More than 677 million COVID-19 cases and 6.8 million deaths have been reported around the world – and incredibly, the World Health Organization (WHO) estimates that 115,500 of those who died between January 2020 to May 2021 worked in the healthcare system – nurses, doctors, technicians and maintenance workers.
A team of 23 experts in the US and Canada – and Prof. Charles Sprung, a long-time, US-born anesthesiologist and expert in critical medicine at Hadassah University Medical Center in Jerusalem who was a corresponding author – wrote “A Consensus Report from a Subcommittee of the Task Force for Mass Critical Care-Systems Strategies to Sustain the Healthcare Workforce” that has just been published in the journal Chest.
They consolidated data on factors impacting mental health, burnout and moral distress in healthcare workers to propose necessary actions to help prevent these issues from reoccurring and to promote workforce resilience, sustainment and retention.
The result was 197 statements that were synthesized into 14 major suggestions organized into three categories: mental health and well-being for staff in medical settings; system-level support and leadership; and research priorities and gaps.
What did they find?
The team found, in a wide range of results from many medical institutions worldwide, that 12%-89% of healthcare workers suffered from increased anxiety; 16%-82% from depression; 3%-69% from burnout; 7%-73% from post-traumatic stress disorder; 3%-50% emotional exhaustion; and 8%-96% from sleep disturbances.
They found as well that while signs of burnout can overlap with other conditions, such as depression, it typically involves exhaustion, alienation and decreased performance. “This has led to a crisis in healthcare workers staffing,” they wrote.
The triggers for these manpower problems include direct contact with infected patients; fear of infection or transmission of infection; the lack of key supplies like ventilators and personal protective equipment; inadequate beds for patient care, triage of patients and ethical and end-of-life decisions; information and communication problems; high work demands with low work control; perceived inadequate training; inadequate rest; the inability to care for one’s family; and visitation limitations.
By pushing health systems and workers to the breaking point, the pandemic revealed how overburdened these systems and healthcare workers’ functioning within them already were.
The US Department of Health and Human Services (HHS) announced in July 2021 that $103 million would be allocated to address burnout and strengthen resiliency in the healthcare workforce, as well as to fund hospitals, professional associations and other groups to identify strategies for the promotion of mental health and resiliency amongst the workers.
A Task Force for Mass Critical Care (TFMCC) – composed of physicians and advanced practice provider specialists in critical care, infectious disease, pediatrics, emergency medicine and hospital medicine, as well as nursing specialists and pharmacy and methodology experts – was asked to make recommendations.
What are the suggestions?
The suggestions included ensuring that healthcare workers have significant input into alterations of clinical operations – including policies regarding shift scheduling and care assignment, including rotation among demanding and less-demanding jobs – flexible scheduling, regular training for disaster response, readily available psychological support and a culture of safety where staff can communicate concerns without fear of retribution. All of these can enhance baseline resilience.
To encourage health professionals to stay and new employees to join, loan-repayment programs, tax benefits and support for childcare should be offered, plus an overtime limit of no more than 50% over standard work hours and ideally no more than 25%.
They also noted that globally, the majority of healthcare workers are women, including 88% of nurses, 44% of physicians, 68% of physician assistants, 89% of nurse practitioners, 61% of respiratory therapists and 60% of pharmacists in the US alone.
Since most of them have families to take care of, they need support. “Therefore, we suggest health systems ensure compliance with mandated rest periods; adequate respite between day and night shifts; strict adherence to the 12-hour shift including sign-out times; opportunities for staff physical fitness; mental health breaks and/or debriefs following stressful events like workplace assault and peer illness or deaths; and development of models for healthcare worker engagement.”