An excerpt from Health Care Nation.
Of all the lessons learned from fighting a pandemic, none was more frightening or important than discovering how dependent the system is on how we treat our doctors, nurses, and frontline caregivers.
They were already in short supply, with burnout on the rise, when the pandemic hit. As multiple waves of COVID-19 variants washed over us, frontline health workers stepped in at great risk and personal sacrifice to care for highly infectious patients.
From pop-up ICUs to workarounds bridging shortages of ventilators and supplies, frontline medical workers kept the system afloat using their skills, experience, and ingenuity. They witnessed and managed patients’ pain, suffering, and mortality at a rate not seen in a century. Some witnessed more deaths on a double shift than they did in a normal year. They delivered the bad news to families and managed end-of-life care. They were often the last face and warm voice a COVID-19 victim saw and heard.
In the end, they not only saved lives but saved the system from total collapse.
In exchange for their tremendous dedication and sacrifices, we expressed our gratitude. We called them heroes. And we promised to do better in how we treated them once the COVID-19 crisis passed.
Promises made should be promises kept. While we continue to talk about workforce burnout using polite terms with concern in our voices, let us be clear:
A system with a mission of healing continues to harm in record numbers the very people in short supply who are there to take care of the rest of us. Despite our gratitude and promises made, the burnout felt by our nurses, doctors, and other frontline health workers is worse today than it has ever been.
Burnout is on the rise. Significantly more nurses and other health care workers are reporting burnout today than during the pandemic, according to a study by the Centers for Disease Control and Prevention (CDC).
- Fifty-five percent of frontline health care workers are reporting burnout, with the highest rate (69 percent) among the youngest staff.
- Half of nurses report feeling emotionally drained (50.8 percent), used up (56.4 percent), fatigued (49.7 percent), burned out (45.1 percent), or at the end of their rope (29.4 percent) “a few times a week” or “every day.”
- Twenty-five percent of nurse leaders report not being emotionally healthy.
- Nearly two-thirds of doctors are experiencing at least one symptom of burnout, a huge increase from before the pandemic.
Burnout is not just another new buzzword. It is well defined in medical literature. The Maslach Burnout Inventory, first published in 1981, measures burnout on three dimensions: emotional exhaustion, depersonalization from work, and a sense of personal accomplishment.
And while the idea of burnout has become almost ubiquitous across all industries today, its impact in health care is hazardous to everyone’s health.
For frontline health workers, burnout is linked to higher rates of depression, alcohol abuse, suicidal ideation, cardiovascular diseases, sleep disturbances, and more.
Burnout among our health workers is also linked to harming patients. It increases medical errors and worsens patient outcomes.
- Major medical errors reported by surgeons are strongly related to their degree of burnout and their mental quality of life.
- Physicians reporting one or more conditions of burnout are significantly more likely to deliver lower-quality care and have lower patient satisfaction ratings.
Burnout is a symptom of a deeper issue.
Clinician burnout is a symptom of deeper issues that force them to work in a broken system. This “brokenness” includes excessive administrative burdens, workplace chaos, endless reporting requirements, and organizational cultures that foster a lack of connectedness, reduced control, diminished meaning in work, and a fundamental lack of trust.
Burnout is one of many symptoms seen in those experiencing a condition known as moral distress. Other symptoms include exhaustion, numbness, disconnection, and diminished moral sensitivity (also known as compassion fatigue).
Moral distress is a term coined in 1984 by philosopher Andrew Jameton to describe the suffering nurses experience when institutional or systemic barriers prevent them from acting with integrity, particularly when it comes to fundamental moral principles and ethical responsibilities.
The American Association of Critical-Care Nurses defines it simply as “knowing the right thing to do but being in a situation in which it is nearly impossible to do it.”
Nurses and doctors wrestle daily with moral challenges in their work. The pandemic compounded these everyday challenges. Frontline health workers struggled to maintain their professional, emotional, and moral equilibrium when caught in tragic situations beyond their control. And while the pandemic has passed and the issues are different, doctors, nurses, and others are still struggling.
The most damaging aspect of moral distress is instilling in our health experts an overwhelming sense of powerlessness. It occurs when they are put in a position where they feel they have to compromise themselves or something they hold dear due to external forces beyond their control.
It is also the frustration that others do not see or grasp a moral imperative that is clear to them.
Psychologists tell us that humans manage such stress in one of three ways: fight (try to regain control), flight (disengaging by quitting), and freeze (going through the motions and dissociation).
Frontline health care workers at all levels are increasingly burned out, overworked, and unsatisfied. They are walking out in droves to explore new opportunities or exiting the workforce altogether.
- One hundred thousand registered nurses (RNs) left the workforce during the COVID-19 pandemic due to stress, burnout, and retirements.
- By 2027, almost 900,000, or about one-fifth of registered nurses, intend to leave the workforce.
- One in five physicians surveyed during the pandemic said they planned to leave medicine within the next two years, while one in three said they would cut back on their hours.
The coming care calamity if nothing changes
Health care today employs more people than any other industry in the United States, including manufacturing and retail. One out of every eight workers is in the field of health care. That is 16 million workers and growing. A third of all new jobs created this decade will be in health care.
And while these numbers are impressive, we are nowhere close to having enough qualified health workers to keep up with today’s demand, let alone what is coming. At least not the way the health system operates today.
- Eighty-three million people in the U.S. currently live in areas without sufficient access to a primary care physician.
- More than one-third of Black Americans live in cardiology deserts.
- Nearly half of all practicing physicians in the U.S. today are over age 55. It takes a decade or more to educate and train a physician.
If nothing changes, the crisis in health care will only deepen, jeopardizing the well-being of both health workers and patients alike.
Tom Lawry is a health care consultant and author of Health Care Nation.
