Doctors, nurses risked their lives to battle COVID. Now they're facing a mental health crisis
In May 2020, medical workers in New York were serenaded for their valiant efforts to save lives during the early days of COVID-19 in the U.S. Now, with the cumulative scars of two years of pandemic pressures and systemic problems in the medical system, healthcare workers face a bruising burnout crisis and loving public support, in some cases, has been replaced by patient hostility.
COVID hospitalizations and deaths may be down from their surge peaks, but the nation's hospitals and clinics still face a population in crisis: the healthcare workers themselves.
Overworked medical professionals, who risked their health and their families' well-being to help patients through the pandemic, are now dealing with a public that is increasingly distrustful in a politicized environment where hospital violence is not uncommon. Staffing shortages and the administrative demands of an increasingly complicated medical system have also created frustration for those who see care for fellow human beings as their calling.
Professional burnout and frustration, pre-existing conditions before COVID, were aggravated by the pandemic, resulting in mental health challenges for some healthcare workers; resignations and early retirements for others; and a jolt to morale overall. Although the severity of hospitalizations and deaths has subsided, cases are rising in many parts of the country and there's a cumulative cost now coming due, medical professionals said.
"The first two years of the pandemic, you could liken that to an adrenaline rush. And then the sheer exhaustion and emotional fatigue that comes after that is what we're in right now," said Karen Grimley, chief nursing executive for UCLA Health in Los Angeles. "With the death and the prolonged illness and the inability to let family members in to comfort their loved ones, being the person who held that patient's hand while they passed away because nobody else could, those were devastating blows to some of our best nurses."
If doctors and nurses aren't feeling in tip-top condition, that could put the country's healthcare system at risk, according to the nation's top doctor, U.S. Surgeon General Vivek Murthy.
"Health worker burnout is a health crisis for all Americans and it has to be addressed as a national priority," Murthy told USA TODAY. "I've been worried about the burnout crisis that's taking place among our health workforce. It's one that preceded the pandemic... but COVID has made things dramatically worse."
U.S. Surgeon General Vivek Murthy, noting the severity of burnout and resignation among the nation's healthcare workers, issued a surgeon general advisory with recommendations on resolving a systemic crisis that was aggravated by the COVID-19 pandemic.
The well-being of the nation's highly trained health force is so concerning that Murthy last week issued a surgeon general's advisory, a call for attention and action reserved for urgent public health issues. The title states the situation plainly – "Addressing Health Worker Burnout" – and the report, released during Mental Health Awareness Month, details the challenges and proposes solutions. It continues a focus on mental health problems exposed or aggravated by COVID and follows a December surgeon general advisory on the youth mental health crisis.
Burnout is characterized by physical and emotional exhaustion and can lead to anxiety and depression, as well, Murthy said. Healthcare workers are strong and resilient, he said, but heavy administrative demands, lack of support in some areas and all the damage wrought by the pandemic make him concerned about the mental health of the medical workforce.
"These are the individuals who help keep us safe when it comes to our health and whether we look at doctors or nurses or public health workers, across the board, we see worrisome indicators. Their rates of anxiety and depression are rising, the burnout is rising," he said.
With some healthcare workers moving on to non-medical careers and an increasing number opting for early retirement, the employment losses make for a grim employment prognosis. More than 1 million nursing jobs will need to be filled, as a half million nurses plan to retire by the end of this year; there may be up to 140,000 fewer doctors than needed by 2033, a 15% shortfall; and the nation faces a deficit of more than 3 million lower-wage health workers within five years.
As with so many societal problems, marginalized groups will feel the brunt of such shortages in terms of losing access to medical care, creating an equity gap, Murthy said. At the same time, women and racial and ethnic minorities make up the vast bulk of lower-wage healthcare workers, who are struggling to make ends meet as well as facing the same mental pressures and challenges as everyone working in the healthcare system.
Problems were apparent before the pandemic, with more than half of nurses, doctors, medical students and residents reporting burnout in 2019. COVID made the situation worse, with many dedicated workers taking the healthcare system's inadequacies home with them, which can lead to burnout, depression, anxiety and, in some cases, suicide. Many medical professionals substitute a different term for burnout: moral injury, a feeling of not being able to provide patients the care they deserve and need.
"We nurses joke. When we come to work, we'll say, 'Well, what did you dream about last night?" said Jean Ross, R.N., president of National Nurses United, the country's largest nurses union. "The standards are, 'I couldn't get medications for the patient (when) they needed it.' 'I found out I had a patient at the end of the shift that I hadn't looked at it in eight hours because I didn't know I had that patient.' Those are typical dreams for us because of conditions we work in. It could happen when you’re really short-staffed."
For all its devastation, COVID has offered a comparative silver lining: The public recognized the valiant efforts of healthcare professionals and also the pressures and challenges facing them.
Such attention could wane, however, as the number of COVID hospitalizations and deaths fall (even though case numbers are again on the rise in many places). Doctors and nurses praised the timing of the surgeon general advisory and Vice President's Kamala Harris's speech last week on health care worker mental health at Children's National Hospital in Washington, D.C., saying they can help keep the focus on such a serious matter.
Feeling valued within their organizations would be the most important morale boost for embattled medical workers, but public support is significant, too, and that dynamic has changed since the early days of COVID, said Dr. Jonathan Ripp, dean for well-being and resilience at Mt. Sinai Health System in New York.
"What we saw in New York City were people coming out at 7 o'clock each day back in the spring of 2020, banging their pots and pans, calling us heroes. Now where we are, we've actually seen an increase of workplace violence towards healthcare workers," he said. "It almost flipped on its bottom (to where) we are we're seeing the opposite in terms of how our people are feeling valued by the community."
Some of that change comes from frayed emotions built up and now overflowing after more than two years of the pandemic, but it also emanates from misinformation and politicization regarding mask mandates, vaccinations and other health protocols, medical experts said.
Dr. Gillian Schmitz, a San Antonio emergency physician and president of the American College of Emergency Physicians, has seen the tension in emergency departments, the frontline of hospital intervention, with a rise in both emotional and physical violence targeting healthcare workers in hospitals around the country.
"Whether it's because of politics or the pandemic or a more divided country, people's tempers just seem to be shortened and their expectations are not always what we can meet as far as time or patient satisfaction," she said. "People are kicked, punched, had their hair pulled, yelled at. We've had several people who have been looking at the end of the gun. People have been threatened with their lives."
Add in frustration with a medical system where administrative and clerical demands take time away from patient care and COVID infection remains an ongoing concern – Schmitz still changes in her garage after each shift to protect her husband and children – and burnout, or worse, is to be expected, medical professionals said.
A shift in recent years in the way medical payments are made, ostensibly focused on quality metrics, has resulted in more focus on how quickly a task can be completed and how many patients a doctor can see, rather than on patient outcome, a situation that hurts morale, Schmitz said.
"When you're constantly asked to do more, with less resources and less support, it is leading to that moral injury where people feel like they are just a widget, that they are replaceable and that they put as much into it as they can but eventually burnout," said Schmitz, saying that the nursing staffing shortage, in particular, could come to "a breaking point."
Hospitals and medical organizations are taking some steps to alleviate pressures, including appointing wellness officers, officials whose focus is on the well-being of medical staff. Stanford Health Care in California was the first to do so, appointing Dr. Tait Shanafelt, an oncologist, to the post in 2017, and now there are more than 40 nationwide, including Ripp at Mt. Sinai.
Murthy's advisory includes recommendations focusing on systemic issues, including reducing administrative burdens on healthcare workers; listening more to their concerns and suggestions; eliminating punitive policies aimed at those seeking mental health or substance abuse disorder care; and protecting their health and safety.
Medical professionals support looking at such structural matters, rather than putting the onus on healthcare workers to become more resilient, the traditional approach to dealing with workplace pressures.
"We need to stop trying to teach healthcare workers to be better able to tolerate a broken work environment. We need to actually focus on improving that work environment," Shanafelt said. "That's really the next frontier and I think the surgeon general advisory lays out a path for us."
This article originally appeared on USA TODAY: Healthcare workers face burnout crisis due to COVID, systemic problems