US healthcare workers more emotionally drained amid pandemic

US healthcare workers more emotionally drained amid pandemic

A survey of American healthcare workers (HCWs) before and during COVID-19 finds that emotional exhaustion (EE) – a problem even before the pandemic – has worsened, threatening to compromise patient care and health. fuel staff turnover.

In the study, published today in Open JAMA Networka team led by Duke University investigators analyzed 107,122 responses to the Safety, Communication, Organizational Reliability, Physicians, and Employee Burnout and Engagement (SCORE) electronic survey conducted in September 2019, September 2020 and September 2021 to January 2022.

Respondents included health care workers performing clinical and non-clinical functions in 76 community hospitals within two major health systems. The most commonly reported role was nurse (40.9%) and 16.9% had worked less than a year at their workplace, while 56.2% said 1-10 years and 26 .9% 11 years or older.

“A social contagion effect”

Over the study period, estimated EE rates increased from 31.8% in 2019 to 40.4% (proportional increase, 26.9%). Physicians reported fewer EEs from 2019 to 2020 (31.8% to 28.3%) but more EEs (37.8%) in 2021. Nurses’ EE fell from 40.6% in 2019 to 46.5% in 2020 and to 49.2% in 2021 and 2022. Compared to nurses, healthcare workers in other roles showed a comparable but milder trend in EE.

“Intraclass correlation coefficients revealed a clustering of burnout in workplaces over the 3 years, with coefficients of 0.15 to 0.17 for emotional burnout and 0.22 to 0.24 for emotional exhaustion climate, greater than the coefficient of 0.10 typical for organizational climate (an average effect for shared climate variance), suggesting a social contagion effect of healthcare worker exhaustion”, have writes the researchers.

Healthcare workers in all roles at all times, including two in three at the end of 2021, reported that their colleagues had a higher EE than them. This finding, the researchers say, reflects decades of research showing that people tend to be unrealistically optimistic about their own health and well-being than they are about the health of others.

The findings, according to the authors, suggest that current HCW wellness programs and resources may not be sufficient to offset increases in EE and may be even more difficult to access due to understaffing, lack of education, exhaustion and motivation to start and finish these interviews. .

“The challenges posed by COVID-19 have been an undue test for human well-being around the world,” they wrote. “Few groups have experienced this stress more intensely than the healthcare workers (HCWs) who constantly put themselves at risk to serve patients.”

While healthcare workers were hailed as heroes early in the pandemic, the investigators noted, they were often reviled and ostracized later, when public health mandates became highly politicized.

Like other workers, healthcare workers have had to adapt to school and daycare closures, but have had the added stress of caring for infected patients amid shortages of personal protective equipment. and other resources, changing patient visiting policies, difficult clinical choices resulting in moral harm (distress when one’s actions conflict with one’s personal beliefs), and often unpopular vaccination mandates.

After widespread availability of vaccines and amid surges of the more transmissible Delta and Omicron variants, healthcare workers also had to deal with many unvaccinated and stressed patients and their families and apply infection control protocols, often while facing vitriolic and baffling verbal attacks and threats.

“Moral injuries in healthcare workers are consistently associated with lower quality of life and higher levels of emotional exhaustion,” the researchers wrote. “Perhaps it should come as no surprise that 40% of nurses and 23.8% of physicians plan to leave their practice within the next 2 years.

Calling existing programs and resources to support the wellbeing of healthcare workers “woefully inadequate,” the authors said such initiatives must be widely accessible and evidence-based and that leaders should model their use. “We are only beginning to understand the toll of the pandemic on the well-being of healthcare workers, and many more will be revealed over the next few years,” they wrote.

Promoting the health and well-being of healthcare workers

In a related comment, Ari Shechter, PhD, and Allison Norful, PhD, RN, both of Columbia University, called for research into burnout among other HCW roles such as respiratory therapists, pharmacists and practical nurses, as well as those who work in non-hospital settings such as primary care.

“Roles and responsibilities, team dynamics, and geographically dependent resources can play a role in healthcare worker burnout and depend on the setting of care delivery,” Shechter and Norful wrote. “Future research should consider isolating these variables to better determine discipline- or context-specific factors so that we can inform the development and testing of targeted burnout mitigation interventions at all levels. “

Likewise, real-time data should be collected to determine which organizational, structural and individual factors contribute to healthcare worker burnout and associated health risks, they added.

“This could improve our ability to inform interventions and policy changes that mitigate risk and promote effective recovery,” Shechter and Norful wrote.

“We need to harness the lessons learned from this pandemic so that we can reshape approaches to care delivery, improve HCW training, and conduct the rigorous research needed to develop strategies to promote HCW wellness.

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