address the short-term and long-term risks of declining staff morale and mental health and rising levels of burnout.

Fostering trust through communication 

Providers count on their frontline staff every day to provide the best care possible regardless of factors like stress and mental health. That relationship needs to be reciprocal. Medical staff should go to work each day knowing that their employer has their safety, well-being, and best interests at heart. 

Foundational to that type of understanding is trust, built through communication. Hospital and facility leaders need to have real-time understanding of the issues affecting staff well-being, and make data-driven decisions to address them, demonstrating to staff members that they do in fact, have their back. Just as nurses round on patients to understand and act on their needs, then, leaders need to enact purposeful staff rounding programs to understand the evolving concerns of their employees.

Purposeful staff rounding can not only engender a culture of transparency that shows leadership is supportive and approachable, it can improve retention and uncover operational and systemic issues that need to be addressed. To be purposeful, however, it needs to be about more than a one-way survey—it requires foresight and follow through. 

It’s important that leaders craft rounding processes that not only ask the right questions, but do so in an environment that’s conducive to honest, open responses. Importantly, leaders need to digest what they hear through rounding processes and turn insight to action, making data-driven decisions to improve conditions on the ground.

Here are some key questions that can be included in any staff rounding program:

• What can leadership do to ensure you have everything you need during the day?
• Have you been getting enough rest? Have you been able to care for your family?
• Have you been asked to work excessive overtime shifts to the point that it is affecting your mental health or performance?
• Have you seen or experienced any incidents around safety that you would like to share?
• Do you have the proper hygiene equipment and PPE you need for you and your unit?
• Do you have what you need to manage your patient load?
• Are there any members of the care staff you would like to recognize for exceptional service or performance?

Response options should be structured, but leave the opportunity for staff to add their own thoughts in an open-ended format where appropriate. Importantly, responses should be automatically captured and digested to inform decisions made in real time at the unit, department, and organizational levels. 

Engaged and empowered staff members feel greater confidence to solve the most pressing challenges, provide a higher standard of care, and achieve better patient outcomes. But the results go beyond that.

The country is at the beginning of a winter marred by a public health catastrophe at a scale likely not seen for generations. The degree to which hospitals and treatment centers enable, empower, and listen to their frontline workers will not only determine how well we weather this pandemic, but the state of our healthcare workforce and our ability to manage future healthcare crises. 

Lisa Romano RN, MSN, is chief nursing officer for CipherHealth.